Prostate inflammation/ Infections of the Urinary Tract

Infekcije urotrakta najčešće su bolničke infekcije, a druge su po učestalosti u izvanbolničkoj sredini. Radi boljeg pristupa liječenju i evaluaciji djelotvornosti antimikrobnih lijekova infekcije urotrakta dijele se u pet skupina: akutne nekomplicirane infekcije donjeg dijela mokraćnog sustava u žena koje nisu trudnice, akutni nekomplicirani pijelonefritis, komplicirane infekcije urotrakta uključujući i sve infekcije urotrakta u muškaraca, asimptomatska bakteriurija te rekurentne infekcije urotrakta. Infekcije mokraćnog sustava mogu uzrokovati bakterije, virusi, gljive ili paraziti. Najčešći put ulaska je kroz vanjsko ušće mokraćne cijevi. Najčešći uzročnik je E. coli, a u patogenezi je važno formiranje biofilma. Ponavljane uroinfekcije u žena i uroinfekti u muškaraca zahtijevaju kliničku, urološku obradu. Najbolje je ciljano liječenje antibiotikom prema antibiogramu u dovoljnoj dozi i dovoljno dugo.Urinary tract infections are the most common nosocomial infections, immediately after respiratory infections. In order to achieve better treatment and evaluation of antimicrobial agents, urinary tract infections are divided into five groups. Urinary tract infections can be caused by bacteria, viruses, fungi or parasites. The most common route of entry is through the external meatus of the urethra. The most common agent is E. coli. The biofilm formation is important in the pathogenesis of urinary tract infections. Both repeated urinary tract infections in women and first infections in men require urological examination and evaluation. The best treatment option are targeted antibiotics in sufficient doses and over a sufficiently long period of time

Increased Bone Turnover Markers after Renal Transplantation

Bone remodeling is a process that occurs continuously in a seemingly inactive tissue like bone. Because of decreased vitamin D synthesis, phosphorus retention and decreased calcium blood concentration, patients with chronic renal failure (CRF) develop secondary hyperparathyroidism1–5. Elevated PTH levels shifts balance between osteoblast and osteoclast activity in favor of osteoclast activity and, therefore, bone resorption. Bone metabolic disorder that affects patients with CRF is called renal osteodystrophy (ROD)1–5. We presume that renal transplantation reverses bone metabolism disorder and our goal was to establish whether osteoblast and osteoclast activity returns to the levels of healthy individuals

Urodynamics in clinical practice

Urodinamika je metoda kojom se procjenjuje funkcija mokraćnoga sustava, najčešće njegovog donjeg dijela. Donji dio urinarnog sustava je funkcionalna cjelina koja se sastoji od mokraćnoga mjehura, sfinkterskoga mehanizma i mokraćne cijevi. Osnovna funkcija mu je punjenje i pražnjenje mjehura uz kontinenciju. Urodinamikom se mogu adekvatno evaluirati sve te funkcije. Urodinamika je indicirana kao nadopuna standardnim pretragama. Najčešće korištene metode su mikciometrija, cistometrija i profilometrija uretre. Mikciometrijom se određuje protok urina u jedinici vremena tijekom akta mikcije. Cistometrijom mjerimo tlakove u mjehuru tijekom njegova punjenja i pražnjenja. Profilometrijom uretre određujemo tlakove u uretri, a dobiveni podaci govore nam o kontinenciji ispitanika. U preglednom radu prikazat ćemo osnove urodinamskog ispitivanja s kliničkim primjerima.Urodynamics is a method for evaluation of urinary tract function, specially lower urinary tract. Lower urinary tract is a unique functional entity consisted of urinary bladder, sphincteric mechanism and urethra. Their main function is storage of urine, voiding and continence. Urodynamics is used for evaluation of all this functions. Urodynamics is performed as adjunct to the basic clinical evaluation. The most frequently used methods are uroflow, cistometry, and urethral profilometry. Uroflow represent urinary flow during micturation. Cistometry is used for measurement of pressures during storage and expulsion of the urine. Urethral profilometry measured urethral pressure and show data about patient’s continency. In this review article we present basic information about urodynamic tests with clinical examples

AUTONOMIC DYSREFLEXIA

Autonomna disrefl eksija (AD) jest sindrom koji se javlja u osoba s visokom lezijom kralježnične moždine. Posljedica je aktivacije simpatičkog sustava štetnim podražajem nastalim ispod nivoa ozljede (najčešće distenzija i/ili iritacija mokraćnog mjehura, konstipacija). Aktivacija simpatičkog sustava dovodi do porasta arterijskoga krvnog tlaka jer ga kompenzatorni mehanizmi, zbog oštećenja kralježnične moždine, ne mogu adekvatno regulirati. Najvažnija joj je manifestacija arterijska hipertenzija jer može dovesti do cerebrovaskularnih i kardiovaskularnih komplikacija pa i smrti. Osnova liječenja jest što ranije prepoznavanje i uklanjanje uzroka AD-a. U bolesnika u kojih je tlak visok ili se ne spušta unatoč uklanjanju uzroka nužno je započeti s antihipertenzivnom terapijom (nifedipin, kaptopril ili nitroglicerin). Izuzetno je bitna i prevencija ovog stanja koja se sastoji u sprečavanju nastanka mogućih okidača, a u prvom redu to znači osiguravanje prikladnoga mikcijskog programa i rada crijeva. Također je nužna edukacija bolesnika, osoba koje se skrbe o njima i zdravstvenih radnika o ovom sindromuAutonomic dysrefl exia (AD) is a syndrome that occurs in patients with high spinal cord lesion. It is caused by activation of sympathetic nervous system by a noxious stimulus below the level of injury, usually consisting of distention and/or irritation of the bladder or constipation. Sympathetic system activation leads to blood pressure elevation because compensatory mechanisms cannot properly regulate blood pressure due to the spinal cord lesions. The most important manifestation of AD is arterial hypertension because of the possible cerebrovascular and cardiovascular complications, including death. Initial treatment consists of recognition of the symptoms and resolution of the cause. In patients with high blood pressure antihypertensive therapy is initiated (with nifedipine, captopril and nitroglycerin). Prevention is also a very important task, with the goal of infl uencing all possible triggers of this condition, specially micturition and colon disorders. One of the most important tasks is educating patients, their caregivers and health professionals about A

AUTONOMIC DYSREFLEXIA

Autonomna disrefl eksija (AD) jest sindrom koji se javlja u osoba s visokom lezijom kralježnične moždine. Posljedica je aktivacije simpatičkog sustava štetnim podražajem nastalim ispod nivoa ozljede (najčešće distenzija i/ili iritacija mokraćnog mjehura, konstipacija). Aktivacija simpatičkog sustava dovodi do porasta arterijskoga krvnog tlaka jer ga kompenzatorni mehanizmi, zbog oštećenja kralježnične moždine, ne mogu adekvatno regulirati. Najvažnija joj je manifestacija arterijska hipertenzija jer može dovesti do cerebrovaskularnih i kardiovaskularnih komplikacija pa i smrti. Osnova liječenja jest što ranije prepoznavanje i uklanjanje uzroka AD-a. U bolesnika u kojih je tlak visok ili se ne spušta unatoč uklanjanju uzroka nužno je započeti s antihipertenzivnom terapijom (nifedipin, kaptopril ili nitroglicerin). Izuzetno je bitna i prevencija ovog stanja koja se sastoji u sprečavanju nastanka mogućih okidača, a u prvom redu to znači osiguravanje prikladnoga mikcijskog programa i rada crijeva. Također je nužna edukacija bolesnika, osoba koje se skrbe o njima i zdravstvenih radnika o ovom sindromuAutonomic dysrefl exia (AD) is a syndrome that occurs in patients with high spinal cord lesion. It is caused by activation of sympathetic nervous system by a noxious stimulus below the level of injury, usually consisting of distention and/or irritation of the bladder or constipation. Sympathetic system activation leads to blood pressure elevation because compensatory mechanisms cannot properly regulate blood pressure due to the spinal cord lesions. The most important manifestation of AD is arterial hypertension because of the possible cerebrovascular and cardiovascular complications, including death. Initial treatment consists of recognition of the symptoms and resolution of the cause. In patients with high blood pressure antihypertensive therapy is initiated (with nifedipine, captopril and nitroglycerin). Prevention is also a very important task, with the goal of infl uencing all possible triggers of this condition, specially micturition and colon disorders. One of the most important tasks is educating patients, their caregivers and health professionals about A

AUTONOMIC DYSREFLEXIA

Autonomna disrefl eksija (AD) jest sindrom koji se javlja u osoba s visokom lezijom kralježnične moždine. Posljedica je aktivacije simpatičkog sustava štetnim podražajem nastalim ispod nivoa ozljede (najčešće distenzija i/ili iritacija mokraćnog mjehura, konstipacija). Aktivacija simpatičkog sustava dovodi do porasta arterijskoga krvnog tlaka jer ga kompenzatorni mehanizmi, zbog oštećenja kralježnične moždine, ne mogu adekvatno regulirati. Najvažnija joj je manifestacija arterijska hipertenzija jer može dovesti do cerebrovaskularnih i kardiovaskularnih komplikacija pa i smrti. Osnova liječenja jest što ranije prepoznavanje i uklanjanje uzroka AD-a. U bolesnika u kojih je tlak visok ili se ne spušta unatoč uklanjanju uzroka nužno je započeti s antihipertenzivnom terapijom (nifedipin, kaptopril ili nitroglicerin). Izuzetno je bitna i prevencija ovog stanja koja se sastoji u sprečavanju nastanka mogućih okidača, a u prvom redu to znači osiguravanje prikladnoga mikcijskog programa i rada crijeva. Također je nužna edukacija bolesnika, osoba koje se skrbe o njima i zdravstvenih radnika o ovom sindromuAutonomic dysrefl exia (AD) is a syndrome that occurs in patients with high spinal cord lesion. It is caused by activation of sympathetic nervous system by a noxious stimulus below the level of injury, usually consisting of distention and/or irritation of the bladder or constipation. Sympathetic system activation leads to blood pressure elevation because compensatory mechanisms cannot properly regulate blood pressure due to the spinal cord lesions. The most important manifestation of AD is arterial hypertension because of the possible cerebrovascular and cardiovascular complications, including death. Initial treatment consists of recognition of the symptoms and resolution of the cause. In patients with high blood pressure antihypertensive therapy is initiated (with nifedipine, captopril and nitroglycerin). Prevention is also a very important task, with the goal of infl uencing all possible triggers of this condition, specially micturition and colon disorders. One of the most important tasks is educating patients, their caregivers and health professionals about A

CT PERITONEOGRAFIJA – DIJAGNOSTIČKA METODA U OTKRIVANJU “SLATKOG HIDROTORAKSA” U BOLESNIKA NA PERITONEJSKOJ DIJALIZI

Peritoneal dialysis (PD) can be considered as the first method to start dialysis treatment because it improves the patient quality of life and survival compared to hemodialysis (in the first two years). Hydrothorax is a rare complication of PD. We present a 66-year-old female patient diagnosed with end-stage renal disease caused by chronic tubulointerstitial nephritis. One month after peritoneal catheter had been inserted, the patient started continuous ambulatory PD. Several weeks after PD had been introduced, the patient complained of cough and weight gain. Chest x-ray revealed pleural effusion on the right side and pleural puncture proved a high concentration of glucose in the aspirate, and the diagnosis of ‘sweet hydrothorax’ was made. Additionally, computerized tomography (CT) peritoneography clearly showed contrast leak from peritoneal cavity to thoracic cavity. PD was stopped and the catheter for PD removed. Now, the patient is on the waiting list for kidney transplantation. ‘Sweet hydrothorax’ is a rare complication of PD and CT peritoneography is the most sensitive noninvasive diagnostic tool. In most patients, PD is replaced by hemodialysis, although surgical treatment is also possible.Peritonejska dijaliza (PD) se može smatrati metodom dijalitičkog izbora, jer u odnosu na hemodijalizu poboljšava kvalitetu života i preživljenje bolesnika u prve dvije godine. Hidrotoraks je rijetka komplikacija PD. Prikazujemo 66-godišnju bolesnicu kojoj je dijagnosticiran završni stadij kronične bubrežne bolesti uzrokovan kroničnim tubulointersticijskim nefritisom. Jedan mjesec od postavljanja katetera za PD bolesnica je započela s dijalitičkim liječenjem. Nekoliko tjedana od početka dijalitičkog liječenja bolesnica se počela žaliti na kašalj i porast težine. RTG snimka prsnih organa pokazala je desnostrani pleuralni izljev. Njegovom punkcijom dokazana je visoka koncentracija glukoze u aspiratu te je postavljena dijagnoza “slatkog hidrotoraksa”. CT peritoneografija je nedvojbeno pokazala da kontrast iz abdominalne šupljine ide u pleuralnu. PD je zaustavljena, a kateter za PD izvađen. Sad se bolesnica nalazi na listi čekanja za transplantaciju bubrega. “Slatki hidrotoraks” je rijetka komplikacija bolesnika na PD, a CT peritoneografija je najosjetljiviji neinvazivni dijagnostički test. U većine bolesnika PD se zamijeni hemodijalizom, ali je moguće i kirurško liječenje

MINI-PERCUTANEOUS NEPHROLITHOTRIPSY – OUR FIRST EXPERIENCE

Urolitijaza je važan problem u razvijenim zemljama svijeta jer se broj ljudi s konkrementima povećava. Prije nekoliko desetljeća kirurško liječenje urolitijaze provodilo se samo putem otvorene kirurgije, dok su danas dominantne minimalno-invazivne metode. Jedna od njih je i miniperkutana nefrolitotripsija. U ovom radu prikazana su četiri bolesnika u kojih je učinjena miniperkutana nefrolitotripsija. U svih bolesnika konkrement se nalazio u pijelonu desnoga bubrega. U troje bolesnika konkrement je bio u nativnom bubregu, a u jednoga u transplantiranome. U svih bolesnika uspješno je učinjena laserska litotripsija konkremenata. Na kontrolnom RDG pregledu nije bilo ostatnih fragmenata. Miniperkutana nefrolitotripsija jest minimalno-invazivna metoda koja se pokazala uspješnom u liječenju nefrolitijaze i u nativnim bubrezima i u transplantiranom bubreguUrolithiasis is a significant problem in the developed countries due to the increased number of patients with stones. Just a few decades ago open surgery was the only surgical treatment which is today, in most cases, replaced with minimally-invasive methods. One of these new methods is mini-percutaneous nephrolihotripsy. We present four patients in whom mini-percutaneous nephrolithotripsy was performed. In all patients the stone was located in the renal pelvis. In three patients the stone was in the native kidney and in one in the transplanted kidney. In all patients laser lithotripsy was successfully performed. On the control x-ray the residual fragments were not found in any patients. Mini-percutaneous nephrolithotripsy is a minimally-invasive method which is successfull in the treatment of nephfrolithiasis in native and transplanted kidneys