Knowledge, attitudes and behaviour regarding the infant oral health visit: are dentists in Ireland aware of the recommendation for a first visit to the dentist by age 1 year?

AIM: To assess the knowledge, attitudes and behaviour of dentists nationwide in Ireland regarding the infant oral health visit, and also to elucidate whether dentists were aware of the recommendation for a first dental visit by age 1 year and of what care should be provided at this visit. METHODS: A validated 10-item questionnaire was distributed to a representative sample of non-paediatric dentists (non-PDs) and paediatric dentists (PDs) practicing in Ireland. The questionnaire focused on respondents' demographics in addition to their knowledge, attitudes and behaviour regarding the infant dental visit. RESULTS: Seventy-three percent of non-PDs reported seeing patients aged 0-36 months. Compared to all PD respondents, 58% of non-PDs believed that the first dental visit should occur by age 1 year. Furthermore, non-PDs provided the same care as PDs at the infant dental visit, with the exception of evaluating for fluoride needs and placing fluoride varnish. The main barrier to early oral healthcare was reported to be parents not requesting dental appointments for their infants. CONCLUSIONS: There remains a need to increase the proportion of non-PDs in Ireland seeing infants by their first birthday. It is recommended that Irish undergraduate and continuing education courses incorporate clinical training regarding the infant oral health visit and emphasise fluoride needs evaluation and fluoride varnish application. Additionally, a nationwide health promotion initiative is indicated to inform parents of the importance of a dental visit by age 1 year.

Lactococcus lactis and Lactobacillus salivarius differently modulate early immunological response of Wistar rats co-administered with Listeria monocytogenes.

In the light of the increasing resistance of bacterial pathogens to antibiotics, one of the main global strategies in applied science is development of alternative treatments, which would be safe both for the host and from the environmental perspective. Accordingly, the aim of this study was to test whether two lactic acid bacteria (LAB) strains, Lactococcus lactis BGBU1-4 and Lactobacillus salivarius BGHO1, could be applied as safe supplements for Listeria infection. Two major research objectives were set: to compare the effects of BGBU1-4 and BGHO1 on early immune response in gut tissue of Wistar rats co-administered with Listeria monocytogenes ATCC19111 and next, to test how this applies to their usage as therapeutics in acute ATCC19111 infection. Intestinal villi (IV), Peyer's patches (PP) and mesenteric lymph nodes (MLN) were used for the analysis. The results showed that BGHO1 increased the mRNA expression of innate immune markers CD14, interleukin (IL)-1ß and tumour necrosis factor (TNF)-α in PP and IV, and, in parallel, caused a decrease of listeriolysin O (LLO) mRNA expression in same tissues. In MLN of BGHO1 treated rats, LLO expression was increased, along with an increase of the expression of OX-62 mRNA and CD69, pointing to the activation of adaptive immunity. On the other hand, in BGBU1-4 treated rats, there was no reduction of LLO mRNA expression and no induction of innate immunity markers in intestinal tissue. Additionally, CD14 and IL-1ß, as well as LLO, but not OX-62 mRNA and CD69 expression, were elevated in MLN of BGBU1-4 treated rats. However, when applied therapeutically, both, BGBU1-4 and BGHO1, lowered Listeria count in spleens of infected rats. Our results not only reveal the potential of LAB to ameliorate Listeria infections, but suggest different immunological effects of two different LAB strains, both of which could be effective in Listeria elimination.

Bilateral renal cell carcinoma with bilateral synchronous adrenal gland metastases - a case report.

The authors reported a case of a 52-year-old patient with bilateral synchronous renal cell carcinoma synchronously disseminated in adrenal glands is presented. The patient underwent surgical treatment: radical nephrectomy on the right side, bilateral adrenectomie on the right and partial nephrectomy on the left side. Five years after surgery, patient is in complete remission.

Differential effects of cadmium administration on peripheral blood granulocytes in rats.

Infiltration of circulatory inflammatory cells is a common histopathological finding in target organs following cadmium administration, but there is paucity of data concerning their activity. In this study, the effects of sublethal (1 mg/kg) cadmium on peripheral blood polymorphonuclear (PMN) cells were examined 48 h following administration in rats, when tissue (liver and lung) infiltration of these cells was observed. Cadmium administration resulted in systemic inflammatory cytokine and acute phase response with an increase in circulatory neutrophil numbers and cells that express CD11b molecules. Rise in basic aspects of oxidative activity including intracellular myeloperoxidase (MPO), reactive oxygen (nitroblue tetrazolium/NBT cytochemical assay) and nitrogen (Griess assay) species production was observed in PMNs from cadmium-administered rats. A decrease in levels of mRNA for IL-1ß, TNF-α and IL-6 was noted, but production of these cytokines was affected differentially. Described effects of cadmium on PMNs add further to the understanding of inflammatory potential of this environmental contaminant.

A case report of the first laparoscopic radical nephrectomy done at the Clinic of Urology, Clinical Centre of Serbia.

Laparoscopic interventions are at the very beginning of its evolution in the Clinic of Urology. The first steps have been made primarily to cope with problem of varicocele. We continued to gain laparoscopic experience by switching to solving some demanding intervention, primarily kidney cyst. The only logical next step lead to laparoscopic renal surgery. So, after a few successful primary simple nephrectomy, the next step was to perform a laparoscopic radical nephrectomy. Today, at the Clinic of Urology, Clinical Center of Serbia we successfully perform much more demanding interventions, such as extraperitoneal laparoscopic radical prostatectomy. In this paper we present our experience with the first laparoscopic radical nephrectomy, which was done at the Clinic of Urology, Clinical Center of Serbia.

Diagnostic and therapeutic protocol in the treatment of hypo functional kidney.

Laparoscopic nephrectomy is indicated in the treatment of many benign conditions of the kidneys. Hydronephrosis caused by obstruction of the ureter, either internal, or external, is one of the main indications for laparoscopic reconstruction. If an obstruction is prolonged, consequently, it leads to chronic inflammatory process accompanied by persistent and recurrent pain with fever, which eventually become resistant to therapy. If not operated sufficiently fast to resolve the causes, as a consequence it leads to hypofunction and ultimately afunction of affected kidney. In such a situation, the only therapeutic option is surgical treatment. By analyzing the case, we will try to illustrate the diagnostic algorithm and therapeutic treatment modality.

Preoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy.

PURPOSE: To determine the factors that can improve the prediction of biochemical recurrence after radical prostatectomy for the patients with prostate adenocarcinoma. METHODS: Our study included 182 patients with prostate adenocarcinoma who were biopsied and underwent radical surgical treatment at the Clinic of Urology, Clinical Center of Serbia, Medical Faculty in Belgrade from 1994 to 2004. Patients were prospectively followed-up and monitored for a minimum of 8 years and data were statistically processed by multivariate regression analysis. We arranged the predictors into 3 regressive models. In the first model the predictors were clinical stage of the disease, preoperative Gleason score, F/T PSA ratio and PSA. In the second model these predictors were accompanied with the number of positive biopsies and percent of positive prostate biopsies. In the third model, patient follow-up was added to the predictors. In all 3 models biochemical recurrence was considered as a dependent variable. RESULTS: On multivariate analysis, patient follow-up (p<0.0001), percent of positive prostate biopsies (p<0.0001), bioptic Gleason score (p<0.0001) and preoperative PSA (p<0.003) were significant independent predictors of biochemical recurrence. The most successful prediction of recurrence that provided accurate prognosis for 80% of the patients was obtained by the third model using the percent of positive prostate biopsies, PSA and patient follow-up. CONCLUSION: As stated in multivariate analysis, the independent predictors according to the significance are the follows: patient follow-up, percent of positive prostate biopsies, bioptic Gleason score and preoperative PSA, whereas preoperative F/T PSA ratio is dependent predictor. The number of positive biopsies and clinical stage of the disease are of no significance.

[Degree of renal insufficiency in patients undergoing ileal conduit as a form of urinary diversion in relation to the type of ureteral insertion].

UNLABELLED: Ileal conduit as a form supravesical derivaton, is still one of most popular method of urinary diversion, in daily urological practice. Bearing in mind this fact, this type of diversion, rightfully so, is also called the "gold standard" in the derivation of urine. Considering the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that, in time, this type of diversion lead to some degree of renal insufficiency. Some authors, this effect on renal function, attribute to specific type of ureterointestinal anastomosis during formation of ileal conduit. A very important part of the surgical technique of creating ileal conduit is precisely a step of implantation ureters into the intestinal segment. The ultimate goal is to enable a more natural way of evacuation of urine from the upper urinary tract in terms of maintaining the quality of renal function. Numerous authors describes a quite number of techniques of ureteral implantation into the intestinal segment (Wallace A, Wallace B, Nesbit-Bricker, Le Duc ...). Each of these techniques has its own strengths and weaknesses, and the decision witch technique will be applied is still in the hand of urologist--operator, individually.Bearing in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that the renal function over the time will start to show signs of incipient or advanced failure. OBJECTIVE: To determine the most appropriate type ureterointestinal anastomosis in forming ileal conduit, as a form of supravesical urinary diversion, to ensure adequate renal function postoperatively as an important parameter of quality of life. METHODS AND PATIENTS: This is a retrospective study, which covered a population of 193 patients treated at the Department of Urology, Clinical Center of Serbia, who underwent creation of ileal conduit as a form of urinary diversion. The study was conducted 2007-2011. Postoperative follow-up lasts up to 48 months. The assess of the level of renal insufficiency were analyzed by monitoring parameters which determine the degree of anemia, and biochemical parameters of renal function. We have investigated three techniques of insertion of the ureters into the ileal conduit, which are used in the daily practice (Wallace A, Wallace B, Nesbit-Bricker). CONCLUSION: Kidney failure occurs equally often in all patients who underwent urinary diversion by ileal conduit, ignoring the type of insertion of the ureters to the intestinal segment.

The case of the diverticular bladder tumor treated with diverticulectomy.

INTRODUCTION: The majority of diverticular bladder tumors (DBT) are urothelial. Due to the lack of the muscular layer in the diverticulum, the progression of these tumors is easier than in the bladder wall. CASE REPORT: The case of invasive DBT with painless hematuria is presented. The patient was treated with diverticulectomy. CONCLUSION: Unifocal Stage-T3 DBTs can be successfully treated with diverticulectomy.

[Degree of postoperative renal deterioration in patients who have undergone ileal conduit as a form of urinary diversion in relation to the type of insertion of the ureter].

UNLABELLED: Substitution of the bladder with segment of the digestive tract, within the radical treatment of bladder cancer, as well as treatment of the other bladder abnormality, is extremely demanding surgical procedure, that aims adequate treatment of the underlying disease and provide patient's renal function within physiological level. Surgical implantation of the ureter into the intestinal segment are an important part of the surgical technique, the formation of ileal conduit, with the ultimate aim of providing a more natural way of evacuation of urine from the upper urinary tract in terms of maintaining the adequate quality of renal function. Which of the existing surgical method of implantation of ureter in the intestinal segment will be applied, it is for urologist to decided, according to his affinity and/or his operating school of origin. The literature describes many procedures of this technique (Wallace A, B Wallace, Nesbit-Bricker, Le Duc). Bearing in mind that the ileal conduit, as a form of supravesical derivation, is still one of most widely used method of urinary diversion, with a very large number of patients during the follow-up period were recorded certain complications of renal function disorders, which by some authors attributed to a type of ureterointestinal anastomoses, during the creation of ileal conduit. Having in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect some degree of renal deterioration. These complications require prompt resolution. Bearing in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that the renal function over the time will start to show signs of incipient or advanced failure. OBJECTIVE: The main objective is to show the degree of renal deterioration, postoperatively, according to the type of insertion of the ureters to the ileal conduit. METHODS AND PATIENTS: The study was conducted retrospectively on material of Urological Clinic, Clinical Center of Serbia and on material of Faculty of Medicine, University of Belgrade, on 193 patients, for a period of five years (2007 to 2011), with a time of postoperative follow-up of patients up to 48 months (four years). Assessment of the level of renal deteriorisation was performed by ultrasound examination during regular audits of patients during follow-up. CONCLUSION: It was found that all three examed techniques in an insertion of ureter into ileal conduit were equally satisfactorily, with the similar degree of postoperative complications. Based on these facts, we can conclude, that the quality of life of patients in all three analyzed groups of ureteral insertion in the ileal conduit, approximately the same.

Diagnostic value of the nuclear matrix protein 22 test and urine cytology in upper tract urothelial tumors.

OBJECTIVE: To investigate the diagnostic value of the nuclear matrix protein 22 (NMP22) test in comparison to urine cytology for the detection of upper tract urothelial carcinoma. PATIENTS AND METHODS: Patients with transitional cell carcinoma of the upper urinary tract (n = 34) and patients with renal calculosis (n = 25) were included in this study. Voided urine samples and separated catheter urine specimens were assayed for NMP22 and cytological examination. RESULTS: The sensitivity of the NMP22 test in separated and voided urine was 73.2 and 70.5%, respectively, compared to 64.7 and 58.8% of urine cytology. The specificity of the NMP22 test in separated and voided urine was 88 and 92%, respectively, compared to 96 and 96% of urine cytology. The combination of separated and voided urine is the best method because the sensitivity is 79.41% and specificity 88%. There is a high agreement of the NMP22 test in voided and separated urine (kappa = 0.795, p < 0.01), indicating that the voided urine is adequate for diagnosis. CONCLUSIONS: The NMP22 test has higher sensitivity but lower specificity than cytology. The combination of these two tests could be a very useful diagnostic method for detection of upper urothelial tumors.

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.

What are the possible reasons for urethral PSA varieties after radical prostatectomy?

OBJECTIVE: To examine the possible reasons for great varieties in urethral prostate specific antigen (urPSA) levels, in patients after radical prostatectomy (RP). MATERIALS AND METHODS: In 46 patients with pros-tate cancer, PSA, urPSA, total testosterone, body-mass index (BMI) and the stage of androgenic alopecia (AGA) were determined. Forty-five patients underwent retropubic RP, while one underwent cystoprostatectomy with orthotopic bladder construction, due to bladder cancer. RESULTS: Average patients age prior to surgery plus or minus standard deviation was 65.2 +/- 5.8 years. Average urPSA was 20.9 +/- 47.5 ng/ml (0.05 to 212 ng/ml, median 2.24 ng/ml). With urethral PSA cut-off of 2.0 ng/ml, two groups were formed: A (urPSA < 2.0 ng/ml) and B (urPSA = 2.0 ng/ml). Patients in the group A had significantly lower average AGA score, than the patients from the group B (2.4 +/- 1.3 vs. 4.4 +/- 2.2, p = 0.0003). In addition, patients from the group A had significantly lower pos-toperative PSA (0.07+0.08 ng/ml vs. 0.14 +/- 0.06 ng/ml, p = 0.0014). CONCLUSIONS: The patients with higher urPSA have higher AGA scores and higher postoperative PSA. This phenomenon is probably the consequence of higher local dihydrotestosterone activity in the scalp and PSA-secreting urethral glands.

The case of cavernous testicular hemangioma.

OBJECTIVE: To present the rare case of testicular hemangioma. CASE REPORT: A 45-year-old clerk presented with painless swelling in the left testicle, which he noticed one month ago. Inguinal orchidectomy on the left side was performed and pathological report proved cavernous hemangioma. CONCLUSION: Hemangioma of the testis is very rare clinical condition. Clinical appearance and diagnostic exams are usually not sufficient for the diagnosis. Sometimes, hyperechoic lesion with increased vascularity can be seen on Doppler ultrasonography.

Urinary PSA level and relative tumor volume after prostate biopsy.

OBJECTIVES: To estimate the ratio between urinary prostate specific antigen (uPSA) and tumor volume after prostate biopsy. METHODS: From 2000 to July 2008, uPSA concentration was determined in 60 patients with clinically organ-confined prostate cancer (PCa). All patients underwent six-area transrectal ultrasound (TRUS)--guided biopsy, with at least 12 biopsy cores. Single pathologist determined tumor grade (G), Gleason score (GS), the percentage of tumor infiltration (% TI) and the percentage of positive cores (% PC) in all biopsy cores. Additionally, relative tumor-biopsy volume (RTV) was calculated by multiplying % PC, % TI and prostate ultrasound-derived volume (Vol). Forty-one patients underwent retropubic radical prostatectomy (RRP), while 19 patients underwent radiation therapy. RESULTS: Average uPSA was 308.6 +/- 311.9 ng/ml (range 0.06-988 ng/ml), average PSA was 9.7 +/- 5.5 ng/ml (range 1.2-24.3 ng/ml), tumor grade 1.7 +/- 0.8, Gleason score 5.2 +/- 1.3, the percentage of tumor infiltration 27.6 +/- 21.8%, and the percentage of positive cores, 52.2 +/- 30.7%. Average RTV was 6.3 +/- 8.4 ml (0.29-56 ml). All patients were divided in two groups: I, with RTV 4 ml and II, with RTV = 4 ml. The patients with RTV 4 ml had lower G (1.4 +/- 0.6 vs. 2.1 +/- 0.8, p = 0.0002), lower GS (4.5 +/- 1 vs. 5.8 +/- 1.3, p = 0.003) and higher uPSA (389.4 +/- 340.8 vs. 193.1 +/- 229.7, p = 0.014). There were no differences in serum PSA levels between the groups. CONCLUSION: Relative tumor-biopsy volume (RTV) is useful parameter in the preoperative assessment of tumor volume. Patients with higher RTV had significantly higher G and GS. However, these patients had significantly lower uPSA. This phenomenon could be the consequence of compromised PSA drainage from the peripheral zone of the prostate, caused by the tumor.

Penile metastasis from invasive bladder cancer.

OBJECTIVE: To present the rare case of penile metastasis from bladder cancer. PATIENT REPORT: A 68-year-old man with invasive bladder cancer disseminated in penile shaft and the pelvic lymph nodes is presented. The patient underwent cystoprostatectomy, total penectomy and adjuvant chemotherapy. RESULTS: Ten months after surgery, patient is in complete remission. CONCLUSION: Despite the fact that secondary penile tumors usually require palliative therapy, in selected cases surgical treatment of primary tumor and penectomy, followed with chemotherapy, can improve survival.

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.

Functional characterization of the muscarinic receptors involved in endothelium-dependent relaxation in isolated canine uterine artery.

Acetylcholine interacts with endothelial muscarinic receptors releasing nitric oxide and causing vasodilatation. To identify the receptor subtype responsible for acetylcholine-induced relaxation in canine uterine artery, the usual organ bath method for in vitro investigation on isolated blood vessels was applied. Using a range of muscarinic receptor antagonists such as atropine (nonselective), pirenzepine (M(1)-selective), methoctramine (M(2)-selective) and p-fluoro-hexahydro-sila-difenidol (p-FHHSiD) (M(1)/M(3)) and determining pA2 value of those antagonists through Shild analysis, we aimed at establishing a precise receptor mechanism underlying acetylcholine-induced relaxation in isolated canine uterine artery. The relaxation of uterine arterial rings in response to acetylcholine in the presence or absence of selective muscarinic receptors antagonists was calculated using concentration response curves. Acetylcholine induced concentration-dependent and endothelium-dependent relaxation of arterial rings precontracted with phenylephrine (pEC(50) = 6.90 +/- 0.02). Muscarinic receptors antagonists atropine, pirenzepine, methoctramine and p-FHHSiD competitively antagonized the response to acetylcholine and obtained pA(2) values were 9.91 +/- 0.06, 6.60 +/- 0.04, 6.21 +/- 0.08 and 8.05 +/- 0.1, respectively. This study showed that acetylcholine induced endothelium-dependent relaxation of canine uterine artery by stimulation of muscarinic receptors localized on the endothelial cells. On the basis of differential antagonist affinity, we suggest that the muscarinic receptors involved in the acetylcholine-induced relaxation of canine uterine artery are predominantly of M(3) subtype.

[Retrocaval ureter based on a series of 16 cases]. / Uretère rétrocave: à propos de 16 cas.

INTRODUCTION AND OBJECTIVES: To analyse the postoperative results of surgical treatment for retrocaval ureter. MATERIAL AND METHODS: The authors report a retrospective clinical study of a series of 16 patients (six women and 10 men) with a mean age of 38 years (range: 15-45 years) with retrocaval ureter treated between 1975 and 2005. The mean follow-up was 18 months (range: 12 to 34 months). All patients were evaluated by the standard diagnostic protocol for the time and were treated by one of the following surgical techniques: resection of the ureter and renal pelvis to renal pelvis anastomosis; resection of the ureter and pyelo-ureteric anastomosis; resection of the ureter and oblique end-to-end uretero-ureteric anastomosis; nephrectomy. RESULTS: The mean operating time was 95 min. Late postoperative follow-up revealed two cases (13%) of ureteric stenosis at the site of the oblique end-to-end uretero-ureteric anastomosis. Surgical revision was performed in one patient with resection of the ureter and reanastomosis, while anterograde dilatation of the stenosis was performed in the other patient. The postoperative course was uneventful in both patients. All patients were reviewed at six months with a satisfactory result, corresponding to reduction of hydronephrosis and improvement of renal function. CONCLUSION: Over the last 30 years, the diagnosis of retrocaval ureter has become more reliable and less invasive. Satisfactory results can be obtained with conventional surgical management.