26 research outputs found
CistiÄni limfangiom mezenterija jejunuma koji oponaÅ”a akutni apendicitis: prikaz sluÄaja
Cystic lymphangiomas of the small bowel mesentery are rare manifestations of intra-abdominal tumors. Usually, they are discovered incidentally during examination for an unrelated abdominal illness. We present a case of a 4-year-old boy who was admitted to our hospital because of the right lower quadrant acute abdominal pain suspect of acute appendicitis. At laparotomy, a giant, cystic, encapsulated and lipomatous mesenterial mass was found, 15x15x10 cm in size, infiltrating the jejunum. The tumor was located 70 cm from Treitzās ligament. Extirpation of tumor mass with intestinal resection of the involved loops was necessary. Pathologic examination confirmed the diagnosis of mesenteric cystic lymphangioma. Although they are rare, cystic mesenteric lymphangiomas should be considered as a possible cause of acute abdomen and treated with surgical resection. Prognosis after surgical removal is excellent.CistiÄni limfangiomi mezenterija tankog crijeva pripadaju rijetkim intraabdominalnim tumorima. ObiÄno se naÄu sluÄajno tijekom obrade zbog neodreÄene trbuÅ”ne boli. Prikazuje se sluÄaj ÄetverogodiÅ”njeg djeÄaka hospitaliziranog zbog bolova u donjem desnom abdominalnom kvadrantu sumnjivih na akutnu upalu crvuljka. Nakon uÄinjene laparotomije naÅ”la se velika, cistiÄna, inkapsulirana, lipomatozna mezenterijska masa veliÄine 15x15x10 cm koja je infiltrirala jejunum. Tumor je bio smjeÅ”ten oko 70 cm aboralno od Treitzova ligamenta. UÄinjena je ekstirpacija tumora s infiltriranom jejunalnom vijugom. PatohistoloÅ”ki nalaz je potvrdio dijagnozu mezenterijskog cistiÄnog limfangioma. Iako rijetki, cistiÄni mezenterijski limfangiomi se mogu smatrati moguÄim uzrokom akutne abdominalne boli i lijeÄiti kirurÅ”kom resekcijom. Prognoza je nakon kirurÅ”kog odstranjenja odliÄna
A 3-Year Experience of a Minimally Invasive Technique for Correction of Pectus Excavatum in Croatia
The aim of this study was to assess the early results of a three-year experience with the minimally invasive correction of pectum excavatum, which reguires no cartilage incision or excision, and no sternal osteotomy. Since 2001 we have performed 35 minimally invasive pectus excavatum procedures at our hospital. A convex steel bar is inserted under the sternum through small bilateral incisions, and removed after 2 years when permanent remolding had occurs, the bar is removed. Complications were pneumothorax in 5 patients (only 1 required a thoracostomy tube, the other 4 resolved spontaneously), pneumonia in 3 patients, and bar displacement in 1 patient. The mean follow-up was 3 months to 3 years. Initial excellent results were maintained in 28 patients (normal postoperative chest), good results in 5 patients (mild residual pectus) and poor in 2 patients (severe recurrence requiring further treatment). Poor results occurred because the steel bar was too soft in 1 patient, and the sternum too soft in 1 patient with Marfanās syndrome. Our early results with the minimally invesive technique without cartilage incision and resection or sternal osteotomy showed that the procedure is effective with excellent preliminary results
Coloanal anastomosis in the treatment of congenital megacolon in children: case report
Kongenitalni megakolon ili Hirschprungovu bolest prvi put je opisao Harold Hirschprung. To je uroÄena crijevna aganglioza kao
rezultat poremeÄaja u fetalnom razvoju mienteriÄkog živÄanog sustava. Normalan motilitet crijeva ovisi o koordiniranim segmentalnim
kontrakcijskim valovima koji slijede neposredno nakon opuÅ”tanja glatkih miÅ”iÄa. Bolesnicima s Hirschprungovom boleÅ”Äu
nedostaje funkcionalni mienteriÄki živÄani sustav u zahvaÄenom distalnom crijevu pa imaju nedjelotvornu distalnu peristaltiku.
KliniÄki rezultat je neuspjeÅ”no pasiranje mekonija ubrzo nakon roÄenja, zatvor, distendiran trbuh, palpabilne vijuge crijeva,
povraÄanje, proljevaste vodenaste stolice, slabo napredovanje tjelesne mase, spor rast i malapsorpcija. Aganglionarni distalni segment
crijeva je razlog dilatacije proksimalnog dijela debelog crijeva ili nesposobnosti otvaranja analnog sfi nkternog sustava. Hirschprungova
bolest zahvaÄa izmeÄu 1:5 000 do 1:8 000 živoroÄene djece. VeÄina sluÄajeva dijagnosticira se prije 10. godine života. Bolesnici
se povremeno prezentiraju ovim tegobama u kasnijoj dobi. Nedavno smo operirali 12-godiŔnjeg bolesnika s ovim stanjem.
Najprije smo izveli kirurŔku resekciju rektosigmoidnog kolona sa zatvaranjem bataljka rektuma i formiranjem kolostome, Hartmannov
zahvat. Tri mjeseca nakon toga obavili smo ekstirpaciju rektuma i formirali koloanalnu anastomozu. Postoperativni tijek, stanje
bolesnika i kliniÄki testovi pokazali su da je ovakav naÄin lijeÄenja kongenitalnog megakolona bio uspjeÅ”an, Å”to je bila i svrha ovog
prikaza bolesnika.Congenital megacolon or Hirschsprungās disease was fi rst described by Harold Hirschsprung. It is a congenital intestinal aganglionosis
as a result of arrested fetal development of the myenteric nervous system. Normal intestinal motility depends on a coordinated
segmental contraction waves followed immediately by smooth muscle relaxation as it propagates caudally. Patients with
Hirschsprungās disease lack functional myenteric nervous system in the aff ected distal intestine and have ineff ective distal peristalsis.
The clinical outcomes are failure to pass meconium shortly after birth, constipation, abdominal distension, palpable loops of bowel,
vomiting, watery diarrhea in the newborn, poor weight gain, slow growth and malabsorption. The aganglionic distal segment of
the bowel is the reason for dilatation of the proximal part of the colon or opening debility of the anal sphincter system. Hirschsprungās
disease is aff ecting 1:5000 to 1:8000 live births. Most cases are diagnosed before the patient is 10 years of age. Occasionally, patients
present with this problem at a later age. Recently we operated on a 12-year-old patient with this condition. First we performed surgical
resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy, also known as Hartmannās
procedure. Three months later, the rectum was extirpated and coloanal anastomosis formed. Based on the uneventful postoperative
course, good patientās condition and clinical tests, the treatment of congenital megacolon was successful
A RARE TUMOR OF THE LUNG IN CHILDHOOD ā INFLAMMATORY MYOFIBROBLASTIC TUMOR
Inflamatorni miofibroblastiÄni tumor (IMT) benigna je novotvorina koja uglavnom zahvaÄa pluÄa kod djece. Od svih tumora pluÄa javlja se u 0,7%.1 Brunn je tumor prvi opisao 1939. godine.2 Postavljanje sigurne dijagnoze veoma je teÅ”ko i Äesto moguÄe tek nakon resekcije tumora. Mi želimo prikazati 13-godiÅ”nju bolesnicu s pluÄnim IMT-om koja je duže vrijeme kaÅ”ljala, imala zaduhu i osjeÄaj nelagode u prsnom koÅ”u. Rendgenska snimka, kao i kompjutorizirana tomografija pokazale su prisutnost tumorske mase u donjem pluÄnom režnju s desne strane. Njezini kliniÄki i radioloÅ”ki nalazi nisu bili specifiÄni da bi se mogla utvrditi dijagnoza pa se indicirao kirurÅ”ki zahvat. Sam zahvat i postoperativni tijek protekli su bez komplikacija. Tumor je odstranjen u cijelosti, histoloÅ”ki je potvrÄen upalni miofibroblastiÄni tumor pluÄa. Bolesnica je 2 godine nakon operacije bila bez kliniÄkih znakova recidiva bolesti.Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm, mainly involving the lungs of the children. It represents 0.7% of all lung tumors.1 It was first described by Brunn in 1939.2 Diagnosis is very difficult and often only possible after resection of the tumor. We would like to present a case of pulmonary IMT in a 13-year-old girl who presented with symptoms like cough, shortness of breath , and chest discomfort. Chest X ray and computed tomography revealed the presence of a right lower lobe lung mass. Its clinical and radiological findings were diverse and non specific. The mass was removed in toto, histopathology confirmed the inflammatory myofibroblastic tumor of the lung. Intraoperative and postoperative courses were uneventful. The patient has been without any signs of relapse 2 years after the surgery
Haemorrhagic pseudocyst of the adrenal gland: case report and literature review
Adrenalne pseudociste su relativno rijetke patoloÅ”ke tvorbe u pedijatrijskoj populaciji. ObiÄno su asimptomatske te su sporadiÄan
nalaz na radioloÅ”kim pretragama. No kad promjerom prelaze veliÄinu od 5 cm, mogu uzrokovati simptome kompresije susjednih
organa te zahtijevati kirurÅ”ko lijeÄenje. U dijagnostici takvih lezija u pedijatrijskoj populaciji izrazito je bitno razlikovati benignu od
maligne lezije. Prikazujemo pacijenticu u dobi od 12 godina koja se prezentirala slikom difuznih bolova u abdomenu te febriliteta.
Kod pacijentice je ultrazvuÄno praÄena cista desne nadbubrežne žlijezde kroz prethodne dvije godine. Pacijentica je kirurÅ”ki zbrinuta
ekscizijom te drenažom cistiÄne tvorbe otvorenom medijalnom laparotomijom. PatohistoloÅ”ki nalaz verifi cira tumorsku tvorbu kao
hemoragiÄnu pseudocistu nadbubrežne žlijezde. PraÄenje Å”est mjeseci postoperativno pokazalo je dobre rezultate.Adrenal pseudocyst is a rare pathologic fi nding in paediatric population. They tend to be asymptomatic lesions and are usually
found sporadically in radiologic fi ndings. However, cysts larger than 5 cm in diameter can cause symptoms of compression on adjacent
organs and therefore surgical removal is needed. Regarding diff erential diagnosis, it is crucial to diff er a benign from malignant
lesion in paediatric population. We report a case of a 12-year-old girl who presented with acute abdominal pain and fever. She had
been diagnosed with a right abdominal cyst two years before and was routinely followed up through our outpatient clinic. Medial
laparotomy, surgical excision and drainage of the cystic lesion were performed. Histopathology examination reported a haemorrhagic
adrenal pseudocyst. Six-month follow up was uneventful
Has OmbrĆ«danneās Method of Hypospadic Urethra Reconstruction Been Ignored with Reason?
A B S T R A C T
From January 1970 to December 1979 inclusive, 193 boys (aged 2 to 16) underwent surgery for distal hypospadia using Ombredanneās method at the Department of Pediatric Surgery University Hospital Center Rijeka and at the Department of Pediatric Surgery Zagreb. Follow-up period was 7 to 20 years (mean 13.4). 20 (10.36%) subjects had post-operative organic complications and 15 (7.77%) of them required surgical correction. According to these findings, the success rate using Ombredanneās method of reconstruction of the hypospadic urethra in no way lags behind the success rate using MAGPI and Mathieuās methods as well as Ā»Preputial island flap urethroplastyĀ« for analogous cases. Out of 193 subjects who underwent surgery, 80 (41.45%) of those who were sexually mature and had normal psychosexual development were questioned. In this sample, 75 (93.75%) were satisfied with the post-operative appearance of the penis while only 5 (6.25%) were dissatisfied, 3 of which had hypoplastic penis. In 78 (97.50%) subjects questioned, the post-operative urinary squirt was normal and two of them had weak urinary squirt (2.50%), due to meatal stenosis. In conclusion, Ombredanneās method of reconstruction of the urethra in boys with distal hypospadia is equally successful as other methods used for this purpose
Central Venous Catheters for Chemotherapy of Solid Tumors ā Our Results in the Last 5 Years
Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve
a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling
central venous catheters has become commonplace in the management of children undergoing oncological treatment.
There are two types of central lines commonly used. There are Broviac catheters and Port-A-Cath (PAC) catheters. In the
last 5 years we inserted 194 catheters in 175 children. We inserted 121 Broviac catheters and 73 PAC catheters. During
the follow up of 39382 catheter days 44 complications were observed. In Broviac group the median follow up was 155
days and in PAC group was 230 days. We observed differences in the incidence between two devices. In Broviac group infections
were more frequent and in PAC group other complications were more frequent than infections
Abernethy malformation as a rare indication for liver transplantation: Case report
Abernethyjeva malformacija ili kongenitalna ageneza portalne vene (KAPV) rijetka je malformacija abdominalnoga splanhniÄkog venskog sustava. Dijagnoza se najÄeÅ”Äe postavlja u djeÄjoj dobi i Äesto je povezana s drugim malformacijama poput srÄanih greÅ”aka i poremeÄaja skeletnog sustava, kao i s tumorima jetre. Sama malformacija može se manifestirati u dva oblika. Kod tipa I portalna krv potpuno zaobilazi jetru te se gornja mezenterijska vena i lijenalna vena odvojeno (tip Ia) ili zajedno (tip Ib) dreniraju u donju Å”uplju venu, a u jetri ne postoje intrahepatalni portalni venski ogranci. Kod tipa II prisutan je parcijalni portokavalni shunt i portalna krv djelomiÄno opskrbljuje jetru. Nema jedinstvenoga terapijskog pristupa za sve bolesnike s Abernethyjevom malformacijom, meÄutim, kod bolesnika sa simptomima jetrene bolesti (encefalopatija, loÅ”a funkcija jetre) te onih s tumorima jetre preporuÄuje se transplantacija jetre. U ovom radu prikazujemo Abernethyjevu malformaciju tipa Ib u 17-godiÅ”nje bolesnice kod koje se obradom kroniÄne malaksalosti praÄene bolima pod desnim rebrenim lukom pronaÅ”ao neresektabilni tumor jetre te joj je uspjeÅ”no obavljena ortotopna transplantacija jetre.Abernethy malformation or congenital agenesis of the portal vein (CAPV) is a rare malformation of the abdominal splanchnic venous system. This malformation is commonly found in children and is often
associated with other malformations such as congenital cardiac anomalies and skeletal system disorders, as well as liver tumors. There are two types of Abernethy malformation. In type I, portal blood bypasses the liver completely, with the superior mesenteric vein and the splenic vein draining into the inferior vena cava separately (type Ia), or together (type Ib). There are no intrahepatic portal vein branches in the liver. Type II is a partial portocaval shunt in which portal blood partially supplies the liver. There is no unified therapeutic approach for all patients with Abernethy malformation, however, liver transplantation is recommended in patients with liver disease
(encephalopathy, poor liver function) and those with liver tumors. In this case report we present a case of Abernethy type Ib malformation in a 17-year-old patient with chronic malaise and uper abdominal pain. During diagnostic work-up, an unresectable liver tumor was found and the patient was successfully treated with orthotopic liver transplantation
Knowledge and attitudes about undescended testicles ā the need for an educational approach
Cilj: S obzirom na loÅ”e pokazatelje dobi orhidopeksije za kongenitalnu skupinu nespuÅ”tenih testisa, cilj ovoga rada bio je istražiti znanja i stavove specijalizanata/mladih specijalista pedijatrije, obiteljske i Å”kolske medicine o navedenoj problematici jer upravo su oni, u veÄini sluÄajeva prvi kojima se roditelji obraÄaju za pomoÄ i miÅ”ljenje. Metode: Znanje i stavovi specijalizanata i mladih specijalista ispitani su pomoÄu anonimnog online upitnika, temeljenog na najno- vijim spoznajama i smjernicama. Prikupljanje podataka provedeno je putem besplatnog programa Google FormsĀ®. Kako bismo utvrdili odstupaju li dobiveni odgovori od odgovora koje bismo oÄekivali pod odreÄenom hipotezom, odgovori su usporeÄivani koriÅ”tenjem hi-kvadrat testa uz razinu statistiÄke znaÄajnosti od 5%. Rezultati: Upitnik je ispunilo 129 specijalizanata/mladih specijalista, od kojih veÄina smatra kako za vrijeme studiranja i specijalistiÄ- kog usavrÅ”avanja nisu dovoljno Äuli i nauÄili o nespuÅ”tenim testisima, kako svoje znanje o problematici nespuÅ”tenih testisa smatraju nezadovoljavajuÄim te kako se u dosadaÅ”njoj karijeri nisu susreli sa smjernicama koje govore o dijagnostici i lijeÄenju nespuÅ”tenih testisa. Odgovori na veÄinu pitanja, koja su se temeljila na najnovijim smjernicama, bili su nezadovoljavajuÄi. Gotovo 2/3 ispitanika smatra kako se o djeÄacima s nespuÅ”tenim testisima u Republici Hrvatskoj ne vodi pravodobna briga i lijeÄenje, a 1/3 ispitanika kljuÄni problem vidi u primarnim pedijatrima, obiteljskim lijeÄnicima te u timovima Å”kolske medicine. ZakljuÄci: S obzirom na dobro poznate posljedice nepravodobnog lijeÄenja nespuÅ”tenih testisa u djeÄaka, rezultatima analize anke- te kojima ne možemo biti zadovoljni potrebno je ozbiljno pristupiti. Stoga potiÄemo buduÄe edukativne intervencije, utemeljene na dokazima, koje Äe za cilj imati bolju informiranost o problematici nespuÅ”tenih testisa i u konaÄnici 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 FormsĀ® 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