Aggressiveness of inflammation in histological prostatitis--correlation with total and free prostate specific antigen levels in men with biochemical criteria for prostate biopsy.

BACKGROUND AND AIMS: Although prostatitis can contribute to the lack of prostate specific antigen (tPSA) specificity, there is disagreement concerning the effect of histological inflammation on free PSA (fPSA). We investigated the correlation between aggressiveness of histological inflammation and tPSA, fPSA and f/tPSA in patients without detectable prostate cancer (PC). METHODS: The study included 106 patients with tPSA <10 ng/mL, without clinical prostatitis and with biopsy negative for PC. The inflammation in prostate biopsies was scored for aggressiveness using the four-point scale reported by Irani. The patients were divided into two groups of less aggressive and more aggressive inflammation and compared by use of regression analysis. RESULTS: The median tPSA, fPSA and f/tPSA levels were 6.39 ng/mL, 1.1 ng/mL and 16% in the less aggressive inflammation group and 7.3 ng/mL, 0.79 ng/mL and 10.7% in the more aggressive inflammation group, respectively. There was no significant between-group difference in tPSA levels (P=0.16), however, statistically significant between-group differences were recorded in fPSA and f/tPSA levels (P<0.001 both). Spearman's analysis yielded a significant negative correlation of inflammation aggressiveness with fPSA (r=-0.34; P<0.001) and f/tPSA (r=-0.45; P<0.001). Free PSA and f/tPSA were lower in the group with more aggressive inflammation. CONCLUSIONS: Histological inflammation has a high prevalence in cancer-free prostate biopsy specimens and exerts similar effects on fPSA and f/tPSA levels as PC. Our study suggests histological prostatitis to be an important cause of decreased fPSA and f/tPSA values; therefore, when it is identified, antibiotic or anti-inflammatory therapy should be introduced to reduce the percentage of men with a continuing indication for prostate biopsy.

Laparoscopic cholecystectomy in an ambulatory setting--initial experience in Croatia.

BACKGROUND/AIMS: The purpose of this study was to discover if ambulatory laparoscopic cholecystectomy is feasible in our environment and to determine the factors which will predict its success. METHODOLOGY: From November 12th 2002, to February 25th 2005 one hundred and fifty patients were admitted to our surgical ward of the General Hospital in Bjelovar due to cholelithiasis or biliary colic. Patients were unselected. Six to eight hours after the surgery we rated the ability of the patients to be discharged from the hospital (although they weren't discharged). RESULTS: The research has shown that 61% of the patients were eligible for ambulatory procedure. Among ultrasonographic attributes the most significant independent predictive factor of potential complications, prolongation of the procedure and ineligibility of the patient for the ambulatory laparoscopic cholecystectomy in our study was the thickened wall of the gallbladder. Among non-ultrasound preoperative attributes, the most important are the anamnestic data of prior cholecystitis and ASA classification. Pain was the most common reason why the patients were classified as non-candidates (36.6%). In the second place (25.4%) was the negative subjective patient's judgement to be discharged when all objective parameters were good. CONCLUSIONS: LC is also feasible in our environment but the patient's own motivation is the key factor in our situation.

A clinical decision rule for triage of children under 5 years of age with hydrocarbon (kerosene) aspiration in developing countries.

BACKGROUND: Unintended hydrocarbon ingestion is a common reason for pediatric hospitalization in the developing world. OBJECTIVE: To derive a clinical decision rule, to identify patients likely to require a higher level facility (resource-requiring cases), that can be used at primary health care facilities with limited diagnostic and therapeutic resources. METHODS: A prospective study of children 2 to 59 months old presenting to a poison treatment facility within 2 hours of oral hydrocarbon exposure. History and objective signs were recorded at admission and at 6, 12, 24 and, if present, 48 hours. Inclusion in the resource-requiring outcome group required: oxygen saturation <94%; any CNS depression; any treatment with (salbutamol); any care in the ICU; or death. RESULTS: 256 met the inclusion criteria and completed the study. Of these, 170 had a course requiring resources unavailable at most primary health care facilities, and 86 did not. The presence of wheezing, any alteration in consciousness (lethargy or any restlessness), or a rapid respiratory rate for age (RR >or= 50/min if age < 12 mo, >or= 40/min if age >or= 12 mo) at presentation identified 167 of 170 of these patients (sensitivity 0.98). Thirty-six of 86 patients classified as non-resource requiring were correctly identified (specificity 0.42). No combination of clinical symptoms provided better discrimination while preserving sensitivity. CONCLUSIONS: This study suggests a triage decision rule based on the presence of wheezing, altered consciousness, or a rapid respiratory rate within 2 hours of hydrocarbon exposure. Such a rule requires validation in other settings.

Prognostic significance of transforming growth factor alpha TGF-alpha) in human lung carcinoma: an immunohistochemical study.

Despite emerging data relating oncogene expression, growth factors and/or their receptors to the etiology of lung cancer, standard clinicopathological evaluation is still used for the diagnostic and prognostic purposes. Recent studies have shown that expression of some oncogenes and growth factors/receptors may be useful as markers in routine diagnostic and prognostic processes. For example, EGF/erb-B family of peptides may play a role in lung carcinogenesis. Similarly, expression of TGF-alpha mRNA and peptide has been shown to occur in various human lung carcinomas in vivo and in vitro. However, results concerning the role of TGF-alpha in lung carcinoma are conflicting and therefore its clinical value still remains obscure. To better evaluate the potential value of TGF-alpha in clinical application we have investigated the relationship between TGF-alpha expression in 51 lung carcinomas and 26 different clinical and clinicopathological parameters. The only significant correlation noted was between TGF-alpha and venous blood erythrocytes and eosinophils. This study suggests a relationship between metastasis and aggressive behavior of lung cancer. This data shows that TGF-alpha expression can not serve as an independent tumor marker for lung cancer.

Comparison of protective media and freezing techniques for cryopreservation of human semen.

OBJECTIVE: To evaluate the influence of cryopreservation medium and freezing-thawing techniques on human sperm motility and morphology. STUDY DESIGN: 63 semen samples were obtained from 39 donors to the artificial insemination programme. Possible effects of the sperm dilution with cryomedium on the motility were examined 10 min after exposure of 24 high initial quality semen samples to TEST-yolk ¿zwitterion-citrate-egg yolk extender containing TES [N-Tris (hydroxymethyl) methylaminoethane sulfonic acid] and Tris [(hydroxymethyl) aminomethane]¿ and human sperm preservation medium (HSPM). Post-thaw sperm motility from 24 frozen semen samples was examined comparing the cryoprotective efficacy of TEST-yolk and HSPM following different freezing techniques (vapour freezing, fast programmable freezing and slow programmable freezing). The relationship of sperm morphology to the effects of freezing was investigated on 39 semen samples following different freezing techniques. Post-thaw sperm motility from 39 frozen semen samples was compared among three groups divided according to the percentage of morphologically normal cells (<40, 40-50 and >50%) in fresh semen. RESULTS: Exposure of spermatozoa to cryomedia for 10 min at room temperature significantly reduced motility in TEST-yolk treatment group for 9% and in HSPM treatment group for 18% (P<0.01). The recovery of motile sperms (mean+/-standard deviation) was 49+/-15.7, 43+/-15.2 and 52+/-16.8% when TEST-yolk was used and 34+/-17.8, 32+/-18.2 and 50+/-13.6% when HSPM was used as a cryopreservative following vapour freezing, and fast and slow programmable freezing, respectively. Following vapour freezing and also following fast programmable freezing, the recovery of motile sperm was significantly higher (P<0.05) after addition of TEST-yolk medium than after addition of HSPM. Post-thaw motility of the sperm cryopreserved in HSPM showed significant differences (P<0.05) after three different freezing techniques. The recovery of motile sperms was 57+/-26.4, 38+/-8.6 and 38+/-17.3% in groups with >50, 40-50 and <40% morphologically normal cells, respectively. The percentage of morphologically normal spermatozoa was reduced 8% after vapour freezing and 6 and 3% after fast and slow programmable freezing, respectively. The results were statistically analysed using SAS/STAT software. CONCLUSIONS: Slow programmable freezing was superior to vapour freezing and fast programmable freezing as a method for sperm cryopreservation. However, none of these methods of freezing had discernible effects on sperm morphology. Motility of spermatozoa decreased due to the exposure of semen to cryomedium. TEST-yolk was a superior cryomedium to HSPM. Fresh semen with more than 50% of morphologically normal cells showed the best recovery of motile cells after freezing and thawing.

The triple-marker test in predicting fetal aneuploidy: a compromise between sensitivity and specificity.

OBJECTIVE: to review the contribution of unconjugated estriol in Down's syndrome detection, and influence of maternal age, cut-off choice, and population specificity on the balance between triple-marker test sensitivity and specificity. STUDY DESIGN: Prenatal karyotyping was performed in 2833 pregnant women, 73% of them over the age of 34. Duration of gestation was determined by ultrasound in 98% of women. Prior to amniocentesis, the serum levels of alpha-fetoprotein, human chorionic gonadotropin and unconjugated estriol were evaluated and corrected for weight. The risk of trisomy 21 was calculated for the first 986 subjects using default medians, and for 1847 by our population-specific medians. The cut-off was initially 1:300 at term, but the 1:100 and 1:200 risks were also tested. Down syndrome risk was calculated with alpha-fetoprotein and human chorionic gonadotropin combination as well. Linear logistic regression model was performed to test the ability of aneuploidy markers to classify patients into normal and trisomic groups. RESULTS: There were twelve cases of Down's syndrome, seven of trisomy 18, four of trisomy 13, and one trisomy 22. Four cases of aneuploidy (16.7%) referred to women younger than 35. With the cut-off risk of 1:300, detection rate was 87.5% and specificity 63.3%, and with 1:100, 66.7% and 79.5%, respectively. The sensitivity for Down's syndrome was from 75% for cut-off=1:100 to 92% for cut-off=1:300, while detection of other trisomies was less successful (58% and 83%, respectively). Exclusion of unconjugated estriol MoM from the risk calculations reduced detection rate by 33% and improved specificity by 4% independently of cut-off choice. Linear logistic regression analysis showed that only unconjugated estriol was able to correctly classify patients between normal and trisomy 21 (p=0.011, odds ratio=1.445), and normal and trisomy 18 (p=0.0023, odds ratio=1.96) groups. CONCLUSIONS: The unconjugated estriol significantly contributes in Down's syndrome detection with cost of slightly reduced specificity. The 1:300 risk caused an unfavorable compromise between sensitivity and specificity. A higher cut-off, 1:100, would indicate performance of amniocentesis in women aged 39 years and older, and in those aged 35-39 only after the screen-positive result.

ILLM--inductive learning algorithm as a method for prediction of life expectancy achieving.

The aim of the paper was to use inductive learning algorithm ILLM in the field of epidemiology, for prediction the life expectancy achieving. Data base comprised results of epidemiological investigation in some regions of Croatia. Overall accuracies for different samples and corresponding rules produced by ILLM algorithm, showed some interesting results. Algorithm can be seen as having the capacity to forecast 'achieving the life expectancy'. In the same time algorithm was not able to make a good forecast for 'not achieving the life expectancy'.

Possibilities of See5 software in forecasting of life expectancy not achieving.

Results of application of See5 to epidemiological domain were presented. The aim of this paper is to find out if See5 can be used for forecasting whether life expectancy will be achieved or not. The basis for forecasting are data-attributes, predictors (anthropological data, living habits, laboratory data, blood pressure measured in years 1970/71, and the status of examinee--class (alive or dead) in 1990. Data were split at random into 10 blocks with approximately the same number of cases and the same distribution of classes. Results were given in the form of decision trees and rulesets, and tested through crossvalidation. The most interesting question--what are prediction-candidates for not achieving life expectancy estimated in the year of examination--did not give a satisfactory result: the accuracy of classification was about 70%. However, a very interesting fact is that each rule consists of at least one candidate predictor, usually considered as risk factor (e.g. high diastolic blood pressure and animal fat consumption).

Redundant thyroid laboratory diagnostic modules in laboratory information system--a way to improve the performance.

In this paper, we introduced an idea of using redundant thyroid laboratory diagnostic modules integrated in laboratory information system. The first module was based on decision tree which was the result of Assistant algorithm applied to thyroid laboratory test results. Instead of improving decision rules, the "second opinion" module was designed based on Spad-S software. Diagnosis obtained with both modules were compared with results before introducing the "second opinion" module. From the first results it was clear that introducing the "second opinion" module decreased the number of misclassified records from the first module. With three or more modules, the final diagnosis could be obtained by voting or more complex procedures.

Depressive disorder as possible risk factor of osteoporosis.

Hypothalamo-pituitary-adrenal (HPA) axis is a very complicated control system playing an important role in stress reaction, where glucocorticoids suppress the autonomic (vegetative), endocrine, immunologic and psychic responses to stressful stimuli. We described the marked clinical, physiological, and biochemical connection between osteoporosis and major depressive disorder (MDD). Both conditions are associated with a hyperactive HPA axis and LC/NE system, and hence with increased CRH, cortisol, and catecholamine secretion. There are numerous states or diseases associated with osteoporosis and we were looking for a hypercorticism value as a one of these. Some recent studies demonstrated that earlier history of MDD was associated with marked osteoporosis. In MDD there are two well-documented biochemical abnormalities: hypercortisolism and its resistance to dexamethasone suppression. The present study included 31 MDD patients (19 males and 12 females, mean age 37 +/- 1.3, age range 29-41 years), and 17 healthy male volunteers (mean age 39 +/- 1.6, age range 34-45 years). In each of our patients 24-hour urinary free cortisol, serum cortisol level at 8 a.m. and 5 p.m., cortisol in dexamethasone suppression test and bone mineral density were measured. We have, therefore, analyzed a group of young men and women with normal menstrual cycles, who were without signs of osteoporosis in the beginning, and who received anti-depressive therapy for many years. Analysis showed that increased levels of cortisol and the occurrence of osteoporosis, that developed as the result of elevated cortisol level. For our workshop we used nonparametric rang-correlation with Spearman's rho = -0.805, with statistic significant at the 0.01 level (2-tailed). Patients under long-term history of depression could develop a very stronger type of osteoporosis i.e. it is before known that the patients with untreated Cushing syndrome developed hard osteoporosis.

[Respiratory symptoms and ventilatory function of the lungs in wool textile industry workers]. / Respiracijski simptomi i ventilacijska funkcija pluca radnica u tekstilnoj industriji na preradi vune.

Subjects in the study were 158 female wool textile workers and 87 control non-exposed workers. Respiratory symptoms were assessed by means of a questionnaire. Ventilatory capacity was measured in wool workers by recording maximum expiratory flow-volume (MEFV) curves on Monday before and after the work shift. Forced vital capacity (FVC), one-second forced expiratory volume (FEV1) and flow rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were measured on MEFV curves. Significantly higher prevalences of all chronic respiratory symptoms were recorded in exposed than in control workers (P < 0.01). Exposure to wool dust caused significant across shift reductions of ventilatory capacity varying from 2.0 to 9.1%. Those reductions were similar in textile workers exposed to wool for more than 10 years showed similar across shift reductions of ventilatory capacity tests as those with shorter exposure. Smokers and non-smokers had similar acute and chronic lung function changes. In a larger number of wool workers FEF50 and FEF25 were below 70% of predicted normal values. Bronchoprovocation testing with wool dust extract did not demonstrate correlation with respiratory impairment. Our data suggest that dust exposure in wool textile mills may be associated with the development of chronic respiratory symptoms and impaired lung function.

[Follow-up study of changes in respiratory function in the same workers after an additional 6 years of exposure to pollutants in the rubber industry]. / Ponovljeno ispitivanje promjena respiratorne funkcije istih radnika nakon daljnjih sest godina izlozenosti oneciscenjima u industriji gume.

Follow-up study of respiratory function was carried out in a group of 311 male workers employed in one rubber industry. The prevalence of respiratory symptoms and ventilatory capacity were recorded over te period of six years. Lung function was measured by recording maximum expiratory flow-volume (MEFV) curves on which forced vital capacity (FVC), one-second forced expiratory volume (FEVI) and flow rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were read. The prevalence of all chronic respiratory symptoms was higher during the follow-up study although not statistically significant (p > 0.05). During both studies smokers had significantly higher prevalence of chronic cough, chronic phlegm and chronic bronchitis than nonsmokers (p < 0.05 or < 0.025). Measured values of ventilatory capacity were significantly lower than predicted normal values during both studies (p < 0.01). Percentage of predicted values were lower during the follow-up study in comparison to that during the initial study. The mean lowest percentages were obtained for FEF25 (initial study: 77.4%; follow-up study: 70.5%). Smokers had larger mean annual decrease of FVC: 0.073 L; FEVI: 0.063 L; FEF50: 0.100 L/s; FEF25: 0.085 L/s than nonsmokers (FVC: 0.063 L; FEVI: 0.058 L; FEF50: 0.083 L/s; FEF25: 0.058 L/s). Workers exposed for more than 10 years had larger mean annual decrease of ventilatory capacity tests than hose with shorter exposure. Our data indicate that exposure to noxious agents in rubber industry may be responsible for the development of chronic respiratory symptoms and chronic lung function changes.

[The inductive approach in the routine laboratory diagnosis of thyroid dysfunction]. / Induktivni pristup rutinskoj laboratorijskoj dijagnostici disfunkcije stitnjace.

The method for defining strategy for thyroid function laboratory testing is presented in this study. In order to accomplish this task an available software, ASSISTANT Professional, was used. The strategy is generated by induction from routine data, using the method of minimizing entropy. Each of 1002 patients was described by 15 attributes and thyroid function status (euthyreosis, hyperthyreosis, hypothyreosis). Seventy per cent of the patients were chosen at random for generating and 30% for testing the strategy. The result is the decision tree or a set of decision rules. Absolute prognostic accuracy is estimated to 96% and relative to 90.16%.

[Data analysis of daily reports in general medicine]. / Analiza podataka dnevnih izvjesca ordinacije opce medicine.

Health priorities in a sample of 1,425 subjects of a defined urban population were studied from data collected routinely in general practice. Analysis of prevalence has shown 1/5 of circulatory diseases, 1/7 of respiratory diseases, 1/8 of musculoskeletal diseases, and 1/10 of mental disorders. According to incidence for the first medical examination, the leading diagnostic categories were diseases of the respiratory, circulatory, musculoskeletal, digestive, and genitourinary system. Both prevalence and incidence have shown that health priorities in the studied population were diseases of circulatory system, with hypertension, and diseases of the respiratory system, with common cold, of the highest prevalence.

Effect of pentoxifylline on motility and membrane integrity of cryopreserved human spermatozoa.

The purpose of this study was to examine the effects of pentoxifylline used before and after semen cryopreservation-thawing on sperm motility and membrane integrity. Twenty-four semen samples were split into four equal aliquots. Aliquots were incubated at 37 degrees C for 30 min, followed by cryopreservation with TEST-yolk freezing medium using slow programmable freezing protocol. After 2 weeks the sperm samples were thawed, washed twice in Quinn's Sperm Washing Medium (modified HTF with 5.0 mg/mL Human Albumin) and incubated at 37 degrees C for 30 min. Aliquots were treated by adding 3 mmol/L pentoxifylline to: (1) fresh sperm samples during incubation period prior to cryopreservation, (2) sperm samples as a supplement to the cryoprotectant prior to cryopreservation, and (3) thawed sperm samples during incubation period. One aliquot received no treatment (control group). The addition of 3 mmol/L pentoxifylline to fresh semen during incubation period prior to cryopreservation significantly decreased progressive and total motility compared with controls. However, the addition of 3 mmol/L pentoxifylline to cryopreserved semen after thawing significantly increased progressive and total motility compared with controls. After post-thaw, no differences in motion characteristics between sperm samples treated by adding 3 mmol/L pentoxifylline as a supplement to the cryoprotectant and control groups were observed. Post-thaw hypoosmotic swelling (HOS) test scores did not improve with the addition of pentoxifylline compared with the control group. It is concluded that pentoxifylline enhanced post-thaw motility of cryopreserved human spermatozoa when added after thawing. No improvement was found by freezing sperm with pentoxifylline.

Comparative study of pterygium surgery.

The aim of this study was the comparison of recurrence rates of pterygia following different surgical methods. Twenty-one patients were operated by the bare sclera technique, with the application of mitomycin C (0.25 mg/ml for 2 min). Twenty-seven patients were operated by limbal stem cell transplantation. The third group contained 13 patients who were operated by amniotic membrane transplantation. Five recurrences of pterygia were noted in the mitomycin C group and 2 each in the limbal stem cell transplantation group and the amniotic membrane group. The mean time to recurrence was 5.4 +/- 4.12 months in the mitomycin C group versus 10.5 +/- 3.5 months in the group of patients with limbal transplantation. In the third group, both recurrences were evident 4 months after the operation.

Survival of AIDS patients in Croatia prior to the introduction of combined antiretroviral therapy with protease inhibitors.

We report our experience on survival of adults with AIDS, treated at the University Hospital of Infectious Diseases, Zagreb, Croatia from October 1986 to December 1998. The median survival of our 116 patients was 15.8 months. Multivariate analysis showed that factors independently associated with survival were type of presenting AIDS indicator disease and CD4+ cell count.

The expression of p185(HER-2/neu) correlates with the stage of disease and survival in colorectal cancer.

BACKGROUND & AIMS: HER-2/neu oncogene encodes a transmembrane tyrosine kinase receptor that is amplified and/or overexpressed predominantly in adenocarcinomas. This phenomenon has been most intensively studied in breast carcinoma where its amplification and overexpression correlate with the overall course of disease and poor prognosis. This study was designed to investigate HER-2/neu gene expression in benign and malignant colorectal lesions and to evaluate its prognostic importance in colorectal cancer. METHODS: Two hundred twenty-one samples of normal colon, benign lesions, and colorectal adenocarcinomas were studied for expression of HER-2/neu oncoprotein. Immunohistochemical staining of formalin-fixed, paraffin-embedded tissue sections of primary tumor and lymph nodes was performed. Immunoprecipitation followed by Western blotting of freshly frozen samples of the same tumors were also performed. RESULTS: Normal colon mucosa, benign lesions, and adenocarcinomas clearly differed in the expression levels and histological distribution of p185(HER-2/neu). Normal mucosa was mostly negative, but significant number of benign lesions and adenocarcinomas overexpressed HER-2/neu protein. Adenocarcinomas were significantly more positive than benign lesions. The results show significant correlation with the epithelial abnormality degree and clinical parameters including Dukes' classification and relapse-free and postoperative survival period. CONCLUSIONS: The p185(HER-2/neu) rate expression could serve as an independent prognostic factor in patients with p185(HER-2/neu)-positive colorectal malignancies.