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

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

AGREGACIJA TROMBOCITA U ZAVRŠNOM STADIJU ZATAJIVANJA BUBREGA – RAZLIKE IZMEĐU BOLESNIKA KOJI SU LIJEČENI HEMODIJALIZOM I PERITONEJSKOM DIJALIZOM

End-stage renal disease patients (ESRD) suffer from procoagulant abnormalities that lead to excessive cardiovascular events, as well as from platelet dysfunction manifesting as an increased risk of bleeding. The exact pathogenesis of complex hemostatic disorders in ESRD patients is not completely understood. The aim of our study was to investigate the possible different effects of hemodialysis (HD) and peritoneal dialysis (PD) on platelet function in patients with ESRD by using the platelet function analyzer (PFA-100) which in vitro simulates the process of aggregation and platelet activation. Tests were performed with collagen/epinephrine (COL/EPI) and collagen/adenosine-5-diphosphate (COL/ADP) cartridges. The study included 44 patients with ESRD undergoing regular HD (n=32) or PD (n=12). Although there were no significant differences in COL/EPI and COL/ADP tests, it is indicative that more than 50% of HD patients had COL/EPI test values above the upper limit. These findings correlated with a higher chance for bleeding in HD group.Additionally, patients in HD group were significantly older and had significantly lower platelet count compared to PD patients.Završni stadij kronične bubrežne bolesti obilježen je različitim prokoagulantnim odstupanjima koja dovode do razvoja tromboembolijskih komplikacija uz istodobno poremećenu funkciju trombocita s posljedičnim porastom rizika za nastanak krvarenja. Točna etiologija složenih hemostatskih poremećaja u završnom stadiju kronične bubrežne bolesti nije u potpunosti razjašnjena. Cilj ovoga istraživanja bio je usporediti učinak hemodijalize i peritonejske dijalize na funkciju tromobocita kod bolesnika u završnom stadiju kronične bubrežne bolesti primjenom analizatora funkcije trombocita (PFA-100) koji in vitro stimulira proces aktivacije i agregacije trombocita. Ispitivanje je provedeno na 2 testa (COL/EPI i COL/ADP) koji mjere vrijeme potrebno cirkulirajućoj krvi da okludira membranu obloženu kolagenom i adrenalinom (COL/EPI) odnosno kolagenom i ADP-om (COL/ADP). U istraživanje su bili uključeni bolesnici na hemodijalizi (n=32) odnosno peritonejskoj dijalizi (n=12). Premda nije zabilježena statistički značajna razlika između testova COL/EPI i COL/ADP, indikativno je da su u više od 50% ispitanika na hemodijalizi vrijednosti testa COL/EPI bile iznad gornje granice referentnog intervala. Ovi rezultati mogu se povezati s većom mogućnosti krvarenja u bolesnika na hemodijalizi. Uz to, bolesnici na hemodijalizi bili su značajno stariji te su imali statistički značajno niži broj trombocita u odnosu na ispitanike na peritonejskoj dijalizi