Tumori jetre u dječjoj dobi

Liver tumors count for approximately 2% of all childhood tumors and almost 70% of them are malignant. Most of them present as palpable abdominal mass. Correct diagnosis considering type, size and localization of the tumor is crucial for the right treatment strategy. Although surgical resection still remains the most important factor for survival, when combined with chemotherapy, the survival rates will raise. Liver transplantation is also considered in some cases of liver tumors. From 1991 to 2008 we treated 13 children with liver tumors. Our experience together with the review of recent literature is presented here.Tumori jetre čine ukupno 2% svih tumora dječje dobi, a preko dvije trećine su zloćudni. Većina se prezentira kao palpabilna tvorba u abdomenu. Za odabir ispravnog plana liječenja nužno je postaviti točnu dijagnozu i odrediti stupanj bolesti. Iako je kirurška resekcija i dalje najbitniji faktor prognoze, u kombinaciji s kemoterapijom postotak preživljenja značajno raste. U određenim slučajevima neresektabilnih tumora transplantacija jetre daje dobre rezultate. Od 1991. godine do 2008. liječili smo 13 djece s tumorom jetre i u ovom radu prikazujemo naše rezultate uz pregled recentne literature

The Role of Fruit Drinks in Daily Diet of Some Osijek Inhabitants, Croatia

The aim of the study was to assess the role of fruit drinks in daily diet of Osijek inhabitants. A special questionnaire was administered to 199 patients visiting a family physician’s office during December 2003. The concentration of vitamin C (L-ascorbic acid) was determined in 42 commercially available fruit drinks. Only 11% (22/199) of study subjects did not take fruit drinks. The mean concentration of vitamin C in all samples was 150.10166.83 mg/L. The questionnaire revealed that 89% (177/199) of study subjects using fruit drinks were taking a mean of 0.4 L of fruit drink per day, yielding a mean of 60.04 mg of vitamin C, i.e. 100% of the recommended daily allowance of 60 mg. Study results indicated fruit drinks to be a significant source of vitamin C in daily diet, however, great variation in vitamin C intake according to socioeconomic status of study subjects and type of fruit drink should be noted

Praćenje metaboličkog profila i kvalitete ovčjeg mlijeka tijekom laktacije u ekološkoj proizvodnji

The aim of this research was to monitor the metabolic profile of blood and the quality of ewes’ milk during lactation in organic farming. Biological investigations were carried out on 32 clinically healthy Merinolandschaf ewes during the 3th lactation on the 20th, 60th and 100th day of lactation. Ewes’ milk was analyzed for the non fat dry matter, milk fat, protein, lactose, urea, the somatic cells count (SCC) and te total viable cell number (CFU), as well as for the concentration of fatty acids, atherogenic (AI), thrombogenic (TI) and Δ9-desaturase activity index. Concentrations of minerals (Ca-calcium, P-phosphorus-inorganic, Mg-magnesium, and Fe-iron), biochemical parameters (urea, glucose, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, total protein, albumin, globulin, NEFA-non-esterified fatty acids, BHBA-beta-hydroxybutyrate) and enzyme activity (ALT-alanine aminotransferase, AST-aspartate aminotransferase, ALP-alkaline phosphatase, CK-creatine kinase and GGT-γ-glutamyl transferase) were analyzed in blood serum. Chemical composition of milk differed among different stages of lactation, which was marked by the increased content of milk fat, the decreased urea concentration, as well as by numeorus changes of fatty acid concentration observed along with lactation progression. Number of SCC and CFU in milk increased during lactation. AT and TI were appropriate in all stages of lactation, which resulted in satisfactory quality of ewes’ milk from organic farming. Determined concentrations of certain biochemical parameters (NEFA, triglycerides, VLDL-cholesterol, Ca and Fe) in blood of ewes originating from organic farming indicated lower deficit of energy during the 20th day of lactation, as well as a lack of Ca and Fe concentrations in blood, which most likely occurred due to higher loss through milk. Accordingly, the blood metabolic profile can be considered as an indicator for feeding and health status of ewes during lactation in organic farming.Cilj istraživanja bio je utvrditi metabolički profil ovaca i kvalitetu ovčjeg mlijeka tijekom laktacije u ekološkoj proizvodnji. Istraživanje je provedeno na 32 ovce Merinolandschaf pasmine u trećoj laktaciji 20., 60. i 100. dana laktacije. U mlijeku je utvrđen udjel suhe tvari bez masti, sadržaj mliječne masti, bjelančevina, laktoze, koncentracija ureje, broj somatskih stanica (SCC) i ukupan broj mikroorganizama (CFU), kao i koncentracija masnih kiselina, aterogeni (AI) i trombogeni (TI) indeksi te indeksi aktivnosti enzima Δ9-desaturaze. U serumu ovaca utvrđene su koncentracije minerala (Ca-kalcij, P-anorganski fosfor, Mg-magnezij i Fe-željezo), biokemijskih pokazatelja (urea, glukoza, kolesterol, HDL-kolesterol, LDL-kolesterol, trigliceridi, ukupne bjelančevine, albumin, globulin, NEFA-neesterificirane masne kiseline, BHBA-beta-hidroksibutirat) i aktivnosti enzima (ALT-alanin aminotransferaze, AST-aspartat aminotransferaze, ALP-alkalne fosfataze, CK-kreatin kinaze i GGT-γ-glutamil transferaze). Utvrđene su značajne razlike u kemijskom sastavu mlijeka, odnosno povećanje udjela mliječne masti i smanjenje koncentracije ureje, kao i promjene masnokiselinskog sastava mlijeka s napredovanjem laktacije. Broj somatskih stanica i ukupan broj mikroorganizama u mlijeku su rasli s napredovanjem laktacije. Osim toga, vrijednosti AI i TI bile su odgovarajuće u svim stadijima laktacije, što je rezultiralo povoljnoj kvaliteti ovčjeg mlijeka iz ekološke proizvodnje. Utvrđene koncentracije pojedinih biokemijskih pokazatelja (NEFA, triglicerida, VLDL kolesterola, Ca i Fe) u krvi ovaca u ekološkoj proizvodnji ukazuju na slabiju opskrbljenost energijom 20. dana laktacije, kao i smanjenje koncentracije Ca i Fe u krvi, zbog njihovog izlučivanja mlijekom. Prema navedenome, metabolički profil se može koristiti kao pokazatelj hranidbenog i zdravstvenog statusa ovaca u laktaciji u ekološkoj proizvodnji

Abdominal aortic thrombosis in a healthy neonate

Abdominal aortic thrombosis is a rare entity in neonates and has mostly been associated with umbilical artery or cardiac catheterization. We present a complicated case of an otherwise healthy neonate who developed thrombosis of abdominal aorta with renal failure. Therapy with intravenous heparin was unsuccessful, and thrombolysis was contraindicated because of disseminated intravascular coagulation so we decided to perform open thrombectomy using the left retroperitoneal approach. The following day, thrombosis recurred in the same extent and despite high risk of bleeding Alteplase was eventually given, which resulted in recanalization of the aorta 6 hours later. Renal function recovered, dialysis was discontinued, and further course was uneventful. The treatment of abdominal aortic thrombosis in neonates should be considered on a case-by-case basis because the available data on the condition are limited to case report and series. If open thrombectomy is performed, retroperitoneal approach should be preferred because it allows for easy institution of peritoneal dialysis should the need arise

Quality of communication at the Division of Pediatric Surgery, Zagreb University Hospital Center

Istraživanje je provedeno kako bi se ispitalo zadovoljstvo i utvrdilo iskustvo roditelja hospitalizirane djece s različitim aspektima komunikacije s medicinskim osobljem za vrijeme bolničkog liječenja. U istraživanju je sudjelovalo osamdeset pet roditelja djece hospitalizirane na Zavodu za dječju kirurgiju i urologiju Klinike za kirurgiju KBC Zagreb. Za potrebe istraživanja primijenjen je prilagođeni „Upitnik o iskustvima roditelja djece s teškoćama u razvoju u komunikaciji s medicinskim osobljem“. Upitnik su ispunjavali roditelji na dan djetetova otpusta iz bolnice. Roditelji medicinsko osoblje najčešće ocjenjuju kao profesionalno, ljubazno i empatično. Informacije koje su dobili u razgovoru bile su im razumljive, a to su provjerili liječnici. Najviše informacija dobili su o djetetovom trenutnom stanju i o tijeku i postupcima liječenja. Svi roditelji smatraju važnim da na Zavodu postoji stručna osoba koja pruža psihosocijalnu potporu. Najveći broj ispitanih roditelja izjavio je da su im od medicnskog osoblja najveću potporu pružili liječnik i medicinske sestre. Na pitanje o zadovoljstvu s komunikacijom s medicinskim osobljem općenito, većina ispitanika izjasnila se kao vrlo zadovoljni (75% ih je vrlo zadovoljno s komunikacijom s liječnikom, 82% ih je vrlo zadovoljno s komunikacijom s medicinskim sestrama). Odnos medicinskog osoblja i obitelji važan je u procesu liječenja djece i adolescenata. Primjerena komunikacija medicinskog osoblja i roditelja umanjuje stres roditelja zbog bolesti i liječenja i unapređuje tijek i rezultate liječenja.The study was designed to assess the level of parental satisfaction and experience with diff erent aspects of communication with medical personnel during hospitalization of their children. The study included eighty-fi ve parents of children hospitalized at the Division of Pediatric Surgery and Urology, Department of Surgery, Zagreb University Hospital Center in Zagreb. On the day of discharge from the hospital, the parents voluntarily fi lled in the specially designed questionnaire. In most cases, parents rated medical personnel as professional, kind and sympathetic. They understood information provided by medical personnel and physicians made sure that the parents fully understood what had been communicated to them. Most of the given information was about the current medical condition of the child, and the course and procedures of treatment. All participating parents consider professional psychosocial support as an important asset on the ward. Regarding the support given by medical personnel, most parents stated that it was provided by both the physician and the nurse. When asked to rate their satisfaction with communication with medical personnel in general, the majority of parents stated that they were very satisfi ed (75% very satisfi ed with communication with physicians and 82% very satisfi ed with communication with nurses). In conclusion, the relationship between medical personnel and patient family is important in the process of the child and adolescent treatment. Appropriate communication between medical personnel and parents reduces the parents’ stress caused by their children sickness and treatment and improves the course and outcome of treatment

SURGICAL TREATMENT OF THYROID GLAND DISEASES IN CHILDHOOD – OUR RESULTS

Bolesti štitne žlijezde jedna su od najčešćih endokrinopatija u djece. Većina njih uspješno se liječi konzervativnom terapijom, no u određenim slučajevima potrebno je kirurško liječenje. Odluka o kirurškom liječenju rezultat je suradnje pedijatra endokrinologa i kirurga, ovisi o prirodi bolesti, a opseg kirurškog zahvata o patološkoanatomskim promjenama u žlijezdi. Prikazani su rezultati kirurškog liječenja 41 djeteta provedenog u Zavodu od 1991. do 2009. godine te današnja stajališta u kirurškom liječenju djece s različitim bolestima štitne žlijezde.Thyroid gland diseases are the most common endocrinopathies in children. Vast majority of these conditions are treated with medical therapy but in individualised cases surgery is indicated. Decision about surgical treatment is made in cooperation of pediatric endocrinologist and surgeon, treatment options depend on the nature of the disease while the extent of surgical procedure is determined by the pathological changes present in the gland. In this paper we represent the results of surgical treatment of 41 children at our department from 1991 to 2009 and current trends in surgical treatement of thyroid gland disease

Rijetka lokalizacija neuroblastoma u zdjelici

Neuroblastom je najčešći ekstrakranijalni maligni solidni tumor kod djece koji se većinom pojavljuje u trbuhu (nadbubrežna žlijezda, simpatički lanac) i medijastinumu, dok su druge lokacije rijetke. Tumor se liječi kirurški, kemoterapijom i radioterapijom. U ovom članku prikazan je rijedak slučaj neuroblastoma sakralnog pleksusa u zdjelici 9-mjesečnog ženskog dojenčeta sa širenjem u desni ishijadični i opturatorni kanal. Učinjena je ekstirpacija tumora s paraaortalnom i ilijakalnom limfadenektomijom, dok je manji dio tumora zaostao u opturatornom otvoru jer bi pokušaj potpunog odstranjenja nosio visok rizik od neurološkog oštećenja. Pokušaj potpunog odstranjenja tumorskog tkiva nije preporučiv jer nosi visok rizik od znatnih neuroloških oštećenja, a ne poboljšava preživljenje

FRONTAL, AXILLARY AND TYMPANIC TEMPERATURE MEASUREMENTS IN CHILDREN

Svrha ovoga prospektivnog istraživanja, provedenog u jednom istraživačkom centru, bila je usporediti vrijednosti tjelesne temperature izmjerene dvjema metodama: standardnim staklenim termometrom u aksilarnoj regiji i infracrvenim temperaturama timpanične i frontalne regije u afebrilne djece. Studija obuhvaća 345-ero afebrilne djece životne dobi od 4 do 16 godina, koja su radi elektivnog zahvata boravila na odjelu dječje kirurgije. Temperature su mjerene u 1000 navrata simultano aksilarno, u slušnom kanalu i frontalno. Koristili smo se dvama različitim infracrvenim termometrima; jednom vrstom za timpaničnu, drugom za frontalnu temperaturu. Aksilarna temperatura definirana je kao standard i mjerena je klasičnim staklenim termometrom. Svaki je pacijent bio izložen konstantnoj temperaturi okoliša minimalno 10 minuta prije simultanog mjerenja temperatura. Prosječna frontalna temperatura bila je 36,9 ± 0,38 °C i jednaka je aksilarnoj tempera­turi, 36,9 ± 0,16 °C. Prosječna timpanična temperatura bila je 36,3 ± 0,98 °C. Srednja je razlika timpanične i aksilarne temperature –0,4 °C. Izmjereni niz timpaničnih temperatura u skupini naših ispitanika ima trostruko veću disperziju nego frontalni niz i pet puta veću nego aksilarne temperature. Aksilarne temperature, mjerene klasičnim staklenim termometrom, imaju najmanju disperziju izmjerenih vrijednosti, slijede frontalne temperature mjerene infracrvenim termometrom, a najmanje su pouzdane izmjerene timpanične temperature.The purpose of this study was to compare the results of body temperature measurements obtained by standard axillary thermometers with the results of infrared tympanic and frontal skin thermometry in afebrile children. This study comprises a single-center, prospective comparison trial. A total of 345 afebrile children aged 4 to 16 years hospitalized in the pediatric surgery department for elective surgery were included. One thousand axillary, tympanic and frontal measurements were obtained and compared. We used two different infrared thermometers in this study; one type measured the tympanic temperature, the other the temperature on the forehead. The axillary temperature measured with the glass thermometer was set as the standard. Each patient was exposed to a constant environmental temperature for a minimum of 10 min before simultaneous temperature measurements. The mean frontal temperature 36.9± 0.38 °C was equal to the axillary temperature 36.9± 0.16 °C. The mean tympanic temperature was 36.3 ± 0.98 °C. The mean difference between the tympanic and axillary temperatures was –0.4 °C. The tympanic temperature had a threefold greater dispersion than frontal and a fivefold greater dispersion than axillary temperature. The results of this study suggest that the axillary temperature measured with glass thermometer has the least dispersion. Somewhat less reliable is the frontal temperature measured with infrared thermometer. The least reliable is tympanic temperature measurement