D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial.

PURPOSE: To test whether D-mannose powder is effective for recurrent urinary tract infection (UTI) prevention. MATERIALS AND METHODS: After initial antibiotic treatment of acute cystitis, 308 women with history of recurrent UTI and no other significant comorbidities were randomly allocated to three groups. The first group (n = 103) received prophylaxis with 2 g of D-mannose powder in 200 ml of water daily for 6 months, the second (n = 103) received 50 mg Nitrofurantoin daily, and the third (n = 102) did not receive prophylaxis. RESULTS: Overall 98 patients (31.8%) had recurrent UTI: 15 (14.6) in the D-mannose group, 21 (20.4) in Nitrofurantoin group, and 62 (60.8) in no prophylaxis group, with the rate significantly higher in no prophylaxis group compared to active groups (P < 0.001). Patients in D-mannose group and Nitrofurantoin group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients in no prophylaxis group (RR 0.239 and 0.335, P < 0.0001). In active groups, 17.9% of patients reported side effects but they were mild and did not require stopping the prophylaxis. Patients in D-mannose group had a significantly lower risk of side effects compared to patients in Nitrofurantoin group (RR 0.276, P < 0.0001), but the clinical importance of this finding is low because Nitrofurantoin was well tolerated. CONCLUSIONS: In our study, D-mannose powder had significantly reduced the risk of recurrent UTI which was no different than in Nitrofurantoin group. More studies will be needed to validate the results of this study, but initial findings show that D-mannose may be useful for UTI prevention.

[Informed consent with special emphasis on Croatia]. / Pristanak obavijestenog pacijenta s posebnim osvrtom na Hrvatsku.

Respecting the informed consent and its implementation is one of the fundamental components of high-quality health care. This article discusses the informed consent with an overview of Croatian and international legal documents and scientific studies dealing with this issue. Based on the review of the literature it can be concluded that this is an important issue that contains several key components that should be observed and investigated. It is necessary to evaluate the purposefulness and quality of the implementation of the informed consent, to systematically examine respect of the patients' right to information regarding the medical procedure during treatment, to explore decision-making model in the physician-patient encounter in Croatian hospitals, to determine the content and amount of information shared between physicians and patients, to determine the content and readability of consent forms and written patient information on the medical procedure. In order to assure higher quality of the implementation of the informed consent it is necessary to define by law a list of medical procedures that require written consent and to uniform consent forms for the same medical procedures country-wide.

A new approach for transversalis fascia reinforcement in Lichtenstein's inguinal hernia repair.

Operations undertaken for inguinal hernia repair are the most common elective surgical procedures. According to the current guidelines, Lichtenstein's tension-free method is the gold standard for elective hernia operations. The most common types of implanted mesh are polypropylene and composite mesh. We herein present Lichtenstein's operation using a biological hemostatic mesh (Tachosil) used for transversalis fascia reinforcement, and our results after a 3-year follow-up period for 52 patients implanted with Tachosil mesh are reported. According to our results, the biological mesh can be safely implanted during hernia repair with the same recurrence rate and lower postoperative pain and complications compared to hernia repair with polypropylene mesh implantation.

Fournier's gangrene: etiology and outcome analysis of 41 patients.

INTRODUCTION: Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area with high mortality. MATERIALS AND METHODS: A retrospective review included 41 patients diagnosed with FG in our hospitals from 1995 to 2010, divided into survivors and nonsurvivors. We analyzed anamnestic, clinical and laboratory data. RESULTS: The mortality rate was 36.6% (15/41 patients). Elevated heart and respiratory rates, high serum creatinine, low serum bicarbonate, pre-existing kidney disease, and higher median extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension below 90 mm Hg were also predictive for higher mortality. The median FG severity index (FGSI) score was higher in nonsurvivors (11 compared to 6, p < 0.0001). No cases of testicular necrosis were noted. CONCLUSION: Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were also positively associated with mortality.

An unusual cause of anuria and hydronephrosis in a 12-year-old girl.

A 12-year-old girl was admitted for abdominal pain and signs of acute kidney injury. Physical examination showed abdominal distension and a tumefaction in the lower abdomen. Laboratory and clinical findings were consistent with acute kidney injury. Abdominal ultrasonography showed an oval mass, which corresponded with hematometrocolpos, and right-sided hydronephrosis. Catheterization followed by cruciate hymenectomy was performed. The patient recovered completely. Imperforate hymen is an obstructive anomaly of the female reproductive tract of unknown etiology that can cause a variety of symptoms. It is a rare, but possible cause of acute kidney injury. Patient history data and genital examination findings are sufficient to establish the diagnosis. Abdominal ultrasonography is the most useful diagnostic modality.

[Histrelin acetate--the first once yearly LHRH agonist]. / Histrelin acetat--prvi LHRH-agonist s primjenom jednom na godinu.

Long-acting synthetic luteinising hormone-releasing hormone agonists have become the mainstay for androgen-deprivation therapy, because they avoid the physical and psychological discomfort associated with orchidectomy and lack the potential cardiotoxicity associated with estrogens such as diethylstilbestrol. Currently available luteinising hormone-releasing hormone agonist analogues include leuprolide, goserelin, triptorelin, degarelix and buserelin were administered as either intramuscular or subcutaneous depot injections on a 1, 2, 3 or 6 months basis. Histrelin acetate is the first long-acting luteinising hormone-releasing hormone agonist available as a once-yearly subcutaneous implant.

[Feasibility of alpha-blockers in chronic category III prostatitis]. / Uloga alfa-blokatora kod kronicnog prostatitisa tipa III.

Studies were identified on internet by searching on address: http://www.ncbi.nlm.nih.gov/pubmed/ with criteria that studies should be placebo-controlled and randomized in trials of alpha-blockers in chronic category III prostatitis evaluated by symptom-score NIH-CPSI. From 13 clinical studies three were excluded because of not using NIH-CPSI, three were in Chinese language and two were congress abstracts. Analysed were five studies with four or five Jadad scale including 563 patients. Alpha-blockers alfuzosin, terazosin, tamsulosin and doxazosin have been used through 6 weeks and 6 months. Better results were accomplished by less selective alpha-blockers alfuzosin, terazosin and doxazosin through 3-6 months in patients having higher NIH-CPSI score and higher voiding score.

An unusual cause of chronic lumbar back pain: retained surgical gauze discovered after 40 years.

OBJECTIVE: Retained surgical gauze left inside the patient during a surgical procedure is called textiloma or gossypiboma. Most often found in abdominal and pelvic cavities, retained gauze can cause a variety of symptoms, including fever, palpable mass and pain. Symptoms depend on the location (and possible migration) of the retained gauze and local tissue reaction (inflammatory or aseptic). DESIGN: Case report. SETTING AND PATIENTS: We present a case of a patient with lumbar pain and constipation caused by surgical gauze mimicking a tumor, which was retained from previous abdominal surgery performed almost 40 years prior. MEASURES: We discuss the diagnosis, treatment and prevention of retained surgical gauze. CONCLUSION: Retained surgical gauze occurrences are not as rare as they are widely considered to be, and clinicians should be aware of that. In reality, retained gauze can be extremely difficult to diagnose, especially if a patient presents after a very long asymptomatic period.

[Molecular aspects of apoptosis]. / Molekularni aspekti apoptoze.

Corresponding to its importance in cell count homeostasis in the body, apoptosis is a tightly regulated phenomenon. Both extracellular and intracellular molecules provide multiple regulatory and counter-regulatory pathways. Cell death is usually a response to the cell microenvironment, where the absence of certain factors (survival factors) or the presence of lethal factors promotes apoptosis. Surrounding cells, soluble mediators and the extracellular matrix regulate cell death and survival. Surrounding cells can synthesize survival or lethal factors. The intracellular regulation of apoptosis is also one of the forefront fields in biomedicine research. During the past five years, tremendous progress has been made in understanding apoptosis as a result of molecular identification of the key components of this intracellular suicide program. Biochemical activation of these key components of the cell death program is responsible for the morphological changes observed in apoptosis, including mitochondrial damage, nuclear membrane breakdown, DNA fragmentation, chromatin condensation and the formation of apoptotic bodies. Caspase activation plays a central role in the execution of apoptosis. Most caspases are constitutively expressed as inactive proenzymes (procaspases) in the cytosol and according to some reports in the mitohondria. Caspases are sequentially activated by proteolysis during apoptosis. In this review, we focus on the biochemical pathways that control caspase activation, particularly the activation pathways that are initiated by cell surface death receptors and mitochondria.

[Alpha-adrenergic blockers as a support in the treatment of acute urinary retention]. / Alfaadrenergicki blokatori kao pomocno sredstvo u lijecenju akutne urinarne retencije.

Catheterization remains the standard management of acute urinary retention (AUR), followed by a trial without catheter (TWOC) or prostatectomy in men who do not void spontaneously. If AUR is caused by increased sympathetic activity at the level of the prostatic smooth muscles, alpha-blockers (alpha-1 adrenoreceptor antagonists) should increase the likelihood of a successful trial without catheter (TWOC) following AUR. Alpha-blockers effectively reduce the symptoms associated with benign prostatic hyperplasia (BPH) and improve the urodynamic parameters of obstruction. They may diminish the incidence of AUR and the need for prostatectomy in symptomatic men. The adventage of tamsulosin and slow-release alfuzosin over doxazosin and terazosin in the management of AUR is that a therapeutic dose can be administered at the onset of AUR, thereby reducing the time for attempting catheter removal.

[Medical therapy of benign prostatic hyperplasia]. / Konzervativno lijecenje benigne hiperplazije prostate.

The aim of treatment for benign prostatic hyperplasia is relieving lower urinary tract symptoms, desreasing bladder outlet obstruction, improving bladder emptying, ameliorating detrusor instability, reversing renal insufficiency, and preventing future episodes of gross hematuria, urinary tract infection and urinary retention. A potent role of medical therapy is to prevent the development and/or progression of benign prostatic hyperplasia. Medical therapies investigated for benign prostatic hyperplasia include plant extracts, alpha adrenergic blockers and 5-alpha-reductase inhibitors. Clinical observations suggest that the efficacy of combination therapy could be superior to that of individual monotherapies.