Family Physician's Educational Interview with Patients Helps in Early Recognition of Lower Urinary Tract Symptoms.

PURPOSE: Lower urinary tract symptoms (LUTS) can have an etiology outside the lower urinary tract (LUT) and are therefore an important diagnostic indicator for assessing the overall health of a person. However, LUTS is still mainly neglected by primary health care providers as well as by patients. In this study, we assessed the importance of an educational interview (EI) conducted by a GP on the patients' ability to recognize LUTS. We also investigated other factors that affect the recognition of LUTS: subjects' personal educational level, number of LUT symptoms and their bothersome level on a scale 0-10. PATIENTS AND METHODS: This cross-sectional study was conducted in Croatia (2018-2020) by interviewing 499 subjects. We compared recognized LUT symptoms before and after the EI and determined whether their number, their bothersome level, or the subjects' personal educational level were associated with LUTS recognition. RESULTS: EI significantly improved the ability to recognize LUTS (p=0.001). The number of LUT symptoms and bothersome level in subjects before EI was much greater than the number in subjects after EI (p<0.0001, mean>4 and p<0.0001, median>8, respectively). Subjects with higher educational level recognized LUTS with fewer symptoms after the EI (p<0.01), but no difference was observed among subjects who recognized LUTS before the EI. CONCLUSION: For subjects to recognize LUTS, their condition had to be severe - more than 4 symptoms and bothersome level >8/10. Personal educational level had little impact on LUTS recognition. However, an EI proved to be an excellent tool for raising awareness about LUTS and its early recognition.

Cost effectiveness of antihypertensive drugs and treatment guidelines.

PURPOSE: Arterial hypertension (AH) is associated with a high economic burden for the individual patient and for society in general. The study evaluates antihypertensives and their cost-effectiveness, comparing diuretics (D), beta-blockers (B), angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers (A) and calcium channel blockers (C) with no intervention (NI). METHODS: The study included five health states in a Markov model. Cost values included average cost of the drugs used, treatment in hospital and treatment in general practice (collected from Croatian Health Insurance Fund). The study was conducted separately for 65-year old men and women, with an initial probability of cardiovascular death risk of 2% and heart failure risk of 1%. The results were presented in terms of increase in QALYs and associated financial savings or costs in euros (€). RESULTS: Results for men (compared with NI): treatment with D resulted in a QALY increase of 0.76 and €886 in savings, treatment with C in an increase of 0.74 QALYs and €767 in savings, treatment with A in an increase of 0.69 QALYs and €834 in savings, treatment with B resulted in an increase of 0.40 QALYs, but with an additional cost of €41. Results for women (compared with NI): treatment with D resulted in an increase of 0.93 QALYs and €987 in savings, treatment with C in an increase of 0.89 QALYs and savings of €855, treatment with A in an increase of 0.86 QALYs and savings of €991, treatment with B in an increase of 0.48 QALYs, but with an additional cost of €148. CONCLUSIONS: Treatment of AH with D, C and A is cost effective compared with the no-intervention scenario. Diuretics are the most cost-effective first-line treatment. The scenario with beta-blockers resulted in additional QALY when compared with no intervention, but also additional costs; therefore, based on our results, this therapy would not be recommended as first-line treatment.

Algorithm based on the short-term Rényi entropy and IF estimation for noisy EEG signals analysis.

Stochastic electroencephalogram (EEG) signals are known to be nonstationary and often multicomponential. Detecting and extracting their components may help clinicians to localize brain neurological dysfunctionalities for patients with motor control disorders due to the fact that movement-related cortical activities are reflected in spectral EEG changes. A new algorithm for EEG signal components detection from its time-frequency distribution (TFD) has been proposed in this paper. The algorithm utilizes the modification of the Rényi entropy-based technique for number of components estimation, called short-term Rényi entropy (STRE), and upgraded by an iterative algorithm which was shown to enhance existing approaches. Combined with instantaneous frequency (IF) estimation, the proposed method was applied to EEG signal analysis both in noise-free and noisy environments for limb movements EEG signals, and was shown to be an efficient technique providing spectral description of brain activities at each electrode location up to moderate additive noise levels. Furthermore, the obtained information concerning the number of EEG signal components and their IFs show potentials to enhance diagnostics and treatment of neurological disorders for patients with motor control illnesses.

[THE FIRST CROATIAN GUIDELINES FOR DIAGNOSIS, TREATMENT AND FOLLOW-UP OF PERSONS WITH PREMATURE EJACULATION].

Premature ejaculation (PE) is a sexual disorder with high prevalence, defined by three characteristics: short intravaginal ejaculation latency time, poor control over delaying ejaculation and personal and/or partner distress. The diagnosis is reached by a thorough and comprehensive history taking, which should include presence/absence of other ­co-morbid conditions (e.g. erectile dysfunction, anxiety), and assessing the type of PE (primary, secondary, variable, subjective). It is important to counsel the patient (and, if possible, the partner) about this condition and treatment options. The first line of treatment is selective serotonin reuptake inhibitors (dapoxetine, which is the only drug with an official label for this indication, paroxetine, sertraline, fluoxetine, citalopram, escitalopram). The first line of treatment also includes psychological/sexological treatment methods, such as behavioural methods (stop-start and squeeze techniques), and new functional sexological treatment. The choice of the method depends on the type of PE and on the patient preference. The second line of treatment are clomipramine and local anaesthetics, and the third line is tramadol.

Matrix metalloproteinases 2 and 9 immunoexpression in prostate carcinoma at the positive margin of radical prostatectomy specimens.

The aim of this study was to evaluate the expression of matrix metalloproteinase 2 (MMP-2) and matrix metalloproteinase 9 (MMP-9) in prostate cancer in the main tumor mass and tumor cells at the positive margin as well as the influence of these biomarkers on the biochemical recurrence of the disease in prostatectomy patients. Tissue microarrays of 120 archival prostate carcinoma samples were immunohistochemically evaluated for MMP-2 and MMP-9 expression and compared with clinicopathological parameters. Tumors with positive surgical margins showed significantly higher overall expression of MMP-9 versus tumors with negative resection margins (P = 0.0121). MMP-9 expression was significantly elevated in tumors from patients who had biochemical recurrence (P = 0.0207). In the group of patients with negative margins, MMP-9 expression above the cut-off value was significantly associated with recurrence (P = 0.0065). Multivariate analysis indicated that MMP-9 is a good predictor of biochemical recurrence (odds ratio = 10.29; P = 0.0052). Expression of MMP-2 in tumor cells was significantly higher at the positive margins than in the main tumor mass (P = 0.0301). The present results highlight the potential value of MMP-2 and MMP-9 expression for predicting the behavior of prostate tumors after prostatectomy with both positive and negative surgical margins.

Hypoalbuminemia and complication incidence in hemodialysed uremic patients.

Discussions whether hypoalbuminemia is just a marker for the malnutrition-inflammation syndrome as well as for the increased morbidity and mortality of those patients or is it an etiological factor, are becoming more and more intense. In this research of the relation between hypoalbuminemia and the complications that threaten the vascular access with special reference to infection, and consequently to the life of the patients treated with chronic haemodialysis, we have chosen 120 patients with terminal renal insufficiency (ESRD) treated at the Clinical Hospital Mostar by chronic haemodialysis. The chosen patients for this study were observed throughout a time period of 18 months. Only the patients who, at the moment of starting the research did not exhibit either a local or a systemic infection, as well as no signs of any other complication that might have endangered the vascular access and consequently the life of the patient, were selected. From the 120 (100.0%) patients, 86.8% of them had a serum albumin level below 40.0 g/L. By analysing the research results of the clinical material, it has been established that in patients with serum albumin level below 40.0 g/L, the infection incidence was significantly higher than in those patients with the albumin level above 40.0 g/L (chi2 = 7.215 P = 0.0077). The complication incidence is significantly higher (chi2 = 9.92 P = 0.0022) among the patients with serum albumin level below 40.0 g/L, than in those patients with higher serum level. Among the patients with a serum albumin level lower than 40.0 g/L, the sepses incidence was significantly higher (chi2 = 4.77 P = 0.03), than among those patients with a serum albumin level above this value. However, the difference in incidence of local infection of the vascular access between the group of patients with a serum albumin level below 40.0 g/L and those patients with albumin level above this value is not significant (chi2 = 0.65 P = 0.69). The total infection incidence in the 120 observed patients was 3.8 episodes per 100 patient months, and within the parameters mentioned by other authors.

Prognostic significance of vascular endothelial growth factor expression in clear cell renal cell carcinoma.

The purpose of this investigation was to analyze and correlate the immunohistochemical pattern of vascular endothelial growth factor (VEGF) expression with the average of microvessel density (MVD) and other clinicopathologic parameters in clear cell renal cell carcinoma (CCRCC) in order to determine its prognostic significance. Surgical specimens of 93 CCRCC were immunohistochemically analyzed for VEGF expression, MVD with anti-CD31, and Ki 67 proliferative index. VEGF expression was recorded as the percentage of positive tumor cells (<75% and >75%) and as diffuse or perimembranous VEGF expression according to cytoplasmic distribution. Sixty-three (68%) RCC had <75% and 30 had (32%) >75% of VEGF expression. A diffuse cytoplasmic pattern of VEGF expression was found in 61(66%) RCC and a perimembranous one in 32 (34%) RCC. Statistical analysis showed that tumors with >75% of VEGF expression were characterized by lower MVD value (p=0.034), higher nuclear grade (p=0.018), and higher Ki 67 proliferation index (p=0.023). Moreover, a higher nuclear grade of tumor cells was characterized by diffuse cytoplasmic VEGF distribution (p=0.005). This tumor model did not confirm the postulated simple relationship between VEGF overexpression and angiogenesis through high microvessel count. However, the study results indicated that overexpression of VEGF was a worse histologic prognostic parameter in CCRCC.

Endoscopic evacuation of a hematoma resulting from strain injury of the medial head of the gastrocnemius muscle.

Strain of the medial head of the gastrocnemius muscle (GM) is a common injury that can be confirmed by ultrasound (US) or magnetic resonance imaging. We report a case of strain injury of the medial head of the GM, with a hematoma between the soleus muscle and the GM. US revealed an enlarged hypoechoic area between the soleus and the GM. By US-guided puncture, only a small amount of old blood was evacuated. Hence we undertook a surgical approach. It was performed under general endotracheal anesthesia, in the prone position. The most superficial area of hematoma was shown by US. A sharp 4-mm trocar was inserted in the posteromedial side of the calf and the hematoma was partially evacuated by suction. The cavity was washed out with saline solution. The arthroscope was then inserted. A second portal was made laterally and a shaver was inserted under optic control. The inflow pressure was not allowed to exceed 45 mm Hg. The shaver was used to remove blood coagula and fibrin septa that divided the cavity. The fibrous cavity membrane was debrided. By the end of the procedure, the circumference of the leg was reduced by 3 cm and the skin was softer on palpation. The patient was discharged the next day. One week after surgery, US examination revealed only a thin hypoechoic area in place of the previous collection. Two weeks after surgery, he was able to walk painlessly, and at 6 weeks he had regained normal walking activity.

Osteopontin expression correlates with prognostic variables and survival in clear cell renal cell carcinoma.

BACKGROUND AND OBJECTIVES: Osteopontin (OPN) is a phosphorylated glycoprotein with diverse functions including tumorigenesis and tumor cell metastasis. Recently, it has been detected in a growing number of human tumors, and assessed as a potential prognostic marker. The aim of this study was to analyze the expression of OPN in normal renal tissue and clear cell renal cell carcinomas (CRCCs), and to assess its prognostic significance. METHODS: The expression of OPN protein was immunohistochemically analyzed in 171 CRCCs and compared to usual clinicopathological parameters such as tumor size, nuclear grade, pathological stage, Ki-67 proliferation index, and cancer-specific survival. RESULTS: In normal renal parenchyma, the expression of OPN was seen in distal tubular epithelial cells, calcifications, and some stromal cells. The upregulation of OPN was observed in 61 CRCCs (35.7%) in the form of cytoplasmic granular staining of various intensities. Statistical analysis showed correlation of the OPN expression with tumor size (P < 0.001), Fuhrman nuclear grade (P < 0.001), pathological stage (P = 0.011), and Ki-67 proliferation index (P < 0.001). Moreover, patients with OPN-positive tumors had significantly worse prognosis in comparison to patients with tumors lacking OPN protein (P = 0.004). CONCLUSION: Our results suggest that overexpression of OPN is involved in the progression of CRCC.

Might telesonography be a new useful diagnostic tool aboard merchant ships? A pilot study.

BACKGROUND: Developments of new, ultra-light diagnostic ultrasound systems (UTS) and modern satellite telecommunication networks are opening new potential applications for diagnostic sonography. One such area is maritime medicine. It is our belief that ship officers can be trained to use diagnostic ultrasound systems with the aim to generate ultrasound images of sufficient quality to be interpreted by medical professionals qualified to read sonograms. METHODS: To test our thesis we included lectures and hands on scanning practice to the current maritime medicine curriculum at the Faculty of Maritime Studies at the University of Rijeka. Following the didactic and practical training all participating students examined several patients, some with pathology some without. Images obtained by students were then submitted for interpretation to a qualified physician (specialist of general surgery trained in UTS) who was unaware of the patient's pathology. RESULTS: In total, 37 students performed 37 examinations and made 45 ultrasound images, on 3 patients. In this paper, results on this pilot study are presented. CONCLUSION: It is possible to teach ship officers to produce diagnostically usable ultrasound pictures aboard ships at sea. But before reaching final conclusion about applicability of telesonography on board merchant ships, further studies are necessary, that would include studies of economic feasibility, and on validity of introducing such a diagnostic tool to the maritime medical practice.

Expression of osteopontin and CD44 molecule in papillary renal cell tumors.

The aim of the study was to analyze the expression of CD44 adhesion molecule and its ligand osteopontin in papillary renal cell tumors, and to assess the possible prognostic significance of CD44 and osteopontin expression in papillary renal cell carcinomas. The expression of the standard and v6 exon containing isoforms of CD44 molecule, as well as of its ligand osteopontin, was immunohistochemically evaluated in 43 papillary renal cell tumors, which included 5 adenomas and 38 carcinomas. In order to assess their prognostic significance, the results obtained in papillary renal cell carcinomas were compared to usual clinicopathological parameters such as tumor size, histological grade, pathological stage, and Ki-67 proliferation index. Normal renal tissue was negative for CD44s and v6 isoforms, while the expression of osteopontin was found in distal tubular epithelial cells in the form of cytoplasmic granular positivity. CD44s and v6 isoforms were upregulated in 22 (58%) and 12 (32%) out of 38 carcinomas, respectively. Among all clinicopathological parameters examined, we only found significant association of CD44s-positive carcinomas with lower pathological stage (p=0.026). Papillary renal cell adenomas were generally negative for CD44s, except for focal positivity found in one sample. The osteopontin protein was detected in all adenomas and all papillary renal cell carcinomas, except one. Our results show constitutive expression of osteopontin in papillary renal tumors, including papillary renal cell adenomas. The upregulation of CD44s and v6 isoforms, although found in a considerable number of papillary renal cell carcinomas, does not appear to have any prognostic value in this type of renal cancer.