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

Types od anterior cruciate ligament grafts

Ozljede prednjeg križnog ligamenta su najčešće ozljede ligamenata koljena. Prednja ukrižena sveza je iznimno važna zbog svoje presudne uloge u održavanju stabilnosti koljena. Zbog nemogućnosti prednjeg križnog ligamenta da sam zacijeli, u slučaju ozljede ligamenta pristupa se njegovoj rekonstrukciji koristeći transplantate, kako bi se ostvarila ponovna uspostava prirodnih anatomskih i funkcionalnih odnosa u koljenu. Tijekom povijesti razvijale su se sve bolje i naprednije tehnike, te otkrivali novi načini kirurškog liječenja, s ciljem pronalaska najoptimalnije zamjene za nativni prednji križni ligament. Za sada, najučinkovitijima su se pokazali transplantati od vlastitog tkiva pacijenta, tzv. autologni transplantati. Uz njih, za liječenje ozljeda prednjeg križnog ligamenta na raspolaganju su i alogeni transplantati, odnosno tkiva koja su pribavljena od humanih kadavera i pohranjena u banke tkiva. Sintetički transplantati se u prošlosti nisu dokazali kao pouzdana opcija, ali napredovanjem tehnologije i otkrivanjem novih materijala, ova vrsta transplantata ponovno privlači sve veći interes te ima veliki potencijal u budućnosti rekonstrukcije ACL-a.Anterior cruciate ligament (ACL) injuries are the most common knee ligament injuries. The ACL is an extremely important ligament because of its crucial role in maintaining knee stability. Due to the inability of the anterior cruciate ligament to heal on its own, in case of injury to the ligament, its reconstruction is approached using grafts in order to achieve the re-establishment of natural anatomical and functional relationships in the knee. Throughout history, better and more advanced techniques have been developed, and new methods of surgical treatment have been discovered, with the aim of finding the most optimal replacement for the native anterior cruciate ligament. For now, transplants from the patient's own tissue, the so-called autografts, have proven to be the most effective. In addition to them, allogeneic transplants, i.e. tissues obtained from human cadavers and stored in tissue banks, are also available for the treatment of anterior cruciate ligament injuries. Synthetic grafts have not been proven as a reliable option in the past, but with the advancement of technology and the discovery of new materials, this type of graft is once again attracting increasing interest and has great potential in the future of ACL reconstruction

Types od anterior cruciate ligament grafts

Ozljede prednjeg križnog ligamenta su najčešće ozljede ligamenata koljena. Prednja ukrižena sveza je iznimno važna zbog svoje presudne uloge u održavanju stabilnosti koljena. Zbog nemogućnosti prednjeg križnog ligamenta da sam zacijeli, u slučaju ozljede ligamenta pristupa se njegovoj rekonstrukciji koristeći transplantate, kako bi se ostvarila ponovna uspostava prirodnih anatomskih i funkcionalnih odnosa u koljenu. Tijekom povijesti razvijale su se sve bolje i naprednije tehnike, te otkrivali novi načini kirurškog liječenja, s ciljem pronalaska najoptimalnije zamjene za nativni prednji križni ligament. Za sada, najučinkovitijima su se pokazali transplantati od vlastitog tkiva pacijenta, tzv. autologni transplantati. Uz njih, za liječenje ozljeda prednjeg križnog ligamenta na raspolaganju su i alogeni transplantati, odnosno tkiva koja su pribavljena od humanih kadavera i pohranjena u banke tkiva. Sintetički transplantati se u prošlosti nisu dokazali kao pouzdana opcija, ali napredovanjem tehnologije i otkrivanjem novih materijala, ova vrsta transplantata ponovno privlači sve veći interes te ima veliki potencijal u budućnosti rekonstrukcije ACL-a.Anterior cruciate ligament (ACL) injuries are the most common knee ligament injuries. The ACL is an extremely important ligament because of its crucial role in maintaining knee stability. Due to the inability of the anterior cruciate ligament to heal on its own, in case of injury to the ligament, its reconstruction is approached using grafts in order to achieve the re-establishment of natural anatomical and functional relationships in the knee. Throughout history, better and more advanced techniques have been developed, and new methods of surgical treatment have been discovered, with the aim of finding the most optimal replacement for the native anterior cruciate ligament. For now, transplants from the patient's own tissue, the so-called autografts, have proven to be the most effective. In addition to them, allogeneic transplants, i.e. tissues obtained from human cadavers and stored in tissue banks, are also available for the treatment of anterior cruciate ligament injuries. Synthetic grafts have not been proven as a reliable option in the past, but with the advancement of technology and the discovery of new materials, this type of graft is once again attracting increasing interest and has great potential in the future of ACL reconstruction