Iva Bacak Kocman

Prostate cancer is responsible for the largest number of cancer-related deaths in male population in many countries of the world. Aggressive forms of the disease are associated with an increased risk of local recurrence and death. Treatment of high-risk local prostate cancer most commonly involves radical prostatectomy (RP) or external beam radiation therapy (EBRT) combined with androgen deprivation therapy (ADT) with or without the addition of brachytherapy (BT). The use of surgery for high risk prostatic carcinoma (HRPC) is on the rise, because of its advantages including the possibility of cure with surgery alone without the risk of toxicities from prolonged ADT, accurate staging, and avoiding the influence of PSA originating from benign prostatic hyperplasia on future therapy. Oligometastatic prostate cancer may be considered as the last border of possibly curable disease. Radical prostatectomy in oligometastatic prostate cancer can significantly decrease the risk of local complications but only multimodal approach in selected group of patients may offer opportunities to eradicate tumor or delay its progression. Surgery for oligometastatic disease most commonly targets lymphatic disease with salvage pelvic lymph node dissection, whereas it rarely targets distant metastases. Further prospective, randomized studies are necessary to define the role and value of therapies in oligometastatic prostate cancer.

The increasing number of possible recipients for kidney transplantation and relatively unchanged number of organ donors has led to consideration of alternative strategies and expansion of deceased donor criteria in order to expand donor pool. Previously, kidneys from expanded criteria donors (ECD) were strongly underestimated because of the conventional opinion suggesting these kidneys to have a higher rate of preservation injury, delayed graft function, rejection and nonfunction. Reducing the difference between graft outcome in patients transplanted from ECD and standard criteria donor (SCD) is one of the goals of many respectable kidney transplantation centers. This assignment includes major concern about reduction of cold ischemia time, recipient selection, novel and adapted immunosuppressive regimens, increased nephron mass by dual kidney transplantation, and using histologic criteria for marginal donor graft selection. There are not many reports on the outcome of kidneys transplanted from donors with acute renal failure and high terminal creatinine. This review presents the exact definition of marginal donor, especially donor with acute renal failure. The management of such grafts during preimplantation and implantation period, outcomes and post-transplantation care are the main assignments for transplantation teams. Recipients of such grafts should be well informed about the possibilities and potential complications and sign their informed consent thereafter. Some respectable studies have shown that under certain, highly controlled conditions, these kidneys can be used safely, with excellent short- and long-term outcomes.

Inhibitori kalcijneurina imaju ključnu ulogu u imunosupresivnoj terapiji moderne transplantacijske medicine. Prikazujemo naša iskustva u primjeni takrolimusa u imunosupresivnoj terapiji kao i razloge zamjene takrolimusa ciklosporinom u nekih bolesnika. Pratili smo funkciju presatka, lipidogram, vrijednost šećera u krvi prije i nakon prevođenja sa ciklosporina na takrolimus. Najčešći uzrok zamjene imunosupresivne terapije bila je hiperglikemija ovisna o inzulinu, nefrotoksičnost inhibitora kalcijneurina bila je razlog zamjene imunosupresivne terapije u manjeg broja bolesnika, dok je u jednog od njih razlog zamjene imunosupresiva u terapiji bila infekcija BK virusom. Uvođenjem ciklosporina u terapiju ubrzo je došlo do normalizacije šećera u krvi. Praćenjem laboratorijskih nalaza prije zamjene takrolimusa ciklosporinom i nakon zamjene, funkcija presatka je ostala nepromijenjena.

Background and Purpose: Unilateral spinal anaetshesia restricts the distrubution of spinal block preferentially to the operative side. Intrathecal coadministration of opioids increases sensory block without enhancing motor or sympathetic block. In this study we compared unilateral hyperbaric bupivacaine spinal anaesthesia with or without fentanyl in patients undergoing varicose vein surgery. Material and Methods: 40 ASA I-II adults randomly received unilateral spinal anaestehsia with hyperbaric bupivacaine 7.5 mg (Group B, n=20) or hyperbaric bupivacaine 5 mg+ fentanyl 25mg (Group BF, n=20). Sensory and motor block, hemodynamic data and side-effects were recorded. Results: Maximum level of sensory block on operative leg was Th11 (Th12-Th8) in Group B and Th12 (Th12-Th10) in Group BF, P=0.09. Complete motor block had 12 (60%) Group B and 4 (20%) Group BF patients, P=0.02. Total regression of motor block required 127 ± 31 min in Group B and 87 ± 18 min in Group BF, P<0.001. Maximum...

The increasing number of possible recipients for kidney transplantation and relatively unchanged number of organ donors has led to consideration of alternative strategies and expansion of deceased donor criteria in order to expand donor pool. Previously, kidneys from expanded criteria donors (ECD) were strongly underestimated because of the conventional opinion suggesting these kidneys to have a higher rate of preservation injury, delayed graft function, rejection and nonfunction. Reducing the difference between graft outcome in patients transplanted from ECD and standard criteria donor (SCD) is one of the goals of many respectable kidney transplantation centers. This assignment includes major concern about reduction of cold ischemia time, recipient selection, novel and adapted immunosuppressive regimens, increased nephron mass by dual kidney transplantation, and using histologic criteria for marginal donor graft selection. There are not many reports on the outcome of kidneys transp...

As an N-methyl-D-aspartate antagonist, magnesium sulfate has analgesic properties and reduces noxious input during surgery. The aim of the study was to determine the effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy. In this prospective, randomized study, 60 ASA I-II patients undergoing elective laparoscopic cholecystectomy were assigned to three groups (n = 20 each). After anesthesia induction, prior to surgical incision, patients received magnesium sulfate 5.0 mg/kg (group A), magnesium sulfate 7.5 mg/kg (group B) or saline intravenously (group C). General anesthesia was performed with the same drugs in all three groups. Postoperative pain intensities at rest, according to the visual analog scale (VAS 0-10), were evaluated at 1, 3, 6, 9 and 24 hours after surgery. According to the VAS scores, patients intravenously received metamizol 2.5 g (VAS 3-4), diclofenac 75 mg (VAS 5-7) or tramadol 1 mg/kg (VAS 8-10). ...

Anesthesia in patients with chronic kidney disease (CKD) represents a challenge for anesthesiologists and other specialists in the perioperative team. There is a high incidence of CKD among patients preoperatively, especially in elderly population. For anesthesiologists, it is an imperative to understand the pathophysiology of CKD, prevention of further kidney damage and its complications. This requires experienced anesthesiologist, careful preoperative patient assessment, recognition and modification of the potential risk factors in order to improve patient outcome. Priorities for successful prevention of kidney damage are appropriate fluid distribution peri- and intraoperatively, maintenance of euvolemia, and avoiding hypotension.

Aging is a natural process that occurs in all tissues and organs resulting in a decreasing functional capacity. Aging of the population results in an increased number of elderly patients who require replacement of renal function. Renal transplantation is the method of choice for this group of patients if they have no contraindications for immunosuppressive therapy. The lack of donors is the main obstacle for renal transplantation. However, the use of organs from elderly donors for transplantation in elderly recipients is an appropriate method of renal replacement therapy in this group of patients.

The presence of end-stage renal disease (ESRD) has been associated with profound clinical effects on hemostasis ranging from thrombosis to bleeding complications. The pathogenesis of uremic bleeding is multifactorial. It has been attributed to platelet dysfunction, the most important feature, particularly platelet-platelet and platelet-vessel wall interactions. Renal replacement therapy has helped reduce bleeding episodes, but the risk of morbidity and mortality due to hemorrhage persists. Abnormalities of blood coagulation and fibrinolysis predispose uremic patients to hypercoagulable state carrying the risk of atherosclerotic cardiovascular disease and thrombotic complications such as thrombosis of the vascular access wall. There are differences in the measurement of various hemostatic parameters in patients with ESRD concerning treatment with either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Hemostatic disturbances are overlapped by changes in the coag...

Calcineurin inhibitors play the key role in current immunosuppressive therapy in transplantation medicine. We present our experience with tacrolimus as immunosuppressive therapy and the reasons for replacing tacrolimus with cyclosporine in some patients. We monitored graft function, serum lipid levels, and blood glucose concentration before and after immunosuppressant switch. The most common reason for change of immunosuppressive therapy was insulin dependent hyperglycemia; calcineurin inhibitor nephrotoxicity was the reason for switching immunosuppressive therapy in a small number of patients; and in one patient, the reason for immunosuppressive therapy switching was BK virus infection. Blood glucose normalized soon after the introduction of cyclosporine in the treatment. Monitoring of laboratory tests before and after immunosuppressive therapy switching showed the graft function to have remained unchanged.