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SPID (SPeckle Imaging by Deconvolution) is a new speckle camera currently under construction at CRAL-Observatoire de Lyon (FRANCE). Its high spectral resolution and high image restoration capabilities open new astrophysical programs. The instrument SPID is composed of four main optical modules which are fully automated and computer controlled by a software written in Tcl/Tk/Tix and C. This software provides an intelligent assistance to the user by choosing observational parameters as a function of atmospheric parameters, computed in real time, and the desired restored image quality. Data acquisition is made by a photon-counting detector (CP40). A VME-based computer under OS9 controls the detector and stocks the data. The intelligent system runs under Linux on a PC. A slave PC under DOS commands the motors. These 3 computers communicate through an Ethernet network. SPID can be considered as a precursor for VLT's (Very Large Telescope, four 8-meter telescopes currently built in Chile by European Southern Observatory) very high spatial resolution camera.

Prostate cancer is now recognized as one of the most important medical problems in male population. Epigenetic regulation of gene expression by promoter methylation and histone acetylation, proinflammatory enzyme cyclooxygenase-2 and somatic mutations in a variety of genes with diverse biological functions has been implicated in prostate cancer development and progression.

Respecting the informed consent and its implementation is one of the fundamental components of high-quality health care. This article discusses the informed consent with an overview of Croatian and international legal documents and scientific studies dealing with this issue. Based on the review of the literature it can be concluded that this is an important issue that contains several key components that should be observed and investigated. It is necessary to evaluate the purposefulness and quality of the implementation of the informed consent, to systematically examine respect of the patients' right to information regarding the medical procedure during treatment, to explore decision-making model in the physician-patient encounter in Croatian hospitals, to determine the content and amount of information shared between physicians and patients, to determine the content and readability of consent forms and written patient information on the medical procedure. In order to assure higher quality of the implementation of the informed consent it is necessary to define by law a list of medical procedures that require written consent and to uniform consent forms for the same medical procedures country-wide.

Purpose: To test whether D-mannose powder is effective for recurrent urinary tract infection (UTI) prevention., Materials and Methods: After initial antibiotic treatment of acute cystitis, 308 women with history of recurrent UTI and no other significant comorbidities were randomly allocated to three groups. The first group (n = 103) received prophylaxis with 2 g of D-mannose powder in 200 ml of water daily for 6 months, the second (n = 103) received 50 mg Nitrofurantoin daily, and the third (n = 102) did not receive prophylaxis., Results: Overall 98 patients (31.8%) had recurrent UTI: 15 (14.6) in the D-mannose group, 21 (20.4) in Nitrofurantoin group, and 62 (60.8) in no prophylaxis group, with the rate significantly higher in no prophylaxis group compared to active groups (P < 0.001). Patients in D-mannose group and Nitrofurantoin group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients in no prophylaxis group (RR 0.239 and 0.335, P < 0.0001). In active groups, 17.9% of patients reported side effects but they were mild and did not require stopping the prophylaxis. Patients in D-mannose group had a significantly lower risk of side effects compared to patients in Nitrofurantoin group (RR 0.276, P < 0.0001), but the clinical importance of this finding is low because Nitrofurantoin was well tolerated., Conclusions: In our study, D-mannose powder had significantly reduced the risk of recurrent UTI which was no different than in Nitrofurantoin group. More studies will be needed to validate the results of this study, but initial findings show that D-mannose may be useful for UTI prevention.

Primary melanoma of the glans or male urethra is a rare malignant tumor with high mortality. We searched PubMed and found 129 articles reporting on 220 patients. All articles were case reports or case series. Median patient age was 65 years. Median survival was 28 months, with 5-year survival in approximately 10%. All patients who survived over 5 years had a localized disease (stage I/A) with invasion depth <3-3.5 mm. Wide local excision with sentinel lymph node biopsy is the treatment of choice for patients with localized disease. For advanced disease, the prognosis is poor., (Copyright © 2014 Elsevier Inc. All rights reserved.)

A 59-year-old male was admitted to hospital for clinical and radiological signs of large bowel obstruction with clinical signs of generalized peritonitis. As such, he was scheduled to undergo emergency exploratory laparotomy. During preoperative preparation, over 2000 mL of urine was obtained after catheterization. We suggested re-evaluation, and after several hours the symptoms resolved. Although rare, pressure from the distended bladder due to urinary retention can cause complete bowel obstruction and signs of peritonitis. If a large volume of urine is obtained during preoperative preparation for mechanical bowel obstruction, it is recommended to re-evaluate the patient to avoid unnecessary surgery and imaging studies.

The purpose of the article is to present the differential diagnostic criteria between pneumobilia (air in the biliary system) and portal vein gas on abdominal x-ray. Differential diagnosis is essential because of its influence on patient management. Two patients are presented, one with pneumobilia and the other with portal vein gas on abdominal x-ray, with review of the relevant literature. Pneumobilia is often iatrogenic and even in cases of cholecystitis it is never a sole indication for emergency surgery. Patients with pneumobilia on abdominal x-ray can always be investigated further. On the other hand, the presence of air in portal vein is in most cases a sign of acute mesenteric ischemia. In adults with abdominal pain indicating intestinal ischemia (pain that is 'out of proportion' to clinical abdominal examination findings), it is an indication for emergency exploratory laparotomy. It is vital to act early when intestinal ischemia is suspected.

Primary melanoma of the female urethra is a very rare malignant tumor with high mortality. Due to its rarity, there are no guidelines and recommendations on the diagnosis and treatment of such patients, so we aimed to review the reported cases and case series, their treatment, and outcome. We searched through PubMed for all articles reporting on female urethral melanoma. We found 73 articles (case reports and case series) reporting on 112 patients. There are no clinical trials on the topic due to the rarity of the condition. Median patient age at presentation is 68 years. Due to the late presentation, the prognosis of the disease is poor, and median survival is 16 months, with 5-year survival in around 10 % (12 reported patients). Regarding treatment, most authors use either less radical approach (partial or total urethrectomy) or radical approach (anterior pelvic exenteration). We found no evidence that either of the treatment modalities results with higher survival. In local excision, there are indications that margins less than 2-2.5 cm result in high percentage of local recurrence suggesting that resection width should be at least 2.5 cm. For localized urethral melanoma, local resection with margins of 2.5 cm can be recommended and there is no foundation to support radical surgery in such patients. Chemotherapy and immunotherapy can also recommend. For locally advanced disease, the prognosis is poor, and radical surgery will not improve survival significantly.

Operations undertaken for inguinal hernia repair are the most common elective surgical procedures. According to the current guidelines, Lichtenstein's tension-free method is the gold standard for elective hernia operations. The most common types of implanted mesh are polypropylene and composite mesh. We herein present Lichtenstein's operation using a biological hemostatic mesh (Tachosil) used for transversalis fascia reinforcement, and our results after a 3-year follow-up period for 52 patients implanted with Tachosil mesh are reported. According to our results, the biological mesh can be safely implanted during hernia repair with the same recurrence rate and lower postoperative pain and complications compared to hernia repair with polypropylene mesh implantation.

Stapled hemorrhoidectomy (SH) and Ligasure hemorrhoidectomy (LH) are standard for hemorrhoidal disease treatment, but the surgical principle is different. This randomized clinical trial compared the 2 methods. We included 98 patients with grade 3 hemorrhoidal disease: 46 patients treated by SH and 52 patients by LH. Incidence of complications, recurrence, postoperative pain, wound healing time, and time off everyday activity were observed. The follow-up period was 24 months. We found that LH has a significantly shorter wound healing time. The recurrence rate and the overall postoperative complication rate was higher after SH but not significantly (recurrence LH vs. SH: 1.9% vs. 11.1%; complications LH vs. SH: 13.5% vs. 23.9%). Postoperative pain level, analgesic consumption, and time off everyday activity were practically the same in both groups. Both procedures can be used to treat grade 3 hemorrhoidal disease with the same efficacy, but analysis of recurrence after SH is necessary.

Introduction: Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area with high mortality., Materials and Methods: A retrospective review included 41 patients diagnosed with FG in our hospitals from 1995 to 2010, divided into survivors and nonsurvivors. We analyzed anamnestic, clinical and laboratory data., Results: The mortality rate was 36.6% (15/41 patients). Elevated heart and respiratory rates, high serum creatinine, low serum bicarbonate, pre-existing kidney disease, and higher median extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension below 90 mm Hg were also predictive for higher mortality. The median FG severity index (FGSI) score was higher in nonsurvivors (11 compared to 6, p < 0.0001). No cases of testicular necrosis were noted., Conclusion: Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were also positively associated with mortality., (Copyright © 2012 S. Karger AG, Basel.)

Long-acting synthetic luteinising hormone-releasing hormone agonists have become the mainstay for androgen-deprivation therapy, because they avoid the physical and psychological discomfort associated with orchidectomy and lack the potential cardiotoxicity associated with estrogens such as diethylstilbestrol. Currently available luteinising hormone-releasing hormone agonist analogues include leuprolide, goserelin, triptorelin, degarelix and buserelin were administered as either intramuscular or subcutaneous depot injections on a 1, 2, 3 or 6 months basis. Histrelin acetate is the first long-acting luteinising hormone-releasing hormone agonist available as a once-yearly subcutaneous implant.

Studies were identified on internet by searching on address: http://www.ncbi.nlm.nih.gov/pubmed/ with criteria that studies should be placebo-controlled and randomized in trials of alpha-blockers in chronic category III prostatitis evaluated by symptom-score NIH-CPSI. From 13 clinical studies three were excluded because of not using NIH-CPSI, three were in Chinese language and two were congress abstracts. Analysed were five studies with four or five Jadad scale including 563 patients. Alpha-blockers alfuzosin, terazosin, tamsulosin and doxazosin have been used through 6 weeks and 6 months. Better results were accomplished by less selective alpha-blockers alfuzosin, terazosin and doxazosin through 3-6 months in patients having higher NIH-CPSI score and higher voiding score.

A 12-year-old girl was admitted for abdominal pain and signs of acute kidney injury. Physical examination showed abdominal distension and a tumefaction in the lower abdomen. Laboratory and clinical findings were consistent with acute kidney injury. Abdominal ultrasonography showed an oval mass, which corresponded with hematometrocolpos, and right-sided hydronephrosis. Catheterization followed by cruciate hymenectomy was performed. The patient recovered completely. Imperforate hymen is an obstructive anomaly of the female reproductive tract of unknown etiology that can cause a variety of symptoms. It is a rare, but possible cause of acute kidney injury. Patient history data and genital examination findings are sufficient to establish the diagnosis. Abdominal ultrasonography is the most useful diagnostic modality.

Objective: Retained surgical gauze left inside the patient during a surgical procedure is called textiloma or gossypiboma. Most often found in abdominal and pelvic cavities, retained gauze can cause a variety of symptoms, including fever, palpable mass and pain. Symptoms depend on the location (and possible migration) of the retained gauze and local tissue reaction (inflammatory or aseptic)., Design: Case report., Setting and Patients: We present a case of a patient with lumbar pain and constipation caused by surgical gauze mimicking a tumor, which was retained from previous abdominal surgery performed almost 40 years prior., Measures: We discuss the diagnosis, treatment and prevention of retained surgical gauze., Conclusion: Retained surgical gauze occurrences are not as rare as they are widely considered to be, and clinicians should be aware of that. In reality, retained gauze can be extremely difficult to diagnose, especially if a patient presents after a very long asymptomatic period., (Wiley Periodicals, Inc.)

Objective: To compare the efficacy of 4 dosage regimens of cetrorelix pamoate, a sustained release formulation that allows for more convenient dosing, in patients with symptomatic benign prostatic hyperplasia (BPH). Repeated dosing with cetrorelix acetate was shown to be active in the treatment of BPH symptoms., Methods: Double-blind, randomized, multicenter study was undertaken among patients with International Prostate Symptom Score (IPSS) ≥ 13. After a single-blind placebo run-in phase of 4 weeks, treatment was administered at 2-week intervals as follows: 30 + 30 mg, 30 + 30 + 30 mg, 60 + 30, 60 + 60 mg cetrorelix pamoate, or matching placebo. Patients were followed-up for 28 weeks after randomization., Results: A statistically significant overall difference was found with respect to the primary variable, the IPSS (P ≤ .001). Optimal results, a 4-point improvement in IPSS in excess of the changes observed in the placebo group, were achieved with a starting dose of 60 mg cetrorelix pamoate followed by a dose of 30 mg 2 weeks later. In all dosage groups, the symptomatic improvement was paralleled by an increase in uroflow. There was a marked dissociation between only moderate and transient testosterone suppression and the persisting effects on BPH signs and symptoms. Tolerability was good at all cetrorelix dosages., Conclusions: Intramuscular injections of 60 and 30 mg of cetrorelix pamoate within 2 weeks provide rapid symptomatic improvements of BPH that are sustained for the following 6 months., (Copyright © 2010. Published by Elsevier Inc.)

Corresponding to its importance in cell count homeostasis in the body, apoptosis is a tightly regulated phenomenon. Both extracellular and intracellular molecules provide multiple regulatory and counter-regulatory pathways. Cell death is usually a response to the cell microenvironment, where the absence of certain factors (survival factors) or the presence of lethal factors promotes apoptosis. Surrounding cells, soluble mediators and the extracellular matrix regulate cell death and survival. Surrounding cells can synthesize survival or lethal factors. The intracellular regulation of apoptosis is also one of the forefront fields in biomedicine research. During the past five years, tremendous progress has been made in understanding apoptosis as a result of molecular identification of the key components of this intracellular suicide program. Biochemical activation of these key components of the cell death program is responsible for the morphological changes observed in apoptosis, including mitochondrial damage, nuclear membrane breakdown, DNA fragmentation, chromatin condensation and the formation of apoptotic bodies. Caspase activation plays a central role in the execution of apoptosis. Most caspases are constitutively expressed as inactive proenzymes (procaspases) in the cytosol and according to some reports in the mitohondria. Caspases are sequentially activated by proteolysis during apoptosis. In this review, we focus on the biochemical pathways that control caspase activation, particularly the activation pathways that are initiated by cell surface death receptors and mitochondria.

Catheterization remains the standard management of acute urinary retention (AUR), followed by a trial without catheter (TWOC) or prostatectomy in men who do not void spontaneously. If AUR is caused by increased sympathetic activity at the level of the prostatic smooth muscles, alpha-blockers (alpha-1 adrenoreceptor antagonists) should increase the likelihood of a successful trial without catheter (TWOC) following AUR. Alpha-blockers effectively reduce the symptoms associated with benign prostatic hyperplasia (BPH) and improve the urodynamic parameters of obstruction. They may diminish the incidence of AUR and the need for prostatectomy in symptomatic men. The adventage of tamsulosin and slow-release alfuzosin over doxazosin and terazosin in the management of AUR is that a therapeutic dose can be administered at the onset of AUR, thereby reducing the time for attempting catheter removal.

The aim of treatment for benign prostatic hyperplasia is relieving lower urinary tract symptoms, desreasing bladder outlet obstruction, improving bladder emptying, ameliorating detrusor instability, reversing renal insufficiency, and preventing future episodes of gross hematuria, urinary tract infection and urinary retention. A potent role of medical therapy is to prevent the development and/or progression of benign prostatic hyperplasia. Medical therapies investigated for benign prostatic hyperplasia include plant extracts, alpha adrenergic blockers and 5-alpha-reductase inhibitors. Clinical observations suggest that the efficacy of combination therapy could be superior to that of individual monotherapies.

With the widespread use of non-invasive diagnostic tools, such as abodminal ultrasound and computerized tomography, renal cysts are diagnosed with increasing frequency. In patients 50 years or older, simple renal cysts of various size may be found in nearly one third. Increasing frequency with age is clearly demonstrated. Two thirds of simple renal cysts are 2 cm or less in diameter. The average renal cyst needs about 10 years to reach 2 cm in size. Simple renal cysts (category I according to Bosniak classification) usually are asymptomatic, produce no harm to the kidney and require no treatment once diagnosed. However, an occasional eypanding cyst causes progressive obstruction to caliceal and pelvic outflow. There is a possible association between renal cysts and arterial hypertension. Renal cysts may produce segmental renal ischemia, and in turn activate the renin angiotensin system. Percutaneous cyst aspiration or surgical cyst removal could cause a fall in blood pressure. Bosniak suggested a classification in an attempt to sort out the different cases into nonsurgical (category I and II), and surgical ones (category III and IV). Borderline between cystic lesions type II and III is not clear-cut, but Bosniak type IV lesions are clearly cystic renal cell carcinoma.