Prikaz rijetkog slučaja hamartoma larinksa

Hamartoma (from the Greek language, where hamartia means defect or an error and -oma denoting a tumor or neoplasm) is a benign tumor-like mass composed of mature tissue or cells that are present in abnormal proportions or show a disorganized arrangement. Hamartomas are rarely seen in the head and neck area and especially rare in the larynx. Only few cases of laryngeal hamartoma have been reported in the literature so far. They are usually manifested by stridor, dysphonia and symptoms associated with airway obstruction. The diagnosis must be confirmed histologically and the method of choice in treatment is complete excision of the lesion. The authors present a case of laryngeal hamartoma of a 43-year-old woman treated for hoarseness and paralysis of the left vocal cord.Hamartom (iz grčkog hamartia, što znači greška, defekt i -oma, označava tumor ili neoplazmu) je benigna masa izgledom slična tumoru, sastavljena od zrelih tkiva ili stanica koje pokazuju poremećaj proporcija ili se pojavljuju u neorganiziranom rasporedu. Hamartomi rijetko zahvaćaju područje glave i vrata, a još rjeđe ih pronalazimo u području larinksa. Dosad je u literaturi opisano samo nekoliko slučajeva laringealnih hamartoma. Najčešće se manifestiraju stridorom, disfonijom te simptomima vezanim uz opstrukciju dišnih putova. Dijagnoza se postavlja patohistološki, a metoda izbora u liječenju je potpuna ekscizija lezije. Autori prikazuju slučaj laringealnog hamartoma u 43-godišnje žene obrađivane zbog promuklosti i pareze lijeve glasnice

Učestalost ozljeda glave u djece u Brodsko-posavskoj županiji

Head injuries are very common in children and are the most frequent cause of disability and death among children. This retrospective study included 350 children hospitalized for injury of neurocranium over a 5-year period at Dr Josip Benčević General Hospital in Slavonski Brod. Boys were more commonly injured (63.4%) than girls. The most common injuries were recorded in children aged 7-14 (47.1%), followed by those aged 1-6 (33.8%) years. The injuries occurred slightly more often in urban (50.9%) than in rural (46.6%) setting. Children were more commonly injured in the street or on the road (38.6%), followed by injuries sustained at home (35.2%), at school (9.3%) and on playgrounds (5.7%). They were most commonly injured by fall (50%), followed by traffic injuries (33.5%). Statistically significant differences were found in the following age groups: all children younger than one year were injured by fall; children aged 1-14 were mostly injured by fall (less in traffic, and due to hitting), and those aged 15-18 mostly in traffic (less by fall and due to hitting). Children were mostly injured in the street or on the road (in traffic accidents), followed by injuries at home (mostly by fall), at school and around the house or in the yard (mostly by fall); on the playground (due to hitting) and on the road (in traffic accidents) (statistically significant difference). Most of them had head contusion and cerebral commotion combined (46.8%), followed by head contusion alone (12.5%) and skull fractures (10.5%). Hemorrhages and hematomas were rare (epidural, subdural, subarachnoid hemorrhage), found in 3.2% of cases. We hope that our results will prove helpful in planning preventive measures and treatment of injured children.Ozljede glave su česte u djece i najčešći su uzrok nesposobnosti i smrti djece. Retrospektivnom analizom obrađeno je 350 djece hospitalizirane zbog ozljeda neurokranija u 5-godišnjem razdoblju u Općoj bolnici “Dr. Josip Benčević” u Slavonskom Brodu. Češće su bili ozlijeđeni dječaci (63,4%) od djevojčica. Najčešće su ozlijeđena djeca u dobi od 7. do 14. godine (47,1%), zatim od 1. do 6. godine (33,8%). Nešto više ozljeda bilo je u gradu (50,9%) nego na selu (n=162; 46,6%). Djeca su najčešće bila ozlijeđena na ulici ili cesti (38,6%), zatim u kući (35,2%), u školi (9,3%) te na igralištu (5,7%). Najčešće su bila ozlijeđena pri padu (50%), zatim u prometu (33,5%). Do ozljeda je najčešće dolazilo u travnju (11,2%) i srpnju (11,2%), zatim u lipnju (10,6%). Dokazana je statistički značajna dobna razlika: sva djeca do 1. godine ozlijeđena su pri padu; djeca od 1. do 14. godine najčešće su ozlijeđena pri padu (manje u prometu, te zbog udaraca), a starija djeca od 15. Do 18. godine najčešće u prometu (manje pri padu, pa zatim zbog udaraca). Djeca su najčešće bila ozlijeđena na ulici i cesti (u prometnim nesrećama), zatim u kući (uglavnom pri padu), u školi i oko kuće ili u dvorištu (najčešće pri padu); na igralištu (uslijed udaraca), te na autocesti (prometne nesreće) (statistički značajna razlika). Najviše ih je imalo istodobno kontuziju i komociju (46,8%), zatim samu kontuziju glave (12,5%), te frakture kosti lubanje (10,5%). Rjeđa su bila krvarenja i hematomi (epiduralni, subduralni, subarahnoidno krvarenje) (3,2%). Nadamo se da će naši rezultati pomoći u planiranju preventivnih mjera i liječenju ozlijeđene djece

Ozljede glave u djece

Nowadays, head injuries are becoming more frequent in children. The most common cause of head injuries in children is fall, and, in more severe injuries, traffic accident trauma. In traumatic brain injuries in infants and small children, the most common symptoms are paleness, somnolence and vomiting, the so called “pediatric contusion syndrome”. After the first year of age, light head trauma occurs after minor falls, whereas the most severe injuries are caused by car accidents, including pedestrians, or fall from the height. As the child grows, severe head trauma is more likely to occur after bicycle or car accidents. Brain injuries involving or penetrating the brain by broken bone fragments include contusions and lacerations of the brain. Unconsciousness need not always occur during contusion, as it may also appear after swelling of the brain or high intracranial pressure complications. Despite comprehensive injuries in such types of accidents, the outcome of survivors is surprisingly good. Such severe neurocranium injuries usually include heavy bleeding with hematoma (epidural bleeding, subdural bleeding, intracerebral bleeding, and traumatic subarachnoid hemorrhage). Improved prehospital care, readiness and accessibility of multidisciplinary teams, establishment of regional centers, and efforts to prevent and decrease traffic accidents contribute to mortality rate reduction.U današnje vrijeme sve su učestalije ozljede glave u djece. Najčešći uzrok ozljeda glave u djece je pad, a kod težih ozljeda trauma u prometnim nesrećama. Kod traumatskih ozljeda mozga u dojenčadi i male djece najznačajniji simptomi su bljedoća, somnolencija i povraćanje, tzv. „pedijatrijski kontuzijski sindrom“. Nakon prve godine života blaže ozljede glave najčešće nastaju uslijed manjih padova, a najteže ozljede su rezultat nesreća u kojima sudjeluju automobil i pješak ili padova s visine. Kako dijete raste, teške ozljede glave mnogo češće nastaju zbog biciklističkih ili automobilskih nesreća. Ozljede mozga koje nastaju nagnječenjem su kontuzije i laceracije mozga, najčešće uzrokovane prelomljenim kostima koje ozljeđuju i penetriraju mozak. Prilikom samog nagnječenja ne mora doći do gubitka svijesti, ali se nesvijest može javiti nakon razvoja otekline mozga i komplikacija zbog povišenog intrakranijskog tlaka. Unatoč opsežnim ozljedama nastalim takvim tipom nesreće ishod preživjelih je iznenađujuće dobar. Takve teže ozljede neurokranija obično uključuju teža krvarenja s hematomima (epiduralno krvarenje, subduralno krvarenje, intracerebralno krvarenje, traumatsko subarahnoidno krvarenje). Smanjenju stope smrtnosti doprinosi unaprijeđena predbolnička njega, spremnost i dostupnost multidisciplinarnih timova, uspostavljanje regionalnih centara, te pokušaji prevencije i smanjivanja broja prometnih nesreća

Spontano povlačenje posttraumatskog kroničnog subduralnog hematoma: prikaz slučaja

Spontaneous resolution of post-traumatic chronic subdural hematoma is a very rare and unexpected event. It has been rarely reported in the literature, mostly cases of chronic subdural hematoma resolution in idiopathic thrombocytopenic purpura. Operative procedure is generally considered the treatment of choice for chronic subdural hematoma. We present a rare case, which did not require an open surgery, i.e. a case of post-traumatic chronic subdural hematoma spontaneous resolution in a 76-year-old female having sustained a fall without classic head injury. The possibility of conservative treatment is extremely rare in patients with chronic subdural hematoma, but it should be considered based on the patient’s neurological and physical condition.Spontano povlačenje kroničnog subduralnog hematoma je vrlo rijetko vidljivo i neočekivano u praksi. Rijetko se spominje u literaturi, najčešće slučajevi povlačenja hematoma u bolesnika koji boluju od idiopatske trombocitopenične purpure. Operacijsko liječenje je opće prihvaćeni način liječenja kroničnih subduralnih hematoma. U radu se prikazuje slučaj u kojem smo se odlučili za nekirurško liječenje: posttraumatski kronični subduralni hematom izliječen konzervativno u 76-godišnje bolesnice koja je nastradala pri padu, bez klasične ozljede glave. Mogućnost konzervativnog liječenja je iznimno rijetka u bolesnika s kroničnim subduralnim hematomom, ali se o tome treba razmisliti shodno neurološkom stanju bolesnika i fizičkoj kondiciji

Usporedba različitih metoda izvanbolničkog održavanja dišnoga puta u bolesnika sa srčanim zastojem u slavonskoj regiji

Endotracheal intubation is the gold standard in inpatient treatment of cardiac arrest patients; however, there are conflicting research results in out-of-hospital conditions. This prospective study included 92 patients with confirmed cardiac arrest occurring outside a hospital facility, who fulfilled the inclusion criteria and whom the emergency ambulance team reached within 20 minutes from the event. Medical data on each patient (age, gender, cause of arrest, estimated time of arrest, time to arrival of the ambulance team, resuscitation commenced prior to arrival of the ambulance team, initial electrocardiographic rhythm, method of airway management, and success of resuscitation) were recorded. The airway maintenance techniques applied in the patients were endotracheal intubation and I-gel laryngeal mask (LMA). The rate of spontaneous circulation recovery resulting from different techniques of airway management and the incidence of spontaneous circulation recovery between the defibrillation rhythm and non-defibrillable rhythm groups were recorded for each patient. Forty-seven patients received endotracheal tube and the rest of 45 patients I-gel LMA treatment. The ratio of achieving spontaneous circulation with intubation versus I-gel LMA was 13 (28%) to 11 (24%) (p=0.725). The best return of spontaneous circulation results was recorded in patients suffering from ventricular fibrillation; however, there was no statistically significant difference between the intubation and I-gel LMA treatments (8 (47%) vs. 7 (41%); p=0.916). No statistically significant difference was observed between the outcomes of patients resuscitated by endotracheal intubation and I-gel LMA methods either.Endotrahealna intubacija je „zlatni standard“ u liječenju bolesnika sa srčanim zastojem u bolnici, ali rezultati istraživanja u izvanbolničkim uvjetima su proturječni. U ovo istraživanje bila su uključena 92 bolesnika sa srčanim zastojem doživljenim u izvanbolničkim uvjetima, koji su ispunjavali kriterije uključenja u studiju te kod kojih je hitna medicinska pomoć stigla unutar 20 minuta od srčanog zastoja. Bilježeni su sljedeći podatci: spol, dob, uzrok srčanog zastoja, vrijeme srčanog zastoja, vrijeme do dolaska ekipe hitne pomoći, započinjanje reanimacije prije dolaska ekipe hitne pomoći, početni elektrokardiografski ritam, metoda osiguravanja dišnog puta te uspješnost postupka reanimacije. Od tehnika održavanja dišnog puta rabila se I-gel laringealna maska te endotrahealni tubus. Bilježeni su rezultati povrata spontane cirkulacije kod pojedine metode održavanja dišnog puta te razlike između skupina s obzirom na ritmove koji se defibriliraju i one koji se ne defibriliraju. Bila su 47 bolesnika s endotrahealnim tubusom, dok je 45 bolesnika imalo laringealnu masku. Omjer povrata spontane cirkulacije između skupine s intubacijom i skupine s laringealnom maskom bio je 13 (28%) prema 11 (24%) (p=0,725). Najbolji rezultati oživljavanja zabilježeni su u skupini bolesnika s ventrikulskom fibrilacijom, ali bez statistički značajne razlike između skupine s endotrahealnom intubacijom i skupine s laringealnom maskom (8 (47%) prema 7 (41%); p=0,916). Nije pronađena statistički značajna razlika u uspješnosti oživljavanja između skupine bolesnika s endotrahealnom intubacijom i skupine s laringealnom maskom