The use of anti-TNF drugs in pregnant inflammatory bowel diseas patients

Upalna bolest crijeva je kronični upalni poremećaj koji se najčešće javlja u reproduktivnoj dobi u periodu od 15. do 30. godine života. Bolesnice se teže odlučuju na zasnivanje obitelji zbog straha od ishoda trudnoće, mogućih komplikacija zbog neželjenih utjecaja lijekova ili pojava komplikacije osnovne bolesti. Novija literatura o utjecaju bolesti i lijekova na trudnoću potvrđuje da je sigurnost trudnoće visoka, a posljedice djelovanja lijekova na plodnost, trudnoću i ishod trudnoće male. Tijek bolesti u trudnoći uvelike ovisi o aktivnosti bolesti u vrijeme začeća te se stoga savjetuje planirati trudnoću u remisiji bolesti. Potrebno je multidisciplinarno praćenje bolesnica kako bi se na vrijeme ukinuli lijekovi koji su kontraindicirani te kako bi se pažljivim praćenjem trudnoće spriječio nastanak mogućih komplikacija. Anti-TNF lijekovi za liječenje upalnih bolesti crijeva pripadaju u skupinu bioloških lijekova. Za njihovu primjenu karakteristična je visoka učinkovitost u postizanju remisije, značajan potencijal cijeljenja crijeva, ali i mogući razvoj važnih nuspojava. Kako su sve češće u primjeni, cilj ovog rada je prikaz dostupne literature o primjeni anti-TNF lijekova na plodnost, trudnoću i ishod trudnoće. Anti-TNF lijekovi smiju se primijeniti u trudnoći, ali s obzirom da se radi o monoklonskim protutijelima preporuča se u trećem trimestru trudnoće prekinuti liječenje jer postoji mogućnost placentarnog prijenosa. Kako je utjecaj anti-TNF molekula na imunosni sustav značajan, u dojenačkoj dobi, do šestog mjeseca života djeteta, ne preporuča se cijepljenje živim cjepivima.Inflammatory bowel disease is a chronic inflammatory disorder most commonly occurring in the reproductive age, in the period from 15 to 30 years of age. Female patients have a problem of family planning decision because of fear of pregnancy outcome, possible complications due to drug side-effects or complications of the underlying disease. Recent literature on the impact of diseases and drugs on pregnancy confirms that the most of drugs are safe and the effects of drugs on fertility and pregnancy outcome are positive. The course of illness during pregnancy largely depends on the disease activity at conception time and therefore is recommended to plan pregnancy in remission of the disease. Multidisciplinary monitoring of the patient is required in order to overcome the drugs that are contraindicated and to prevent possible complications during the pregnancy. Anti-TNF drugs for the treatment of inflammatory bowel diseases belong to a group of biological drugs. Anti-TNF drugs have high efficacy in achieving remission, significant potential for mucosal healing, as well as possible development of important side effects. As more and more commonly used last years, the aim of this study is to provide an overview of available anti-TNF drugs on fertility, pregnancy and pregnancy outcome. Anti-TNF drugs may be used during pregnancy, but regarding to the fact that there are monoclonal antibodies, it is recommended termination of therapy in the third trimester of pregnancy because of a possibility of placental transmission. As the effect of the anti-TNF molecule on the immune system is significant, at the infant age, up to the sixth month of the child's life, vaccination with live vaccines is not recommended

The use of anti-TNF drugs in pregnant inflammatory bowel diseas patients

Upalna bolest crijeva je kronični upalni poremećaj koji se najčešće javlja u reproduktivnoj dobi u periodu od 15. do 30. godine života. Bolesnice se teže odlučuju na zasnivanje obitelji zbog straha od ishoda trudnoće, mogućih komplikacija zbog neželjenih utjecaja lijekova ili pojava komplikacije osnovne bolesti. Novija literatura o utjecaju bolesti i lijekova na trudnoću potvrđuje da je sigurnost trudnoće visoka, a posljedice djelovanja lijekova na plodnost, trudnoću i ishod trudnoće male. Tijek bolesti u trudnoći uvelike ovisi o aktivnosti bolesti u vrijeme začeća te se stoga savjetuje planirati trudnoću u remisiji bolesti. Potrebno je multidisciplinarno praćenje bolesnica kako bi se na vrijeme ukinuli lijekovi koji su kontraindicirani te kako bi se pažljivim praćenjem trudnoće spriječio nastanak mogućih komplikacija. Anti-TNF lijekovi za liječenje upalnih bolesti crijeva pripadaju u skupinu bioloških lijekova. Za njihovu primjenu karakteristična je visoka učinkovitost u postizanju remisije, značajan potencijal cijeljenja crijeva, ali i mogući razvoj važnih nuspojava. Kako su sve češće u primjeni, cilj ovog rada je prikaz dostupne literature o primjeni anti-TNF lijekova na plodnost, trudnoću i ishod trudnoće. Anti-TNF lijekovi smiju se primijeniti u trudnoći, ali s obzirom da se radi o monoklonskim protutijelima preporuča se u trećem trimestru trudnoće prekinuti liječenje jer postoji mogućnost placentarnog prijenosa. Kako je utjecaj anti-TNF molekula na imunosni sustav značajan, u dojenačkoj dobi, do šestog mjeseca života djeteta, ne preporuča se cijepljenje živim cjepivima.Inflammatory bowel disease is a chronic inflammatory disorder most commonly occurring in the reproductive age, in the period from 15 to 30 years of age. Female patients have a problem of family planning decision because of fear of pregnancy outcome, possible complications due to drug side-effects or complications of the underlying disease. Recent literature on the impact of diseases and drugs on pregnancy confirms that the most of drugs are safe and the effects of drugs on fertility and pregnancy outcome are positive. The course of illness during pregnancy largely depends on the disease activity at conception time and therefore is recommended to plan pregnancy in remission of the disease. Multidisciplinary monitoring of the patient is required in order to overcome the drugs that are contraindicated and to prevent possible complications during the pregnancy. Anti-TNF drugs for the treatment of inflammatory bowel diseases belong to a group of biological drugs. Anti-TNF drugs have high efficacy in achieving remission, significant potential for mucosal healing, as well as possible development of important side effects. As more and more commonly used last years, the aim of this study is to provide an overview of available anti-TNF drugs on fertility, pregnancy and pregnancy outcome. Anti-TNF drugs may be used during pregnancy, but regarding to the fact that there are monoclonal antibodies, it is recommended termination of therapy in the third trimester of pregnancy because of a possibility of placental transmission. As the effect of the anti-TNF molecule on the immune system is significant, at the infant age, up to the sixth month of the child's life, vaccination with live vaccines is not recommended

Treatment of primary spontaneous pneumothorax in pediatric patients: 15-year experience at a single-institution

Background: Primary spontaneous pneumothorax (PSP) is a relatively uncommon condition in children. Due to the lack of pediatric-specific guidelines the treatment strategy varies among different centers. This study demonstrates a single-institution experience in the treatment of primary spontaneous pneumothorax in pediatric patients. Materials and methods: Retrospective review of 49 patients with the diagnosis of primary spontaneous pneumothorax between 2003 and 2018 who were treated conservatively or invasively at the surgical department of Children’s Hospital Zagreb. Results: During the period of 15 years there were 49 patients noted with spontaneous pneumothorax at the surgical department of Children’s Hospital Zagreb. The patient age ranged from 11 to 18 years (mean 15.28). 36 patients were male and 13 female, with a male to female ratio of 2.77:1. Pneumothorax occurred on the left side in 31 patients, on the right side in 15 patients, and on both sides in 3 patients. Clinical presentation in all patients was sudden, powerful chest pain. Other symptoms include dyspnea, cough. In all patients, a plain x-ray was made, and later the vast majority of patients underwent computed tomography (CT) scan. The CT scans detected 13 cases of apical bullae, 2 large bullae, 1 bulla in 6. segment and 1 parenchymal inflammation. Eight patients with stable clinical presentation and small pneumothorax underwent hospital observation. Eighteen patients were successfully managed with chest tube drainage without recurrence. Video-assisted thoracoscopic surgery (VATS) was performed on 19 patients with only two recurrences. Open thoracotomy was performed on 4 patients. Conclusion: Due to the variation of diagnostic and therapeutic approaches from different centers, the creation of guidelines and standardized practice for the pediatric patient is necessary

Malignant transformation of germ cell tumor with teratomatous component into advanced retroperitoneal sarcoma - case report and literature review

Background: A late-relapse germ cell tumor (GCT) might contain malignant non-germ cell tumor cells, known as „somatic-type malignancy” (SM). Development of secondary SM is extremely rare and occurs in only 1% of patients with GCT. Case study: We present the case of a 42-year-old patient who developed retroperitoneal tumor with duodenal and right colon involvement 6 years after he underwent left orchidectomy for stage IIC mixed GCT (95% seminoma, 5% teratoma). Since the tumor markers for germline tumor were normal, another type of tumor was highly suspected, most likely a malignant alteration of the residual teratoma. Tumor was completely removed and pathological report suggested undifferentiated sarcoma. Conclusion: R0 resection and postoperative patient follow-up by the protocol for at least 6 years after orhidectomy is the key to successful treatment of GCT. Malignant tumor transformations are rare, but still possible so clinicians should be aware of the importance of frequent and adequate patient monitoring

Knowledge and attitudes about undescended testicles – the need for an educational approach

Cilj: S obzirom na loše pokazatelje dobi orhidopeksije za kongenitalnu skupinu nespuštenih testisa, cilj ovoga rada bio je istražiti znanja i stavove specijalizanata/mladih specijalista pedijatrije, obiteljske i školske medicine o navedenoj problematici jer upravo su oni, u većini slučajeva prvi kojima se roditelji obraćaju za pomoć i mišljenje. Metode: Znanje i stavovi specijalizanata i mladih specijalista ispitani su pomoću anonimnog online upitnika, temeljenog na najno- vijim spoznajama i smjernicama. Prikupljanje podataka provedeno je putem besplatnog programa Google Forms®. Kako bismo utvrdili odstupaju li dobiveni odgovori od odgovora koje bismo očekivali pod određenom hipotezom, odgovori su uspoređivani korištenjem hi-kvadrat testa uz razinu statističke značajnosti od 5%. Rezultati: Upitnik je ispunilo 129 specijalizanata/mladih specijalista, od kojih većina smatra kako za vrijeme studiranja i specijalistič- kog usavršavanja nisu dovoljno čuli i naučili o nespuštenim testisima, kako svoje znanje o problematici nespuštenih testisa smatraju nezadovoljavajućim te kako se u dosadašnjoj karijeri nisu susreli sa smjernicama koje govore o dijagnostici i liječenju nespuštenih testisa. Odgovori na većinu pitanja, koja su se temeljila na najnovijim smjernicama, bili su nezadovoljavajući. Gotovo 2/3 ispitanika smatra kako se o dječacima s nespuštenim testisima u Republici Hrvatskoj ne vodi pravodobna briga i liječenje, a 1/3 ispitanika ključni problem vidi u primarnim pedijatrima, obiteljskim liječnicima te u timovima školske medicine. Zaključci: S obzirom na dobro poznate posljedice nepravodobnog liječenja nespuštenih testisa u dječaka, rezultatima analize anke- te kojima ne možemo biti zadovoljni potrebno je ozbiljno pristupiti. Stoga potičemo buduće edukativne intervencije, utemeljene na dokazima, koje će za cilj imati bolju informiranost o problematici nespuštenih testisa i u konačnici vremenski pomak samih orhido- peksija k ranijoj dobi.Objective: Considering the poor indicators relating to the age group undergoing orchidopexy for the congenital group with undescended testicles, the objective of this article is to investigate the knowledge and attitudes of residents and young specialists in the fi eld of pediatrics, family, and school medicine concerning the above-mentioned issue, given that these specialists are, in most cases, the fi rst from whom parents contact seek help and opinion. Methods: The knowledge and attitudes of residents and young specialists were examined using an anonymous online questionnaire, based on the latest knowledge and guidelines. Data collection was carried out using the free Google Forms® program. To determine whether the obtained answers deviate from the answers expected under a certain hypothesis, the answers were compared using the chi-square test with a statistical signifi cance level of 5%. Results: The questionnaire was fi lled out by 129 residents and young specialists, most of whom believe that, during their studies and specialist training, they had not heard and learned enough about undescended testicles, and they considered their knowledge about the problem of undescended testicles to be unsatisfactory, and they had not encountered guidelines in their career detailing the diagnosis and treatment of undescended testicles. The answers to most of the questions were unsatisfactory based on the latest guidelines. Almost two-thirds of the respondents believe that boys with undescended testicles in the Republic of Croatia are not cared for and treated on time, and one-third of the respondents see the key problem in primary pediatricians, family doctors, and school-age medical teams. Conclusions: Considering the well-known consequences of untimely treatment of undescended testicles in boys, the results of the survey analysis, which we cannot be satisfi ed with, must be approached seriously. Therefore, we encourage future evidence-based educational interventions to provide better information about the problem of undescended testicles and ultimately shift the timing of orchidopexies to an earlier age

Endoscopic treatment of primary vesicoureteral reflux at Zagreb Children’s Hospital

Cilj ovog članka je dati pregledni prikaz endoskopskog liječenja primarnog vezikoureteralnog refluksa u djece, u razdoblju od 2012.do 2013. godine, koja su liječena u Klinici za dječju kirurgiju Klinike za dječje bolesti Zagreb.Metode: Kratkom presječnom retrospektivnom analizom obradili smo ukupno 66-ero bolesnika koji su endoskopski liječeni na Klinici zbog primarnog VUR-a. Rezultat se smatrao zadovoljavajućim ako su dijagnostički nalazi upućivali na odsutnost VUR-a ili ako je od posljednjeg zahvata prošlo više od dvije godine bez recidiva.Rezultati: Od ukupnog broja uretera 96,5% je uspješno izliječeno endoskopskim načinom liječenja, 3,5% nije bilo izliječeno. Nakon prvog endoskopskog zahvata izliječeno je 50,9%, nakon drugog postotak raste na 75,4%, a nakon trećeg zahvata na 92,1%, a postotakod 96,5% postignut je četvrtim zahvatom kod probranih bolesnika. Kod 3,5% uretera učinjena je otvorena antirefluksna plastika prema Lich-Gregoiru. Zaključci: Endoskopski način liječenja zbog svog visokog postotka učinkovitosti, brzog oporavka i kratkog boravka u bolnici, ima prednost pred ostalim metodama liječenja, pa je zato postao novi zlatni standard u liječenju VUR-a.Objective: The aim of this paper is to give a preview of primary vesicoureteral reflux (VUR) endoscopic treatment at Department ofPaediatric Surgery, Zagreb Children’s Hospital, in 2012 and 2013.Methods: Sixty-six patients having undergone endoscopic procedure for primary VUR were retrospectively analysed in this shortcross-sectional study. The outcome was deemed satisfactory in the absence of VUR as indicated by diagnostic methods or 2-yearpostprocedural relapse-free period.Results: Endoscopic procedure proved successful in 96.5% and unsuccessful in 3.5% of cases; 50.9% of all patients were successfullytreated in the first procedure, and this percentage increased to 75.4%,92.1% and 96.5% after the second, third and fourth procedurein selected patients, respectively; an open surgical procedure was required in 3.5% of cases. Our procedure of choice is Lich-Gregoirtechnique.Conclusion: Advantages of endoscopic treatment in comparison to other modalities are high-percentage success, faster recovery,and shorter hospital stay, therefore it has become the new gold standard of VUR treatment

The use of anti-TNF drugs in pregnant inflammatory bowel diseas patients

Upalna bolest crijeva je kronični upalni poremećaj koji se najčešće javlja u reproduktivnoj dobi u periodu od 15. do 30. godine života. Bolesnice se teže odlučuju na zasnivanje obitelji zbog straha od ishoda trudnoće, mogućih komplikacija zbog neželjenih utjecaja lijekova ili pojava komplikacije osnovne bolesti. Novija literatura o utjecaju bolesti i lijekova na trudnoću potvrđuje da je sigurnost trudnoće visoka, a posljedice djelovanja lijekova na plodnost, trudnoću i ishod trudnoće male. Tijek bolesti u trudnoći uvelike ovisi o aktivnosti bolesti u vrijeme začeća te se stoga savjetuje planirati trudnoću u remisiji bolesti. Potrebno je multidisciplinarno praćenje bolesnica kako bi se na vrijeme ukinuli lijekovi koji su kontraindicirani te kako bi se pažljivim praćenjem trudnoće spriječio nastanak mogućih komplikacija. Anti-TNF lijekovi za liječenje upalnih bolesti crijeva pripadaju u skupinu bioloških lijekova. Za njihovu primjenu karakteristična je visoka učinkovitost u postizanju remisije, značajan potencijal cijeljenja crijeva, ali i mogući razvoj važnih nuspojava. Kako su sve češće u primjeni, cilj ovog rada je prikaz dostupne literature o primjeni anti-TNF lijekova na plodnost, trudnoću i ishod trudnoće. Anti-TNF lijekovi smiju se primijeniti u trudnoći, ali s obzirom da se radi o monoklonskim protutijelima preporuča se u trećem trimestru trudnoće prekinuti liječenje jer postoji mogućnost placentarnog prijenosa. Kako je utjecaj anti-TNF molekula na imunosni sustav značajan, u dojenačkoj dobi, do šestog mjeseca života djeteta, ne preporuča se cijepljenje živim cjepivima.Inflammatory bowel disease is a chronic inflammatory disorder most commonly occurring in the reproductive age, in the period from 15 to 30 years of age. Female patients have a problem of family planning decision because of fear of pregnancy outcome, possible complications due to drug side-effects or complications of the underlying disease. Recent literature on the impact of diseases and drugs on pregnancy confirms that the most of drugs are safe and the effects of drugs on fertility and pregnancy outcome are positive. The course of illness during pregnancy largely depends on the disease activity at conception time and therefore is recommended to plan pregnancy in remission of the disease. Multidisciplinary monitoring of the patient is required in order to overcome the drugs that are contraindicated and to prevent possible complications during the pregnancy. Anti-TNF drugs for the treatment of inflammatory bowel diseases belong to a group of biological drugs. Anti-TNF drugs have high efficacy in achieving remission, significant potential for mucosal healing, as well as possible development of important side effects. As more and more commonly used last years, the aim of this study is to provide an overview of available anti-TNF drugs on fertility, pregnancy and pregnancy outcome. Anti-TNF drugs may be used during pregnancy, but regarding to the fact that there are monoclonal antibodies, it is recommended termination of therapy in the third trimester of pregnancy because of a possibility of placental transmission. As the effect of the anti-TNF molecule on the immune system is significant, at the infant age, up to the sixth month of the child's life, vaccination with live vaccines is not recommended