13 research outputs found
IMPLEMENTATION OF BIGDATA TECHNOLOGIES IN HEALTHCARE SYSTEMS
U radu se prezentira utjecaj tehnologije velikih podataka na primjeru zdravstvenog sustava. Detaljnije se objaÅ”njava sam koncept tehnologije kako bi se kasnije lakÅ”e shvatila primjena iste. Osim teoretskog dijela, u radu su prikazani i konkretni primjeri zdravstvenih aplikacija, te se detaljnije, s tehniÄkog aspekta objaÅ”njava na koji naÄin prezentirana tehnologija funkcionira. Prvotni rezultat rada bio bi prikazati na koji naÄin suvremeni sustavi mogu unaprijediti svoje poslovanje koristeÄi aktualne tehnologije velikih podataka poput onih navedenih u radu (Map Reduce, Hadoop, Bigtable,ā¦), a finalni da s pomoÄu tih istih tehnologija maksimiziraju profit i minimaliziraju troÅ”kove, uz Å”to veÄi naglasak na kvalitetu usluge i Å”to bolju skrb prema krajnjem korisniku, pacijentu.The thesis presents the impact of Big data technologies in the healthcare systems. In addition to the theoretical part, the thesis presents concrete examples of healthcare applications, and detailed explains the technical aspect of technology itself. The first reason of the thesis is to āput accentā on which way can modern systems improve their business by using current Bigdata technologies such as Map Reduce, Hadoop, Bigtable, etc, and the final one is usage of the same technologies to maximize systemās profit and minimize systemās costs, with a bigger emphasis on the quality of service, and to provide as best as possible care for the end user, the patient
Treatment of atelectasis in children
Atelektaza oznacava bezracni dio veceg ili manjeg dijela pluca. Popratna je pojava u tijeku niza plucnih bolesti. NajceŔci uzrok atelektaze je opstrukcija diŔnog puta, kompresija plucnog parenhima, nedostatak ili disfunkcija surfaktanta. Lijecenje ovisi o uzroku. NajceŔce se provodi respiratorna fizioterapija, inhalacije
bronhodilatatora, sekretolitika, razlicite tehnike poviÅ”enog ekspiracijskog tlaka, fleksibilna bronhoskopija, te kirurÅ”ko lijecenje. U radu su prikazana tri bolesnika s atelektazom. Kod jednog bolesnika radilo se o akutnoj atelektazi u tijeku egzacerbacije astme, koja je rijeÅ”ena fleksibilnim bronhoskopom. Kod dva bolesnika radilo se o kronicnoj atelektazi, gdje je bilo indicirano kirurÅ”ko lijecenje ā lobektomija, koja je ucinjena kod jednog bolesnika, dok kod drugoga roditelji nisu prihvatili kirurÅ”ko lijecenje.Atelectasis is a collapsed or airless state and may involve all or part of the lung. Many lung diseases can be associated with atelectasis. It occurs most commonly with bronchoobstruction, lung parenchyma
compression, surfactant deficiency or disfunction. Atelectasis treatment depends on the cause. Chest physiotherapy is carried out most often. Bronchodilatator and secretolytics inhalation, various techniques of increased expiratory pressure, flexibile bronchoscopy and surgery, respectively, are often performed. In the present paper three cases of atelectasis in children are presented. In the first patient atelectasis appeared during acute asthmatic exacerbation, and it was cured by flexibile bronchoscopy. Lobectomy was indicated
in the other two children with chronic atelectasis, but it was performed in one patient, while the parents of the second child did not give their consent for surgical treatment
Tumorous form of lung tuberculosis in children: case report
U radu je prikazan djecak u dobi od dvije godine i osam mjeseci s tumoroznim oblikom plucne tuberkuloze. Na temelju rendgena pluca, te racunalne tomografije toraksa (CT), postavljena je dijagnoza
ekspanzivne tvorbe u podrucju desnog gornjeg sredoprsja. IzvrŔena je lobektomija desnog gornjeg plucnog režnja, a patohistoloŔki nalaz glasio je: granulomatozna upala, u prvom redu tuberkuloza. Kod tumoroznih tvorbi u podrucju sredoprsja, diferencijalno dijagnosticki uvijek treba misliti i na tuberkulozu, posebice kada se nade i srediŔnja nekroza.A 2 year and 8 month-old boy with a tumorous form of lung tuberculosis is presented. Both, chest X-ray and thoracic CT, respectively showed an expansive formation in the right upper mediastinum. Right upper lung lobe lobectomy was performed, and granulomatous inflammation (tuberculosis) was confirmed pathohystologically. In the case of mediastinal tumorous formation (especially accompanied with central necrosis), tuberculosis has to be considered in differential diagnostics
Tumori jetre u djeÄjoj 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 Äine ukupno 2% svih tumora djeÄje dobi, a preko dvije treÄine su zloÄudni. VeÄina se prezentira kao palpabilna tvorba u abdomenu. Za odabir ispravnog plana lijeÄenja nužno je postaviti toÄnu dijagnozu i odrediti stupanj bolesti. Iako je kirurÅ”ka resekcija i dalje najbitniji faktor prognoze, u kombinaciji s kemoterapijom postotak preživljenja znaÄajno
raste. U odreÄenim sluÄajevima neresektabilnih tumora transplantacija jetre daje dobre rezultate.
Od 1991. godine do 2008. lijeÄili smo 13 djece s tumorom jetre i u ovom radu prikazujemo naÅ”e rezultate uz pregled recentne literature
RESULTS OF TREATMENT OF DISPLACED SUPRACONDYLAR FRACTURES IN CHILDREN
Prijelomi humerusa u suprakondilarnom podruÄju najuÄestaliji su prijelomi lakta u djeÄjoj dobi. To su veÄinom nestabilani prijelomi, teÅ”ki za repoziciju i retenciju ulomaka, a postupak njihova lijeÄenja nije posve usuglaÅ”en. U radu se analiziraju kasni rezultati lijeÄenja 48-ero djece s prijelomima humerusa u suprakondilarnom dijelu s pomakom ulomaka. Repozicijom zatvorenim naÄinom, fiksacijom s dvije ukriženo postavljene Kirschnerove žice i nadlaktiÄnom imobilizacijom lijeÄeno je 40-ero, a osmero je djece lijeÄeno samo nadlaktiÄnom imobilizacijom. Otvorena repozicija ulomaka bila je uÄinjena u troje djece. Za procjenu uspjeÅ”nosti lijeÄenja mjerene su kutne deformacije i usporedne razlike gibljivosti zdravog i lijeÄenog lakta. Prema Flynnovu kriteriju 93,7% lijeÄene djece ima vrlo dobre i odliÄne rezultate lijeÄenja. NajuÄestalija je komplikacija varus angulacija (16,7%). Kasni rezultati lijeÄenja u naÅ”e djece i rezultati autora sa sliÄnim serijama djece potvrÄuju stav da je zatvorena repozicija i perkutana stabilizacija Kirschnerovim žicama metoda izbora u lijeÄenju suprakondilarnih prijeloma humerusa s pomakom ulomaka.Supracondylar fractures of humerus are the most common fractures in children. The management of severely displaced, unstable fractures of the humerus in children continues to be controversial. We undertook a retrospective study of 48 children with displaced supracondylar fractures (8 were treated with plaster and 40 with cross percutaneous Kirschner wire pinning). Only three children were treated with open reduction and percutaneous cross-pin fixation. Clinical outcome was evaluated by loss of elbow motion and change of carrying angle. According to Flynn s criteria, results were good or excellent in 93.7% patients. The cubitus varus is the most frequent long-term complication (16.7%). Closed reduction with percutaneous pin fixation is believed to represent a safe, reliable, and efficient method of managing displaced supracondylar fractures
RESULTS OF TREATMENT OF TIBIAL FRACTURES IN CHILDREN
Prijelomi dijafize obiju kosti potkoljenice najÄeÅ”Äi su prijelomi donjih ekstremiteta i Äine oko 15% svih prijeloma dugih kostiju u djece. To su veÄinom nestabilni prijelomi, teÅ”ki za repoziciju i retenciju ulomaka, a postupak njihova lijeÄenja nije posve usuglaÅ”en. U radu se analiziraju kasni rezultati lijeÄenja 234-ero djece s prijelomima dijafize kostiju potkoljenice, ovisno o naÄinu lijeÄenja (operacijska i konzervativna metoda). Otvoreni prijelom imala su 23 bolesnika, Å”to Äini 9,8% od ukupnog broja. U 194 bolesnika primijenili smo konzervativne metode, dok smo u njih 40 primijenili neke od operacijskih metoda lijeÄenja. NajÄeÅ”Äa koriÅ”tena operacijska metoda bila je zatvorena repozicija ulomaka, na ekstenzijskom stolu i perkutana elastiÄna stabilna intramedularna osteosinteza titanskim žicama. Za procjenu uspjeÅ”nosti lijeÄenja mjerene su zaostale kutne deformacije i razlike dužine zdrave i lijeÄene noge. Sekundarni pomak ulomaka nakon zapoÄetoga konzervativnog lijeÄenja, imala su 32 djeteta, Å”to Äini 15,2% od ukupnog broja konzervativno lijeÄenih. Ukupno je 80-ero djece imalo zaostalu kutnu deformaciju lijeÄene noge, njih 68 (35,0%) lijeÄeno je konzervativno, a 12-ero (30,0%) operacijski. Bez razlike u dužini bolesne i zdrave noge bilo je 131 (67,5%) konzervativno lijeÄeno dijete i 29-ero (72,5%) operacijski lijeÄene djece. Ove razlike nisu statistiÄki znaÄajne. Rezultati lijeÄenja ovih prijeloma u naÅ”e djece i autora sa sliÄnim serijama potvrÄuju da nema statistiÄki znaÄajne razlike kasnih uÄinaka ovisno o naÄinu lijeÄenja.Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length beetwen treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods
SURGICAL TREATMENT OF THYROID GLAND DISEASES IN CHILDHOOD ā OUR RESULTS
Bolesti Å”titne žlijezde jedna su od najÄeÅ”Äih endokrinopatija u djece. VeÄina njih uspjeÅ”no se lijeÄi konzervativnom terapijom, no u odreÄenim sluÄajevima potrebno je kirurÅ”ko lijeÄenje. Odluka o kirurÅ”kom lijeÄenju rezultat je suradnje pedijatra endokrinologa i kirurga, ovisi o prirodi bolesti, a opseg kirurÅ”kog zahvata o patoloÅ”koanatomskim promjenama u žlijezdi. Prikazani su rezultati kirurÅ”kog lijeÄenja 41 djeteta provedenog u Zavodu od 1991. do 2009. godine te danaÅ”nja stajaliÅ”ta u kirurÅ”kom lijeÄenju djece s razliÄitim bolestima Å”titne 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
CONGENITAL HYPERINSULINISM ā NOVEL INSIGHTS INTO ETIOLOGY, DIAGNOSIS AND TREATMENT
Kongenitalni hiperinzulinizam (KHI) najÄeÅ”Äi je uzrok tvrdokornih hipoglikemija u novoroÄenaÄkom i ranome dojenaÄkom razdoblju. Iako je bolest razmjerno rijetka s pojavnosti od oko 1 : 25ā
000ā50ā
000 živoroÄene djece, bolest se ne smije podcijeniti zbog trajnih neuroloÅ”kih oÅ”teÄenja do kojih dolazi ako se bolest brzo ne otkrije i ne zapoÄne promptno lijeÄiti. Uzrok su mutacije nekog od 7 gena, kljuÄnih u regulaciji inzulinske sekrecije u b-stanicama guÅ”teraÄe. Odmah nakon postavljanja dijagnoze nužno je u terapiju uvesti antihipoglikemike koji djeluju specifiÄno na -stanice guÅ”teraÄe. Kod teÅ”kih neonatalnih oblika nerijetko postoji rezistencija na antihipoglikemike. Tada preostaje kirurÅ”ko lijeÄenje prije kojeg je potrebno odrediti histoloÅ”ki oblik bolesti, Å”to se danas uspjeÅ”no postiže kombinacijom genskog testiranja i scintigrafske pretrage. KirurÅ”kim se zahvatom najÄeÅ”Äe postiže izljeÄenje kod fokalnog KHI, dok difuzni oblik ima loÅ”iju prognozu. Ovaj je tekst pregled novijih spoznaja o KHI, kojim želimo naglasiti važnost Å”to ranijeg postavljanja dijagnoze kao preduvjeta uspjeÅ”noga ciljanog lijeÄenja bolesti, koje je posljednjih godina obogaÄeno novim moguÄnostima.Congenital hyperinsulinism (CHI) is a major cause of persistent hypoglycemia in the neonatal and early infancy periods. Althought the disease is relatively rare with incidence of about 1: 25ā
000ā50ā
000 live births, the importance of the disease should not be underestimated. Namely, prompt recognition and management of patients with CHI is essential, if permanent neurological impairment is to be avoided. CHI is caused by mutations in one of the 7 genes involved in the regulation of insulin secretion in pancreatic b-cells. It is important to introduce specific medical therapy as soon as diagnosis is established. Severe, neonatal forms of CHI are often resistant to medications, thus they require surgical procedure. The preoperative genetic testing and scintigraphy are indicated to distinguish histological subtypes of the disease (focal vs. diffuse CHI). Patients with focal disease are usually cured after pancreatic resection, while diffuse disease has much worse prognosis. This manuscript offers novel insights into CHI and emphasizes the role of early diagnosis as crucial for succesful treatment that was recently enriched with novel options
Rezultati lijeÄenja prijeloma potkoljenice u djece [Results of treatment of tibial fractures in children]
Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length between treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods