How to motivate young doctors to become surgeons

Svjetski je trend da se na specijalizaciju iz opće kirurgije prijavljuje sve manji broj kvalitetnih mladih liječnika. Problem regrutacije kirurga predstavlja i opasnost za budućnost kirurgije pa je potrebno problem na vrijeme prepoznati i adekvatno odgovoriti, pronaći načine kako bi se održao priljev mladih kirurga. Zato je važno znati stoje motiviralo sadašnje kirurge za odabir svoje specijalizacije, što potencijalni kandidati za kirurgiju očekuju od svoje odluke i što uopće motivira mlade ljude kada se odlučuju koju će specijalizaciju izabrati. Sukladno tim spoznajama potrebno je učiniti promjene kako bi proces edukacije na kirurgiji bio prihvatljiv očekivanjima specijalizanata kirurgije.World trend is that the specialization in general surgery reports smaller number of quality young doctors. The problem of surgeon recruitment is a threat to the future of surgery and there is a necessity to recognize problem on time and respond appropriately, find ways to keep the influx of young surgeons. It is therefore important to know what motivated the present surgeons to select their specialization, what potential candidates for surgery expect from their decisions and what motivates young people when deciding what to specialize. Consequently, it is necessary to make changes to the process of education in surgery in order to meet the expectations of young surgical residents

Stražnja ubodna ozljeda vrata: prikaz slučaja

A 45-year-old male patient was admitted to the emergency unit due to posterior stab wound of the neck. The knife was directed diagonally from the left to the right side of the neck in the dorsoventral axis. The patient was fully conscious upon admission with pain and paresthesia along the upper right extremity. The patient underwent computed tomography (CT) and CT angiography scan of the neck, which revealed the knife blade piercing the left sided neck muscles and through the intervertebral ligaments of the C IV/C V in direction to the contralateral internal carotid artery, vertebral artery and the C5 nerve root. The patient underwent an urgent surgery according to the radiographs. Electromyography was performed during the early postoperative care and revealed an acute lesion of the right-sided C5 nerve root. Postoperative follow-up magnetic resonance imaging revealed intact brachial plexus bundles at the site of injury. Symptoms of reduced muscle strength and limited range of motion of the upper right extremity prevailed. Penetrating neck injuries represent a rare entity of all trauma injuries. Meticulous preoperative radiographs revealed close proximity of the knife blade tip to the right-sided vertebral artery and common carotid artery. Limited abduction at the right shoulder during postoperative period correlated to the C5 nerve root injury.Muškarac u dobi od 45 godina primljen je u Objedinjeni hitni prijam zbog stražnje ubodne rane vrata. Oštrica noža bila je dijagonalnog usmjerenja od lijeve prema desnoj strani vrata u dorzo-ventralnoj osovini. Pri prijmu je bolesnik bio prisvjestan, žalio se na bol i trnce desnog gornjeg ekstremiteta. Učinjena je kompjutorizirana tomografija (CT) i CT angiografska obrada vrata kojima se verificira položaj noža koji penetrira lijevostranu vratnu muskulaturu i intervertebralne ligamente u segmentu C IV/C V, usmjeren prema kontralateralnoj zajedničkoj karotidnoj arteriji, vertebralnoj arteriji te korijenu živca C5. Učinjen je hitan operacijski zahvat. Tijekom ranog poslijeoperacijskog razdoblja učinjena je elektroneuromiografija kojom se dokazala akutna lezija korijena C5 desno. Poslijeoperacijskim nalazom magnetske rezonancije verificiran je intaktni brahijalni pleksus na strani ozljede. Kliničkom slikom u poslijeoperacijskom tijeku dominirala je smanjena mišićna snaga i limitirani pokreti desnog gornjeg ekstremiteta. Ubodne ozljede vrata predstavljaju rijetku kliničku patologiju s obzirom na sve slučajeve traumatskih ozljeda. Pravodobna prijeoperacijska radiološka obrada pokazala je blizinu oštrice noža spram desne vertebralne i desne zajedničke karotidne arterije. Tijekom poslijeoperacijskog boravka u kliničkoj slici zaostala je limitirana abdukcija desnog ramena kao posljedica ozljede korijena živca C5

Laparoscopic placement of peritoneal dialysis catheter: surgical method and results

Laparoskopsko postavljanje peritonejskoga katetera pokazalo se sigurnom i učinkovitom metodom zahvaljujući napredovanju instrumenata i tehnike. Na Klinici za kirurgiju KBC Osijek u posljednje dvije godine laparoskopskom tehnikom postavljeno je devet peritonejskih katetera. Operacije su se izvodile u općoj anesteziji. Kateter se uvodio kroz preperitonealni tunel u paramedijanoj lijevoj liniji do suprapubičnoga prostora koristeći 2 5mm troakara i mini laparoskopsku kameru, te se njegov izlazni kraj izvodio u lijevoj medioklavikulamoj liniji infraumbilikalno. Prosječno je trajanje operacije bilo 23 minute i nije bilo nikakvih intraoperacijskih komplikacija i morbiditeta. Jednom pacijentu istovremeno je napravljena hemioplastika umbilikalne hernije. S peritonejskom dijalizom započelo se dva tjedna nakon postavljanja katetera. Kod dva pacijenta pojavile su se komplikacije tipa leakage i okluzija katetera koje su uspješno riješene te se nakon toga mogla i dalje provoditi peritonejska dijaliza.Laparoscopic placement of peritoneal dialysis catheter has shown to be safe and effective due to improved instruments and method. During the period of 2 years, at the Clinic for Surgery of University Hospital Centre Osijek, 9 laparoscopic placements of peritoneal dialysis catheters were performed. The operations were performed under general anesthesia. Peritoneal dialysis catheter was passed through a preperitoneal tunnel until the tip was placed into the pelvis using 2 5mm ports and mini laparoscopic camera. Outer end of peritoneal dialysis catheter was pulled out in the left lower quadrant of abdomen. The mean operating time was 23 minutes. There were no intraoperative complications and morbidity. At the same time one umbilical hernia was repaired. Routine peritoneal dialysis started 2 weeks after its placement. In 2 cases complications such as leakage and catheter occlusion had been observed, however successfully resolved. This method has proven to be both safe and effective

Epidemiologic Data of Malignant Melanoma in Osijek-Baranya County (Eastern Croatia) During the Period of 2000–2008

During the past several decades there has been a substantial increase in the incidence of malignant melanoma worldwide. The highest incidences were reported in New Zealand and Australia. In Europe the northern countries generally have a higher incidence. The aim of this retrospective study was to provide the incidence and mortality for all patients with malignant melanoma diagnosed in Osijek-Baranya County, Eastern Croatia, during 2000–2008. In the past 30 years in the Republic of Croatia the incidence of melanoma increased by 337%. During the period of 2000–2006 in Osijek-Baranja County, the incidence of melanoma increased by 13%. The incidence of melanoma increases with age, but in past decades melanoma is more often diagnosed in people aged 25–40. The mortality between 2000 and 2008 increased by 18%. The incidence of melanoma generally increases equally in men and women. The most common localization of skin melanoma in males was trunk and in females the lower extremities. Presently, in Osijek-Baranya County melanoma is 15th on the list of malignant tumors and represent 2% of all malignant tumors. In New Zealand, Australia and European northern countries mortality is reduced, as result of earlier diagnosis and education of risk groups. Unfortunately, in Osijek-Baranya County, in a comparison with these countries, the mortality is higher although incidence is the same or lower

Laparoscopic resection of the colon

Uspješna primjena laparoskopske kolecistektomije i laparoskopske apendektomije ohrabruje kliničare da razvijaju laparoskopsku tehnologiju prema liječenju oboljenja gastrointestinalnog trakta. Izvodeći različite laparoskopske zahvate u kliničkoj praksi i stječući iskustva u laparoskopskim vještinama, a poslije kontroliranog rada na životinjama, započinjemo s izvođenjem laparoskopske kirurgije kolona u proteklih 12 mjeseci. Za to vrijeme operirano je 30 bolesnika metodom laparoskopski asistirane resekcije kolona. U 14 bolesnika učinjena je resekcija sigmoidnog kolona, lijeva hemikolektomija u 7 bolesnika, desna hemikolektomija u 3 bolesnika, prednja resekcija rektuma u dva te jedna Hartmannova operacija. U tri se bolesnika laparoskopski uspostavio kontinuitet debeloga crijeva nakon operacije po Hartmannu. Indikacije za operativno liječenje bile su divertikularna bolest sigmoidalnog kolona u 14 bolesnika, sigmoidalni karcinom u 7, karcinom cekuma u tri, karcinom ascendentnog kolona u jednog, rektalni karcinom u dva i perforirani divertikul u jednoga bolesnika. Imali smo 4 postoperativne komplikacije, jednu manifestnu insuflcijenciju kolorektalne anastomoze, jedno postoperativno krvarenje i dvije infekcije minilaparotomije. Nije bilo postoperativnoga ileusa, svi pacijenti dobivali su tekućinu na usta prvoga postoperativnoga dana. Imali smo jedan smrtni ishod kao posljedicu septičkih komplikacija. Tri puta bili smo prisiljeni učiniti konverziju zahvata iz laparoskopskog u konvencionalni, uvijek zbog krvarećih adhezija. Devet bolesnika je operirano zbog karcinoma debeloga crijeva i broj limfnih pregledanih čvorova koji je izvađen s preparatom nije bio manji nego kod otvorenog zahvata. Mislimo da postoje mogućnosti da laparoskopska kolektomija postane jednako popularna kao i ostali laparoskopski zahvati.The successful application of laparoscopic surgery to gallblader disease and acute appendicitis has encouraged clinical investigators to develop this technology further in treatment of the gastrointestinal tract. After gaining experience with various laparoscopic skills while performing clinical range of laparoscopic procedures and then in controlled animal laboratory, a program for laparoscopic colonic surgery was initiated 12 months ago. 30 patient went laparoscope assisted colon resection. In 14 patients resection of sigmoid colon was performed, left hemicolectomy in 7, a right hemicolectomy in 3, anterior rectum resection in 2, and one Hartmann’s procedure. In 3 patients colon anastomosis after Hartmann’s procedure was established. Indications for surgery was diverticular disease in 14 patients, sigma carcinoma in 7, caecumcarcinom in 3, colon ascendens carcinoma in 1, rectum carcinoma in 2, perforated diverticulum in one patient. There was 4 postoperative complications, one manifest anastomosis insufflcienty, one postoperative bleeding and 2 wound infections of mini-laparotomy. There was no postoperative ileus, all patients were able to tolerate liquid diet on the first postoperative day. One patient had lethal course because of septic complications. There was three conversions from laparoscopic to open surgery, and every time because of bleeding adhesions. Nine patients were operated of cancer, limph node numbers harvested was not smaller in average than in conventional surgery. We fell that laparoscopic colectomy has the potential to be as popular as laparoscopic surger

Prijelomi distalnog okrajka nadlaktične kosti kod djece

Rezultati istraživanja dobiveni na temelju podataka iz medicinske dokumentacije Odjela dječje kirurgije KBC-a Osijek uglavnom se ne razlikuju od podataka iz literature. Od ukupno 43 pacijenta sa suprakondilarnim prijelomom humerusa, starosti do 15 godina, 24 pacijenta bila su muškog spola, a 19 pacijenata bilo je ženskog spola. Prijelomi su najčešći u dobi od 6 do 11 godina (25 pacijenata). Najčešće su nastali tijekom pada u igri, s bicikla, kreveta i sl. Dominantna strana za nastanak prijeloma bila je lijeva (26 pacijenata). U liječenju suprakondilarnih prijeloma dominira repozicija uz imobilizaciju (30 pacijenata), potom repozicija s vanjskom fiksacijom (10 pacijenata), a otvorena repozicija i unutarnja fiksacija primijenjene su tek kod 3 pacijenta

Role of Zinc in Chronic Gastritis

Oxidative stress occurs in inflammation of gastric mucosa. The role of zinc in modulating oxidative stress has recently been recognized. Zn deficiency results in an increased sensitivity to oxidative stress and have a higher risk of musoca damage in inflammation. The aim of this study was to determine wheather chronic inflammation affects on the concentration of Zn2+ ions in gastric mucosa of patients with chronic gastritis. Forthy-three patients with chronic gastitis were enrolled. Patients were endoscoped. Histology and scoring of gastritis was performed following the guidelines of the updated Sydney system. Endoscopic finding of mucosa were scored according to a Lanza scoring system. The diagnosis of Helicobacter pylori (H. pylori) infection, histopathologic changes, intensity of inflammation and zinc concentration were determined from biopsies of gastric mucosa. The atomic absorption spectrophotometer was used to determine tissue concentrations of zinc. Twenty of 43 patients with chronic gastritis were uninfected by H. pylori. There was no statistically significant difference in tissue concentrations of zinc between H. pylori-positive and H. pylori-negative patients. From those infected patients 53.3% had chronic active gastritis. There was no statistically significant difference in tissue concentrations of zinc between patients with chronic active gastritis and patients with chronic inactive gastritis (p=0.966). Zn in antrum showed positive correlation with density of H. pylori in antrum (Spearman’ rho =0.481, p=0.020), negative correlation with density of H. pylori in corpus (Spearman’ rho = –0.492, p=0.017) and with zinc in corpus (Spearman’ rho = 0.631, p=0.001). Tissue concentration of zinc was not affected by chronic inflammation of gastric mucosa in patients with chronic gastritis

Chronic pancreatitis and pain

Bol je uobičajeni simptom kroničnog pankreatitisa, a najčešće je jakog intenziteta. Usprkos primijenjenoj medikamentoznoj terapiji i kirurškim zahvatima bol perzistira. Patofiziologija boli u kroničnom pankreatitisu nije potpuno jasna i vjerojatno je multifaktorijalna. Dajemo pregled kriterija koje koristimo pri izboru najbolje kirurške metode u bolesnika sa nekontroliranim bolovima uslijed kroničnog pankreatitisa.Chronic pancreatitis is commonly accompanied by severe and unrelenting pain. Pain often persists despite numerous medical and surgical approaches. The pathophysiology of pain from chronic pancreatitis is not well defined and is probably multifactorial in origin. We review the criteria used in choosing the best surgical options for the patient with uncontrolled pancreatic pain