Cistični limfangiom mezenterija jejunuma koji oponaša akutni apendicitis: prikaz slučaja

Cystic lymphangiomas of the small bowel mesentery are rare manifestations of intra-abdominal tumors. Usually, they are discovered incidentally during examination for an unrelated abdominal illness. We present a case of a 4-year-old boy who was admitted to our hospital because of the right lower quadrant acute abdominal pain suspect of acute appendicitis. At laparotomy, a giant, cystic, encapsulated and lipomatous mesenterial mass was found, 15x15x10 cm in size, infiltrating the jejunum. The tumor was located 70 cm from Treitz’s ligament. Extirpation of tumor mass with intestinal resection of the involved loops was necessary. Pathologic examination confirmed the diagnosis of mesenteric cystic lymphangioma. Although they are rare, cystic mesenteric lymphangiomas should be considered as a possible cause of acute abdomen and treated with surgical resection. Prognosis after surgical removal is excellent.Cistični limfangiomi mezenterija tankog crijeva pripadaju rijetkim intraabdominalnim tumorima. Obično se nađu slučajno tijekom obrade zbog neodređene trbušne boli. Prikazuje se slučaj četverogodišnjeg dječaka hospitaliziranog zbog bolova u donjem desnom abdominalnom kvadrantu sumnjivih na akutnu upalu crvuljka. Nakon učinjene laparotomije našla se velika, cistična, inkapsulirana, lipomatozna mezenterijska masa veličine 15x15x10 cm koja je infiltrirala jejunum. Tumor je bio smješten oko 70 cm aboralno od Treitzova ligamenta. Učinjena je ekstirpacija tumora s infiltriranom jejunalnom vijugom. Patohistološki nalaz je potvrdio dijagnozu mezenterijskog cističnog limfangioma. Iako rijetki, cistični mezenterijski limfangiomi se mogu smatrati mogućim uzrokom akutne abdominalne boli i liječiti kirurškom resekcijom. Prognoza je nakon kirurškog odstranjenja odlična

Bus Split Contingency Analysis Implementation in the NetVision DAM EMS

Implementation of the bus coupler outage scenarios, commonly known as bus splitting, in the NetVision DAM energy management system (EMS) contingency analysis is presented in this paper. In order to identify the bus coupler branches in the network model, the existing topology processor was upgraded. The description of the topological algorithm for detection of the bus couplers is given. Based on the topology analysis results, calculation subnodes are created. Calculation model was modified in order to include the bus couplers and the subnodes as the new calculation objects. These modifications are fundamental for the introduction of the bus coupler outages in the contingency analysis. Implications of the bus coupler outages on the load flow mathematical model are discussed. Implemented NetVision DAM solution for the analysis of such outage scenarios is presented

Hypoglycemia as a side eff ect of infantile hemangioma treatment with propranolol: three case reports

Peroralno primijenjen propranolol u dozi od 1-3 mg/kg/dan terapija je izbora kompliciranih hemangioma dojenačke dobi. Prikazujemo dva bolesnika s nastankom simptomatske hipoglikemije i jednog bolesnika s nastankom konvulzija najvjerojatnije povezanih s hipoglikemijom, koji su na peroralnoj terapiji propranololom radi liječenja dojenačkih hemangioma. Iako se propranolol prilično dugo primjenjuje u drugim indikacijama, i čini se pouzdanim lijekom, baš zbog svoje neselektivnosti u djelovanju potrebno je prepoznati moguće i rjeđe nuspojave kao što je hipoglikemija, posebice u novim indikacijama za primjenu lijeka kao što je liječenje dojenačkih hemangioma u proliferativnoj fazi rasta.Therapy of choice for complicated hemangiomas in infancy is orally administered propranolol in a dose of 1-3 mg/kg/day. We report on two patients who developed symptomatic hypoglycemia and one patient experiencing seizures most likely associated with hypoglycemia. Oral propranolol therapy for the treatment of infantile hemangioma was administered to all three patients. Although propranolol is used in other indications and seems to be a safe drug, due to its non-selectiveness it is necessary to recognize the possible less common side eff ects such as hypoglycemia, especially when administered for a new indication, such as treatment of infantile hemangiomas in the stage of proliferative growth

Coloanal anastomosis in the treatment of congenital megacolon in children: case report

Kongenitalni megakolon ili Hirschprungovu bolest prvi put je opisao Harold Hirschprung. To je urođena crijevna aganglioza kao rezultat poremećaja u fetalnom razvoju mienteričkog živčanog sustava. Normalan motilitet crijeva ovisi o koordiniranim segmentalnim kontrakcijskim valovima koji slijede neposredno nakon opuštanja glatkih mišića. Bolesnicima s Hirschprungovom bolešću nedostaje funkcionalni mienterički živčani sustav u zahvaćenom distalnom crijevu pa imaju nedjelotvornu distalnu peristaltiku. Klinički rezultat je neuspješno pasiranje mekonija ubrzo nakon rođenja, zatvor, distendiran trbuh, palpabilne vijuge crijeva, povraćanje, proljevaste vodenaste stolice, slabo napredovanje tjelesne mase, spor rast i malapsorpcija. Aganglionarni distalni segment crijeva je razlog dilatacije proksimalnog dijela debelog crijeva ili nesposobnosti otvaranja analnog sfi nkternog sustava. Hirschprungova bolest zahvaća između 1:5 000 do 1:8 000 živorođene djece. Većina slučajeva dijagnosticira se prije 10. godine života. Bolesnici se povremeno prezentiraju ovim tegobama u kasnijoj dobi. Nedavno smo operirali 12-godišnjeg bolesnika s ovim stanjem. Najprije smo izveli kiruršku resekciju rektosigmoidnog kolona sa zatvaranjem bataljka rektuma i formiranjem kolostome, Hartmannov zahvat. Tri mjeseca nakon toga obavili smo ekstirpaciju rektuma i formirali koloanalnu anastomozu. Postoperativni tijek, stanje bolesnika i klinički testovi pokazali su da je ovakav način liječenja kongenitalnog megakolona bio uspješan, što je bila i svrha ovog prikaza bolesnika.Congenital megacolon or Hirschsprung’s disease was fi rst described by Harold Hirschsprung. It is a congenital intestinal aganglionosis as a result of arrested fetal development of the myenteric nervous system. Normal intestinal motility depends on a coordinated segmental contraction waves followed immediately by smooth muscle relaxation as it propagates caudally. Patients with Hirschsprung’s disease lack functional myenteric nervous system in the aff ected distal intestine and have ineff ective distal peristalsis. The clinical outcomes are failure to pass meconium shortly after birth, constipation, abdominal distension, palpable loops of bowel, vomiting, watery diarrhea in the newborn, poor weight gain, slow growth and malabsorption. The aganglionic distal segment of the bowel is the reason for dilatation of the proximal part of the colon or opening debility of the anal sphincter system. Hirschsprung’s disease is aff ecting 1:5000 to 1:8000 live births. Most cases are diagnosed before the patient is 10 years of age. Occasionally, patients present with this problem at a later age. Recently we operated on a 12-year-old patient with this condition. First we performed surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy, also known as Hartmann’s procedure. Three months later, the rectum was extirpated and coloanal anastomosis formed. Based on the uneventful postoperative course, good patient’s condition and clinical tests, the treatment of congenital megacolon was successful

A RARE TUMOR OF THE LUNG IN CHILDHOOD – INFLAMMATORY MYOFIBROBLASTIC TUMOR

Inflamatorni miofibroblastični tumor (IMT) benigna je novotvorina koja uglavnom zahvaća pluća kod djece. Od svih tumora pluća javlja se u 0,7%.1 Brunn je tumor prvi opisao 1939. godine.2 Postavljanje sigurne dijagnoze veoma je teško i često moguće tek nakon resekcije tumora. Mi želimo prikazati 13-godišnju bolesnicu s plućnim IMT-om koja je duže vrijeme kašljala, imala zaduhu i osjećaj nelagode u prsnom košu. Rendgenska snimka, kao i kompjutorizirana tomografija pokazale su prisutnost tumorske mase u donjem plućnom režnju s desne strane. Njezini klinički i radiološki nalazi nisu bili specifični da bi se mogla utvrditi dijagnoza pa se indicirao kirurški zahvat. Sam zahvat i postoperativni tijek protekli su bez komplikacija. Tumor je odstranjen u cijelosti, histološki je potvrđen upalni miofibroblastični tumor pluća. Bolesnica je 2 godine nakon operacije bila bez kliničkih znakova recidiva bolesti.Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm, mainly involving the lungs of the children. It represents 0.7% of all lung tumors.1 It was first described by Brunn in 1939.2 Diagnosis is very difficult and often only possible after resection of the tumor. We would like to present a case of pulmonary IMT in a 13-year-old girl who presented with symptoms like cough, shortness of breath , and chest discomfort. Chest X ray and computed tomography revealed the presence of a right lower lobe lung mass. Its clinical and radiological findings were diverse and non specific. The mass was removed in toto, histopathology confirmed the inflammatory myofibroblastic tumor of the lung. Intraoperative and postoperative courses were uneventful. The patient has been without any signs of relapse 2 years after the surgery

Otkrivanje Bakerove ciste: Ultrazvučna dijagnostika (duplex scan) u izvanbolničkim uvjetima

Popliteal cyst, also called Baker’s cyst, is a popliteal fossa enlargement filled with synovial fluid. Baker’s cysts can be symptomatic and cause considerable pathologies such as thrombophlebitis, compartment syndrome and even nerve entrapment. It is the most common nonvascular pathology seen in the popliteal fossa but clinically indistinguishable from deep vein thrombosis. The aim of the present study was to evaluate venous duplex scanning in detecting and distinguishing complicated Baker’s cyst and deep vein thrombosis in outpatient setting. Medical records of all patients undergoing venous duplex scanning during 2008 and 2009 to rule out deep vein thrombosis were reviewed. Ten patients having undergone ultrasonography examination were found to have complicated Baker’s cyst. Baker’s cysts are a rather common condition. When presenting with swollen and painful calf, it is impossible to differentiate it from deep vein thrombosis by simple clinical examination. Venous duplex scanning of lower extremity was found to be a useful imaging modality for detection of Baker’s cysts, deep vein thrombosis and associated pathology.Poplitealna cista poznata i kao Bakerova cista je tvorba ispunjena sinovijskom tekućinom i smještena u poplitealnoj jami. Ona može biti simptomatska i prouzročiti ozbiljne poremećaje kao što su tromboflebitis, sindrom fascijalnih prostora i neuropatiju uslijed kompresije živca. To je najčešća nevaskularna tvorba u zakoljenoj jami i katkada ju je klinički nemoguće razlikovati od duboke venske tromboze. Cilj ove studije bio je procijeniti vrijednost ultrazvučne dijagnostike(duplex scan) u otkrivanju i razlikovanju komplicirane Bakerove ciste i duboke venske tromboze u ambulantnim uvjetima. Analizirala se medicinska dokumentacija bolesnika koju su u posljednje dvije godine (2008. i 2009.) bili podvrgnuti duplexultrasonogafiji kako bi se isključila duboka venska tromboza. Komplicirana Bakerova cista je utvrđena u desetoro bolesnika. Bakerova cista je prilično česta tvorba i kada se očituje otečenom i bolnom potkoljenicom nemoguće ju je običnim kliničkim pregledom sa sigurnošću razlikovati od duboke venske tromboze. Ultrasonografija metodom duplex scan je koristan modalitetet za otkrivanje Bakerove ciste, duboke venske tromboze i pridružene patologije

THE INFLUENCE OF MYCORRIZAL FUNGI INOCULATION ON THE GRAŠEVINA (Vitis vinifera L.) GRAPEVINE CULTIVAR’S PLANT NUTRIENT SUPPLY

Cilj istraživanja bio je utvrditi učinak živoga mikoriznog cjepiva na dinamiku opskrbljenosti biljnim hranivima vinove loze. Pokus je proveden na kultivaru Graševina (Vitis vinifera L.), cijepljenome na podlozi SO4 u uvjetima Vinogorja Kutjevo. Uzgojni oblik je Guyot, s opterećenjem od 10 pupova. U neposrednu blizinu korijenova sustava inokulirano je 20 ml mikorizne suspenzije koja sadrži oko 2000 propagacijskih jedinica živoga mikoriznog micelija. Istraživanje je provedeno u dvama klimatski vrlo različitim godinama. Prvu godinu istraživanja (2014.) karakterizirale su obilne oborine i manje sunčanih dana, što je rezultiralo kasnijom tehnološkom zrelošću grožđa od 34 dana u odnosu na 2015. godinu, koja je u periodu dozrijevanja grožđa bila iznadprosječno topla i suha. U obje godine istraživanja, u uvjetima slabe opskrbljenosti tla organskom tvari, fosforom i kalijem, mikorizna simbioza utjecala je na veći sadržaj fosfora i kalija u suhoj tvari list kultivara Graševine. U godini s više oborina i manje topline utvrđen je veći sadržaj dušika u listovima trsova s mikoriznom simbiozom. U suhim i toplim uvjetima tijekom cijeloga perioda dozrijevanja grožđa povećan je sadržaj kalcija, a opravdano veći sadržaj cinka, mangana i željeza utvrđen je u periodu neposredno prije tehnološke zrelosti grožđa. Nije utvrđen pozitivan utjecaj mikorize na urod, sadržaj šećera i ukupnu kiselost.The aim of the study was to determine the effect of a live mycorrhizal vaccine on the dynamics of grapevine’s plant nutrient supply. The experiment was performed on the Graševina variety (Vitis vinifera L.), grafted on an SO4 rootstock in the conditions of the Kutjevo Vineyards. The training system was Guyot, with a 10‐bud load. In the root system’s immediate vicinity, 20 ml of mycorrhizal suspension containing approximately 2,000 propagation units of a live mycorrhizal mycelium were inoculated. From the viticultural aspect, the research was conducted in two climatically very different years. The first research year (2014) was characterized by an abundant precipitation and less sunny days, resulting in a later technological grape maturity, amounting to 34 days when compared to the year 2015, which was extraordinarily warm and arid during the grape ripening period. In both research years, in the conditions of the soil’s low supply with the organic matter, phosphorus, and potassium, a mycorrhizal symbiosis influenced the higher content of phosphorus and potassium in the Graševina’s dry leaf matter. In a year experiencing more precipitation and less heat, a higher nitrogen content was found in the vine leaves manifesting a mycorrhizal symbiosis. In the dry and warm conditions, the calcium content was increased during the entire period of grape ripening, and a justifiably higher content of zinc, manganese, and iron was found in the period immediately preceding a technological grape ripeness. A positive influence of mycorrhiza on the yield, sugar content, and total acidity was not determined

Osjetljivost i specifičnost Fenyö-Lindbergova i Teicherova sustava bodovanja u dijagnostici akutne upale crvuljka u žena

The aim of the study was to assess diagnostic accuracy (sensitivity and specificity) of Fenyö-Lindberg and Teicher scores for distinguishing patients that need immediate surgical treatment from the others, in a female population from an urban setting. The study prospectively included 130 female patients admitted to the emergency department with abdominal pain indicating acute appendicitis. The scores and parameters of validity were calculated and compared to definitive diagnosis. For Fenyö-Lindberg score of -17 or less, 84.5% sensitivity, 55.6% specificity, 87.9% positive predictive value (PPV) and 48.4% negative predictive value (NPV) were recorded. For cut-off value greater or equal to -2, there was 59.2% sensitivity, 77.8% specificity, 91% PPV and 33.3% NPV. The Receiver Operating Characteristic (ROC) curve analysis of Fenyö-Lindberg score showed that the best single cut-off value for discriminating acute appendicitis in the study population was -15. For Teicher score, values greater than -3 yielded 89.3% sensitivity and 22.2% specificity, 81.4% PPV and 35.3% NPV. In conclusion, Fenyö-Lindberg score could be used as an additional tool to exclude appendicitis and avoid unnecessary appendectomies. Teicher score may help in recognizing patients with appendicitis. None of the two scores can indicate or decline appendectomy in all cases. Scoring systems may be useful for pointing to important clinical signs and symptoms in specific subpopulations.Cilj istraživanja bio je analizirati dijagnostičku točnost (osjetljivost i specifičnost) Fenyö-Lindbergove i Teicherove bodovne ljestvice u postavljanju dijagnoze akutne upale crvuljka u ženskoj populaciji u urbanom okruženju. U studiju je prospektivno uključeno 130 bolesnica primljenih u hitnoj službi s bolovima u trbuhu i sumnjom na akutni apendicitis. Rezultati i parametri valjanosti izračunati su i uspoređeni s obzirom na konačnu dijagnozu. Za vrijednosti Fenyö-Lindbergova zbira -17 ili manje nađena je osjetljivost od 84,5%, specifičnost od 55,6%, pozitivna prediktivna vrijednost (PPV) od 87,9% i negativna prediktivna vrijednost (NPV) od 48,4%. Za vrijednosti istoga zbira većeg ili jednakog -2 utvrđena je osjetljivost od 59,2%, specifičnost od 77,8%, PPV od 91% i NPV od 33,3%. Usporedba krivulja ROC za Fenyö-Lindbergov zbir pokazala je da je najbolja pojedinačna granična vrijednost u proučavanoj populaciji u svrhu diskriminacije akutne upale crvuljka -15. Za Teicherov zbir vrijednosti veće od -3 pokazale su osjetljivost od 89,3%, specifičnost od 22,2%, PPV od 81,4% i NPV od 35,3%. U zaključku, Fenyö-Lindbergov zbir se može koristiti kao dodatni alat u isključivanju upale crvuljka i izbjegavanju nepotrebnih operacija. Teicherov zbir može pomoći u prepoznavanju bolesnica s akutnom upalom crvuljka. Niti jedan zbir se ne može koristiti kao jedino sredstvo za indiciranje ili nepoduzimanje operacije akutne upale crvuljka u svim slučajevima. Bodovni sustav može biti koristan u isticanju važnih kliničkih znakova i simptoma u pojedinim skupinama bolesnika

Otkrivanje Bakerove ciste: Ultrazvučna dijagnostika (duplex scan) u izvanbolničkim uvjetima

Popliteal cyst, also called Baker’s cyst, is a popliteal fossa enlargement filled with synovial fluid. Baker’s cysts can be symptomatic and cause considerable pathologies such as thrombophlebitis, compartment syndrome and even nerve entrapment. It is the most common nonvascular pathology seen in the popliteal fossa but clinically indistinguishable from deep vein thrombosis. The aim of the present study was to evaluate venous duplex scanning in detecting and distinguishing complicated Baker’s cyst and deep vein thrombosis in outpatient setting. Medical records of all patients undergoing venous duplex scanning during 2008 and 2009 to rule out deep vein thrombosis were reviewed. Ten patients having undergone ultrasonography examination were found to have complicated Baker’s cyst. Baker’s cysts are a rather common condition. When presenting with swollen and painful calf, it is impossible to differentiate it from deep vein thrombosis by simple clinical examination. Venous duplex scanning of lower extremity was found to be a useful imaging modality for detection of Baker’s cysts, deep vein thrombosis and associated pathology.Poplitealna cista poznata i kao Bakerova cista je tvorba ispunjena sinovijskom tekućinom i smještena u poplitealnoj jami. Ona može biti simptomatska i prouzročiti ozbiljne poremećaje kao što su tromboflebitis, sindrom fascijalnih prostora i neuropatiju uslijed kompresije živca. To je najčešća nevaskularna tvorba u zakoljenoj jami i katkada ju je klinički nemoguće razlikovati od duboke venske tromboze. Cilj ove studije bio je procijeniti vrijednost ultrazvučne dijagnostike(duplex scan) u otkrivanju i razlikovanju komplicirane Bakerove ciste i duboke venske tromboze u ambulantnim uvjetima. Analizirala se medicinska dokumentacija bolesnika koju su u posljednje dvije godine (2008. i 2009.) bili podvrgnuti duplexultrasonogafiji kako bi se isključila duboka venska tromboza. Komplicirana Bakerova cista je utvrđena u desetoro bolesnika. Bakerova cista je prilično česta tvorba i kada se očituje otečenom i bolnom potkoljenicom nemoguće ju je običnim kliničkim pregledom sa sigurnošću razlikovati od duboke venske tromboze. Ultrasonografija metodom duplex scan je koristan modalitetet za otkrivanje Bakerove ciste, duboke venske tromboze i pridružene patologije