Usporedba preoperativnog i postoperativnog kliničkog stadija i gradusa karcinoma prostate u bolesnika s vrijednostima PSA 2-10 ng/ml

Patients are selected for radical prostatectomy with a disease limited to the organ, satisfying general condition and enough long life expectancy. Postsurgical findings often point out more advanced disease or less differentiated cancer compared to findings upon which an indication for prostatectomy was made, what affects prognosis and points out need for adjuvant treatment. The study is aimed at establishing in what manner the clinical stage and grade of the disease correlate to the definitive histological finding. The investigation was done in 80 patients with histologically proven, clinically organ confirmed prostate cancer, and initial PSA values 2-10 ng/ml, which underwent retro-pubic prostatectomy. Pathohistological analysis of complete resection sample was performed in order to establish spread and differentiation of the tumor. Clinical and pathological stage of the disease, Gleason score and Gleason grade were compared. In 11 patients (14%) extra-prostatic invasion of the disease was found following examination of the obtained slides. After surgery, in a significant number of patients inclusion of both prostate lobes was established, so the number of clinical stage T2b was significantly higher than pT2b (40 compared to 18), and T2c was significantly lower than pT2c (3 compared to 22). The Gleason score was underestimated in 25 (31, 25%) while it was overrated in 2 (2.5%). In more than one-third of patients the bioptical Gleason score was lower than the definitive pathohistologic score of the prostate slide. There is a significant difference between the biopsy and definitive pathohistologic T stage of prostate cancer also in a sense of underestimation. The frequency of established extra-capsular invasion and lymphatic metastasis corresponds to the rates of predictive models (Partin tables). The study did not show extra-capsular invasion in cases of well-differentiated prostate cancer (Gleason score ≤ 6).Za radikalna prostatektomiju selekcioniraju se pacijenti s na organ ograničenom bolešću, zadovoljavajućem općem stanju i dovoljno dugim očekivanim preživljenjem. Postoperativni nalazi često upućuju na veću uznapredovalost ili slabiju diferenciranost karcinoma u odnosu na nalaze na osnovi kojih je postavljana indikacija za kirurški zahvat, što utječe na prognozu i upućuje na potrebu adjuvantnog liječenja. Cilj rada je utvrditi u kojoj mjeri klinički stadij i gradus bolesti odgovaraju definitivnim patohistološkim nalazima kod pacijenata kod kojih je preoperativno postavljena dijagnoza na organ ograničenog karcinoma prostate i učinjena radikalna prostatektomija. Ispitivanje je provedeno kod 80 pacijenata s histološki dokazanim karcinomom prostate, vrijednostima PSA od 2 do 10 ng/ml, klinički na organ ograničenom bolešću, te učinjenom retropubičnom radikalnom prostatektomijom. Napravljena je patohistološka analiza kompletnog reseciranog materijala sa ciljem utvrđivanja uznapredovalosti i diferenciranosti tumora. Uspoređivan je klinički i patohistološki stadij bolesti, te Gleason skor i Gleason gradus karcinoma postavljen na osnovi pregleda bioptičkog materijala s istim pokazateljima diferenciranosti tumora utvrđenim u materijalu dobivenom radikalnom prostatektomijom. Pregledom definitivnog preparata kod 11 pacijenata (14%) utvrđena je ekstraprostatična ekstenzija bolesti. Kod značajnog broja postoperativno je utvrđena zahvaćenost oba lobusa prostate, tako da je u definitivnom preparatu prostate broj kliničkih u odnosu na patološki stadij T2b znatno manji (40 u odnosu na 18), a T2c znatno veći (3 u odnosu na 22). Biopsijski Gleason skor podcijenjen je u odnosu na Gleason skor preparata prostate kod 25 (31.25%) , dok je precijenjen kod 2 (2.5%). Kod više od trećine pacijenata u biopsijskom preparatu Gleason skor niži je u odnosu na definitivni patohistološki Gleason skor preparata prostate. Postoji značajna razlika između biopsijskog i definitivnog patohistološkog T stadija karcinoma prostate također u smislu podcjenjivanja. Učestalost utvrđenog ekstrakapsularnog širenja i limfnih metastaza odgovara stopama prediktivnih modela (Partinove tablice). U provedenom istraživanju ekstrakapsularno širenje nije nađeno kod dobro diferenciranih karcinoma prostate (Gleason skor ≤ 6)

The optimal design of school desks depending on the height and weight of students

Background: The subject of this research is the creation of an optimal school bench design with the aim of determining the most favorable posture of students while sitting, taking into account the relevant ergonometric and biomechanical characteristics of the human body. For the proposed model of the school bench which allows adjusting the different slopes of its surface, the corresponding computer model of the student and the table was first created, and then biomechanical and RULA analysis was performed in order to determine the maximum load in the lumbar part. Next, for each test subject of given weight, it was necessary to determine the amount of maximum load in lumbar zone L3/L4 for different slope angles and to determine the critical angles at which the maximum permissible load of 3400 N is reached. Methods: The analysis is performed on a total of 5 subjects of the same height (180 cm) and various weights (60, 70, 80, 90, 100 kg). The task is to determine at which weight and at what angle of the workbench with standard height will not exceed the permissible loads of the spine, specifically referring to the L4/L5 vertebrae whose stresses should not exceed 3400 N. The CATIA software package (Dassault Systèmes, Vélizy-Villacoublay, France) is used for the analysis. By knowing the anthropometric and work environment data with ergonomic design and analysis, the following analyzes were made: biomechanical analysis, rapid upper limb assessment (RULA) and carry analysis (an option from CATIA software). Results: The proposed school bench design allows for flexible adjustments to its worktop, that is, changing its tilt. This allows students of different body masses to have an optimal position at work that does not compromise their maximum permissible load in the L4/L5 spinal column (3400N). Conclusions: The proposed ergonomic design of the desk will result in students being adequately positioned during their activities at school with the minimal risk of permanent deviations and other health problems

Effect of Preoperative Hormonal Therapy in Hypospadias Surgery: Evaluation of the current practice at the Pediatric surgery Clinic, Clinical Center University of Sarajevo

Introduction:The most common congenital abnormality of the penis is hypospadias. Although the main treatment is surgical; hormone therapy with dihydrotestosterone is also used.Materials and Methods: This randomized clinical trial was carried out between January 2012 and December 2017 on 79 children with hypospadias (in the Clinic of Pediatric Surgery, Clinical Centre University of Sarajevo). Their mean age was 38.2±2.8 months. GroupI included 36 children whom were treated with 2.5% dihydrotestosterone gel which was applied twice a day to the penile shaft and glans for one month prior to surgery. GroupII included 43 children whom did not receive any treatment preoperatively.Results: Mean age of patients in group I was 37.3±6.3 months and in groupII it was 39.1±5.9 months which were comparable. Complications occurring postoperatively were: urethrocutaneous fistula in 6 patients (13.9%) in group II, versus 1 patient (2.7%) in group I. There were 2 patients with meatalstenosis in group II (4.7%), and 3 (8.3%) in group I. Finally, there was a significant difference (p<0.05) between the overall reoperation rates between groups (p<0.05).Conclusion: Pretreatment with 2.5% dihydrotestosterone transdermal gel before hypospadias repair is beneficial in decreasing complication rates

Assessment of postoperative cosmetic outcomes of distal form hypospadias repair with the Hypospadias Objective Scoring Evaluation (HOSE)

Aim A standardized assessment for the optimal repair of hypos-padias remains elusive. The aim of this study was to assess a postoperative cosmetic outcome of hypospadias repair using a validated questionnaire, Hypospadias Objective Scoring Evaluation (HOSE). Methods During the period between January 2016 and May 2019, 40 patients who underwent hypospadias repair were identified and they agreed to a follow-up using the HOSE. Distal hypospadias repairs underwent a cross-sectional assessment of the cosmetic outcome. Cosmetic assessment was performed by an independent physician using the HOSE scoring system. Results The native meatus was coronal in 10 (25%), subcoronal in eight (20%), and distal penile in 22 (55%) patients. Mean follow-up was 35.90 months (SD ±29.58) postoperatively (range 12–162 months). Complications occurred in one (2.5%) patient. Out of 40 uncomplicated repairs, 39 (97.5%) were satisfactory. A verti-cal slit-like meatus located at the distal glans was created in 33 (82.5%) boys, and at the proximal glans in seven (17.5%). The uri-nary stream was single and straight in 39 and spray in one patient. A straight erection was observed in 39 (97.5%) boys. The median HOSE score was 16 (range 12–16). One patient had a small, single coronal fistula. The technique used included tubularised incised plate urethroplasty. Conclusion The HOSE score is simple, easy, non-invasive and non-expensive tool for objective assessment of long-term outcomes of hypospadias repair

Influence of school backpacks on spinal column load in primary school students

Background: The problem of heavy school bags is a global problem recognized in many countries in Europe and the world, including in Bosnia and Herzegovina. In addition to poor posture habits, "sedentary lifestyles" and insufficient physical activity, school bags is one of the main causes of low back pain and deformity in pupils. The recommendation of the World Health Organization (WHO) is that the weight of the school bag should not exceed 10% of the student's weight. However, in practice these limitations are far from reality with the obvious problems caused by too heavy bags. The aim of the paper is to identify and analyze the backbone load caused by the overweight school backpacks in real school work conditions and eliminate them by creating new solutions that are in line with ergonomic and biomechanical principles, as well as the recommendation given by WHO. Methods: The research included first grade primary school students at the age of seven, including their parents. The research began by interviewing parents with relevant questions, as well as measuring the students’ height and weight and the weight of their school backpacks. The analysis was performed in CATIA v5 software package (Dassault Systèmes, Vélizy-Villacoublay, France) using its advanced biomechanical modules. By knowing the anthropometric and work environment data with ergonomic design and analysis, the biomechanical analysis, rapid upper limb assessment (RULA) and carry analysis were performed. Results: The conducted survey showed that 84% of students walk from home to school nineteen minutes on average and that 77% of them carry their school backpacks independently. Based on the measurements, it has been shown that, on average, the weight of the school backpacks is well above the WHO recommendation. A study conducted on a representative sample of students confirmed the relation between fatigue and spinal pain caused by carrying a heavy school bag. Computer analysis showed excessive loads on the spinal segment of L4/L5 that were outside the normal range of 3,400 N. Conclusions: A simulated computer analysis using RULA and biomechanical analysis with calculations of maximum loads in the lumbar segment of students found that school backpacks carried by students were too heavy for their age and well beyond the normal limits and WHO recommendations. The analysis showed that it is necessary to reduce the weight of the bag by about 30%

Adrenal abscess in a preterm neonate with sepsis

The adrenal abscess is a rare complication of adrenal hemorrhage in the neonatal period. Due to its rare occurrence and non-specific signs, diagnosing and treating an adrenal abscess in the neonatal period might be challenging. We present herein a 3-week-old male neonate with an adrenal abscess associated with Escherichia coli sepsis, which was successfully treated by open surgery (using the minimal posterior lumbar approach) following an unsuccessful ultrasound-guided percutaneous drainage.The article-processing fee was covered by the Qatar National Library (QNL)

High grade intraepithelial neoplasia of prostate is associated with values of prostate specific antigen related parameters intermediate between prostate cancer and normal levels

High grade prostatic intraepithelial neoplasia (HGPIN) is widely regarded as the precancerous. The aim of this study was to determine PSA related parameters in patients with initial PSA values 2-10 ng/mL and diagnosis of HGPIN without finding carcinoma at the time of their first needle biopsy. Study groups consisted of 100 men who were diagnosed HGPIN, 84 with cancer and 183 with benign hyperplasia on first biopsy of prostate. Total PSA and free PSA were measured and ratio free/total PSA and PSA density calculated. Mean values of these parameters were compared, and receiver operating characteristic curves were used for comparison of PSA related parameters to discriminate groups of patients. Total PSA, free PSA level and PSA density in patients with HGPIN (6.388 ng/mL) did not differ significantly compared to prostate carcinoma (6.976 ng/mL) or benign prostatic hyperplasia (6.07 ng/mL) patients. Patients with HGPIN had significantly higher ratio free/total PSA than those with prostate carcinoma (0.168 vs 0.133), but significantly lower than patients with benign prostatic hyperplasia (0.168 vs 0.185). Ratio of free/total PSA significantly discriminate HGPIN from prostate carcinoma with sensitivity 84.52 and specify 45.00 at cut-off point of ≤ 0.18. Values of PSA, free PSA and ratio free/total PSA in cases of HGPIN appear to be intermediate between prostate cancer and normal levels. Ratio of free/total PSA may help in decision to repeat biopsies in the presence of HGPIN on biopsy, without concomitant prostate cancer, in patients suitable for curative treatment, with normal digito-rectal examination and trans-rectal sonography

High grade intraepithelial neoplasia of prostate is associated with values of prostate specific antigen related parameters intermediate between prostate cancer and normal levels

High grade prostatic intraepithelial neoplasia (HGPIN) is widely regarded as the precancerous. The aim of this study was to determine PSA related parameters in patients with initial PSA values 2-10 ng/mL and diagnosis of HGPIN without finding carcinoma at the time of their first needle biopsy. Study groups consisted of 100 men who were diagnosed HGPIN, 84 with cancer and 183 with benign hyperplasia on first biopsy of prostate. Total PSA and free PSA were measured and ratio free/total PSA and PSA density calculated. Mean values of these parameters were compared, and receiver operating characteristic curves were used for comparison of PSA related parameters to discriminate groups of patients. Total PSA, free PSA level and PSA density in patients with HGPIN (6.388 ng/mL) did not differ significantly compared to prostate carcinoma (6.976 ng/mL) or benign prostatic hyperplasia (6.07 ng/mL) patients. Patients with HGPIN had significantly higher ratio free/total PSA than those with prostate carcinoma (0.168 vs 0.133), but significantly lower than patients with benign prostatic hyperplasia (0.168 vs 0.185). Ratio of free/total PSA significantly discriminate HGPIN from prostate carcinoma with sensitivity 84.52 and specify 45.00 at cut-off point of ≤ 0.18. Values of PSA, free PSA and ratio free/total PSA in cases of HGPIN appear to be intermediate between prostate cancer and normal levels. Ratio of free/total PSA may help in decision to repeat biopsies in the presence of HGPIN on biopsy, without concomitant prostate cancer, in patients suitable for curative treatment, with normal digito-rectal examination and trans-rectal sonography

Management of Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is unsatisfactorily defined and insufficiently studied illness. Also, the treatment success is questionable and therefore, this illness is a therapeutical problem for urologists - which medications are the best choice in treating this uncomfortable condition? This paper presents results of prospective, open, analytical, comparative study that was performed on 90 patients with diagnosed chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Patients were divided into three groups and were treated with two medications ciprofloxacin (C), doxazosin (D) and combination of ciprofloxacin + doxazosin (C+D). The effects were measured using symptom questionnaire for prostate illnesses of the National Institute for Health - USA (NIH-CPSI). During the basic evaluation, sum ranging from 0 to 43 was calculated for each patient. This number is called total sum NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) of the questionnaire, which generates the questions from 1 to 9. The most significant change occurred in C+D group where the total sum changed from 18-38 in the beginning to 5-31 at the end of the treatment (55,1% (p<0,001)). Significant changes were also found in D group where the change was 46, 4% (p<0,001). At the end of the treatment no significant change was registered in C group (p<0,005): p<0,001 – significance threshold. Combination of ciprofloxacin + doxazosin proved to be the best choice for treatment

Management of Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is unsatisfactorily defined and insufficiently studied illness. Also, the treatment success is questionable and therefore, this illness is a therapeutical problem for urologists - which medications are the best choice in treating this uncomfortable condition? This paper presents results of prospective, open, analytical, comparative study that was performed on 90 patients with diagnosed chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Patients were divided into three groups and were treated with two medications ciprofloxacin (C), doxazosin (D) and combination of ciprofloxacin + doxazosin (C+D). The effects were measured using symptom questionnaire for prostate illnesses of the National Institute for Health - USA (NIH-CPSI). During the basic evaluation, sum ranging from 0 to 43 was calculated for each patient. This number is called total sum NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) of the questionnaire, which generates the questions from 1 to 9. The most significant change occurred in C+D group where the total sum changed from 18-38 in the beginning to 5-31 at the end of the treatment (55,1% (p<0,001)). Significant changes were also found in D group where the change was 46, 4% (p<0,001). At the end of the treatment no significant change was registered in C group (p<0,005): p<0,001 – significance threshold. Combination of ciprofloxacin + doxazosin proved to be the best choice for treatment