Clinical and Biochemical Influence of Prostatic Stones.

INTRODUCTION: The study aimed to explore clinical influence of prostatic stones on lower urinary tract symptoms (LUTS), seminal plasma cytokines, and serum biomarkers. MATERIALS AND METHODS: A total of 70 men aged ≤50 years with LUTS divided into 2 groups: group with stones (GSt) and group without prostatic stones (GNoSt). All subjects completed the International Prostate Symptom Score (IPSS) questionnaire and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scoring questionnaire. Pre- and post-prostate massage test and uroflowmetry were performed. The serum concentration of total prostate specific antigen (PSA), free PSA, and free/total PSA (f/t PSA) ratio, seminal concentration of cytokines interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12p70, and tumor necrosis factor-alpha were measured. RESULTS: GSt subjects had significantly more severe symptoms based on IPSS answers (p = 0.0289). All domains in NIH-CPSI scores were significantly higher in the GSt group: pain (p = 0.001), urinary symptoms (p = 0.023), quality of life (p = 0.008), and with overall (p = 0.003). GSt subjects also had significantly lower maximum urinary flow (Qmax; p = 0.011), lower f/t PSA ratio (p = 0.048), and higher concentration of IL-1ß (p = 0.011) and IL-8 (p = 0.001). CONCLUSIONS: Prostatic stones may influence the severity of LUTS and the symptoms of chronic prostatitis. They might reduce Qmax rate and lead to reduction of the f/t PSA ratio and produce more severe inflammation causing increased seminal concentration of IL-1ß and IL-8.

Rare Case of Multiple Aneurysms with Rupture of the Deep Femoral Artery Aneurysm.

Profunda femoris artery aneurysms (PFAA) are very rare and easily overlooked. Currently, around 100 PFAA and 20 ruptured PFAA have been described in the literature. This is a report on a case of ruptured PFAA with thoracoabdominal aortic aneurysm. A ligation of the profunda femoris artery (PFA) and a femoropopliteal supragenicular bypass with vascular prosthesis were performed in the surgical treatment, which showed good results on the further follow-ups. A month after the procedure the patient had a rupture of the thoracoabdominal aortic aneurysm with fatal result. Therefore, it is recommended to perform a search for another aneurysm, especially on the aortoiliac segment, in every diagnosed PFAA case.

Prevalence of the palmaris longus in relation to the hand dominance.

PURPOSE: The incidence of left-handedness in the general population is between 8 and 15%. There is a presumption that the prevalence of palmaris longus muscle differ between right-handed and left-handed people. This prospective study was conducted to determine the prevalence of the palmaris longus in relation to the hand dominance. METHODS: The study included 542 subjects (216 male and 326 female). They were initially tested to hand dominance and after that they were asked to do the standard test (Schaeffer's test) for the assessment of the palmaris longus tendon. If the tendon was not visualized or palpable, four additional tests (Thompson's test, Mishra's tests I and II, Pushpakumar's "two-finger sign" method) were done to confirm its absence. RESULTS: Right hand dominance was recorded in 452 (83.4%) subjects while the left hand dominance was recorded in 90 (16.6%) subjects. In right-handed subjects, palmaris longus tendon was absent on the right side in 24 (5.3%) and on the left side in 50 (11.1%) cases. In left-handed subjects, it was absent on the right side in 18 (20%) and on the left side in 2 (2.2%) cases. These differences were statistically significant. Bilateral absence of palmaris longus tendon was similar in both examined groups (25.1% in the overall series, 24.3% in right-handed subjects, 28.9% in left-handed subjects). CONCLUSIONS: The results of our study show that a right-sided absence was more common in left-handed persons while the left-sided absence was more common in right-handed persons. Unilateral tendon absence was more common on the non-dominant hand.

Low adiponectin serum level--reduced protective effect on the left ventricular wall thickness.

Adiponectin, secreted by fat tissue, is down - regulated in obesity and may be involved in obesity-related disorders. It has anti-inflammatory, antiatherosclerotic and antidiabetic effect. Obesity is a strong predictor for hypertension and cardiovascular diseases. Recent studies showed that adiponectin level has important role in metabolic disorders, arterial hypertension and ischemic heart disease but its effect on left ventricular hypertrophy (LVH) has not been fully clarified. The aim of this research is to determine whether the protective effect of adiponectin against development of left ventricular hypertrophy is decreased in hypertensive overweight patients. The study included 61 adult, overweight hypertensive patients, with body mass index in range 25-30 kg/m2. Patients had regular morning glucose serum values and regular creatinine level. They were divided into four groups, according to sex and the presence of LVH. There were 16 female and 15 male hypertensive patients with LVH and 15 female and 15 male hypertensive patients without LVH, who were a control group. Glucose profile, lipidogram, creatinine clearance and anthropometric measures were determined in all patients. Cardiovascular measurements were taken applying two-dimensional ultrasound. Adiponectin serum level was measured using enzyme immunoassay (ELISA). Results showed that adiponectin serum level was significantly lower in hypertensive, overweight females and males with LVH than in the control groups without LVH. Adiponectin serum level did not correlate significant with intraventricular or with posterior wall thickness of left ventricle. Hypoadiponectinemia presents part of neurohumoral, non-haemodynamic system who contributes to obesity-related hypertension and left ventricular hypertrophy development. Low adiponectin level together with others adipokines, cytokines and chemokines secreted by fat tissue could contribute to pathophysiologic changes of the myocardium via unknown molecular mechanisms yet.

Numerical analysis of standard and modified osteosynthesis in long bone fractures treatment.

The fundamental problem in osteoporotic fracture treatment is significant decrease in bone mass and bone tissue density resulting in decreased firmness and elasticity of osteoporotic bone. Application of standard implants and standard surgical techniques in osteoporotic bone fracture treatment makes it almost impossible to achieve stable osteosynthesis sufficient for early mobility, verticalization and load. Taking into account the form and the size of the contact surface as well as distribution of forces between the osteosynthetic materials and the bone tissue numerical analysis showed advantages of modified osteosynthesis with bone cement filling in the screw bed. The applied numerical model consisted of three sub-models: 3D model from solid elements, 3D cross section of the contact between the plate and the bone and the part of 3D cross section of the screw head and body. We have reached the conclusion that modified osteosynthesis with bone cement resulted in weaker strain in the part of the plate above the fracture fissure, more even strain on the screws, plate and bone, more even strain distribution along all the screws' bodies, significantly greater strain in the part of the screw head opposite to the fracture fissure, firm connection of the screw head and neck and the plate hole with the whole plate and more even bone strain around the screw.

Vasculometry of upper and lower extremities in correlation with development of pathologic conditions like the diabetic foot.

We assume that the vascular apparatus of the lower limb did not evolutionary adapt to leg mass and volume. The lower limb is greater in length and volume that the upper limb, and therefore the arteries should have a bigger diameter and cross-sectional area. During pathoanatomic autopsies at the Department of Pathology of University Hospital Center Osijek we have taken segments of 1 cm of length from the subclavian, femoral, radial and tibial artery. Our sample contained segments from 51 bodies, 24 female and 27 male. We have measured leg and arm length and circumference. From these data the idealized limbs volume was calculated by geometric approximations to a cone fragment. The relation between idealized leg and arm volume and arterial cross-sectional area were calculated. For statistical analysis, Student's t-test was used. At the Department of Radiology of the University Hospital Center Osijek we measured the diameter of subclavian and femoral artery in systole and diastole in 41 patients (21 female and 20 male) by Color Doppler ultrasound, and the circumference and length of upper and lower limb was measured. There is a slightly difference between the diameter and cross-sectional area of subclavian and femoral artery. Leg length was for 48.5% bigger than arm length and the difference in volume between upper and lower limb is significantly different. The foot has four to five times greater volume than the arm, and is vascularised by an arterial tree of similar diameter. This fact proves our hypothesis that the blood supply to the lower limbs compared to the mass of tissue is smaller.

Real mineral density of the sternum.

Mineral density of the sternum is insufficiently known. The aim of this research was to investigate mineralisation of the sternum and collect normative data on mineral density of the standard male and female sternum in elderly people (average age of female samples was 64 and male's was 62 years). The research was conducted on 93 cadaveric sternums, 56 male and 37 female samples. To determine regional mineral density of the sternum each sample was cut into six bony segments (Figure 1). Mineral density of every segment was determined using the method of ashing. Male sternums were on average denser than female ones in all segments. Average mineral density of the manubrium in women was 0.169 g/cm3 and 0.220 g/cm3 in men. Average mineral density of the body of the sternum also showed existence of sex difference; it was 0.160 g/cm3 in women and 0.227 g/cm3 in men. Both male and female sternums showed identical mineral density distribution. Mineral density of the manubrium and the body was roughly equal, while the analysis of longitudinal segments showed that the central part of both the manubrium and the body of the sternum was denser than lateral parts. Complex determination of the real mineral density for defined segments of the sternum and analysis of the obtained results were used to create the map of mineral density of the sternum in men and women (Figure 2). Maximum density values were four times greater than minimum density values for analysed samples. These data showed that osteoporosis also occurs on the sternum. Loss of structure and lower mineral density decrease the sternum quality and increase the risk of sternal dehiscence after median sternotomy.

Hyperleptinemia--non-haemodynamic risk factor for the left ventricular hypertrophy development in hypertensive overweight females.

Obesity is directly and strongly associated with hypertension and left ventricular hypertrophy (LVH). Development of LVH is multifactorial, caused both by haemodynamic and non-haemodynamic factors. Hypertension is the main haemodynamic factor. Humoral mechanisms, as a non-haemodynamic factor for LVH development, have not been completely explained. The aim of this study is to determine whether hyperleptinemia can be one of humoral--non-haemodynamic factor inducing LVH together with haemodynamic factors in overweight females. The study was done on thirty six adult, overweight female patients, body mass index in range 25-30 kg/m2. Patients are nondiabetic with regular renal function. Twenty one female patients were hypertensive with left ventricular hypertrophy. Control group included fifteen hypertensive female patients without left ventricular hypertrophy. In all patients was determined glucose profile and creatinine clearance, cholesterol, triglycerides, LDL, HDL. Weight, high, circumference of the waist and hips was taken. Cardiovascular determination was done applying two-dimensional ultrasound. Serum leptin level was measured using radioimmunoassay method (RIA). Results showed that serum leptin level was significantly higher in hypertensive, overweight females with LVH. This suggests that non-haemodynamic factors, such as hyperleptinemia, participate in left ventricular hypertrophy development together with haemodynamic factors in adult hypertonic, overweight females.

A case of intra-amniotic maternal hemorrhage in term pregnancy.

INTRODUCTION: Intra-amniotic maternal hemorrhage is a rare condition, hard to differentiate from some other conditions in pregnancy. We report an unusual case of intra-amniotic maternal hemorrhage in term pregnancy ending in urgent cesarean section, identified on ultrasound examination. CASE REPORT: A 24-year-old female (gravida 3, para 2, abortion 0) was admitted to hospital at 40 weeks' gestation for collapse and general weakness. Her blood pressure was 90/60 mm Hg, pulse 112 bpm, temperature 36 degrees C. The fetal heart race tracings were stable and reactive. The cervix was opened 3 cm. Further examination revealed no vaginal bleeding and normal amnioscopic findings. An ultrasound examination confirmed singleton, head-presenting gestation without any visible congenital anomalies, amniotic fluid index was at the 50th percentile, anterior placenta without evidence of previa, abruption or retroplacental hematoma. An inhomogeneous echogenic mass, measuring 12 x 8 cm, was noted within the amniotic cavity, there was no evidence of pathological flow through the mass on color Doppler. After admittance to the hospital, the patient complained of regular pains, weakness and collapsed with signs of hemorrhagic shock. Repeated ultrasound evaluation showed no change in acoustic texture and size, but the amniotic fluid now had a hyperechoic appearance which revealed increasing intra-amniotic hemorrhage. Because of clinical signs of maternal hemorrhagic shock confirmed by laboratory findings of decreasing red blood parameters, an urgent cesarean section was performed. A female infant weighing 3,070 g, Apgar score 5/7, was delivered. After removal of the placenta there was no sign of abruption, which was confirmed at histopathology. Hemoglobin A was detected in the amniotic fluid by Abt's test. The patient had an uncomplicated postoperative course. The infant developed normally. CONCLUSION: When there are signs of fetal distress or maternal hemorrhagic shock, an urgent cesarean section should be performed.

Supracondylar fractures of the humerus in children caused by traffic.

A sample of 38 patients aged under 14 treated at the Surgery Clinic of the University Hospital Osijek has been used in showing therapeutic guidelines supported by patients' functional status after the completed treatment. The patients suffered from supracondylar fractures caused by traffic accidents and classified into three types according to Gartland. Not a single patient with neurocirculatory disturbances has been registered. The most common treatment was a conservative one while more than half of the patients with fractures from type III underwent surgery. The duration of immobilization approximated three weeks whereas patients' recovery considering their functional status has justified the choice of the treatment. However, a lot can be done in the field of prevention, which would greatly decrease the frequency of such injuries.

Morphometric analysis of the sternum.

Sternum has a great clinical significance, considering that median sternotomy is the most common surgical approach used in cardiac surgery. The aim of this study is to standardize the sternum according to size, shape and sex and to obtain ranges of the "standard sternum". The study was done on 55 male and 35 female sterna of the average age of 65. Complex morphometric analysis of breadth, length and thickness of the sterna were performed on sternal segments which were defined by costal notches. Morphometric analysis shows that the general sternum structure in the females and in the males is equal. The standard dimensions of female and male sternum were determined. Standardization according to shape suggests that there is one standard sternum shape present in more than 2/3 of analysed samples of both sexes.

Morphological classification and sexual dimorphism of hyoid bone: new approach.

Hyoid bone is a part of viscerocranium placed between the tongue root and thyroid cartilage to which it is connected by thyrohyoid membrane. Widely accepted morphological classification does not exist. Sexual dimorphism was analysed in this study and new guidelines for anatomical classification of hyoid bones based on anthropometric parameters were given. Total number of analysed bones was 70. The bones were classified into three groups: symmetrical U-type, symmetrical V-type and asymmetrical type according to the angle between greater horns and the proportion of greater horns length. In the females incidence of asymmetrical type is considerably higher than in the males, while the incidence of symmetrical V-type is lower The angle value that is on average higher in males may be the parameter indicating that in puberty hyoid bone, still not completely ossified, to some extent follows development of thyroid cartilage because of their close anatomical relation.

Atmospheric pressure as a force that fills developing bones with marrow and air.

Many theories try to explain the existence and function of paranasal sinuses. This paper is an attempt to correlate process of paranasal sinus development in human with bone pneumatization processes in animals. It is here proposed that this mechanism starts in utero and continues after birth. During endochondral development, a solid hyaline cartilage model transforms into long bones. Central chondrocytes hypertrophy and their lacunae become confluent. Dissolving of the cartilage intercellular matrix forms a primitive marrow cavity. It is soon invaded by the periostal bud. Once circulation is established in the developing bone, the dissolved hyaline matrix can be slowly washed away from the bone cavity. Circulation in the bone cavity can develop slight subatmospheric pressures, similar to negative interstitial pressures in subcutaneous tissues. The amniotic fluid conducts atmospheric pressure to the fetal body. The pressure is trying to fill enlarging bone cavities through the existing vascular openings, or to create new openings. Bone walls of developing paranasal bones are to weak to resist the pressure gradient on their walls. New openings form on the weakest spots allowing airway mucosa to form initial paranasal sinuses. The enlarging cavities of long bones that are remote from the body surface and airway also develop a slightly subatmospheric pressure that fills them with cellular elements. These elements enter bone through the feeding vessels and form bone marrow. During after birth skeletal growth, bone remodeling shapes paranasal sinuses in a process of slow evolution that do not require measurable pressure gradients. When two sinuses come in vicinity, their growth rate declines, since the remaining thin and fragile bone lamella between them does not retract anymore.

Circadian rhythm of blood leptin level in obese and non-obese people.

Leptin, an adipose tissue hormone, has circadian variations in its secretion. Aims of this study were to show how circadian rhythm depends on fat tissue distribution in obese and non-obese subjects. The research was carried out on 70 subjects (37 men and 33 women) with an average body mass index (BMI) of 25.22 kg/m2. Concentration of leptin in blood was measured at 8.30 a.m., 12.30 p.m. and 6.30 p.m. Basal leptin level correlated strongly with all isolated regions of subcutaneous fat tissue in women and obese subjects. Circadian changes of blood leptin level in non-obese people are more significant than these changes in obese people. Differences in circadian pattern of leptin secretion between obese and non-obese subjects were probably caused by enlarged volume of subcutaneous fat tissue in obese people. Lean subjects have subcutaneous fat in physiological range which allows influence of some hormones (insulin or cortizol) or food intake on leptin secretion.

Secondary abdominal appendicular pregnancy: case report.

INTRODUCTION: The case report describes a 29-year-old nulliparous woman that was admitted at the Department of Gynecology and Obstetrics of the Clinical Hospital Osijek complaining of mild abdominal pain without vaginal discharge. CASE OUTLINE: The patient's menstrual cycle was irregular, from 30-45 days. An ultrasound examination showed suspicion of an ectopic pregnancy with a betaHCG level of 1358 IU/L. Due to the presence of liquid in the pouch of Douglas the patient underwent emergency laparoscopy, which showed the presence of tumor mass between the right Fallopian tube and the appendix. These two structures associated with adhesions corresponded to secondary implantation after spontaneous tubal abortion which was confirmed by histopathologic analysis. CONCLUSION: Laparoscopy has emerged as the"gold standard"in the diagnosis and treatment of ectopic pregnancy, in this case the secondary abdominal pregnancy. From the diagnostic point of view, all women of reproductive age should be considered pregnant until proven otherwise, also keeping in mind that ectopic pregnancies can have different locations and many clinical features.

Overweight - early stage of "adipokines related cardiovascular diseases": leptin and adiponectin relation to anthropometric parametars.

AIM: Adipose tissue possess endocrine functions that include synthesis of various adipocytokines, which affect the metabolism of lipids and glucoses, development of atherosclerotic processes, and are involved in the development of hypertension and cardiovascular diseases. Body fat distribution is a significant risk factor for the development of obesity related diseases. Leptin and adiponectin are adipokines whose concentrations vary with the level of obesity. The aim of this research is to determine the relation of the changes in leptin and adiponectin concentrations in overweight persons with anthropometric parameters of the subjects. METHODS: The study included 40 adult, hypertensive subjects - divided into two groups according to sex, with the body mass index 25-30 kg/m², with regular glycemia and renal function. All subjects underwent biochemical (serum lipid, glucose and creatinine level) and anthropometric measurements. Leptin concentration was determined by radioimmunoassay, while adiponectin concentration was determined by enzyme immunoassay. RESULTS: Both leptin and adiponectin concentrations significantly correlated with the waist circumference in both groups of subjects. In male subjects, leptin concentration correlated positively with the body mass index and the hip circumference, while adiponectin concentration correlated negatively with the hip circumference. CONCLUSION: Being overweight is a condition marked by pathologically altered values of leptin concentration (increased level) and adiponectin (decreased level), that are changing as the obesity level and the waist circumference increase. It can be concluded that abdominal obesity and higher body mass index increase the risk for the development of overweight-obesity-related diseases.

Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review.

The authors describe three patients who developed massive primary postpartum hemorrhage and review the case reports. In two patients, primary postpartum hemorrhage was due to uterine atony, and in one patient it was due to atony and thrombophilia. In all three patients, excellent effect was achieved with hemorrhage reduction by a compression B-Lynch suture alone, with bimanual compression following medicamentous uterotonic therapy. B-Lynch suture is an efficient, safe, and simple method for the treatment of primary postpartum hemorrhage during cesarean section, which successfully reduces the number of urgent postpartum hysterectomies, also preserving subsequent fertility. In our opinion, the method should be included in the algorithm of primary postpartum hemorrhage management at all obstetric departments.

3D-ultrasound detection of fetal grasping of the umbilical cord and fetal outcome.

A case of persistent fetal palmar grasping of the umbilical cord in a 23-year-old primigravida is described. Palmar grasping was detected with three-dimensional ultrasound examination after cardiotocographically recorded fetal bradyarrhythmia. Because of acute fetal hypoxia, urgent Misgav-Ladach cesarean section was performed to deliver a hypotrophic female newborn, 2,120 g/43 cm, Apgar score 4/7, pH 7.29. No other pathology was found during the procedure. The postoperative course proceeded uneventfully and the early neonatal neurological status and neurosonographic findings were normal.

Iliofemoral-popliteal phlebothrombosis in twin pregnancy treated with cesarean section and thrombectomy in the same act: a case report.

A case is presented of a 39-year-old primigravida who developed iliofemoral-popliteal thrombosis in the 34th week of twin pregnancy. Thrombectomy by use of a Fogarty catheter with previous protection from thrombus embolization by proximal placement of temporary occlusion was performed at the same time as the cesarean section for completion of premature delivery.