Mathematical analysis of the heart rate performance curve during incremental exercise testing.

In this study we performed laboratory treadmill protocols of increasing load. Heart rate was continuously recorded and blood lactate concentration was measured for determination of lactate threshold by means of LTD-max and LT4.0 methods.Our results indicate that the shape of heart rate performance curve (HRPC) during incremental testing depends on the applied exercise protocol (change of initial speed and the step of running speed increase, with the constant stage duration). Depending on the applied protocol, the HRPC can be described by linear, polynomial (S-shaped), and exponential mathematical expression.We presented mathematical procedure for estimation of heart rate threshold points at the level of LTD-max and LT4.0, by means of exponential curve and its relative deflection from the initial trend line (tangent line to exponential curve at the point of starting heart rate). The relative deflection of exponential curve from the initial trend line at the level of LTD-max and/or LT4.0 can be defined, based on the slope of the initial trend line. Using originally developed software that allows mathematical analysis of heart rate-load relation, LTD-max and/or LT4.0 can be estimated without direct measurement of blood lactate concentration.

Radical perineal prostatectomy: the first experience.

OBJECTIVE: to present relatively uncommon surgical procedure for the treatment of localized prostate cancer. MATERIAL AND METHODS: Six patients with localized prostate cancer (PCa) underwent perineal radical prostatectomy (PRP) from 2006 to 2010. The average age was 65 +/- 5.2 years. The average preoperative PSA was 7.8 +/- 1.3 ng/ml. Two patients had pT2b stage, while four had pT2c stage. Gleason score ranged from 4-7. RESULTS: All patients had negative surgical margins. Average operative time was 109 +/- 20 minutes and average blood loss was 525 +/- 180 ml. The urethral catheter was removed after 12 days in all patients except one, who required prolonged catheterization due to urinary fistula. All patients were continent after three months. Average postoperative PSA was 0.07 +/- 0.03 ng/ml. CONCLUSION: Perineal radical prostatectomy is valuable surgical procedure that provides good oncological results as well as urinary and sexual function.

Renal cell carcinoma in a horseshoe kidney.

A case of an adenocarcinoma within a horseshoe kidney (HK) is presented. Male patient presented with a history of a painless hematuria. A contrast enhanced magnetic resonance (MR) scan showed a horseshoe kidney. A large soft tissue mass was also noted on the right side. Kidney was receiving supply from two arteries on the left side and one at the right side. Angiography of the right renal artery demonstrated hypervascular tumor staining. The kidney was approached through midline abdominal incision, and a right heminephrectomy was performed. The histopathology examination showed pT2, grade 2 renal cell carcinoma. To conclude, angiography is indispensable for guiding surgical interventions.

Multiple cutaneous metastases of advanced prostate cancer: case report and a review of the literature.

Between 2% and 9% of malignant tumours are metastasizing to the skin. Cutaneous metastases from carcinoma of the prostate occur infrequently. Their presence is associated with poor prognosis. We report the case of a 65-year-old man with carcinoma of the prostate, presenting multiple metastases in the scrotal skin region.

Radical retropubic prostatectomy--results in 127 surgically treated patients.

Radical prostatectomy represents an optimal therapeutic method in treatment of the localized prostatic carcinoma. It may be performed using retropubic, perineal, transcoccygeal or laparoscopic approach. In a multicenter study, the authors have analyzed 127 patients surgically treated in the period 1992 - 2003. All the patients were preoperatively diagnosed with the localized prostatic carcinoma. The patients were operated at the Clinic of Urology in Belgrade (92 patients) and other departments of urology in Serbia (35 patients). The youngest patient was 49 while the oldest one was 75 (mean age 64 years). The surgical procedure duration ranged between 60 and 120 minutes. Over the last five years, the need for blood transfusion was below 50%. All the patients underwent retropubic radical prostatectomy.

Clinical and urodynamic outcomes of tension-free vaginal tape procedure.

The tension--free vaginal tape procedure (TVT) has been regarded as a safe, minimally invasive method for the treatment of female stress urinary incontinence. In a prospective multicenter study we evaluated safety and efficacy of TVT procedure for the treatment of female stress incontinence. From 1998. to 2003, a total of 42 patients, mean age 60 years (range 34-76) with urodynamically verified stress urinary incontinence underwent the TVT procedure. The mean follow-up period was 28 months (range 14 to 32). Intra- and postoperative complications were few, including bladder perforations (4.7%), vaginal hematoma (2.4%), complete urinary retention (2.4%), transient urinary retention (19%) and urinary tract infection (7.1%). Postoperatively, voiding time and functional urethral length significant increased. The subjective and objective cure rates were 85.7% and 90.5%, respectively. We conclude that the TVT procedure is associated with high cure rate and low morbidity.

Postobstructive pulmonary oedema during anaesthesia in children with mucopolysaccharidoses.

We present case reports of five patients with severe forms of mucopolysaccharidoses who developed postobstructive pulmonary oedema during anaesthesia. The difficulties of anaesthesia in these patients and the particular predisposition that these patients exhibit for the development of postobstructive pulmonary oedema is discussed.

Myotonia dystrophica and spinal surgery.

Two cases of patients suffering from the congenital form of myotonia dystrophica under going spinal surgery are presented. Both patients had major complications, including cardiac arrhythmias, postoperative wound infection and more minor complications, such as sedation and opioid sensitivity. However, the most notable complication resulting in long-term morbidity was the deterioration of bulbar muscular function in one of the patients. This resulted in recurrent aspiration pneumonia and the need for a tracheostomy. This serious complication has not previously been reported following surgery.

[Juxta-vesical ureterolithotomy with intubation of the distal part of the ureter without opening the urinary bladder]. / Jukstavezikalna ureterolitotomija sa intubacijom distalnog dela uretera bez otvaranja mokracne besike.

A new surgical method in the treatment of juxtavesical ureterolithiasis is described; its advantage in relation to the classical juxtavesical ureterolithotomy is in the intubation of distal part of the ureter without incision of the bladder. In this way a stenosis at the place of ureterolithotomy is prevented, and on the other side the existent stenosis is dilated. 23 patients have been operated upon, in 9 of whom there was a blockage of the kidney caused by a stone in juxtavesical part of the ureter, with uretero-hydronephrosis in 14 patients. In 14 patients the urine was infected, and in 9 ones sterile; the stone has been in the ureter about 2-3 months in 15 cases. In all patients an extraction of the stone by a Dormy catheter has been tried, but without success. The follow-up of the patients, 8-12 months after surgery showed that the kidney does secrete well, ureter was with a fair passage at the x-ray, and without stenosis of the ureter.