Genitourinarni karcinomi: potencijalna uloga oslikavanja

Imaging is an essential part of the management of patients with genitourinary cancers. Imaging is necessary for diagnosis, treatment selection and planning, applying minimally invasive image-guided techniques, assessment of response to treatment, and post-treatment follow-up. With advances in technology, imaging now comprises far more than descriptive anatomy. In the next decade anatomic, functional and molecular imaging information will increasingly be combined to achieve more accurate disease characterization and better patient care. In this review we present standard as well as some new imaging methods used in patients with kidney and prostate cancer.Oslikavanje je sastavni dio liječenja bolesnika s genitourinarnim karcinomima. Oslikavanje je nužno za dijagnozu bolesti, izbor i planiranje terapije, te vođenje minimalno invazivnih tehnika liječenja, procjenu odgovora na terapiju, te praćenje bolesnika nakon liječenja. S napretkom tehnologije oslikavanje je danas puno više od deskriptivne anatomije. U sljedećoj dekadi kombinirat će se informacije anatomskog, funkcionalnog i molekularnog oslikavanja s ciljem postizanja što bolje karakterizacije bolesti, a samim time i boljeg liječenja bolesnika. U ovom članku prikazat ćemo standardne i neke nove metode oslikavanja koje se primjenjuju kod bolesnika s karcinomom bubrega i karcinomom prostat

Analiza prijava sumnji na nuspojave lijekova za liječenje benigne hiperplazije prostate prijavljene HALMED-U

Benign prostatic hyperplasia is one of the most common diseases in men, with a prevalence rate of 50% in their 50s to 80% in their 80s, and is mostly treated with chronic drug therapy. The aim of this study was to analyze adverse drug reactions (ADR) to drugs used in benign prostate hyperplasia (BPH) treatment reported to HALMED from 2008 to 2021. Data on ADR reports in Croatia were obtained from the VigiFlow national database and on the use of drugs for BPH in Croatia from Drug Utilization Reports from HALMED. In the observed period, the number of reports on each BPH drug, total number of reports, seriousness of reported ADR, patient age and sex, type of reporter, and most reported ADRs were analyzed. Results showed that 438 ADR reports were received, of which 45.95% on tamsulosin as the most frequently used drug for BPH. Of all reports, 84% were non-serious, 96% were reported in men and 82% in patients older than 45 years. The most frequently reported ADRs were consistent with the known safety profile of BPH drugs. Pharmacists were the most common (47%) reporters of ADRs for BPH drugs, while 33% were reported by physicians. Analysis of the reported ADRs showed that most frequently reported ones were in line with the known safety profile of BPH drugs. However, given the prevalence of the disease and the extent of the use of BPH drugs, it could be argued that the number of reports could be higher (i.e., 34 reports/year). Reporting on ADRs is necessary to better understand the safety profile of drugs in the post-authorization period, and more information on the safe use of medicines could be collected by raising awareness of healthcare professionals.Benigna hiperplazija prostate (BHP) jedna je od najčešćih bolesti u muškaraca dobi od 50 godina i više, s učestalošću od 50% do 80% u muškaraca starijih od 80 godina. Danas se najčešće liječi kroničnom terapijom lijekovima. Cilj ovoga rada bio je analizirati prijave sumnji na nuspojave lijekova za liječenje BHP prijavljene Agenciji za lijekove i medicinske proizvode (HALMED) od 2008. do 2021. godine. Podaci o prijavama izdvojeni su iz nacionalne baze nuspojava VigiFlow. Analiziran je ukupan broj prijava za lijekove za BHP, broj prijava za svaki lijek za BHP, ozbiljnost prijavljenih nuspojava, dob i spol bolesnika, vrsta prijavitelja i najčešće prijavljene nuspojave. Podaci o potrošnji lijekova izdvojeni su iz HALMED-ovih Izvješća o potrošnji lijekova u Republici Hrvatskoj. U promatranom razdoblju zaprimljeno je 438 prijava sumnji na nuspojave lijekova koji se primjenjuju u liječenju BHP-a, od čega je najviše prijavljeno za tamsulozin (45,95%), koji je i najčešće primjenjivani lijek za BHP. Od ukupnog broja prijava 83,5% prijava je bilo ne-ozbiljne naravi, 95,9% je prijavljeno u muškaraca, a 81,5% prijava prijavljeno je u bolesnika u dobi od 45 godina i više. Najčešći prijavitelji bili su farmaceuti (u 46,7% prijava). Liječnici su prijavili 32,9% prijava. Najčešće prijavljivane nuspojave u skladu su s poznatim sigurnosnim profilom lijekova za BHP. Međutim, uzimajući u obzir učestalost BPH i čestu primjenu farmakoterapije u liječenju BPH moglo bi se zaključiti da bi broj prijava mogao biti veći od sadašnje 34 prijave godišnje. Prijavljivanje sumnji na nuspojave nužno je za bolje razumijevanje sigurnosnog profila lijekova nakon stavljanja u promet. Podizanjem svjesnosti svih zdravstveni djelatnika o važnosti prijavljivanja nuspojava može se doprinijeti prikupljanju veće količine informacija i ukupnom znanju o sigurnoj primjeni lijekova

TUMORSKI ANTIGENI U KARCINOMU PROSTATE, STRESNI KOMUNIKATIVNI PROBLEMI SUVREMENOG ČOVJEKA

This study investigated the immunohistochemical expression of the cancer testis antigen SSX in prostate cancer. SSX expression, with varying staining intensities, was observed in 83% of cancer samples. Substantial heterogeneity of expression was observed within individual samples. SSX expression was significantly higher in Gleason score 7 than in Gleason score 6 cancer (p=0.008). Tumours demonstrating capsular invasion had higher SSX expression than did tumours without capsular invasion (p=0.005). SSX expression did not correlate significantly with prostate-specific antigen level or tumour size. Further studies are needed to investigate SSX expression in prostate cancer and its potential implications for diagnosis and immunotherapy.U ovom radu istraživali smo imunohistokemijsku ekspresiju karcinom testis antigena SSX u karcinomu prostate. SSX ekspresija različitog intenziteta je pokazana u 83% uzoraka karcinoma. Pokazana je također i značajna heterogenost ekspresije unutar individaulnih uzoraka. SSX ekspresija je bila značajno više u Gleason zbroju 7, nego u Gleason zbroju 6 karcinoma prostate (p=0.008). Tumori koji su zahvatili kapsulu prostate imali su također značajniju SSX ekspresiju nego tumori koji nisu zahvatili kapsulu (p=0.005). SSX ekspresija nije korelirala značajno s vrijednostima prostata-specifičnog antigena ili veličinom tumora. Daljnje studije su potrebna da bi se istražila ekpresija SSX antigena u karcinomu prostate s potencijalnim implikacijama i na dijagnostiku i na imunoterapiju karcinoma prostate

TUMORSKI ANTIGENI U KARCINOMU PROSTATE, STRESNI KOMUNIKATIVNI PROBLEMI SUVREMENOG ČOVJEKA

This study investigated the immunohistochemical expression of the cancer testis antigen SSX in prostate cancer. SSX expression, with varying staining intensities, was observed in 83% of cancer samples. Substantial heterogeneity of expression was observed within individual samples. SSX expression was significantly higher in Gleason score 7 than in Gleason score 6 cancer (p=0.008). Tumours demonstrating capsular invasion had higher SSX expression than did tumours without capsular invasion (p=0.005). SSX expression did not correlate significantly with prostate-specific antigen level or tumour size. Further studies are needed to investigate SSX expression in prostate cancer and its potential implications for diagnosis and immunotherapy.U ovom radu istraživali smo imunohistokemijsku ekspresiju karcinom testis antigena SSX u karcinomu prostate. SSX ekspresija različitog intenziteta je pokazana u 83% uzoraka karcinoma. Pokazana je također i značajna heterogenost ekspresije unutar individaulnih uzoraka. SSX ekspresija je bila značajno više u Gleason zbroju 7, nego u Gleason zbroju 6 karcinoma prostate (p=0.008). Tumori koji su zahvatili kapsulu prostate imali su također značajniju SSX ekspresiju nego tumori koji nisu zahvatili kapsulu (p=0.005). SSX ekspresija nije korelirala značajno s vrijednostima prostata-specifičnog antigena ili veličinom tumora. Daljnje studije su potrebna da bi se istražila ekpresija SSX antigena u karcinomu prostate s potencijalnim implikacijama i na dijagnostiku i na imunoterapiju karcinoma prostate

Promjene u usnoj šupljini nakon transplantacije bubrega

Permanent immunosuppression is necessary to prevent rejection after kidney transplantation. However, it may predispose patients to different conditions and diseases including oral lesions. The most common benign oral lesions in kidney transplant recipients are gingival hyperplasia, oral candidiasis, hairy leukoplakia and saburral tongue. Oral form of Kaposi sarcoma, although rarely, can also be seen in kidney transplant patients. In this review, we present the incidence, etiology, clinical findings, diagnosis and treatment options for these lesions. For kidney transplant recipients, it is important to maintain good oral hygiene and care, as well as regular professional control by the dentist. This approach can reduce the number and severity of oral lesions.Nakon transplantacije bubrega bolesnici moraju biti na trajnoj imunosupresiji, što ih čini osjetljivima za različita stanja i bolesti uključujući oralne lezije. Najčešće dobroćudne oralne lezije kod bolesnika s transplantiranim bubregom su hiperplazija gingive, oralna kandidijaza, vlasasta leukoplakija i obloženi jezik. Oralna forma Kaposijevog sarkoma također se, iako rijetko, može vidjeti kod bolesnika s transplantiranim bubregom. Donosimo pregled incidencije, etiologije, kliničke slike, dijagnoze i liječenja ovih lezija. Kod bolesnika s transplantiranim bubregom važna je redovita skrb za oralno zdravlje uz održavanje oralne higijene te redovite posjete liječnicima dentalne medicine, što sve može smanjiti broj i ozbiljnost oralnih lezija

Zdjelična i retroperitonealna lipomatoza : prikaz slučaja

A rare case of pelvic and retroperitoneal lipomatosis lasting for more then three decades is presented. Although the disease is benign, it is usually progressive and may lead to renal insufficiency. On the other hand, treatment options are limited and with questionable effects. The clinical features, intravenous urography, computed tomography and magnetic resonance images, differential diagnosis and therapeutic aspects of this rare disease are presented.Prikazan je rijedak slučaj zdjelične i retroperitonealne lipomatoze koji traje više od tri desetljeća. Iako je ova bolest u svojoj naravi dobroćudna ona uglavnom s vremenom napreduje te može dovesti do bubrežne insuficijencije, a mogućnosti liječenja su ograničene s upitnim rezultatima. Opisuju se kliničke značajke, slike intravenske urografije te kompjutorizirane tomografije i magnetske rezonance, kao i diferencijalna dijagnoza te terapijske mogućnosti liječenja zdjelične i retroperitonealne lipomatoze

Expression of MAGE-A1, MAGE-A3/4 and NY-ESO-1 Cancer-Testis Antigens in Fetal Testis

SUMMARY Immunohistochemical expression of MAGE-A1, MAGE-A3/4 and NY-ESO-1/LAGE-1 cancer testis antigens (CTA) was assessed in 24 fetal testes from 15 th to 36 th week of gestation. Three monoclonal antibodies were used for immunohistochemical staining: 77B recognizing MAGE-A1, 57B recognizing multiple MAGE-A CTA, and D8.38 recognizing NY-ESO-1/ LAGE-1. Expression of MAGE-A1 was not observed in fetal testis samples, whereas multi-MAGE-A and NY-ESO-1/LAGE-1 specific reagents stained pro-spermatogonia in all samples with different expression levels during the period of fetal development observed. Significant expression of MAGE-A3/4 and almost continuous expression of NY-ESO-1 in fetal testes after 22 nd week of gestation suggested their important role in the development of sex cords and pro-spermatogonia in particular

Laparoskopska radikalna prostatektomija: serija slučajeva jednog centra

Laparoscopic radical prostatectomy (LRP) is traditionally characterized as a technically difficult procedure with a long learning curve but it is successfully performed worldwide. The aim of this paper was to assess the initial learning curve and clinical outcomes for LRP in our center. We performed a retrospective study including 63 LRP cases, in the course of 22 months, performed by 2 urologists, with no previous LRP experience. All patients were previously assessed by a multidisciplinary team and were selected on the basis of low and intermediate risk disease attributes according to the classification of prostate cancer risk groups of the European Association of Urology. The main outcomes of follow-up are procedure duration, estimated blood loss, complications, positive surgical margins, biochemical relapse and urinary continence. The median follow-up was 19.6 months. The median procedure duration was 196.8 minutes and median blood loss 257.1 mL. Significant decrease in both outcomes was observed when comparing first and last cases in the series. There were 5 (7.9%) Clavien Dindo grade II complications. Undetectable prostate specific antigen (PSA) was observed in 59 (93.6%) patients, and fifty-five patients (87.3%) were continent. Following a methodical learning approach, LRP can be safely mastered with favorable outcomes.Laparoskopska radikalna prostatektomija (LRP) tradicionalno se smatra tehnički zahtjevnom operacijom s dugom krivuljom učenja, ali se uspješno primjenjuje u cijelome svijetu. Cilj rada je prikazati krivulju učenja i ishode liječenja za LRP u našem centru. Proveli smo retrospektivnu studiju koja je uključila 63 pacijenta tijekom 22 mjeseca. Sve zahvate izvela su 2 specijalista urologa bez iskustva u LRP. Uključene pacijente prethodno je procijenio multidisciplinarni tim te su imali karakteristike nisko i srednje rizičnog bolesti prema klasifikaciji karcinoma prostate Europskog urološkog udruženja. Glavni ishodi praćenja bili su trajanje operacije, procijenjen gubitak krvi, učestalost komplikacija, prisutnost pozitivnog kirurškog ruba, biokemijski povrat bolesti i kontinencija mokraće. Medijan praćenja bio je 19.6 mjeseci. Medijani trajanja operacije i procijenjenog gubitka krvi bili su 196.8 minuta i 257.1 mL. Značajno smanjenje oba parametra zabilježeno je uspoređujući zadnje s prvim slučajevima u seriji. Zabilježeno je 5 (7.9%) Clavien Dindo stupanj II komplikacija. Nemjerljiv post-operacijski prostata specifični antigen (PSA) imalo je 59 (93.6%) pacijenata, a pedeset i pet pacijenata (87.3%) bilo je kontinentno. Prateći metodičan sustav učenja, moguće je na siguran način savladati LRP u zadovoljavajuće ishode liječenja

Usporedba kratkoročnih ishoda perkutane radiofrekventne i mikrovalne ablacije u liječenju malih tumora bubrega

Although the gold standard in the management of kidney tumors is surgical treatment, thermal ablation methods are a viable therapeutic option for patients with small (<4 cm) renal masses who are poor surgical candidates. The aim of this study was to compare the technical success, primary efficacy and complication rate of percutaneous radiofrequency and microwave ablation in the treatment of small renal masses. A retrospective analysis of consecutive patients with small renal masses treated with radiofrequency or microwave ablation between December 2017 and January 2022 was conducted. Response to the ablative therapy was assessed on contrast-enhanced computed tomography examination after 3 months. Ablations of 44 kidney lesions were performed in 43 patients. Sixteen lesions were treated with radiofrequency and 28 with microwave ablation. Both methods were associated with high technical success (100%). Primary efficacy rates of radiofrequency and microwave ablation were 81.3% and 89.3%, respectively. Ablation-related complications were noted only in the patients treated with microwave ablation (18.5%), all of them being low grade (Clavien-Dindo 1 and 2). Radiofrequency and microwave ablation exhibited comparable efficacy in the treatment of small renal masses. Microwave ablation was associated with a comparatively higher number of complications.Iako je zlatni standard u liječenju tumora bubrega kirurško liječenje, metode termalne ablacije dobar su izbor za bolesnike s malim (<4 cm) tumorima bubrega koji nisu kandidati za operativni zahvat. Cilj ovoga rada je usporediti tehnički uspjeh, odgovor na terapiju i učestalost komplikacija perkutane radiofrekventne i mikrovalne ablacije u liječenju malih tumora bubrega. Učinjena je retrospektivna analiza uzastopnih bolesnika s malim tumorima bubrega liječenih radiofrekventnom ili mikrovalnom ablacijom između prosinca 2017. i siječnja 2022. godine. Odgovor na terapiju procijenjen je na temelju pregleda kompjutoriziranom tomografijom 3 mjeseca nakon zahvata. Ablacijom su liječene 44 lezije kod 43 bolesnika, pri čemu je 16 lezija liječeno radiofrekventnom, a 28 mikrovalnom ablacijom. Kod obje metode postignuta je visoka razina tehničkog uspjeha (100%). Potpun odgovor na terapiju zabilježen je kod 81,3% lezija liječenih radiofrekventnom i 89,3% lezija liječenih mikrovalnom ablacijom. Komplikacije vezane uz ablaciju zabilježene su samo kod bolesnika liječenih mikrovalnom ablacijom (18,5%), no sve su bile niskog gradusa (Clavien-Dindo 1 i 2). Radiofrekventna i mikrovalna ablacija podjednako su uspješne u liječenju malih tumora bubrega, pri čemu je mikrovalna ablacija povezana s usporedbeno većim brojem komplikacija