Snodgrass’ Urethroplasty in Hypospadias Surgery in Clinical Hospital Mostar – Preliminary Report

Amongst the various methods of reconstructing the hypospadic urethra such as the MAGPI, Mathieu’s and Preputial island flap urethroplasty method and the Snodgrass method, the latter is being used more frequently nowadays in patients with the urethral meatus located in the proximity of the penis. In the Pediatric ward at Mostar Clinical Hospital, we have recently adopted the Snodgrass method when reconstructing the hypospadic urethra. We herewith present our research regarding the successful results in adopting the aforementioned method. Success was evaluated according to the frequency of post-operative complications, as well as the patients’ satisfaction with the functional and the cosmetic result of the urethra reconstruction. The conclusions relating to our research result in an addition basis from which to evaluate whether the Snodgrass method should receive privileged preference in future operative treatment of the hypospadias over others methods, as can be seen from our research

Cerebrovascular Insult Hospital Cases in the Clinical Hospital Mostar (Bosnia and Herzegovina) From 1999 to 2003 – An Example of an Institutional Register

The analysis of a cerebro-vascular insult hospitalized cases in the Clinical Hospital Mostar as a retrospective epidemiological study was done in the Clinical Hospital Mostar for the period from 1999 to 2003. The major source of data was medical documentation of this hospital (an institutional register), the only hospital for the treatments of 457,491 inhabitants who gravitate by a health insurance for the treatment in this hospital. The study included a total of 1,555 cerebro-vascular insult cases treated in the Clinical Hospital Mostar. Among them 727 (46.8%) were male patients, while 828 (53.2%) cases were female. The majority of the cases were above 50 years of life. Majority of treated female patients were older than 61 (45.6% of all cases), as well as among male patients (31.3%). The least number of cases was under 41 years in both groups (1.2%). Prevalence of risk factors was 2,035 cases (74%). During the same period risk factors research for entire Federation of Bosnia and Herzegovina (FBiH) was performed on the sample of 2,750 national insurance holders, out of which 852 gravitate for treatment in CB Mostar. Out of them 1.7% was found to suffer of cerebro vascular insult

The Advantages of End-to-Side Arteriovenous Anastomosis over the Other Two Types of Arteriovenous Anastomosis in Dialysis Patients

The functional duration of vascular access in dialysis patients depends on the emergence of threatening complications. Discussions are constantly being held in an attempt to discover their causality and decrease their emergence. In 260 patients undergoing haemodialysis, we have studied the potential existence of a cause-and-effect relation between the emergence of complications in the vascular access and the applied type of arteriovenous (av.) anastomosis in the arteriovenous (AV) fistula. We have observed the incidence of all complications, both that of the thrombosis incidence as well as the primary and secondary fistula patency (survival). The complications – The examinees with the end-to-end anastomosis showed the incidence of 8.08%, 6.15% of the patients with the end-to-side anastomosis and 7.31% of the patients with the side-to-side anastomosis. The differences regarding incidences are statistically significant ( 2-test = 29.25; P=0.0001). Thrombosis – it has been found that thrombosis was the most frequent complication developing in 30.00 % patients with the end-to-end av. anastomosis, in 2.31% patients with end-to-side av. anastomosis and in 5.56% patients with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 27.69%, and it is statistically relevant ( 2-test = 33.920; P=0.0001). The »primary patency« (primary survival): within a 6-month interval following the establishment of vascular access, the first complications arose in 62.50% of patients with end-to-end av. anastomosis, 10.76% in those with end-to-side av. anastomosis and 18.88% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 51.74%, which is statistically significant ( 2-test = 49.009; P=0.0001). The secondary patency: 24 months subsequent to the establishment of vascular access, the AV-fistula was still functional in 52.50% of the patients with end-to-end av. anastomosis, 89.23% in those with end-to-side av. anastomosis and 81.11% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 36.73%, which is also statistically significant ( 2-test = 26.579; P=0.0001). According to our research, the end- -to-side type of av. anastomosis in vascular access provides better results both in relation to the duration as well as the maintenance of the functionality of the Av-fistula and in the lower incidence of the complications than the other types, and hence it shows a definite advantage

Recent Diagnostic and Therapeutic Approaches to Prenatally and Perinatally Diagnosed Hydronephrosis and their Implementation in the University Clinical Hospital Mostar

A shift of the diagnostics of urological malformations towards the fetal age by means of ultrasound, especially hydronephrosis which, apart from refl ux, is the most frequent developmental urological disorder, opened many dilemmas and debates. In the course of more than three decades the application of this diagnostic approach to the problem of hydronephrosis became a routine clinical practice in all modern clinics. In this paper we present the problems related to this diagnostic method and its delayed application in the Mostar University Clinical Hospital. Along with the exposition of a general approach to the problem of hydronephrosis we briefl y present our modest collection of cases which points to the most recent trend of a vigorous medical development in this region, despite unfavorable overall conditions which prevailed so far. The observation included 56 children with prenatal, perinatal and early age determination of pyelon dilatation by means of ultrasonic exploration who were treated surgically. Of this number 32 (57.14%) were male, and 24 (42.86%) female children. Of the observed patients 56 had unilateral and 6 had bilateral pyelon dilatation so that 62 kidneys in all were observed and treated. The dilatation was determined prenatally in 24 (38.7%) out of 62 kidneys observed in all, in 7 (11.29%) the disorder was observed perinatally and in remaining 31 cases (49.9%) it manifested during early childhood, school age, even at the age of pre-puberty. Of the children with prenatally and perinatally determined dilatation, in 14 (45.16%) out of 31 (100.0%) observed kidneys the ap radius of the dilated pyelon was between 10–15 mm, and in 17 (54.84%) more than 15 mm. Along with other examinations (MAG3 and DMSA) the patients were followed-up by ultrasonic exploration of the observed kidney for 6 to 30 (average 18) months after postnatal diagnosis; the ultrasonic exploration was repeated in intervals of 6 months. Within 12 months of birth surgical intervention on the pyeloureteral junction was done on all 17 kidneys with an ap radius of the pyelon greater than 15 mm, as well as on 4 kidneys in which ap radius was between 10 and 15 mm. In other 10 kidneys with prenatally and perinatally determined ap radius of 10 to 15 mm the follow-up period was 25 to 30 months (average 27.5). As the examinations (ultrasound, MAG3 and DMSA) even after this period showed no signs of regression of the dilatation, nor an improvement in patency this provided an indication for surgical intervention with the aim of establishing a normal fl ow across the pyeloureteral junction. Antibiotic prophylaxis was not applied systematically, but in a targeted manner if the uroinfection was confi rmed clinically and in the lab. Through the presentation of cases we demonstrate the relationship of earlier and more recent procedures in the treatment of hydronephrosis in the gravitational area of the Mostar University Clinical Hospital. The fact that some children were subjected to surgical treatment due to hydronephrosis at the time of pre-puberty refl ects earlier views on this clinical entity. The successfulness of surgical treatment of hydronephrosis in the observed patients is complete and comparable to medically more developed environments, and our diagnostic capabilities are getting close to that level too. We specially wish to stress the recent introduction of ultrasonic examination of pregnant women and foetus in the third trimester with the aim of an early detection of anomalies and malformations of the urotract as an indicator of a marked medical development. On the global level there are still inconclusive and opposing opinions on this subject, as is seen in recent literature. The controversies relate to the diagnostics as well as to therapy

Recent Diagnostic and Therapeutic Approaches to Prenatally and Perinatally Diagnosed Hydronephrosis and their Implementation in the University Clinical Hospital Mostar

A shift of the diagnostics of urological malformations towards the fetal age by means of ultrasound, especially hydronephrosis which, apart from refl ux, is the most frequent developmental urological disorder, opened many dilemmas and debates. In the course of more than three decades the application of this diagnostic approach to the problem of hydronephrosis became a routine clinical practice in all modern clinics. In this paper we present the problems related to this diagnostic method and its delayed application in the Mostar University Clinical Hospital. Along with the exposition of a general approach to the problem of hydronephrosis we briefl y present our modest collection of cases which points to the most recent trend of a vigorous medical development in this region, despite unfavorable overall conditions which prevailed so far. The observation included 56 children with prenatal, perinatal and early age determination of pyelon dilatation by means of ultrasonic exploration who were treated surgically. Of this number 32 (57.14%) were male, and 24 (42.86%) female children. Of the observed patients 56 had unilateral and 6 had bilateral pyelon dilatation so that 62 kidneys in all were observed and treated. The dilatation was determined prenatally in 24 (38.7%) out of 62 kidneys observed in all, in 7 (11.29%) the disorder was observed perinatally and in remaining 31 cases (49.9%) it manifested during early childhood, school age, even at the age of pre-puberty. Of the children with prenatally and perinatally determined dilatation, in 14 (45.16%) out of 31 (100.0%) observed kidneys the ap radius of the dilated pyelon was between 10–15 mm, and in 17 (54.84%) more than 15 mm. Along with other examinations (MAG3 and DMSA) the patients were followed-up by ultrasonic exploration of the observed kidney for 6 to 30 (average 18) months after postnatal diagnosis; the ultrasonic exploration was repeated in intervals of 6 months. Within 12 months of birth surgical intervention on the pyeloureteral junction was done on all 17 kidneys with an ap radius of the pyelon greater than 15 mm, as well as on 4 kidneys in which ap radius was between 10 and 15 mm. In other 10 kidneys with prenatally and perinatally determined ap radius of 10 to 15 mm the follow-up period was 25 to 30 months (average 27.5). As the examinations (ultrasound, MAG3 and DMSA) even after this period showed no signs of regression of the dilatation, nor an improvement in patency this provided an indication for surgical intervention with the aim of establishing a normal fl ow across the pyeloureteral junction. Antibiotic prophylaxis was not applied systematically, but in a targeted manner if the uroinfection was confi rmed clinically and in the lab. Through the presentation of cases we demonstrate the relationship of earlier and more recent procedures in the treatment of hydronephrosis in the gravitational area of the Mostar University Clinical Hospital. The fact that some children were subjected to surgical treatment due to hydronephrosis at the time of pre-puberty refl ects earlier views on this clinical entity. The successfulness of surgical treatment of hydronephrosis in the observed patients is complete and comparable to medically more developed environments, and our diagnostic capabilities are getting close to that level too. We specially wish to stress the recent introduction of ultrasonic examination of pregnant women and foetus in the third trimester with the aim of an early detection of anomalies and malformations of the urotract as an indicator of a marked medical development. On the global level there are still inconclusive and opposing opinions on this subject, as is seen in recent literature. The controversies relate to the diagnostics as well as to therapy

Stajališta i navike adolescenata prema oralnome zdravlju u Hercegovini

The aim of the study was to determine attitudes towards and habits in oral health of adolescents in Herzegovina, as well as to evaluate the possible differences in habits among individuals of different adolescent categories. The study included 120 participants (35 male and 85 female) divided into three adolescent categories, as follows: early (11-14 years of age), middle (15-18 years) and late (19-21 years) adolescence, from the Herzegovina-Neretva Canton, who presented for dental examination. All participants completed the socio-demographic questionnaire and standardized Hiroshima University Dental Behavioral Inventory (HU-DBI). The answers provided by study adolescents in the HU-DBI showed statistically significant differences among particular age groups, i.e. between early and middle adolescence in items 7 (p=0.046) and 15 (p=0.007); between middle and late adolescence in items 8 (p=0.021), 11 (p=0.04) and 12 (p=0.027); and between middle and late adolescence in item 11 (p=0.032). Respondents in middle adolescence had poorer oral hygiene attitudes than those in early and late adolescence. In order to improve the oral hygiene habits of adolescents in Herzegovina, it is necessary to put emphasis on continuous education about oral hygiene habits during their secondary education.Cilj ovoga istraživanja bio je utvrditi stajališta i navike adolescenata prema oralnome zdravlju u Hercegovini, kao i procijeniti moguće razlike u navikama između ispitanika različitih adolescentskih kategorija. U istraživanje je bilo uključeno 120 ispitanika (35 muških, 85 ženskih) podijeljenih u tri adolescentske kategorije: ranu (11-14 godina), srednju (15-18 godina) i kasnu (19-21 godina) adolescentsku dob s područja Hercegovačko-neretvanske županije, koji su došli na dentalni pregled. Svi ispitanici ispunili su Sociodemografski upitnik i standardizirani Hiroshima University-Dental Behavioral Inventory (HU-DBI). U odgovorima iz upitnika HU-DBI utvrđene su statistički značajne razlike s obzirom na dobne skupine adolescenata: između rane i srednje adolescentske dobi u 7. (p=0,046) i 15. (p=0,007) pitanju, između srednje i kasne adolescencije u 8. (p=0,021), 11. (p=0,04) i 12. (p=0,027) pitanju te između srednje i kasne adolescencije u 11. (p=0,032) pitanju. Ispitanici u srednjoj adolescenciji imali su lošije oralno-higijenske stavove od ispitanika u ranoj i kasnoj adolescenciji. Provedba obrazovnih programa o promicanju oralnog zdravlja tijekom srednjoškolskog obrazovanja potrebna je radi unaprjeđenja oralnohigijenskih navika kod adolescenata u Hercegovini

Burkitt’s Lymphoma in the Boy: Infiltration in the Stomach, Colon and the Retroperitoneum – Ileocecal Invagination

A 4-year-old boy was hospitalised because showing signs of weakness, slight pain in the abdomen and while urinating. The symptoms occurred 7 days before hospitalisation. The boy did not vomit, nor did he have the urge to vomit, the defecation was regular showing no traces of blood. The physical visit a soft and painless tumefaction was confirmed ileocecally. The echography tests and the computed tomography suggested invagination, not excluding the second substrate. Barium enema showed irreductible invagination. The operative test showed that it was about the ileocolic invagination with extreme thickening of the cecum, the ascedental colon, the intestine and the retroperitoneum walls. A resection of the small intestine and a ileocolic anastomosis was performed. The pathohistological test shows the primar abdominal Burkitt’s lymphoma. In spite of the subsequent therapy the boy dies three weeks after the first symptoms’ manifestation. We, herewith, suggest at the importance of the echography analysis when diagnosing the Burkitt’s tumor and give advantage to this analysis against the computerized tomography. We also point at the huge level of malignancy of the Burkitt’s tumor in this boy

The Advantages of End-to-Side Arteriovenous Anastomosis over the Other Two Types of Arteriovenous Anastomosis in Dialysis Patients

The functional duration of vascular access in dialysis patients depends on the emergence of threatening complications. Discussions are constantly being held in an attempt to discover their causality and decrease their emergence. In 260 patients undergoing haemodialysis, we have studied the potential existence of a cause-and-effect relation between the emergence of complications in the vascular access and the applied type of arteriovenous (av.) anastomosis in the arteriovenous (AV) fistula. We have observed the incidence of all complications, both that of the thrombosis incidence as well as the primary and secondary fistula patency (survival). The complications – The examinees with the end-to-end anastomosis showed the incidence of 8.08%, 6.15% of the patients with the end-to-side anastomosis and 7.31% of the patients with the side-to-side anastomosis. The differences regarding incidences are statistically significant ( 2-test = 29.25; P=0.0001). Thrombosis – it has been found that thrombosis was the most frequent complication developing in 30.00 % patients with the end-to-end av. anastomosis, in 2.31% patients with end-to-side av. anastomosis and in 5.56% patients with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 27.69%, and it is statistically relevant ( 2-test = 33.920; P=0.0001). The »primary patency« (primary survival): within a 6-month interval following the establishment of vascular access, the first complications arose in 62.50% of patients with end-to-end av. anastomosis, 10.76% in those with end-to-side av. anastomosis and 18.88% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 51.74%, which is statistically significant ( 2-test = 49.009; P=0.0001). The secondary patency: 24 months subsequent to the establishment of vascular access, the AV-fistula was still functional in 52.50% of the patients with end-to-end av. anastomosis, 89.23% in those with end-to-side av. anastomosis and 81.11% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 36.73%, which is also statistically significant ( 2-test = 26.579; P=0.0001). According to our research, the end- -to-side type of av. anastomosis in vascular access provides better results both in relation to the duration as well as the maintenance of the functionality of the Av-fistula and in the lower incidence of the complications than the other types, and hence it shows a definite advantage

Prirođene anomalije bubrega i urinarnog trakta (CAKUT)

Congenital anomalies of the kidney and urinary tract (CAKUT) are wide spectrum of prenatal malformations (isolated or as a part of syndromes), accounting for up to one quarter of overall birth defects and causes endstage renal disease in up to a half of these cases. The most sever CAKUT phenotypes arise from a disturbed differentiation or interaction of the ureteric bud and the metanephric mesenchyme. CAKUT can be triggered through interplay of various genetic and epigenetic factors, as well as by numerous extrinsic factors including maternal diabetes, medications, and folate and iron deficiency, highlighting environmental factors that modify expression of disease. Genetic impairments (about 40 monogenic isolated and about 150 as a part of a syndrome) underlay about 15% of cases with variable expressivity and incomplete penetrance. Copy number variations (CNVs) and submicroscopic chromosomal imbalances are diagnostic challenge. Early identification of mutations in genes which can lead to CAKUT can facilitate targeted therapy. Gene panels based on next generation sequencing technology (NGS) might elucidate and significantly improve the process of testing and may lead to proper and thereby more effective diagnosis of CAKUT.Kongenitalne anomalije bubrega i urinarnog trakta (CAKUT) predstavljaju širok spektar prenatalnih malformacija (izoliranih ili u sklopu sindroma), koje čine do jedne četvrtine ukupnih urođenih mana i uzrokuju završnu bubrežnu bolest u do polovice ovih slučajeva. Najteži CAKUT fenotipovi proizlaze iz poremećene diferencijacije ili interakcije mokraćovodnog pupoljka i metanefričkog mezenhima. CAKUT može nastati međudjelovanjem različitih genetskih i epigenetskih čimbenika, kao i zbog brojnih vanjskih čimbenika kao što su dijabetes majke, lijekovi, nedostatak folata i željeza, uz naglasak na čimbenike okoliša koji modificiraju ekspresiju bolesti. Genetski poremećaji (oko 40 izoliranih gena i oko 150 koji su dio sindroma) su u pozadini oko 15% slučajeva s promjenjivim izražajem i nepotpunom penetrantnosti. Varijacije broja kopija i submikroskopske kromosomske neravnoteže predstavljaju dijagnostički izazov. Rano prepoznavanje mutacija u genima koje mogu dovesti do CAKUT-a olakšali bi ciljanu terapiju. Paneli gena temeljeni na tehnologiji sekvenciranja sljedeće generacije mogli bi razjasniti i značajno poboljšati proces testiranja i dovesti do ispravne i učinkovitije dijagnoze CAKUT-a

Prirođene anomalije bubrega i urinarnog trakta (CAKUT)

Congenital anomalies of the kidney and urinary tract (CAKUT) are wide spectrum of prenatal malformations (isolated or as a part of syndromes), accounting for up to one quarter of overall birth defects and causes endstage renal disease in up to a half of these cases. The most sever CAKUT phenotypes arise from a disturbed differentiation or interaction of the ureteric bud and the metanephric mesenchyme. CAKUT can be triggered through interplay of various genetic and epigenetic factors, as well as by numerous extrinsic factors including maternal diabetes, medications, and folate and iron deficiency, highlighting environmental factors that modify expression of disease. Genetic impairments (about 40 monogenic isolated and about 150 as a part of a syndrome) underlay about 15% of cases with variable expressivity and incomplete penetrance. Copy number variations (CNVs) and submicroscopic chromosomal imbalances are diagnostic challenge. Early identification of mutations in genes which can lead to CAKUT can facilitate targeted therapy. Gene panels based on next generation sequencing technology (NGS) might elucidate and significantly improve the process of testing and may lead to proper and thereby more effective diagnosis of CAKUT.Kongenitalne anomalije bubrega i urinarnog trakta (CAKUT) predstavljaju širok spektar prenatalnih malformacija (izoliranih ili u sklopu sindroma), koje čine do jedne četvrtine ukupnih urođenih mana i uzrokuju završnu bubrežnu bolest u do polovice ovih slučajeva. Najteži CAKUT fenotipovi proizlaze iz poremećene diferencijacije ili interakcije mokraćovodnog pupoljka i metanefričkog mezenhima. CAKUT može nastati međudjelovanjem različitih genetskih i epigenetskih čimbenika, kao i zbog brojnih vanjskih čimbenika kao što su dijabetes majke, lijekovi, nedostatak folata i željeza, uz naglasak na čimbenike okoliša koji modificiraju ekspresiju bolesti. Genetski poremećaji (oko 40 izoliranih gena i oko 150 koji su dio sindroma) su u pozadini oko 15% slučajeva s promjenjivim izražajem i nepotpunom penetrantnosti. Varijacije broja kopija i submikroskopske kromosomske neravnoteže predstavljaju dijagnostički izazov. Rano prepoznavanje mutacija u genima koje mogu dovesti do CAKUT-a olakšali bi ciljanu terapiju. Paneli gena temeljeni na tehnologiji sekvenciranja sljedeće generacije mogli bi razjasniti i značajno poboljšati proces testiranja i dovesti do ispravne i učinkovitije dijagnoze CAKUT-a