PSA Screening for Early Detection of Prostate Cancer

Testiranje na karcinom prostate kontroverzno je područje s većim brojem spornih pitanja vezanih za sistematski ili individualno podešen program probira (screening). Sistematskim praćenjem literature svih objavljenih studija objedinjeno meta-analizama i Cochraneov pregled mogli bi pružiti pravovaljane argumente. Strategija testiranja na PSA trebala bi biti individualizirana s preporukom da se bolesniku izlože prednosti i nedostatci praćenja vrijednosti PSA. Preduvjet je bolesnikovo dobro opće stanje i barem 10 godina očekivanog trajanja života. Probir na PSA trebalo bi započeti s 50 godina života, odnosno sa 45 godina života u slučaju pozitivne obiteljske anamneze. Muškarci u 40-im godinama života s vrijednošću PSA iznad 1 ng/mL i muškarci u 60-im godinama života s PSA preko 2 ng/mL zahtijevaju razdoblja praćenja od najviše dvije godine. Novi biološki biljezi poput PCA 3, kalikreina ili TMPRSS2-Erg uključeni u testove Phi ili 4K zbroja pokazuju dodatnu osjetljivost i specifičnost u usporedbi s testom na PSA, i na taj način bi se mogle izbjeći nepotrebne biopsije prostate kao i dodatno unaprijediti dijagnostika.Screening for prostate cancer is a controversial topic with some conflicting issues regarding systematic or opportunistic program. The potential impact of this topic would necessitate the highest level of evidence produced through a systematic literature search of all published trials or cohorts summarized in a meta-analysis and a Cochrane review. Risk-adapted strategy for PSA screening should be individualized with discussing potential risks and benefits. Prerequisite is general good health and at least ten years life expectancy in well-informed patients. PSA screening should begin at 50-years old men or 45-years old with positive family history of prostate cancer. Men with a PSA value higher than 1 ng/ml at 40 years of age, and with a PSA value higher than 2 ng/ml at 60 years of age, need at least two years follow-up interval. New biological markers such as PCA 3, kallikreines or TMPRSS2-Erg fusion incorporated in the Phi or 4K score tests show additional sensitivity and specificity comparing to PSA test, therefore, avoiding unnecessary biopsies and lowering overdiagnosis

Nonvenereal Sclerosing Lymphangitis of the Penis

No abstract availabl

Nonvenereal Sclerosing Lymphangitis of the Penis

No abstract availabl

Malignant melanoma of the urethra: a rare histologic subdivision of vulvar cancer with a poor prognosis

Malignant melanoma of the urethra is a rare tumour that is difficult to diagnose and treat, resulting in a poor prognosis. In this paper, we present the case of a 65-year-old woman who was referred to a gynaecologist because of a urethral mass that mimicked a caruncle. The tumour was removed by local excision, and a pathological analysis revealed a malignant melanoma. Distal urethrectomy was performed after three months with no evidence of residual tumour. There was no evidence of disease at a six-year followup. In this paper, we compare the epidemiology, treatment, staging, and prognosis of vulvar cancer in general to malignant melanoma of the vulva in particular

“Psoas Hitch” procedure

U 51-godišnjega bolesnika učinjena je transuretralna resekcija urotelijalnoga karcinoma završnoga dijela lijevoga mokraćovoda. U sljedećoj fazi odstranjen je donji dio lijevoga mokraćovoda s pripadajućim dijelom mokraćnoga mjehura te je na toj strani postavljena perkutana nefrostoma. Radi postizanja boljega kapaciteta mokraćnoga mjehura, učinjena je transuretralna resekcija prostate i u posljednjoj fazi učinjen je ”psoas hitch” postupak s ureteroneocistostomijom.In 51-year-old patient urothelial carcinoma of the terminal left ureter was resected transurethrally. In the next phase, a distal part of the left ureter with a ”cuff” of the bladder was removed, and ipsilateral percutaneous nephrostomy introduced. Better bladder capacity was achieved by transurethral resection of the prostate, and in the last phase left-sided ”psoas hitch” procedure with ureteroneocystostomy was performe

Diferencijalna dijagnostika i kliničko značenje pneumobilije ili zraka u portalnoj veni na rendgenskoj snimci abdomena

The purpose of the article is to present the differential diagnostic criteria between pneumobilia (air in the biliary system) and portal vein gas on abdominal x-ray. Differential diagnosis is essential because of its influence on patient management. Two patients are presented, one with pneumobilia and the other with portal vein gas on abdominal x-ray, with review of the relevant literature. Pneumobilia is often iatrogenic and even in cases of cholecystitis it is never a sole indication for emergency surgery. Patients with pneumobilia on abdominal x-ray can always be investigated further. On the other hand, the presence of air in portal vein is in most cases a sign of acute mesenteric ischemia. In adults with abdominal pain indicating intestinal ischemia (pain that is ‘out of proportion’ to clinical abdominal examination findings), it is an indication for emergency exploratory laparotomy. It is vital to act early when intestinal ischemia is suspected.Cilj rada je prikazati diferencijalno-dijagnostičke kriterije između pneumobilije i zraka u portalnom venskom sustavu na rendgenskoj snimci nativnog abdomena. Ti kriteriji su ključni, jer o njima ovisi daljnje postupanje s bolesnikom. Prikazane su dvije bolesnice, jedna s nalazom pneumobilije, a druga s nalazom zraka u portalnoj veni na rendgenskoj snimci nativnog abdomena, te je pretražena literatura. Pneumobilija je često jatrogena i čak u slučajevima kolecistitisa nije isključiva indikacija za hitan kirurški zahvat. Bolesnike kod kojih je nađena pneumobilija na snimci nativnog abdomena se uvijek može uputiti na daljnji dijagnostički postupak. Međutim, prisutnost zraka u portalnoj veni je u većini slučajeva znak mezenterijske ishemije. U odraslih bolesnika koji se žale na bol koja bi mogla odgovarati mezenterijskoj ishemiji (vrlo jaka bol uz mekan trbuh) zrak u portalnoj veni je indikacija za hitnu eksplorativnu laparotomiju. Od vitalne važnosti je djelovati brzo kada se sumnja na mezenterijsku ishemiju

PRIMARNI MALIGNI MELANOM ŽENSKE URETRE

Primary malignant melanoma of the female urethra is a rare tumor that most commonly affects meatus and the distal urethra. The prognosis is poor. We report the case of 65-year-old woman who was refered by a gynaecologist due to an urethral mass mimicking a caruncule. The tumor was removed by a local exscision, and pathological analysis revealed malignant melanoma. After three months distal urethrectomy was performed with no evidence of residual tumor. The patient was uneventful during 6-year follow up period.Primarni maligni melanom ženske uretre je rijedak tumor. Najčešće je lokaliziran u meatusu i distalnom dijelu uretre. Prognoza je loša. Prikazujemo šezdesetpetogodišnju bolesnicu upućenu od ginekologa zbog tumorske promjene uretre nalik karunkulu. Tumor je odstranjen lokalnom ekscizijom, a patohistološkim pregledom je postavljena dijagnoza malignog melanoma. Nakon tri mjeseca učinjena je resekcija donje trećine uretre, pri čemu tumor nije nađen. Bolesnica je bez znakova recidiva, odnosno metastatskog širenja bolesti i nakon šest godina kliničkog praćenja

INFORMED CONSENT WITH SPECIAL EMPHASIS ON CROATIA

Poštivanje i provođenje prava pacijenata na obaviještenost i na suodlučivanje jedan su od temeljnjih dijelova visokokvalitetne zdravstvene zaštite. U radu se problematizira institut pristanka obaviještenog pacijenta uz pregled hrvatskih i međunarodnih pravnih dokumenata te znanstvenih istraživanja koja se bave ovim pitanjem. Na temelju pregledane literature može se zaključiti da ovo važno pitanje sadržava nekoliko ključnih dijelova kojima treba posvetiti pozornost i istražiti ih. Potrebno je evaluirati svrhovitost i kvalitetu provedbe pristanka obaviještenog pacijenta, sustavno ispitati poštuje li se pravo pacijenta na obaviještenost o medicinskom postupku tijekom liječenja, istražiti model odlučivanja liječnika i pacijenata u hrvatskim bolnicama, utvrditi sadržaj i količinu informacija izmijenjenih između liječnika i pacijenta, utvrditi sadržaj i razumljivost obrazaca za suglasnost i pisanih obavijesti o medicinskom postupku. U svrhu kvalitetnijeg provođenja procesa pristanka obaviještenog pacijenta potrebno je zakonski definirati popis medicinskih postupaka koji zahtijevaju pisanu suglasnost te uniformirati obrasce za suglasnost za iste medicinske postupke na razini Hrvatske.Respecting the informed consent and its implementation is one of the fundamental components of high-quality health care. This article discusses the informed consent with an overview of Croatian and international legal documents and scientific studies dealing with this issue. Based on the review of the literature it can be concluded that this is an important issue that contains several key components that should be observed and investigated. It is necessary to evaluate the purposefulness and quality of the implementation of the informed consent, to systematically examine respect of the patients’ right to information regarding the medical procedure during treatment, to explore decision-making model in the physician-patient encounter in Croatian hospitals, to determine the content and amount of information shared between physicians and patients, to determine the content and readability of consent forms and written patient information on the medical procedure. In order to assure higher quality of the implementation of the informed consent it is necessary to define by law a list of medical procedures that require written consent and to uniform consent forms for the same medical procedures country-wide

FEASIBILITY OF ALPHA-BLOCKERS IN CHRONIC CATEGORY III PROSTATITIS

Elektroničkim pretraživanjem putem interneta na adresi: http://www.ncbi.nlm.nih.gov/pubmed/ izdvojene su randomizirane studije s kontrolnom skupinom na placebu radi ispitivanja učinkovitosti djelovanja alfa-blokatora na kronični prostatitis tipa III s tegobama definiranim s pomoću simptomskog skora NIH-CPSI. Od 13 odabranih studija tri su isključene zato što nisu rabile NIH-CPSI, tri zato što su bile na kineskom jeziku i dvije zato što su bile u formi kongresnog sažetka. Analizirano je pet studija s ukupno 563 bolesnika, a metodološka kvaliteta studija po Jadadu iznosila je četiri ili pet jedinica. Uporijebljeni alfa-blokatori bili su alfuzosin, terazosin, tamsulozin i doksazosin u trajanju od 6 tjedana do 6 mjeseci. Učinak liječenja alfa-blokatorima bio je izraženiji u bolesnika s kroničnim prostatitisom tipa III s visokim vrijednostima NIH-CPSI i izraženijim tegobama mokrenja, koji su manje selektivne alfa-blokatore alfuzosin, terazosin i doksazosin primali 3–6 mjeseci.Studies were identified on internet by searching on address: http://www.ncbi.nlm.nih.gov/pubmed/ with criteria that studies should be placebo-controlled and randomized in trials of alpha-blockers in chronic category III prostatitis evaluated by symptom-score NIH-CPSI. From 13 clinical studies three were excluded because of not using NIH-CPSI, three were in Chinese language and two were congress abstracts. Analysed were five studies with four or five Jadad scale including 563 patients. Alpha-blockers alfuzosin, terazosin, tamsulosin and doxazosin have been used through 6 weeks and 6 months. Better results were accomplished by less selective alpha-blockers alfuzosin, terazosin and doxazosin through 3–6 months in patients having higher NIH-CPSI score and higher voiding score

FEASIBILITY OF ALPHA-BLOCKERS IN CHRONIC CATEGORY III PROSTATITIS

Elektroničkim pretraživanjem putem interneta na adresi: http://www.ncbi.nlm.nih.gov/pubmed/ izdvojene su randomizirane studije s kontrolnom skupinom na placebu radi ispitivanja učinkovitosti djelovanja alfa-blokatora na kronični prostatitis tipa III s tegobama definiranim s pomoću simptomskog skora NIH-CPSI. Od 13 odabranih studija tri su isključene zato što nisu rabile NIH-CPSI, tri zato što su bile na kineskom jeziku i dvije zato što su bile u formi kongresnog sažetka. Analizirano je pet studija s ukupno 563 bolesnika, a metodološka kvaliteta studija po Jadadu iznosila je četiri ili pet jedinica. Uporijebljeni alfa-blokatori bili su alfuzosin, terazosin, tamsulozin i doksazosin u trajanju od 6 tjedana do 6 mjeseci. Učinak liječenja alfa-blokatorima bio je izraženiji u bolesnika s kroničnim prostatitisom tipa III s visokim vrijednostima NIH-CPSI i izraženijim tegobama mokrenja, koji su manje selektivne alfa-blokatore alfuzosin, terazosin i doksazosin primali 3–6 mjeseci.Studies were identified on internet by searching on address: http://www.ncbi.nlm.nih.gov/pubmed/ with criteria that studies should be placebo-controlled and randomized in trials of alpha-blockers in chronic category III prostatitis evaluated by symptom-score NIH-CPSI. From 13 clinical studies three were excluded because of not using NIH-CPSI, three were in Chinese language and two were congress abstracts. Analysed were five studies with four or five Jadad scale including 563 patients. Alpha-blockers alfuzosin, terazosin, tamsulosin and doxazosin have been used through 6 weeks and 6 months. Better results were accomplished by less selective alpha-blockers alfuzosin, terazosin and doxazosin through 3–6 months in patients having higher NIH-CPSI score and higher voiding score