Study of quality of "lećevica" cheese

Autori su istraživali fizikalno-kemijske, higijenske i organoleptičke pokazatelje kakvoće lečevičkog sira tijekom ljeta i jeseni 1979. godine. Lećevički sir proizvodi se u P.Z. Lećevica na poluindustrijski način iz ovčjeg, kravljeg i miješanog ovčjeg i kravljeg mlijeka. Sir ima oblik koluta. Težina kravljeg sira iznosi prosječno 1,25 kg a ovčjeg 1,90 kg. Zrenje sira traje 2 do 2,5 mjeseci. Kora sira je svijetložuta a konzistencija čvrsta do čvrstoelastična. Tijesto je bijeložućkasto i plastično s pravilno raspoređenim očicama veličine od 1 do 5 mm u promjeru. Miris sira je specifičan a okus umjereno slan i pikantan. Prosječna količina masti u suhoj tvari kravljeg sira iznosi 48,7 % a ovčjeg 52,9 %. Na osnovi dobivenih rezultata zreli lećevički sir treba svrstati u skupinu tvrdih masnih sireva. U pogledu bakteriološke ispravnosti samo 20 % pretraženih uzoraka zadovoljilo je odredbe postojećih propisa.Ten samples of "lećevica" cheese from Dalmatia were examined. This hard cheese is produced from the milk of ewes or cows or from mixed milk. The fat in total solids varied from 46.6 to 54.7 %. Only 20 % of examined samples met the microbiological requirements

RENAL CELL CARCINOMA IN THE AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Karcinom bubrega je rijetka komplikacija autosomno dominantne policistične bubrežne bolesti (ADPBB). Prikazujemo 63-godišnjeg pacijenta s ADPBB, karcinomom bubrega i bubrežnom funkcijom koja je bila očuvana sve do nefrektomije. Pacijent je od 2012. g. pod kontrolom urologa pri Klinici za urologiju Kliničkog bolničkog centra Zagreb, jer je radiološkom obradom verifi cirana solidna tvorba desnoga bubrega koja je morfološki izgledala kao onkocitom. Bolesnik je od ranije znao da ima policističnu bolest bubrega i jetre. Od subjektivnih poteškoća navodio je samo povremenu lumbalnu bol. Svi laboratorijski nalazi bili su potpuno uredni. Tijekom kontrola uočen je rast tvorbe u desnom bubregu uz očuvanu bubrežnu funkciju, te je bolesniku predložena nefrektomija za koju se nije odmah odlučio. No, kada je pristao, učinjena je desnostrana radikalna nefrektomija. Radilo se o karcinomu bubrega, tipa svjetlih stanica, koji je klasifi ciran kao pT3aN0MX. U prva tri poslijeoperacijska dana dolazi do porasta kreatinina do 165 μmol/L. U trenutku otpusta iz bolnice kreatinin je bio 132 μmol/L, ureja 9,8 mmol/L. Tri mjeseca nakon kirurškog zahvata kreatinin je stabilan na 135 μmol/L, a kontrolni MSCT toraksa, abdomena, zdjelice, UZV trbuha i rendgenogram srca i pluća su, osim poznatih cističnih promjena na jetri i lijevom bubregu, uredni. Dalje su pacijentu preporučene redovite urološke kontrole, a zbog jasne bubrežne insufi cijencije koja se razvila nakon nefrektomije preporučene su i redovite kontrole nefrologa.Aim: The aim of this case report is to point out the specifi city of clinical, diagnostic and therapeutic approach to the patient with the autosomal dominant polycystic kidney disease (ADPKD), renal cell carcinoma along with preserved kidney function. We used patient medical chart, as well as relevant literature from online medical databases (PubMed, EM-base). Case report: We describe a case of a 63-year-old patient with ADPKD, renal cell carcinoma and preserved kidney function until nephrectomy. ADPKD along with hepatic cysts has been known since 2009. Because of the suspicious renal mass detected by ultrasound, non-contrast computed tomography (CT) was performed in 2009, which did not confi rm the presence of renal tumor. In 2012, the patient suffered right-fl ank pain and therefore underwent contrast CT and magnetic resonance imaging (MRI), which confi rmed renal tumor that morphologically seemed like oncocytoma. For that reason, he has been under urologist supervision ever since 2012. Laboratory blood and urine test results were within the normal range all the time and the patient only complained of right-fl ank pain. Further follow up revealed enlargement of the renal mass on MRI and contrast CT. The patient was informed about his condition from the beginning, but he did not accept nephrectomy. However, in December 2015, he agreed and radical nephrectomy of the right kidney was performed. Histopathologic report showed that it was a clear renal cell carcinoma, 6,5x5x5cm, pT3aN0MX (tumor invaded renal sinus fat). In the fi rst three postoperative days, a decline in kidney function was observed, with serum creatinine up to 165 μmol/L. At patient discharge from the hospital, creatinine was 132 μmol/L and urea 9.8 mmol/L. Three months after the operation, serum creatinine was stable (135 μmol/L) and multi-slice CT of the thorax, abdomen and pelvis was normal. Regarding the histopathologic report, the patient was advised to present for follow up by both urologist and nephrologist because of the evident kidney failure that had begun after nephrectomy. Discussion: Renal cell carcinoma is an infrequent complication of ADPKD. It does not occur with increased frequency when compared to the general population. The diagnosis of renal cell carcinoma is more diffi cult to establish in ADPKD than in the general population since fi ndings such as hematuria, fl ank mass, or complex cysts are common in ADPKD in the absence of malignancy. Malignancy should be suspected if the patient complains of systemic signs and symptoms (fever, anorexia, fatigue, weight loss) or if there is rapid growth of a complex cyst. However, there are several characteristics of renal cell carcinoma in ADPKD, i.e. fever, and tumors are more often bilateral, multicentric and sarcomatoid. CT scanning with contrast and MRI are often able to distinguish malignancy from a complex cyst. MRI is considered to be superior to CT in detecting renal cancers. Considering that clinical, radiological and histologic presentation of renal cell carcinoma in this case report was rather unusual, along with the fact that the patient had refused nephrectomy for several years, we can conclude that the outcome is principally favorable for the patient. Conclusion: We present an instructive case of renal cell carcinoma in a patient with ADPKD. Clinical presentation, radiological and histologic characteristics are different from the usual presentation of renal cell carcinoma in ADPKD. It is necessary to keep in mind an individual approach

RENAL CELL CARCINOMA IN THE AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Karcinom bubrega je rijetka komplikacija autosomno dominantne policistične bubrežne bolesti (ADPBB). Prikazujemo 63-godišnjeg pacijenta s ADPBB, karcinomom bubrega i bubrežnom funkcijom koja je bila očuvana sve do nefrektomije. Pacijent je od 2012. g. pod kontrolom urologa pri Klinici za urologiju Kliničkog bolničkog centra Zagreb, jer je radiološkom obradom verifi cirana solidna tvorba desnoga bubrega koja je morfološki izgledala kao onkocitom. Bolesnik je od ranije znao da ima policističnu bolest bubrega i jetre. Od subjektivnih poteškoća navodio je samo povremenu lumbalnu bol. Svi laboratorijski nalazi bili su potpuno uredni. Tijekom kontrola uočen je rast tvorbe u desnom bubregu uz očuvanu bubrežnu funkciju, te je bolesniku predložena nefrektomija za koju se nije odmah odlučio. No, kada je pristao, učinjena je desnostrana radikalna nefrektomija. Radilo se o karcinomu bubrega, tipa svjetlih stanica, koji je klasifi ciran kao pT3aN0MX. U prva tri poslijeoperacijska dana dolazi do porasta kreatinina do 165 μmol/L. U trenutku otpusta iz bolnice kreatinin je bio 132 μmol/L, ureja 9,8 mmol/L. Tri mjeseca nakon kirurškog zahvata kreatinin je stabilan na 135 μmol/L, a kontrolni MSCT toraksa, abdomena, zdjelice, UZV trbuha i rendgenogram srca i pluća su, osim poznatih cističnih promjena na jetri i lijevom bubregu, uredni. Dalje su pacijentu preporučene redovite urološke kontrole, a zbog jasne bubrežne insufi cijencije koja se razvila nakon nefrektomije preporučene su i redovite kontrole nefrologa.Aim: The aim of this case report is to point out the specifi city of clinical, diagnostic and therapeutic approach to the patient with the autosomal dominant polycystic kidney disease (ADPKD), renal cell carcinoma along with preserved kidney function. We used patient medical chart, as well as relevant literature from online medical databases (PubMed, EM-base). Case report: We describe a case of a 63-year-old patient with ADPKD, renal cell carcinoma and preserved kidney function until nephrectomy. ADPKD along with hepatic cysts has been known since 2009. Because of the suspicious renal mass detected by ultrasound, non-contrast computed tomography (CT) was performed in 2009, which did not confi rm the presence of renal tumor. In 2012, the patient suffered right-fl ank pain and therefore underwent contrast CT and magnetic resonance imaging (MRI), which confi rmed renal tumor that morphologically seemed like oncocytoma. For that reason, he has been under urologist supervision ever since 2012. Laboratory blood and urine test results were within the normal range all the time and the patient only complained of right-fl ank pain. Further follow up revealed enlargement of the renal mass on MRI and contrast CT. The patient was informed about his condition from the beginning, but he did not accept nephrectomy. However, in December 2015, he agreed and radical nephrectomy of the right kidney was performed. Histopathologic report showed that it was a clear renal cell carcinoma, 6,5x5x5cm, pT3aN0MX (tumor invaded renal sinus fat). In the fi rst three postoperative days, a decline in kidney function was observed, with serum creatinine up to 165 μmol/L. At patient discharge from the hospital, creatinine was 132 μmol/L and urea 9.8 mmol/L. Three months after the operation, serum creatinine was stable (135 μmol/L) and multi-slice CT of the thorax, abdomen and pelvis was normal. Regarding the histopathologic report, the patient was advised to present for follow up by both urologist and nephrologist because of the evident kidney failure that had begun after nephrectomy. Discussion: Renal cell carcinoma is an infrequent complication of ADPKD. It does not occur with increased frequency when compared to the general population. The diagnosis of renal cell carcinoma is more diffi cult to establish in ADPKD than in the general population since fi ndings such as hematuria, fl ank mass, or complex cysts are common in ADPKD in the absence of malignancy. Malignancy should be suspected if the patient complains of systemic signs and symptoms (fever, anorexia, fatigue, weight loss) or if there is rapid growth of a complex cyst. However, there are several characteristics of renal cell carcinoma in ADPKD, i.e. fever, and tumors are more often bilateral, multicentric and sarcomatoid. CT scanning with contrast and MRI are often able to distinguish malignancy from a complex cyst. MRI is considered to be superior to CT in detecting renal cancers. Considering that clinical, radiological and histologic presentation of renal cell carcinoma in this case report was rather unusual, along with the fact that the patient had refused nephrectomy for several years, we can conclude that the outcome is principally favorable for the patient. Conclusion: We present an instructive case of renal cell carcinoma in a patient with ADPKD. Clinical presentation, radiological and histologic characteristics are different from the usual presentation of renal cell carcinoma in ADPKD. It is necessary to keep in mind an individual approach

Merkel Cell Carcinoma in Renal Transplant Recipient

Kod muškarca u dobi od 57 godina hemodijaliza je započeta 1998. godine zbog završnog stadija kroničnog zatajenja bubrega uzrokovanog IgA nefropatijom. Bolesnik je primio alograft u travnju 2002. godine te je liječen ciklosporinom, mikofenolatom mofetil i steroidima. Funkcija transplantata je bila optimalna, bez akutnog odbacivanja. U rujnu 2004. zapažen je crveni bezbolni intradermalni čvor u lijevom predaurikularnom području. Imunohistokemijsko bojenje je pokazalo perinuklearnu izraženost citokeratina 20 i sinaptofizina, kao i prisutnost za neuron specifične enolaze i kromogranina, sve znakovito za karcinom Merkelovih stanica. Bila je potrebna ponovna radikalna ekscizija uz medijan granice od 2 cm. Bolesnik je primio dopunsku terapiju u ukupnoj dozi od 55 Gy u 20 ciklusa. Imunosupresivna terapija je smanjena. Karcinom Merkelovih stanica je rijedak agresivni rak koji se može pogrešno dijagnosticirati kao indolentna bolest kože. Kod imunokompromitiranih domaćina on nastaje češće, u mlađoj dobi i vjerojatno poprima agresivniji tijek negoli u općoj populaciji.A 57-year-old male was started on hemodialysis in 1998 because of end-stage renal disease caused by IgA nephropathy. He received an allograft in April 2002 and was treated with cyclosporine, mycophenolate mofetil and steroids. Graft function was optimal, without episodes of acute rejection. A red intradermal painless nodule was observed in the left preauricular region in September 2004. Immunohistochemical staining showed perinuclear expression of cytokeratin 20 and synaptophysin as well as the presence of neuron-specific enolase and chromogranin, characteristic of Merkel cell carcinoma. Radical re-excision with a median margin of 2 cm was necessary. The patient received adjuvant radiotherapy in a total dose of 55 Gy in 20 cycles. Immunosuppressive therapy was reduced. Merkel cell carcinoma is a rare aggressive cancer that may be misdiagnosed as an indolent skin disease. In immunocompromised host it is more likely to occur, at a younger age and probably assuming a more aggressive course than in the general population

Interventional ultrasound in acute urologic conditions

Ultrazvučna dijagnostika različitih, a poglavito hitnih uroloških bolesti, u današnje vrijeme dostigla je visoku razinu. Uz anamnezu i fizikalni pregled, ultrazvuk je postao nezaobilazan postupak prilikom obrade urološkog bolesnika te predstavlja moćno oružje za brzo i sigurno postavljanje točne dijagnoze. Osim neizmjerne pomoći pri dijagnostici uroloških bolesti, mnogi urolozi pridaju još veći značaj ultrazvuku kao najboljoj slikovnoj metodi za terapijske intervencijske postupke na mokraćnom sustavu. Ovakva važnost ultrazvuka zasnovana je na nizu prednosti u kojima će biti riječi u ovome članku. Intervencijski ultrazvuk u urologiji obuhvaća niz perkutanih zahvata kojima se prodire u mokraćni sustav pod kontrolom ultrazvuka, s primarnim ciljem brzog i efikasnog otklanjanja potencijalno smrtonosnih komplikacija podležećih bolesti. Naime, svaka bolest koja uzrokuje opstrukciju mokraćnog sustava s posljedičnom smetnjom normalnog otjecanja mokraće, bez obzira radi li se o zloćudnom ili dobroćudnom procesu, može dovesti do ozbiljnih stanja kao što su kompletna retencija mokraće, akutna bubrežna insuficijencija, hidronefroza i urosepsa. Takva stanja u pravilu zahtijevaju hitnu derivaciju mokraće retrogradnim ili perkutanim putem jer podležeću bolest, osim u rijetkim slučajevima, nije moguće u kratkom razdoblju u cijelosti otkloniti. Retrogradna derivacija mokraće često nije moguća radi neprolazne zapreke unutar mokraćnog sustava ili pritiska patološkog procesa izvana, pa perkutani intervencijski zahvat ostaje jedino rješenje. Perkutani zahvati najčešće se izvode na hidronefrotičnom bubregu. Hidronefroza označava proširenje kanalnog sustava bubrega koje, ako se adekvatno ne liječi, dovodi do atrofije bubrežnog parenhima. Naglašavamo kako u domenu urološkog interesa pripadaju i perkutani intervencijski zahvati na tkivima priležećim mokraćnom sustavu, npr. drenaže retroperitonejskih kolekcija.Ultrasound diagnostic of different urological diseases has reached a high level at the present time. Along with patient’s history and physical examination, ultrasound has become an unavoidable procedure when processing urological patients and represents a powerful tool to quickly and safely set the accurate diagnosis. Besides tremendous help in diagnostics of urological diseases, many urologists attach even greater importance to the ultrasound as the best imaging method for therapeutic interventional procedures on the urinary system. Interventional ultrasound in urology includes a number of percutaneous interventions which penetrate into the urinary system under ultrasound guidance, with a primary aim of fast and efficient removal of the potentially fatal complications of underlying diseases. Any obstruction of the urinary system with subsequent disturbance of normal urine flow can lead to serious conditions such as complete urinary retention, acute renal failure, hydronephrosis and urosepsis. Those conditions most often require urgent urinary diversion by retrograde or percutaneous way because the underlying disease, except in rare cases, cannot be entirely eliminated in a short period of time. Retrograde diversion of urine in often impossible due to impassable barrier within the urinary system or pressure of pathologic process from outside, so percutaneous interventional procedure remains the only solution. Hydronephrosis indicates a widening of the renal collecting system which, if mistreated, leads to the atrophy of renal parenchyma. We emphasize that percutaneous interventional procedures on the nearby urinary tract tissues also belong into a field of urologic interest, for example drainages of retroperitoneal collections

The development of panurothelial carcinoma after kidney transplantation in patient with endemic nephropathy

Cilj: Endemska nefropatija (EN) je kronična bubrežna bolest koja nastaje zbog dugotrajnog izlaganja aristolohičnoj kiselini. EN je povezan s razvojem terminalnog stadija bubrežne insuficijencije, ali i s razvojem karcinoma urotela, poglavito gornjeg dijela mokraćnoga sustava. U radu ćemo prikazati pacijenticu s endemskom nefropatijom, u koje se nakon presađivanja bubrega razvio panurotelijalni karcinom. Prikaz slučaja: U 76-godišnje pacijentice s EN-om je 2013. godine učinjena uspješna kadaverična transplantacija bubrega. Nakon transplantacije otkriven joj je površinski karcinom mokraćnoga mjehura koji je više puta liječen transuretralnim putem. Zbog pojave karcinoma u gornjem dijelu mokraćnoga sustava učinjena joj je i obostrana nefroureterektomija. Unatoč promjeni imunosupresivne terapije i kirurškom liječenju razvila se metastatska bolest uz letalni ishod tri godine po transplantaciji uz funkcionirajući presadak. Zaključak: U pacijenata s EN-om može doći do razvoja panurotelijalne bolesti, a posebno su ugroženi pacijenti u kojih je učinjena transplantacija bubrega. U ove skupine pacijenata vrlo je važna prijetransplantacijska obrada, kao i praćenje nakon transplantacije bubrega.Aim: Endemic nephropathy (EN) is a chronic kidney disease caused by long-lasting exposure to aristolochic acid. EN is linked to the development of end-stage renal disease but also with the development of urothelial carcinoma, especially upper urinary tract carcinoma. We present a rare case of patient with EN who developed panurothelial cancer after kidney transplantation. Case report: In a 76-year-old woman with EN, a successful kidney transplantation was performed in 2013. After the transplantation, superficial bladder cancer was diagnosed and therefore treated with transurethral resection a few times. Later on, carcinoma of the upper urinary tract was also diagnosed so the bilateral nephroureterectomy was performed. Despite modified immunosuppression and surgical treatment, the metastatic disease was developed and the patient died three years after the transplantation, with the graft still being functional. Conclusion: Patients with EN have a higher risk of developing panurothelial carcinoma. Special attention must be given to EN patients who had kidney transplantation. In this group of patients, special considerati on must be emphasized on pretransplant evaluation and follow-up after kidney transplantation