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Human echinococcosis remains a significant medical issue in endemic areas. Hydatid cysts can rupture, which is the most severe complication of echinococcosis as it can cause anaphylactic reaction and seeding of secondary cysts. Traditionally, hydatid cysts were evacuated by open surgical procedure in order to remove the entire cyst or by unroofing method, with evacuation of the cyst content. Recently, an increasing number of such operations are performed using laparoscopic approach. This study was prospectively conducted in a 5-year period, from 2004-2008. Altogether, 25 surgically treated patients were included in this study. Clinical examination, specific serological test, abdominal ultrasound and computed tomography were used for establishing diagnosis. Open surgery was initially performed in 17 patients and laparoscopic in 8. Three of those 8 patients required conversion to open surgery. Open pericystectomy was performed in 11 patients and laparoscopic pericystectomy in 3 patients. Open partial pericystectomy according to Papadimitriou was performed in 9 patients with hydatid cyst and laparoscopic partial pericistectomy in 2 patients. Our experience indicates that in the case of liver hydatid cyst disease, laparoscopic exploration, and if possible, laparoscopic pericystectomy or partial pericystectomy, should be performed in selected patients.

Metabolic syndrome (MS), a constellation of metabolic risk factors associated with development of cardiovascular diseases and Type 2 diabetes (T2D), has emerged as a public health problem of enormous proportions in developed and developing countries. We have reported previously its prevalence in several island populations of the Eastern Adriatic coast of Croatia. In spite of leading a relatively traditional life style pattern including adherence to a Mediterranean diet, the prevalence of MS in these populations is high and comparable to that in developed nations. However, data on prevalence of MS among the mainland Croatian populations is limited. Therefore, we conducted a study in an outbred population comprising of Croats, Hungarians and Serbs from the Baranja region of mainland Croatia. Although this is an ethnically heterogeneous population, the constituent groups exchange mates and therefore, are not reproductively isolated. The life style patterns are also similar. Overall prevalence of MS, assessed by the National Cholesterol Education Program (NCEP) criteria, is 40% (35% in males and 42% in females) with Body Mass Index (BMI) as the predictor of obesity and 42% (52% in males and 39% in females) with Waist Hip Ratio (WHR) as the predictor of obesity. It is likely that, in addition to genetic risk factors, a host of environmental factors that include dietary habits and relatively urban life style in a modernized society have influenced the levels of the constituent metabolic traits leading to an increased prevalence of MS.

Metabolic parameters were determined in fasting blood serum, fasting first morning urine, and 24-hour urine of male patients with recurrent calcium oxalate stones (N = 26, age 39.1 +/- 6.2 years) as well as in male healthy controls (N = 18, age 35.0 +/- 7.1 years), recruited from the eastern part of Croatia. The 24-hour urinary calcium excretion was significantly higher (p < 0.01) for patients (5.6 +/- 2.5 mmol) than for controls (3.7 +/- 1.9 mmol), but potassium excretion was higher (p < 0.01) for controls (74.5 +/- 33.8 mmol) than for patients (49.2 +/- 15.7 mmol). The mean ionic activity product of calcium and oxalate ions, IAP(CaOx), calculated from the fasting first morning urine parameters, was 25% higher for patients than for controls, but the difference was not statistically significant (p > 0.05). Very strong correlation (r = 0.97) was obtained between IAP(CaOx) values and calculated Ogawa indices that were recommended for estimating the potential risk for calcium oxalate stone formation.

This report describes the clinical value of transrectal prostate biopsy during which 12 biopsy cores are taken in comparison to the classical sextant method. There were 106 patients included in the study, who had transrectal prostate biopsy (TRB) due to abnormal finding after digitorectal examination (DRE) and/or values of PSA > 4 ng/ml in the period from 4 October 2001 till 14 August 2002. There were 117 biopsies with 12 biopsy cores taken, 6 cores from each lobe. Prostate cancer was confirmed in 49 patients (46%). Out of total number of confirmed cancer cases, initial biopsy detected 94%. There were three patients who had suspicious DRE finding, with PSA value of < 4 ng/ml, but cancer was not detected in any of them. In the patient group with PSA value between 4-10 ng/ml, cancer was detected in 26% of them and in the group with PSA value > 10 ng/ml cancer was detected in 58%. The most common Gleason score in the case of cancer was 7 (43%). During the biopsy procedure, 3 patients experienced strong vasovagal reactions, meaning that out of 117 biopsies incidence of complications was 2.6%. Few days after the biopsy, two patients developed urogenital tract infections (1.7%) and right after the procedure, there was one case of strong hematuria (0.8%) and strong rectal bleeding (0,8%) that needed hospitalization. Our results regarding the incidence of complications do not differ much from the results in the literature. According to data in the literature regarding sextant biopsy, 15-34% of cancer cases remain undiagnosed at initial biopsy. The method of 12 biopsy cores fails to diagnose only 6% of all cancers, but it is important to note that in the mentioned period, re-biopsy was indicated only in 11 from 60 patients with negative biopsies.

Extracorporeal shock wave lithotripsy (ESWL) treatment has been used at Department of Urology, University Hospital "Osijek", Croatia, since July 1988. Until December 2001 seven thousand and eight hundred patients underwent ESWL for urinary stones, 68 of them were children (0.87%). Sixty-eight children aged 4 to 15 years (average 10.14 years) underwent ESWL. They were treated for the total of 91 stones: 35 (38.46%) caliceal, 23 (25.27%) in pyelon, 7 (7.69%) in pyeloureteric segment and 14 (15.38%) ureteral. Staghorn calculi were found in 6 (6.59%) patients and multiple stones (four or more stones in the same kidney) in 6 (6.59%). There was total of 95 ESWL sessions performed in 68 patients (1.39 session per patient). Fifty-six patients (82.35%) without residual stones found at the control plain film and sonography of urinary tract were considered "stone free". Addition of 5 patients with clinically insignificant residual fragments (less than 4 mm) increases overall success rate to 89.70%. ESWL is a simple, safe and effective procedure in the management of urolithiasis in childhood. Clinical experience of our institution confirms ESWL as the first line treatment for kidney stones in the pediatric age patients.

The aim of this study was to confirm the role of screening by determining the percentage of clinically localized prostate cancer (stage A and B) in patients with prostate cancer detected on screening and in those presenting to urologic clinic for the symptoms of urination impairment or ostalgia. During the study, 1,000 men aged > or = 50 from the community of Cepin and village of Josipovac near Osijek were examined. The subjects with elevated concentration of total prostate specific antigen and/or digital rectal examination suspect of carcinoma underwent transperineal biopsy of the prostate. Clinical staging was performed in patients with prostate cancer detected on screening, and data on clinical staging for prostate cancer patients treated during the 1996-1997 period were retrieved from patient files of the Department of Urology, University Hospital "Osijek". On screening, 28 (80%) patients with localized prostate cancer and seven (20%) patients with metastases were detected. In the group of patients examined on an outpatient basis for the signs and symptoms of prostatism, there were 30 (83.4%) patients with metastases and only six (16.6%) patients with localized prostate cancer. Study results indicated that an early diagnosis of prostate cancer could be made by use of noninvasive and inexpensive methods that cause no major discomfort to the patient. Accordingly, these results appear to strongly support such screening in men, if not in all those aged over 50, then at least in the otherwise healthy, 50-70 age group.

This study compares the value of digital rectal examination (DRE) and prostate specific antigen (PSA) determination in the detection of prostate cancer. 1,000 men aged > or = 50 from the Osijek surroundings were examined. The subjects with prostatitis were excluded from the study. The subjects with elevated concentration of total prostate specific antigen and/or digital rectal examination suspect of carcinoma underwent prostate biopsy. The rate of prostate cancer detection showed to be 3.3% for PSA > 4 ng/ml, 2% for abnormal finding of DRE, and 3.7% for combination of the two methods. Out of 35 patients with prostate cancer detected, 19 had suspect DRE finding and 32 had PSA exceeding 4 ng/ml. Thus, PSA pointed to the diagnosis of prostate cancer in 91.4%, and abnormal finding of DRE in 54.2% of cases, the difference being statistically significant. The positive predictive value was 48.7% for abnormal finding of DRE, 47% for PSA > 4 ng/ml, and 80.0% for the combination of both. Although PSA determination detected a considerable proportion of tumors missed on DRE, the former alone was found to be insufficient as a screening method because of its inadequate sensitivity. When combined with digital rectal examination, the probability of prostate cancer detection increased considerably.