Hitna traheotomija kod trahealne stenoze - prikaz slučaja

Airway management in an emergency department is the first step in critical care of an urgent patient. When orotracheal intubation is not possible due to upper airway obstruction, such an emergency is known as a ‘cannot intubate – cannot ventilate’ situation. Then, emergency tracheotomy is indicated. We present a case of a 70-year-old patient complaining of progressive dyspnea. The patient was conscious, highly tachydyspneic, and tachycardic. Loud stridor and a scar from previous tracheostomy suggested upper airway obstruction. Patient history confirmed previous partial laryngectomy and temporary tracheostomy due to laryngeal cancer 10 months before. Differential diagnosis of tracheal stenosis was set, and an ENT specialist was requested. Flexible fiberoptic laryngoscopy demonstrated a 1-mm subglottic tracheal stenosis. Emergency surgical tracheotomy below the obstruction in awake state using local anesthesia was performed to secure the airway. Early postoperative care was complicated by incipient right-sided pneumonia, which may have provoked narrowing of the existing subglottic stenosis in the first place. Tracheal stenosis is an important differential diagnosis of airway obstruction in patients with previous malignant diseases of the upper respiratory system. Emergency physicians should promptly recognize these situations based on clinical examination to secure appropriate airway management.Zbrinjavanje dišnoga puta u hitnoj službi prvi je korak u procjeni i liječenju hitnog bolesnika. Situacije u kojima orotrahealna intubacija nije moguća zbog opstrukcije gornjih dišnih putova poznate su pod nazivom ‘nemoguće intubirati – nemoguće ventilirati’ (cannot intubate – cannote ventilate). U takvim situacijama indicirana je hitna kirurška traheotomija. Autori prikazuju slučaj 70-godišnjeg bolesnika koji se žalio na progresivni osjećaj nedostatka zraka. Bolesnik je bio pri svijesti, izrazito tahidispnoičan i tahikardan. Glasan stridor i ožiljak od prethodne treaheotomije ukazali su na opstrukciju gornjih dišnih putova. Anamnestički se doznaje da je kod bolesnika prije 10 mjeseci učinjena parcijalna laringektomija i privremena traheotomija zbog karcinoma grkljana. Postavljena je dijagnoza trahealne stenoze i pozvan je specijalist otorinolaringologije. Fleksibilna fiberoptička laringoskopija pokazala je subglotičnu trahealnu stenozu promjera 1 mm. Zbog osiguranja dišnog puta učinjena je hitna kirurška traheotomija ispod mjesta opstrukcije u budnom stanju u lokalnoj anesteziji. Rani poslijeoperacijski oporavak kompliciran je početnom desnostranom upalom pluća koja je možda i izazvala suženje postojeće subglotičke stenoze. Trahealna stenoza važna je diferencijalna dijagnoza opstrukcije dišnih putova u bolesnika s prethodnim malignim bolestima gornjega dišnog sustava. Na temelju kliničkog pregleda nužno je odmah prepoznati ovakve situacije kako bi se primjereno zbrinuo dišni put

AN UNCOMMON CLINICAL PRESENTATION OF DIROFILARIASIS IN A CHILD – A CASE REPORT

Dirofilariasis is a zoonotic infection caused by filarial nematodes of the genus Dirofilaria, with D. repens as the most common one. Definitive hosts are usually dogs and other carnivores, while humans are accidentally included into the epizootic chain. It usually manifests as subcutaneous or ocular localization and here we present an unusual case of scrotal dirofilariasis

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 Marfan’s 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

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

A 10-Year Experience in the Treatment of Intraabdominal Cerebrospinal Fluid Pseudocysts

The aim of this retrospective study was to assess a ten-year experience in the treatment of rare complications of ventriculoperitoneal shunting – intraabdominal cerebrospinal fluid pseudocysts. At this time there are no data about incidence, clinical course and treatment of these complications in Croatia. Cerebrospinal fluid (CSF) abdominal pseudocyst is an uncommon but important complication of ventriculoperitoneal shunts. Retrospective data were obtained from 5 children with abdominal CSF pseudocysts, treated between 1996 and 2007. The incidence of intraabdominal CSF pseudocysts in our study is 2.9%. All patients were girls ranged in age from 4 to 12 years old (mean 8.8 years). In most cases etiology of hydrocephalus was congenital, idiopathic. Abdominal pain and distension were the most frequent clinical finding (4/5). Although infection has been reported as responsible for pseudocyst formation, we did not found it in our series. Laparotomy with cyst wall excision and catheter replacement was performed in 2/5 cases, and only cyst fluid aspiration with catheter replacement in 3/5 cases. Recurrence of the abdominal cyst was observed in one girl who was in terminal stadium of anaplastic ependymoma. It is our opinion that only catheter replacement and cyst fluid evacuation, as one of the treatment modalities, may be successful, even in large CSF intraperitoneal pseudocysts

Suicide Attempt by Swallowing Sponge or Pica Disorder: A Case Report

Introduction: There are many ways how children with mental illness have actually tried to hurt themselves. Suicidal thinking or attempts always indicate that professional help is needed (2). Every object which can be potential dangerous should be removed but this is very difficult to do. Some of children with these symptoms had Pica diseases. Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal, coal, soil, feces, paper, soap, gum, etc.) or an abnormal appetite for some things that may be considered foods. Material and Methods: The patient swallow sponge from a pillow over a long period of time and she came into our hospital with abdominal pain. She was 16 years old and had abdominal distension, vomiting, abdominal cramping and failure to pass gas or stool. Immediately we suspected mechanical blockade of the intestine. Diagnosis was clinically confirmed by X-rays of the abdomen and with ultrasound. Results: The operative treatment was indicated and we found the proximal bowel distended and the distal segment collapsed. The part of bowel necrosis was removed and anastomosis was done. Conclusion: When patients are determined to attempt suicide or have Pica disorder it is very difficult to prevent