Koji bi pacijenti trebali primiti radioterapiju u postoperativnom recidivu bolesti?

After radical prostatectomy (RP), up to 60% of patients with high-risk prostate cancer (PC), such as high Gleason score, extracapsular prostatic extension (ECE), positive margins, seminal vesicle involvement (SVI), will develop biochemical relapse and they will require further local treatment. Radiotherapy (RT ) to the prostate bed has been used as adjuvant (ART ) or salvage (SRT ). In patients with high-risk PC, radiotherapy immediately after RP or adjuvant radiotherapy may eradicate residual localized microscopic disease and improve biochemical, progression-free survival, and overall survival. Only a few observational studies have compared RP patients who have received only RT with patients who have received RT with some form of hormonal therapy. A few of them have reported improved progression-free survival with addition of hormonal therapy to SRT , but benefit in overall survival (OS) is not yet known.Nakon radikalne prostatektomije (RP) više od 60% pacijenata s visokorizičnim patološkim pokazateljima, kao što su visok Gleason score, ekstrakapsularno širenje, pozitivni rubovi, zahvaćeni sjemeni mjehurići, razviti će biokemijski relaps, te će zahtijevati daljnji lokalni tretman. Radioterapija na ležište prostate može biti adjuvantna i (salvage) odgođena. Kod karcinoma prostate visokog rizika, radioterapija odmah nakon RP ili adjuvantna radioterapija, može uništiti lokalnu rezidualnu mikroskopsku bolest i povezana je s poboljšanim biokemijskim preživljenjem do progresije bolesti i ukupnim preživljenjem. Malo je istraživanja koja su uspoređivala operirane pacijente koji su proveli zračenje ležišta prostate s pacijentima koji su uz RT primili i neku vrstu hormonske terapije. Neka od njih su pokazala poboljšano preživljenje do progresije bolesti dodatkom hormonske terapije uz SRT , ali učinak na ukupno preživljenje je upitan

Influence of silicone oil tamponade after vitrectomy on intraocular pressure [Tamponada silikonskim uljem i njezin utjecaj na vrijednosti intraokularnog tlaka]

The aim of this prospective study was to determine the possible influence of the silicone oil tamponade after vitrectomy on the early intraocular pressure (IOP) elevation, which is a major risk factor for developing secondary glaucoma in patients with vitreal and retinal proliferative changes. The research included 110 patients which were allocated in three groups according to the medical history data. The surgical procedures were performed at the Eye Clinic, University of Zagreb School of Medicine. The control group comprised 40 patients who underwent vitrectomy with air or saline solution tamponade. The second group consisted of 40 patients with retinal detachment and proliferative retinopathy who had vitrectomy with silicone oil tamponade and the third group were 30 patients with diabetic retinopathy who underwent vitrectomy and tamponade with silicone oil. The intraocular pressure was measured and gonioscopy was performed in all patients one month before and after vitrectomy. The results showed that there is no statistically significant difference among IOP values before and after vitrectomy in the control group (p = 0.104) as well as in the preoperative IOP values among all three groups of patients. The data analysis determined that in both groups of patients with silicone oil tamponade after vitrectomy, there is a statistically significant difference in IOP values one month after the surgical procedure (p = 0.000). The mean IOP values in those patients a month after vitrectomy were significantly higher compared to the control group (p < 0.05). Comparison of the IOP one month after vitrectomy between the patients with retinal detachment and those with diabetic retinopathy showed no statistically significant difference (p = 0.331) but the qualitative analysis showed that the IOP one month after vitrectomy was 2 mmHg higher in the diabetic retinopathy group. The results suggest that there is no difference in angle width before and after vitrectomy among different groups of patients. Emulsified silicone oil was confirmed in 18% of patients in the retinal detachment group. In 17% of patients in the diabetic retinopathy group the emulsified oil was found in the angle, whereas a 10% of patients had neovascularization of the angle one month after vitrectomy. The IOP elevation in the early postoperative course may be caused by intravitreal instillation of the silicone oil after vitrectomy. Emulsification of the silicone oil may lead to the early IOP rise; especially in the diabetic patients with angle neovascularization which itself can additionally accelerate the development of the secondary glaucoma

Recidiv karcinoma mokraćnog mjehura i ekspresija biljega Lynch i HER: istraživanje imunohistokemijskih obrazaca u 113 tumora kod 33 bolesnika

The aim was to identify immunohistochemical (IHC) markers able to predict recurrence of urinary bladder tumors. The method of multivariate adaptive regression splines (MARS) was applied to IHC data of 33 patients with urinary bladder cancer that relapsed one to six times (24 male and nine female, age 57-87 years). The MARS analysis was used to predict the total number of recurrences and the Ki-67 value by nine IHC markers (epidermal growth factor receptor (EGFR), HER2, HER3, E-cadherin, Ki-67, MLH1, MSH2, MSH6 and PMS2). Data were divided as initial tumors, first and subsequent recurrences, and tumors that relapsed within nine months of previous surgery or later. The IHC markers were semiquantitatively classified into four groups, as follows: 0 means no positive cells; 1, 10% of positive cells; 2, 11%-30% of positive cells; and 3, 31%-100% of positive cells. In predicting the overall number of recurrences, as a surrogate marker of tumor biology, the R2 value for all tumors was 0.423, for initial tumors 0.686, for first recurrence 0.700, and for subsequent recurrences only 0.233. The key predictors for initial tumors were HER2 and MSH2, while for the first recurrence it was EGFR. For quick recurrences (within nine months), the R2 was 0.474 with EGFR and HER3 as predictors, while for slow recurrences R2 was 0.640 due to EGFR and PMS2. In predicting the Ki-67 value of that tumor, the R2 value for all tumors was 0.300, for initial tumors 0.262, for first recurrence 0.360, and for subsequent recurrences only 0.533. The key predictors for first recurrences were EGFR and MSH6, and for subsequent recurrences HER2, EGFR and all Lynch markers. The R2 was 0.266 for quick recurrences and 0.370 for slow recurrences. The finding of E-cadherin was not found relevant by any of these MARS models. In conclusion, the MARS results associated multiple IHC markers with the number of recurrences and with Ki-67 values. It is important that differences in predictive markers were found between initial tumors and first recurrences, and between quick and slow recurrences, thus suggesting that tumor biology is different among these subgroups regarding the total number of recurrences and Ki-67 values.Cilj rada bio je identificirati imunohistokemijske (IHC) biljege koji mogu predvidjeti recidiv karcinoma mokraćnog mjehura. Metoda multivarijatnih adaptivnih regresijskih splinova (MARS) primijenjena je u IHC podatcima 33 bolesnika s karcinomom mokraćnog mjehura koji se povratio jedan do šest puta (24 muškarca i 9 žena, dob 57-87). Analiza MARS primijenjena je za predviđanje ukupnog broja recidiva i vrijednosti Ki-67 prema devet IHC biljega: receptor epidermalnog faktora rasta (EGFR), HER2, HER3, E-kadherin, Ki-67, MLH1, MSH2, MSH6 i PMS2. Podatci su podijeljeni na početne tumore, prve i naknadne recidive i tumore koji su se vratili unutar devet mjeseci od prethodne operacije ili kasnije. IHC biljezi semikvantitativno su klasificirani u četiri skupine kako slijedi: 0 znači da nema pozitivnih stanica; 1, 10% pozitivnih stanica; 2, 11%-30% pozitivnih stanica; i 3, 31%-100% pozitivnih stanica. U predviđanju ukupnog broja recidiva kao surogat biljega biologije tumora je vrijednost R2 za sve tumore bila 0,423, za početne tumore 0,686, za prvi recidiv 0,700, a za sljedeće recidive samo 0,233. Ključni prediktori za početne tumore bili su HER2 i MSH2, dok je za prvi recidiv bio EGFR. Za brze recidive (u roku od devet mjeseci) R2 je bio 0,474 s EGFR i HER3 kao prediktorima, dok je za spore recidive R2 bio 0,640 zbog EGFR i PMS2. U predviđanju Ki-67 vrijednosti tog tumora vrijednost R2 za sve tumore bila je 0,300, za početne tumore 0,262, za prvi recidiv 0,360, a za sljedeće samo 0,533. Ključni prediktori za prve recidive bili su EGFR i MSH6, a za sljedeće HER2, EGFR i svi biljezi Lynch. R2 je bio 0,266 za brze recidive i 0,370 za spore recidive. Nijedan od ovih modela MARS nije smatrao relevantnim otkriće E-kadherina. Zaključno, rezultati MARS-a povezuju više IHC biljega s brojem recidiva i s vrijednostima Ki-67. Važno je da su pronađene razlike u prediktivnim biljezima između početnih tumora i prvih recidiva te između brzih i sporih recidiva, što ukazuje na to da je biologija tumora različita među ovim podskupinama u pogledu ukupnog broja recidiva i vrijednosti Ki-67

Chalazion Management – Surgical Treatment Versus Triamcinolon Application

The aim of the study was to compare the length of treatment and efficiency of applied therapy in two groups of patients with chalazion who underwent surgical procedure or got triamcinolone application in chalazion. Our study included 30 patients with chalazions that persisted for about one month. All of them were resistant to applied topical antimicrobial therapy. These patients were devided in two groups. 15 patients underwent surgical procedure that included incision, excochleation and excision of the capsule of chalazion, while other 15 patients underwent triamcinolone aplication directly in chalazion ( dosage of 2–4 mg). Patients were followed up a day after therapy, two weeks after therapy and one month after applied therapy.We found that chalazion treatment with triamcinolone application directly in the lesion was to be more comfortable for patients, took less time to treat and needed no additional topical antimicrobial therapy

Chalazion Management – Surgical Treatment Versus Triamcinolon Application

The aim of the study was to compare the length of treatment and efficiency of applied therapy in two groups of patients with chalazion who underwent surgical procedure or got triamcinolone application in chalazion. Our study included 30 patients with chalazions that persisted for about one month. All of them were resistant to applied topical antimicrobial therapy. These patients were devided in two groups. 15 patients underwent surgical procedure that included incision, excochleation and excision of the capsule of chalazion, while other 15 patients underwent triamcinolone aplication directly in chalazion ( dosage of 2–4 mg). Patients were followed up a day after therapy, two weeks after therapy and one month after applied therapy.We found that chalazion treatment with triamcinolone application directly in the lesion was to be more comfortable for patients, took less time to treat and needed no additional topical antimicrobial therapy

Influence of Silicone Oil Tamponade after Vitrectomy on Intraocular Pressure

The aim of this prospective study was to determine the possible influence of the silicone oil tamponade after vitrectomy on the early intraocular pressure (IOP) elevation, which is a major risk factor for developing secondary glaucoma in patients with vitreal and retinal proliferative changes. The research included 110 patients which were allocated in three groups according to the medical history data. The surgical procedures were performed at the Eye Clinic, University of Zagreb School of Medicine. The control group comprised 40 patients who underwent vitrectomy with air or saline solution tamponade. The second group consisted of 40 patients with retinal detachment and proliferative retinopathy who had vitrectomy with silicone oil tamponade and the third group were 30 patients with diabetic retinopathy who underwent vitrectomy and tamponade with silicone oil. The intraocular pressure was measured and gonioscopy was performed in all patients one month before and after vitrectomy. The results showed that there is no statistically significant difference among IOP values before and after vitrectomy in the control group (p=0.104) as well as in the preoperative IOP values among all three groups of patients. The data analysis determined that in both groups of patients with silicone oil tamponade after vitrectomy, there is a statistically significant difference in IOP values one month after the surgical procedure (p=0.000). The mean IOP values in those patients a month after vitrectomy were significantly higher compared to the control group (p<0.05). Comparison of the IOP one month after vitrectomy between the patients with retinal detachment and those with diabetic retinopathy showed no statistically significant difference (p=0.331) but the qualitative analysis showed that the IOP one month after vitrectomy was 2 mmHg higher in the diabetic retinopathy group. The results suggest that there is no difference in angle width before and after vitrectomy among different groups of patients. Emulsified silicone oil was confirmed in 18% of patients in the retinal detachment group. In 17% of patients in the diabetic retinopathy group the emulsified oil was found in the angle, whereas a 10% of patients had neovascularization of the angle one month after vitrectomy. The IOP elevation in the early postoperative course may be caused by intravitreal instillation of the silicone oil after vitrectomy. Emulsification of the silicone oil may lead to the early IOP rise; especially in the diabetic patients with angle neovascularization which itself can additionally accelerate the development of the secondary glaucoma

Influence of Silicone Oil Tamponade after Vitrectomy on Intraocular Pressure

The aim of this prospective study was to determine the possible influence of the silicone oil tamponade after vitrectomy on the early intraocular pressure (IOP) elevation, which is a major risk factor for developing secondary glaucoma in patients with vitreal and retinal proliferative changes. The research included 110 patients which were allocated in three groups according to the medical history data. The surgical procedures were performed at the Eye Clinic, University of Zagreb School of Medicine. The control group comprised 40 patients who underwent vitrectomy with air or saline solution tamponade. The second group consisted of 40 patients with retinal detachment and proliferative retinopathy who had vitrectomy with silicone oil tamponade and the third group were 30 patients with diabetic retinopathy who underwent vitrectomy and tamponade with silicone oil. The intraocular pressure was measured and gonioscopy was performed in all patients one month before and after vitrectomy. The results showed that there is no statistically significant difference among IOP values before and after vitrectomy in the control group (p=0.104) as well as in the preoperative IOP values among all three groups of patients. The data analysis determined that in both groups of patients with silicone oil tamponade after vitrectomy, there is a statistically significant difference in IOP values one month after the surgical procedure (p=0.000). The mean IOP values in those patients a month after vitrectomy were significantly higher compared to the control group (p<0.05). Comparison of the IOP one month after vitrectomy between the patients with retinal detachment and those with diabetic retinopathy showed no statistically significant difference (p=0.331) but the qualitative analysis showed that the IOP one month after vitrectomy was 2 mmHg higher in the diabetic retinopathy group. The results suggest that there is no difference in angle width before and after vitrectomy among different groups of patients. Emulsified silicone oil was confirmed in 18% of patients in the retinal detachment group. In 17% of patients in the diabetic retinopathy group the emulsified oil was found in the angle, whereas a 10% of patients had neovascularization of the angle one month after vitrectomy. The IOP elevation in the early postoperative course may be caused by intravitreal instillation of the silicone oil after vitrectomy. Emulsification of the silicone oil may lead to the early IOP rise; especially in the diabetic patients with angle neovascularization which itself can additionally accelerate the development of the secondary glaucoma

Computer-Aided Evaluation of Radiologist’s Reproducibility and Subjectivity in Mammographic Density Assessment

Mammographic density is an independent risk of breast cancer. This study has evaluated the radiologists’ repro- ducibility and subjectivity in breast density estimation and in order to decrease the radiologists’ subjective errors the computer software was developed. The very good reproducibility existed in the strong correlation with the first and the second mammogram assessment after three month period for each radiologist (correlation coefficient 0.73–1, p<0.001). The strong correlation was present in the case of all 5 radiologists when compared among themselves and compared with software aided MDEST-Mammographic Density Estimation (correlation coefficient 0.651–0.777, p<0.001). Detected dif- ferences in glandular tissue percentage determination occurred in the case of two experienced radiologists, out of 5 (one radiologist with more than 5 year experience and one with more than 10 year experience, p<0.01), but in the case of breast type determination (American College of Radiology-ACR I-IV), the detected difference occurred in one radiologist with the least experience (less than 5 years, p<0.001). It can be concluded that the estimation of glandular tissue percent- age in breast density is rather subjective method, especially if it is expressed with absolute percentage, but the determina- tion of type of breast (ARCI-IV) depends on the radiologist’s experience. This study showed that software aided determi- nation of glandular tissue percentage and breast type can be of a great benefit in the case of less experienced radiologists

Computer-Aided Evaluation of Radiologist’s Reproducibility and Subjectivity in Mammographic Density Assessment

Mammographic density is an independent risk of breast cancer. This study has evaluated the radiologists’ repro- ducibility and subjectivity in breast density estimation and in order to decrease the radiologists’ subjective errors the computer software was developed. The very good reproducibility existed in the strong correlation with the first and the second mammogram assessment after three month period for each radiologist (correlation coefficient 0.73–1, p<0.001). The strong correlation was present in the case of all 5 radiologists when compared among themselves and compared with software aided MDEST-Mammographic Density Estimation (correlation coefficient 0.651–0.777, p<0.001). Detected dif- ferences in glandular tissue percentage determination occurred in the case of two experienced radiologists, out of 5 (one radiologist with more than 5 year experience and one with more than 10 year experience, p<0.01), but in the case of breast type determination (American College of Radiology-ACR I-IV), the detected difference occurred in one radiologist with the least experience (less than 5 years, p<0.001). It can be concluded that the estimation of glandular tissue percent- age in breast density is rather subjective method, especially if it is expressed with absolute percentage, but the determina- tion of type of breast (ARCI-IV) depends on the radiologist’s experience. This study showed that software aided determi- nation of glandular tissue percentage and breast type can be of a great benefit in the case of less experienced radiologists

Kliničke upute za dijagnostiku, liječenje i praćenje bolesnika oboljelih od raka mokraćnog mjehura Hrvatskoga onkološkog društva i Hrvatskoga urološkog društva Hrvatskoga liječničkog zbora [Clinical guidelines for diagnosing, treatment and monitoring patients with bladder cancer - Croatian Oncology Society and Croatian Urology Society, Croatian Medical Association]

Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia