Varaždin, Croatia
Varaždin, Croatia

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PubMed | General Hospital Varazdin, Institute for Medical Research and Occupational Health and University of Zagreb
Type: Journal Article | Journal: Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering | Year: 2016

In an effort to improve local bladder cancer control, we investigated the cytotoxic and genotoxic effects of quercetin on human bladder cancer T24 cells. The cytotoxic effect of quercetin against T24 cells was examined by MTT test, clonogenic assay as well as DNA damaging effect by comet assay. In addition, the cytotoxic effect of quercetin on the primary culture of papillary urothelial carcinoma (PUC), histopathological stage T1 of low- or high-grade tumours, was investigated. Our analysis demonstrated a high correlation between reduced number of colony and cell viability and an increase in DNA damage of T24 cells incubated with quercetin at doses of 1 and 50 M during short term incubation (2h). At all exposure times (24, 48 and 72h), the efficacy of quercetin, administered at a 10 higher dose compared to T24 cells, was statistically significant (P < 0.05) for the primary culture of PUC. In conclusion, our study suggests that quercetin could inhibit cell proliferation and colony formation of human bladder cancer cells by inducing DNA damage and that quercetin may be an effective chemopreventive and chemotherapeutic agent for papillary urothelial bladder cancer after transurethral resection.


PubMed | General hospital Varazdin, Primary Health Care Center Zagreb East, University of Zagreb and Clinical Hospital Center Rijeka
Type: Journal Article | Journal: Biochemia medica | Year: 2016

We hypothesized that extravascular body fluid (EBF) analysis in Croatia is not harmonized and aimed to investigate preanalytical, analytical and postanalytical procedures used in EBF analysis in order to identify key aspects that should be addressed in future harmonization attempts.An anonymous online survey created to explore laboratory testing of EBF was sent to secondary, tertiary and private health care Medical Biochemistry Laboratories (MBLs) in Croatia. Statements were designed to address preanalytical, analytical and postanalytical procedures of cerebrospinal, pleural, peritoneal (ascites), pericardial, seminal, synovial, amniotic fluid and sweat. Participants were asked to declare the strength of agreement with proposed statements using a Likert scale. Mean scores for corresponding separate statements divided according to health care setting were calculated and compared.The survey response rate was 0.64 (58 / 90). None of the participating private MBLs declared to analyse EBF. We report a mean score of 3.45 obtained for all statements evaluated. Deviations from desirable procedures were demonstrated in all EBF testing phases. Minor differences in procedures used for EBF analysis comparing secondary and tertiary health care MBLs were found. The lowest scores were obtained for statements regarding quality control procedures in EBF analysis, participation in proficiency testing programmes and provision of interpretative comments on EBFs test reports.Although good laboratory EBF practice is present in Croatia, procedures for EBF analysis should be further harmonized to improve the quality of EBF testing and patient safety.


Darabos N.,University of Zagreb | Haspl M.,Special Hospital for Orthopaedics and Traumatology Akromion | Moser C.,Witten/Herdecke University | Darabos A.,General Hospital Varazdin | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011

Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-β1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS. Methods In a prospective, randomized, double-blinded, placebo-controlled trial with two parallel groups, 62 patients were treated. Bone tunnel width was measured by CT scans, while clinical efficacy was assessed by patientadministered outcome instruments (WOMAC, IKDC 2000) up to 1 year following the ACL reconstruction in patients receiving either ACS (Group A) or placebo (Group B). We compared the levels and dynamics of IL-1β concentrations in the synovial liquid and examined the correlation between the levels of IL-1β at three different postoperative points. Results Bone tunnel enlargement was significantly less (6 months: 8%, 12 months: 13%) in Group A than in Group B (6 months: 31%, 12 months: 38%). Clinical outcomes (WOMAC, IKDC 2000) were consistently better in patients treated with ACS at all data points and for all outcome parameters, and there were statistically significant differences in the WOMAC stiffness subscale after 1 year. The decrease in IL-1β synovial fluid concentration was more pronounced in the ACS group, and values were lower, to a statistically significant degree, in the ACS group at day 10. Conclusion The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery. Level of evidence Therapeutic study, Randomized controlled trial (significant differences and narrow confidence intervals), Level I. © Springer-Verlag 2011.


Trkulja V.,University of Zagreb | Car S.,General Hospital Varazdin
Croatian Medical Journal | Year: 2012

Aim To evaluate the prognostic value of serum uric acid (SUA) in acute myocardial infarction (AMI) patients. Methods Systematic review and random-effects metaanalysis of prognostic studies assessing AMI outcomes (death, major adverse cardiac events, MACE) in relation to on-admission SUA. Results Nine studies (7655 patients) were identified, 6 in the ST-segment elevation AMI patients treated with invasive revascularization and three in mixed AMI type cohorts with variable reperfusion strategies. "High" SUA (vs "low," different cut-offs) was univariately associated with higher short-term mortality (8 studies/6805 patients; odds ratio [OR], 3.24; 95% confidence interval [CI], 2.47-4.27) and incidence of MACE (7/6467; OR, 2.46; 95% CI, 1.84-3.27, moderate heterogeneity, mild bias), and with higher medium-term mortality (5/5194; OR, 2.69; 95% CI, 2.00-3.62, moderate heterogeneity, mild bias) and MACE (4/4299; OR, 1.93; 95% CI, 1.36-2.74, high heterogeneity, mild bias). It was independently associated with a higher short-term (4/3625; OR, 2.26, 95% CI, 1.85-2.77) and medium/longterm (3/2683; hazard ratio [HR], 1.30; 95% CI 1.01-1.68, moderate heterogeneity, mild bias) occurrence of poor outcomes (death/MACE). As a continuous variable (by 50 μmol/L), higher SUA was also independently associated with poorer medium/long-term outcomes (4/3533; HR, 1.19; 95% CI, 1.03-1.37, high heterogeneity, mild bias). All individual study effects (unadjusted or adjusted) were in the same direction, but differed in size. Heterogeneity was mainly due to the included AMI type and/or definition of MACE. All bias-corrected pooled effects remained significant. Conclusion Based on the available data, high(er) on-admission SUA independently predicts worse short-term and medium/long-term outcomes after AMI. However, the number of data are modest and additional prospective studies are warranted.


Darabos N.,University of Zagreb | Trsek D.,Special Hospital Akromion | Miklic D.,University of Zagreb | Darabos A.,General Hospital Varazdin | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2014

Purpose: A common consequence of anterior cruciate ligament (ACL) reconstruction is tibial bone tunnel widening. Bone resorption may be indicative for an undesired inflammatory process. The authors hypothesized that double-bundle ACL reconstruction in combination with intra-articular injection of anti-inflammatory autologous conditioned serum (ACS) may lead to improved clinical and radiological outcomes of surgery.Methods: In a clinical trial, 62 patients were treated, divided into two parallel groups. The authors compared tibial bone tunnel width after ACL reconstruction by CT scan at three post-operative time points. Group I: double-bundle ACS; group II: double-bundle placebo. Clinical outcome was assessed by IKDC 2000 and Lysholm scores before and following ACL reconstruction.Results: Increase in bone tunnel width for both tibial bone tunnels d1 and d2 was significantly smaller in group I (d1: 0.6 ± 0.6 mm; d2: 0.5 ± 0.5 mm) compared with group II (d1: 2.6 ± 0.7 mm; d2: 3.0 ± 0.7 mm) at all times of follow-up (p values <0.001). By IKDC (84.7 ± 13.2 vs 61.1 ± 25.5) and Lysholm score (93.2 ± 3.3 vs 66.1 ± 11.8), group I had statistically significant better clinical outcomes compared with group II at 12 months post-surgery (p values <0.001).Conclusion: A combination of anatomical double-bundle ACL reconstruction plus biological augmentation with ACS inhibits bone tunnel widening, improves clinical outcome at 12 months, and may have potential to improve the long-term results of ACL reconstruction.Level of evidence: I. © 2014 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)


Lodeta B.,General Hospital Varazdin | Benko G.,General Hospital Varazdin | Trkulja V.,University of Zagreb
Urologia Internationalis | Year: 2013

Objective: To compare two 12-core transrectal ultrasound-guided prostate biopsy schemes in respect to cancer detection rates. Methods: Retrospective, single-center analysis of consecutive patients (n = 897) who underwent prostate biopsy (S1) with all 12 cores from far lateral areas (n = 269) or prostate biopsy (S2) with 6 cores from parasagittal and 6 from far lateral areas (n = 628). Results: Crude cancer detection rates with S1 and S2 were similar (39.0 and 38.9% for the first biopsy and 29.4 and 31.3% for repeated biopsies, respectively). Abnormal digital rectal exam, lower prostate volume and higher prostate-specific antigen (PSA) levels were independently associated with higher odds of cancer detection. Regarding first biopsies (n = 747), there was significant interaction between biopsy scheme and PSA (p < 0.001). Overall, the adjusted odds of cancer detection were higher with S1 (S1/S2 odds ratio = 2.54, 95% CI: 1.12-5.74), but the S1-S2 relationship was conditional on PSA: odds ratios progressively increased with increasing PSA from 0.64 (95% CI: 0.40-1.02) at PSA 5 ng/ml to 39.1 (95% CI: 2.71-566) at 75 ng/ml. Conclusion: Higher PSA levels increase the probability of cancer detection with 12-core prostate biopsies, but relative efficiency of different procedures appeared conditional on the PSA level. Data suggest that PSA levels should be considered in the choice of prostate biopsy sampling scheme. Copyright © 2013 S. Karger AG, Basel.


Lodeta B.,General Hospital Varazdin | Lodeta M.,Special Hospital for Medical Rehabilitation
Korean Journal of Urology | Year: 2012

Purpose: The primary objective was to assess whether transrectal ultrasound (TRUS)-guided prostate biopsy in the left lateral decubitus (LLD) position differed from the procedure in the lithotomy position regarding patients' pain perception. The secondary objective was to assess the analgesic effect of intrarectal 2% lidocaine gel in this setting. Materials and Methods: This single-center, open-label trial enrolled 148 men undergoing prostate biopsy. Then men were randomly assigned to group 1 (LLD position, no lidocaine, n=50, "test"), group 2 (lithotomy position+lidocaine, n=50, "positive control"), and group 3 (lithotomy position, no lidocaine, n=48, "negative control"). Twelve-core samples were taken in each biopsy set. Pain was assessed by using a 10-point visual analogue scale (VAS). Results: Across the groups, patients were comparable regarding age, prostate-specific antigen levels, prostate volume, digital rectal examination findings, and pathohistological diagnosis. VAS scores were lower in group 1 (median, 2.95) than in group 2 (median, 4.95; p<0.001) or group 3 (median, 4.60; <0.001). The difference between group 2 and group 3 was insignificant (p=0.268). The adjusted mean differences (with adjustment for the above covariates) were as follows: group 1 vs. group 2, -1.43 (95% confidence interval [CI]: -2.25 to -0.60; p<0.001); group 1 vs. group 3, -1.22 (95% CI: -2.04 to -0.41; p=0.001); group 2 vs. group 3, 0.20 (95% CI, -0.63 to 1.04; p=0.836); and group 1 vs. groups 2 and 3, -1.33 (95% CI, -1.92 to -0.73; p<0.001). The procedure was comparably well tolerated across the groups. Conclusions: Pain perception during prostate biopsy was lower in the LLD position than in the lithotomy position. Intrarectal 2% lidocaine gel does not seem to affect pain perception. © The Korean Urological Association, 2012.


Hirs I.,General Hospital Varazdin | Grbcic P.,General Hospital Varazdin
Korean Journal of Anesthesiology | Year: 2012

A seventeen-year-old pregnant woman with a mesencephalic tumor and ventriculoperitoneal (VP) drainage was admitted to the hospital at full term pregnancy to give birth. Elective cesarean section was performed because of her prime disease (mesencephalic tumor), breech position of the baby, gestational diabetes and expected weight of the baby of more than 4 kg. The operation was performed under spinal anesthesia. Spinal block was performed smoothly, using a pencil point spinal needle 27 G, at the L3-L4 intervertebral space, with hyperbaric bupivacaine 8 mg plus fentanyl 15 μg. Sensory block Th 5 was reached within 5 minutes. The patient was hemodynamically stabile during the anesthesia and the procedure was uneventful. The woman developed no neurologic symptoms, and a healthy female child was born. This is the first case of a pregnant woman with a cerebral tumor and VP drainage on whom a successful delivery was performed with C-section under spinal anesthesia. © the Korean Society of Anesthesiologists, 2012.


PubMed | General Hospital Varazdin and Educational Institute of Emergency Medicine of City of Zagreb
Type: Journal Article | Journal: Medical archives (Sarajevo, Bosnia and Herzegovina) | Year: 2016

Colonic perforation is a clinical condition which occurs due to variety of reasons, such as intrinsic disorders of the intestine, extrinsic causes, but also due to presence of foreign bodies. Foreign objects enter gastrointestinal tract by oral or transanal introduction.we present an uncommon case of a 26- year-old tetraplegic male, whose death was a consequence of a widespread purulent peritonitis provoked by colonic perforation inflicted by an unusual foreign body, transanally introduced 28 centimeters long zucchini (Cucurbita pepo L.).we share our experience in order to emphasize the importance of consideration and early recognition of foreign body presence in the alimentary tract as possible diagnosis.


PubMed | General Hospital Varazdin, Paracelsus Medical University and Univerzitetni Klinicni Center
Type: Journal Article | Journal: International journal of molecular sciences | Year: 2016

We explored whether clot density in middle cerebral artery (MCA) occlusion is related to clinical variables, stroke etiology, blood constituents, and prestroke medication. We performed a retrospective chart review of patients with acute ischemic stroke of the anterior circulation admitted to two Central European stroke centers. The acquisition of non-contrast enhanced CT (NECT) and CT angiography (CTA) within 4.5 h of symptom onset was obligatory. We assessed the site of MCA occlusion as well as density, area, and length of the clot in 150 patients. The Hounsfield unit values for the clot were divided with contralateral MCA segment to yield relative Hounsfield Unit ratio (rHU). The site of the vessel occlusion (M1 vs. M2) and antiplatelet usage, but not stroke etiology, significantly influenced rHU. We found an inverse correlation of rHU with erythrocyte count (p < 0.001). The multivariate analysis revealed that a higher rHU (i.e., clot being more hyperdense) was more likely with the use of antiplatelets (OR 4.24, CI 1.10-16.31, p = 0.036). Erythrocyte (OR 0.18, CI 0.05-0.55, p = 0.003), and thrombocyte counts (OR 0.99, CI 0.98-0.99, p = 0.029) were associated with odds for more hypodense clots (lower rHU). Our study disclosed that antiplatelet therapy impacts the composition of intracranial clots of the anterior circulation.

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