Nekrotizirajuća pneumonija u dojenčadi

Community-acquired bacterial pneumonias generally have a good prognosis, given a good response to the antibiotic treatment applied, and complications such as pleural effusion, empyema, abscess and necrotizing pneumonia with pneumatocele formation (cavitary necrosis) are rare. Although cavitary necrosis is manifested as a severe disease, most children show complete recovery even without surgical treatment and have normal chest radiographs at long term. A case is presented of an immunocompetent infant that developed necrotizing pneumonia with pneumatocele formation during treatment of bacterial pneumonia. Conservative treatment led to complete regression of necrotic cavities and resulted in normal chest radiography finding 2.5 months of the occurrence of pneumatoceles.Izvanbolničke bakterijske pneumonije uglavnom imaju dobru prognozu, uz dobar odgovor na primijenjeno antibiotsko liječenje, te se rijetko razviju komplikacije kao što su pleuralni izljev (efuzije), empijem, apsces i nekrotizirajuća pneumonija s razvojem pneumatocela (kavitarna nekroza). Premda se kavitarna nekroza manifestira teškom bolešću, većina djece se potpuno oporavi i bez kirurškog liječenja, te nakon duljeg vremena imaju uredan izgled pluća na rentgenskoj snimci. Ovdje se prikazuje slučaj imunokompetentnog dojenčeta kod kojega je tijekom liječenja bakterijske pneumonije nastupila nekrotizirajuća pneumonija s razvojem pneumatocela. Konzervativno liječenje dovelo je do potpune regresije nekrotičnih šupljina i urednog rentgenskog nalaza pluća 2,5 mjeseca nakon pojave pneumatocela

Astma i eozinofilni kationski protein kao pokazatelj uspješnosti liječenja bolesti

Asthma is the most common chronic disease in children and adolescents. It is necessary to develop objective methods for assessment of disease activity, treatment efficacy, and prevention of attacks. Measurements of eosinophilic cationic protein (ECP) should serve as an objective indicator of allergic inflammation activity. This follow-up study included 100 children treated with inhaled corticosteroid (fluticasone propionate) or sodium cromoglycate over a 12-month period. The values of (ECP) and forced expiratory volume in the first second (FEV1) were measured at the beginning of the study and then once a month for a year, to evaluate treatment efficacy. The fastest drop in ECP values and the highest increase in FEV1 were found in children with newly diagnosed asthma, who were treated with inhalation corticosteroid. This result supports the importance of early introduction of anti-inflammatory therapy in childhood asthma.Astma je najčešća kronična bolest djece i mladeži. Zahtijeva razvoj objektivnog mjerila kojim će se moći pratiti aktivnost bolesti, učinkovitost primijenjene terapije te eventualno predvidjeti napadaji. Mjerenje eozinofilnog kationskog proteina (ECP) ima upravo vrijednost jednog takvog objektivnog parametra aktivnosti alergijske upale. Tijekom 12 mjeseci pratili smo stotinu djece s astmom koji su u terapiji dobivali inhalacijski kortikosteroid (flutikazon propionat) ili natrijev kromoglikat. Kao pokazatelj učinkovitosti primijenjene terapije kod bolesnika se je pratila vrijednost serumskog ECP i forsiranog ekspiracijskog volumena (FEV1) u 1 sekundi prije početka ispitivanja te jedanput na mjesec tijekom 12 mjeseci. Najbrži pad ECP uz najviši porast FEV1 zabilježen je u skupini djece s novootkrivenom astmom na terapiji inhalacijskim kortiko-steroidom. Ovo ukazuje na značenje ranog uvođenja protuupalne terapije u liječenju dječje astme

Spontani pneumomedijastinum kod zdravog adolescenta

Spontaneous pneumomediastinum is a rare clinical entity defined as the presence of free air in the mediastinal structures without an apparent cause such as trauma. Spontaneous pneumomediastinum is rare in children and most frequently occurs in young male patients. It usually develops after alveolar rupture and air penetration into the pulmonary interstice, followed by air penetration towards the hila and into the mediastinum. Alveolar ruptures may be caused by various pathological and physiological processes, in children most frequently by asthma. Clinical diagnosis is based on the symptom triad including chest pain, dyspnea and subcutaneous emphysema. The diagnosis is confirmed by radiography. On differential diagnosis, esophageal perforation should be considered first, and if suspected, contrast esophagogram should be performed. Spontaneous pneumomediastinum usually resolves spontaneously in several days of treatment, which includes identification of the underlying cause (if possible), rest, analgesics and clinical monitoring. Complications involving spontaneous pneumomediastinum, such as tension pneumomediastinum and tension pneumothorax, are quite rare. A case is presented of pneumomediastinum in a 17-year-old male adolescent with no relevant history but with a clinical picture of intense retrosternal pain and subcutaneous emphysema of the neck and supraclavicular region. Thorough examinations including chest x-ray, chest computed tomography, bronchoscopy and esophagoscopy failed to identify the cause of pneumomediastinum. After eight days of conservative treatment, the pneumomediastinum symptoms completely disappeared and x-ray showed resolution of pneumomediastinum.Spontani pneumomedijastinum (SPM) je rijedak klinički entitet obilježen prisutnošću slobodnog zraka oko medijastinalnih struktura bez jasnog uzroka kao što je trauma. SPM je rijedak u djece i javlja se uglavnom u muških adolescenata. Obično se pojavljuje sekundarno nakon rupture alveola i prodora zraka u plućni intersticij, a potom slijedi prodor zraka prema hilusima i u medijastinum. Različiti patološki i fiziološki događaji mogu dovesti do rupture alveola, a u djece je najčešći uzrok astma. Klinička dijagnoza se temelji na trijasu simptoma, a to su bol u prsištu, dispneja i supkutani emfizem. Dijagnoza se potvrđuje rendgenskom snimkom. U diferencijalnoj dijagnozi treba prvenstveno misliti na perforaciju jednjaka, a postoji li sumnja na perforaciju treba učiniti ezofagogram s kontrastom. SPM se obično spontano povlači nakon nekoliko dana liječenja koje uključuje pronalaženje osnovnog uzroka (ako je moguće), odmor, analgetike i kliničko praćenje. Rijetke su komplikacije spontanog pneumomedijastinuma kao što je tenzijski pneumomedijastinum i tenzijski pneumotoraks. Ovdje se prikazuje slučaj pneumomedijastinuma u 17-godišnjeg mladića bez značajne medicinske anamneze, s kliničkom slikom intenzivnih retrosternalnih bolova te supkutanim emfizemom vrata i supraklavikularnih područja. Intenzivnim pretragama uključujući rendgensku snimku pluća, kompjutoriziranu tomografiju prsnog kosa, bronhoskopiju i ezofagoskopiju nije se pronašao uzrok pneumomedijastinuma. Nakon osam dana konzervativnog liječenja došlo je do potpunog nestanka simptoma i povlačenja pneumomedijastinuma na rendgenskoj snimci

Nekrotizirajuća pneumonija u dojenčadi

Community-acquired bacterial pneumonias generally have a good prognosis, given a good response to the antibiotic treatment applied, and complications such as pleural effusion, empyema, abscess and necrotizing pneumonia with pneumatocele formation (cavitary necrosis) are rare. Although cavitary necrosis is manifested as a severe disease, most children show complete recovery even without surgical treatment and have normal chest radiographs at long term. A case is presented of an immunocompetent infant that developed necrotizing pneumonia with pneumatocele formation during treatment of bacterial pneumonia. Conservative treatment led to complete regression of necrotic cavities and resulted in normal chest radiography finding 2.5 months of the occurrence of pneumatoceles.Izvanbolničke bakterijske pneumonije uglavnom imaju dobru prognozu, uz dobar odgovor na primijenjeno antibiotsko liječenje, te se rijetko razviju komplikacije kao što su pleuralni izljev (efuzije), empijem, apsces i nekrotizirajuća pneumonija s razvojem pneumatocela (kavitarna nekroza). Premda se kavitarna nekroza manifestira teškom bolešću, većina djece se potpuno oporavi i bez kirurškog liječenja, te nakon duljeg vremena imaju uredan izgled pluća na rentgenskoj snimci. Ovdje se prikazuje slučaj imunokompetentnog dojenčeta kod kojega je tijekom liječenja bakterijske pneumonije nastupila nekrotizirajuća pneumonija s razvojem pneumatocela. Konzervativno liječenje dovelo je do potpune regresije nekrotičnih šupljina i urednog rentgenskog nalaza pluća 2,5 mjeseca nakon pojave pneumatocela

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. Izvršena je lobektomija desnog gornjeg plucnog režnja, a patohistološki 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 središnja 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

Astma i eozinofilni kationski protein kao pokazatelj uspješnosti liječenja bolesti

Asthma is the most common chronic disease in children and adolescents. It is necessary to develop objective methods for assessment of disease activity, treatment efficacy, and prevention of attacks. Measurements of eosinophilic cationic protein (ECP) should serve as an objective indicator of allergic inflammation activity. This follow-up study included 100 children treated with inhaled corticosteroid (fluticasone propionate) or sodium cromoglycate over a 12-month period. The values of (ECP) and forced expiratory volume in the first second (FEV1) were measured at the beginning of the study and then once a month for a year, to evaluate treatment efficacy. The fastest drop in ECP values and the highest increase in FEV1 were found in children with newly diagnosed asthma, who were treated with inhalation corticosteroid. This result supports the importance of early introduction of anti-inflammatory therapy in childhood asthma.Astma je najčešća kronična bolest djece i mladeži. Zahtijeva razvoj objektivnog mjerila kojim će se moći pratiti aktivnost bolesti, učinkovitost primijenjene terapije te eventualno predvidjeti napadaji. Mjerenje eozinofilnog kationskog proteina (ECP) ima upravo vrijednost jednog takvog objektivnog parametra aktivnosti alergijske upale. Tijekom 12 mjeseci pratili smo stotinu djece s astmom koji su u terapiji dobivali inhalacijski kortikosteroid (flutikazon propionat) ili natrijev kromoglikat. Kao pokazatelj učinkovitosti primijenjene terapije kod bolesnika se je pratila vrijednost serumskog ECP i forsiranog ekspiracijskog volumena (FEV1) u 1 sekundi prije početka ispitivanja te jedanput na mjesec tijekom 12 mjeseci. Najbrži pad ECP uz najviši porast FEV1 zabilježen je u skupini djece s novootkrivenom astmom na terapiji inhalacijskim kortiko-steroidom. Ovo ukazuje na značenje ranog uvođenja protuupalne terapije u liječenju dječje astme

Experiences with the day care hospital at the Department of pediatrics, University hospital Sestre milosrdnice (Sisters of mercy)

Prva iskustva s dnevnom bolnicom na našoj Klinici počeli smo stjecati u siječnju 2002. godine. Tada je našu Kliniku, najstariji pedijatrijski odjel u Hrvatskoj, na njezin 98. rođendan opustošio katastrofalan požar. Dvadeset i četiri sata nakon toga počeli smo opservirati i liječiti naše pacijente u improviziranim bolničkim prostorima na Klinici za internu medicinu. Tamo nismo mogli smjestiti svih 98 postelja, jer je dobiveni prostor odgovarao jednoj petini prijašnjeg prostora. Tamo smo smjestili samo 30 stacionarnih ležajeva, dok smo ostale pacijente zbrinuli kroz dnevnu bolnicu. Nesvakidašnja situacija zahtijevala je ulaganje maksimalnog napora te brzu dijagnostičku obradu i učinkovito liječenje što većeg broja bolesnika. Nakon stjecanja nužnog iskustva liječnici, medicinske sestre, kao i pacijenti i njihovi roditelji, bili su zadovoljni takvim načinom liječenja, usprkos potpuno neprikladnim smještajnim uvjetima, koji su bili glavni problem u funkcioniranju Klinike do ponovnog preseljenja u nove, obnovljene prostore. Nakon četverogodišnjeg iskustva s dnevnom bolnicom iznijeli bismo naša prvenstveno pozitivna iskustva, ali i neke probleme s kojima smo se sretali.We began to acquire our first experiences of a day care hospital at our Clinic in January 2002. That was the time when our Clinic, the oldest pediatric department in Croatia, was destroyed by fire on its 98th anniversary. 24 hours after the fire we restarted observation of a number of our patients in an improvised, donated ward of our University hospital, at the Department of internal medicine. We could not accommodate 98 beds on the ward that was only one fifth of the size of our old ward. We equipped only 30 beds for in-patients, while the others were examined and treated in the day-care hospital. This unusual situation required a great deal of effort, quick examinations and efficacious treatment of as large as possible number of patients in the couple of hours a day. After acquiring the necessary experience both doctors, nurses and patients and their parents became content with that kind of treatment despite the absolutely inadequate accommodation which was the main obstacle until we moved into our present, modern renewed facilities. After the four years of experience with the day care hospital we shall say something first about all our positive experiences although we shall mention some problems that occurred

Spontani pneumomedijastinum kod zdravog adolescenta

Spontaneous pneumomediastinum is a rare clinical entity defined as the presence of free air in the mediastinal structures without an apparent cause such as trauma. Spontaneous pneumomediastinum is rare in children and most frequently occurs in young male patients. It usually develops after alveolar rupture and air penetration into the pulmonary interstice, followed by air penetration towards the hila and into the mediastinum. Alveolar ruptures may be caused by various pathological and physiological processes, in children most frequently by asthma. Clinical diagnosis is based on the symptom triad including chest pain, dyspnea and subcutaneous emphysema. The diagnosis is confirmed by radiography. On differential diagnosis, esophageal perforation should be considered first, and if suspected, contrast esophagogram should be performed. Spontaneous pneumomediastinum usually resolves spontaneously in several days of treatment, which includes identification of the underlying cause (if possible), rest, analgesics and clinical monitoring. Complications involving spontaneous pneumomediastinum, such as tension pneumomediastinum and tension pneumothorax, are quite rare. A case is presented of pneumomediastinum in a 17-year-old male adolescent with no relevant history but with a clinical picture of intense retrosternal pain and subcutaneous emphysema of the neck and supraclavicular region. Thorough examinations including chest x-ray, chest computed tomography, bronchoscopy and esophagoscopy failed to identify the cause of pneumomediastinum. After eight days of conservative treatment, the pneumomediastinum symptoms completely disappeared and x-ray showed resolution of pneumomediastinum.Spontani pneumomedijastinum (SPM) je rijedak klinički entitet obilježen prisutnošću slobodnog zraka oko medijastinalnih struktura bez jasnog uzroka kao što je trauma. SPM je rijedak u djece i javlja se uglavnom u muških adolescenata. Obično se pojavljuje sekundarno nakon rupture alveola i prodora zraka u plućni intersticij, a potom slijedi prodor zraka prema hilusima i u medijastinum. Različiti patološki i fiziološki događaji mogu dovesti do rupture alveola, a u djece je najčešći uzrok astma. Klinička dijagnoza se temelji na trijasu simptoma, a to su bol u prsištu, dispneja i supkutani emfizem. Dijagnoza se potvrđuje rendgenskom snimkom. U diferencijalnoj dijagnozi treba prvenstveno misliti na perforaciju jednjaka, a postoji li sumnja na perforaciju treba učiniti ezofagogram s kontrastom. SPM se obično spontano povlači nakon nekoliko dana liječenja koje uključuje pronalaženje osnovnog uzroka (ako je moguće), odmor, analgetike i kliničko praćenje. Rijetke su komplikacije spontanog pneumomedijastinuma kao što je tenzijski pneumomedijastinum i tenzijski pneumotoraks. Ovdje se prikazuje slučaj pneumomedijastinuma u 17-godišnjeg mladića bez značajne medicinske anamneze, s kliničkom slikom intenzivnih retrosternalnih bolova te supkutanim emfizemom vrata i supraklavikularnih područja. Intenzivnim pretragama uključujući rendgensku snimku pluća, kompjutoriziranu tomografiju prsnog kosa, bronhoskopiju i ezofagoskopiju nije se pronašao uzrok pneumomedijastinuma. Nakon osam dana konzervativnog liječenja došlo je do potpunog nestanka simptoma i povlačenja pneumomedijastinuma na rendgenskoj snimci

Individualizirani pristup u poduci astmatične djece

Asthma is the most prevalent chronic disorder of childhood. In a large number of cases, it can be well managed. In addition to accurate diagnosis, appropriate therapy and control of environmental factors, a good educational program is required, which has not yet received due attention. Prompted by the fact that a large number of asthmatic children and their parents lack sufficient knowledge about asthma, six years ago we launched an individual educational program for all asthmatic children over seven years of age and their parents. We monitored a group of 58 asthmatics, the first to have completed our individual educational program, during the year before and the year after they had received individual education. The prerequisites for inclusion in the study were that the child was over seven years of age, diagnosed with chronic asthma according to the GINA guidelines and had been monitored for one year prior to receiving individual education. We compared the number of asthma exacerbations, hospitalizations due to asthma, days with asthmatic symptoms, the mean value of the forced expiratory volume in 1 second (FEV 1), and the mean dose of inhaled corticosteroids (ICS) taken during the year before and the year after receiving individual education. Study results showed the number of asthma exacerbations (p<0.0001), hospitalizations due to asthma (p=0.0236) and days with asthmatic symptoms (p<0.0001) to have significantly reduced, along with a significant increase in FEV 1 (p<0.0001) and lower mean ICS dose (p<0.0001) upon completion of individual educational program. It is concluded that the addition of individual education in the treatment of asthmatic children enables better control of the disease (lower number of hospitalizations and asthma exacerbations, increased FEV 1) with a lower mean ICS dose. The knowledge about asthma acquired by the children and their parents, self-management, compliance with the written asthma management plan, control of environmental factors, along with good cooperation of the patients and parents in the management of asthma certainly contributed to this favorable observation.Astma je najčešća kronična bolest dječje dobi koja se u velikom broju slučajeva može dobro kontrolirati, za što je uz točnu dijagnozu i odgovarajuću terapiju te kontrolu čimbenika okoline potreban i dobar obrazovni program kojem se jo. uvijek ne posvećuje dostatna pozornost. Upravo potaknuti tom činjenicom da velik broj astmatičara i njihovih roditelja nemaju dostatno znanje o astmi započeli smo prije šest godina program individualne poduke u koju su uključeni svi roditelji i djeca u dobi iznad sedam godina. Pratili smo skupinu od 58 astmatičara koji su prvi prošli individualni program poduke u godini prije te u godini nakon provođenja individualne poduke. Uvjeti za uključivanje u ispitivanje su bili dob iznad sedam godina, dijagnoza trajne astme prema smjernicama GINA te praćenje astmatičara godinu dana prije provođenja individualne poduke. Uspoređivali smo broj egzacerbacija astme, hospitalizacija zbog astme, broj dana sa simptomima astme, srednju vrijednost forsiranog ekspiracijskog volumena u prvoj sekundi (FEV1) te srednju dozu inhalacijskog kortikosteroida (IKS) u godini prije te u godini nakon provođenja individualne poduke. Rezultati ovoga ispitivanja pokazali su da je u bolesnika nakon provođenja individualnog programa poduke statistički značajno smanjen broj egzacerbacija astme (p<0,0001), broj hospitalizacija zbog astme (p=0,0236), broj dana sa simptomima astme (p<0,0001), uza značajan porast FEV1 (p<0,0001), a sve to s nižom srednjom dozom IKS (p<0,0001). Može se zaključiti kako dodatak individualne poduke u liječenju djece astmatičara omogućuje bolju kontrolu bolesti (smanjen broj hospitalizacija i egzacerbacija astme, porast FEV1) uz nižu dozu IKS, čemu sigurno doprinosi bolje znanje djece i roditelja o astmi, o provođenju samokontrole, praćenje pisanog plana liječenja, kontrola čimbenika okoline, uz značajnu suradljivost bolesnika i roditelja u liječenju astme