Atypical congenital cartilaginous rest of the neck in a one-year-old female patient

Škržni ostatak u vratu je rijetko opisana prirođena anomalija za koju nema utvrđenog imena u literaturi, a često se pogjrešno dijagnosticira kao prirođena lateralna cista i/ili vratna fi stula. Autori opisuju slučaj jednogodišnje djevojčice koja je praćena od rođenja zbog čvornatih tvorbi na vratu kako bi upozorili na važnost i širinu diferencijalne dijagnostike prirođenih malformacija lateralne regije vrata kao i na ulogu ultrazvuka u diferencijalnoj dijagnostici, jer kirurško liječenje ovisi o tome. Kliničkim pregledom nađena je tvorba veličine 2x1 cm, dobro diferencirana od površine, na desnoj strani vrata u II./III. regiji. Ultrazvuk vrata nije otkrio nikakve fi stule ili ciste. Kirurškom incizijom nađena je hrskavična srž tvorbe koja je kirurški odstranjena u općoj anesteziji bez ikakvih problema.Cartilaginous rests of the neck are rarely described congenital anomaly for which there is no defi nite name in the literature, and is often misdiagnosed as congenital lateral cysts and/or neck fi stulas. The authors present a case of a one-year old girl monitored from birth due to nodular formations on the neck, in order to highlight the importance and span of diff erential diagnosis of congenital malformations of the lateral neck region and the role of ultrasonography in diff erential diagnosis since the surgical treatment plan depends on it. Clinical examination revealed a formation of 2x1 cm, well diff erentiated from the surface, on the right side of the neck in region II/III. On the left side in region II/III, there was a smaller formation of 2-3 mm in diameter. Sonography of the neck did not reveal any fi stulae or cysts. On surgical excision in general anaesthesia, the cartilaginous core was found and excised without any problems

INCIDENTALNI NALAZ ČVORA NA VRATU KOŽNOG MALIGNOG MELANOMA NAKON 34 GODINE LATENCIJE

The authors report a case of a 64-year-old man who had nodal recurrence of melanoma 34 years after the primary diagnosis of a cutaneous melanoma on his back. Neck ultrasound confirmed an oval anechogenic/hypoechogenic lobular lesion (1.6x1.7 cm) in the right supraclavicular fossa. Fine-needle aspiration revealed sparse population of the poorly preserved malignant cells and bare malignant nuclei with prominent nucleoli. Extirpation of the lymph node was done and the histopathologic diagnosis confirmed metastatic melanoma. The man was referred to positron emission tomography/ computed tomography, dermatologist, ophthalmologist and gastroenterologist for further management to exclude other potential sites of new primary melanoma. It is one of the longest disease-free latency periods between the primary melanoma diagnosis and recurrence reported to date. This article suggests melanoma to be a disease with a potentially lifelong risk of recurrence, however, late recurrences are very rare. The clinicians and patients must be vigilant and aware of the risk of late recurrences.Prikazujemo slučaj 64-godišnjeg muškarca koji je imao metastazu melanoma u limfnom čvoru 34 godine nakon postavljene dijagnoze kožnog melanoma na leđima. Na ultrazvuku je ponađena ovalna anehogena/hipoehogena lobularna lezija (1,6x1,7 cm) u desnoj supraklavikularnoj regiji. Citološka punkcija je ukazivala na slabo diferencirane maligne stanice. Učinjena je ekstirpacija limfnog čvora i patohistološki nalaz je potvrdio metastatski melanom. Daljnjom obradom (pozitronska emisijska tomografi ja, pregled dermatologa, oftalmologa i i gastroenterologa) nije pronađeno novo sijelo primarnog melanoma. To je jedno od najdužih razdoblja između primarnog melanoma i povratka bolesti opisano do danas. Ovaj prikaz pokazuje da se metastaze melanoma mogu javiti tijekom cijelog života. Liječnici i bolesnici moraju biti svjesni rizika kasnih metastaza

OUTCOMES FACTORS IN TRAUMATIC INJURY OF ABDOMINAL PARENCHYMAL ORGANS IN THE DEPARTMENT OF PEDIATRIC SURGERY BEETWEN 2000 – 2013 : HISTORY INTERSECTION STUDY

Cilj istraživanja. Istražiti utjecaj etiologije, vrste ozljede, stanja svijesti, “zlatnog sata“ i AIS i ISS vrijednosti na odabir metode liječenja i preživljenje. Ispitanici i metode. Bolesnici koji su imali traumatsku ozljedu parenhimnih organa trbuha u razdoblju od 1. siječnja, 2000. do 31. prosinca, 2012. godine. Istražili smo udio bolesnika koji su liječeni operacijski i konzervativno. Zatim smo u obje skupine raščlanili bolesnike na hemodinamski stabilne i nestabilne pri prijemu. Idući korak bila je raščlamba u odnosu na spol, dob, etiologiju, stanje svijesti, te na one dovedene u “zlatnom satu“ i na one dovedene nakon. Izračunali smo ISS vrijednost, također bodovali težinu ozljede AIS vrijednošću, te uspoređivali dobivene vrijednosti u odnosu na etiologiju i stanje svijesti, preživljenje i vrijeme dolaska u bolnicu. Proučili smo operacijski tijek svakog bolesnika koji je liječen operacijski, te izdvojili najčešće operacijske metode. Rezultati. Istraživanje je obuhvatilo 89 bolesnika, od čega je većina bila muškog spola. Prosječna dob bila je 11.11 godina. Bilo je 50,5 % politrauma. Bolesnika koji su liječeni transfuzijom krvnih pripravaka bilo je 16 (17.9 %). Preživjelo je 88 bolesnika. Etiološki je najviše bolesnika stradalo pri padu. Slezena je najčešće ozlijeđen organ, uglavnom se radilo o rupturi. AIS i ISS niže su u bolesnika koji su preživjeli, te u onih koji su dovedeni u “zlatnom satu“ i bili pri svijesti pri prijemu. Bolesnik koji nije preživio bio je hemodinamski nestabilan, sa pridruženim ozljedama. Zaključci. Na preživljenje utječu hemodinamska stabilnost pri prijamu, AIS i ISS vrijednosti, ozljede ostalih organa u trbušnoj šupljini i ostatku tijela, stanje svijesti pri prijamu, dolazak u “zlatnom satu“. Svi ti parametri utječu i na odabir metode liječenja, pa će se bolesnici koji su hemodinamski nestabilni sukladno tome uglavnom liječiti operacijski. Hemodinamska stabilnost, stanje svijesti i AIS i ISS vrijednosti pokazali su se kao kvalitetni prediktori preživljenja nakon traumatskih ozljeda trbuha.Objectives and background. To research the influence of ethiology, the types of injury, states of consciousness, “golden hour“, AIS and ISS values in selecting the method of treatment and survival. Patients and Methods. Patients who had a traumatic injury of parenchymal organs in the abdomen in the period between January 1, 2000. and December 31, 2012. We examined the proportion of patients who were treated surgically or conservatively. Then, in both groups we divided the patients in hemodynamically stable ones and those unstable on admission. The next step was the analysis in relation to gender, age, ethiology, state of consciousness and those brought in the “golden hour“and those brought after. We calculated the ISS value and we assessed the severity of injury by AIS value, and compared the obtained values in relation to ethiology and state of consciousness, survival and the time of arrival at the hospital.We studied the operational course of each patient treated surgically, and we separated the most common surgical methods. Results. The study included 89 patients, most of whom were male sex. The average age was 11,11 years. There were 50,5% of polytrauma. There were 16 (17,9%) patients treated with transfusion of blood products. 88 patients survived. Ethiologically most patients got injured falling. The spleen is the most commonly injured organ; it was mainly about the rupture. AIS and ISS are lower in the patients who were brought within “golden hour“ and were conscious on admission. The patient who did not survive was hemodynamically unstable, with associated injuries. Conclusions. Survival is influenced by hemodynamic stability on admission, AIS and ISS values, the injuries of other organs in abdominal cavity and in the rest of the body, the state of consciousness on admission, arrival within “golden hour“. All these parameters influence the selection of treatment methods, so the patients who are hemodynamically unstable will mainly be treated surgically. Hemodynamic stability, the state of consciousness, AIS and ISS values have proved to be good predictors of survival after traumatic injuries of abdomen

OUTCOMES FACTORS IN TRAUMATIC INJURY OF ABDOMINAL PARENCHYMAL ORGANS IN THE DEPARTMENT OF PEDIATRIC SURGERY BEETWEN 2000 – 2013 : HISTORY INTERSECTION STUDY

Cilj istraživanja. Istražiti utjecaj etiologije, vrste ozljede, stanja svijesti, “zlatnog sata“ i AIS i ISS vrijednosti na odabir metode liječenja i preživljenje. Ispitanici i metode. Bolesnici koji su imali traumatsku ozljedu parenhimnih organa trbuha u razdoblju od 1. siječnja, 2000. do 31. prosinca, 2012. godine. Istražili smo udio bolesnika koji su liječeni operacijski i konzervativno. Zatim smo u obje skupine raščlanili bolesnike na hemodinamski stabilne i nestabilne pri prijemu. Idući korak bila je raščlamba u odnosu na spol, dob, etiologiju, stanje svijesti, te na one dovedene u “zlatnom satu“ i na one dovedene nakon. Izračunali smo ISS vrijednost, također bodovali težinu ozljede AIS vrijednošću, te uspoređivali dobivene vrijednosti u odnosu na etiologiju i stanje svijesti, preživljenje i vrijeme dolaska u bolnicu. Proučili smo operacijski tijek svakog bolesnika koji je liječen operacijski, te izdvojili najčešće operacijske metode. Rezultati. Istraživanje je obuhvatilo 89 bolesnika, od čega je većina bila muškog spola. Prosječna dob bila je 11.11 godina. Bilo je 50,5 % politrauma. Bolesnika koji su liječeni transfuzijom krvnih pripravaka bilo je 16 (17.9 %). Preživjelo je 88 bolesnika. Etiološki je najviše bolesnika stradalo pri padu. Slezena je najčešće ozlijeđen organ, uglavnom se radilo o rupturi. AIS i ISS niže su u bolesnika koji su preživjeli, te u onih koji su dovedeni u “zlatnom satu“ i bili pri svijesti pri prijemu. Bolesnik koji nije preživio bio je hemodinamski nestabilan, sa pridruženim ozljedama. Zaključci. Na preživljenje utječu hemodinamska stabilnost pri prijamu, AIS i ISS vrijednosti, ozljede ostalih organa u trbušnoj šupljini i ostatku tijela, stanje svijesti pri prijamu, dolazak u “zlatnom satu“. Svi ti parametri utječu i na odabir metode liječenja, pa će se bolesnici koji su hemodinamski nestabilni sukladno tome uglavnom liječiti operacijski. Hemodinamska stabilnost, stanje svijesti i AIS i ISS vrijednosti pokazali su se kao kvalitetni prediktori preživljenja nakon traumatskih ozljeda trbuha.Objectives and background. To research the influence of ethiology, the types of injury, states of consciousness, “golden hour“, AIS and ISS values in selecting the method of treatment and survival. Patients and Methods. Patients who had a traumatic injury of parenchymal organs in the abdomen in the period between January 1, 2000. and December 31, 2012. We examined the proportion of patients who were treated surgically or conservatively. Then, in both groups we divided the patients in hemodynamically stable ones and those unstable on admission. The next step was the analysis in relation to gender, age, ethiology, state of consciousness and those brought in the “golden hour“and those brought after. We calculated the ISS value and we assessed the severity of injury by AIS value, and compared the obtained values in relation to ethiology and state of consciousness, survival and the time of arrival at the hospital.We studied the operational course of each patient treated surgically, and we separated the most common surgical methods. Results. The study included 89 patients, most of whom were male sex. The average age was 11,11 years. There were 50,5% of polytrauma. There were 16 (17,9%) patients treated with transfusion of blood products. 88 patients survived. Ethiologically most patients got injured falling. The spleen is the most commonly injured organ; it was mainly about the rupture. AIS and ISS are lower in the patients who were brought within “golden hour“ and were conscious on admission. The patient who did not survive was hemodynamically unstable, with associated injuries. Conclusions. Survival is influenced by hemodynamic stability on admission, AIS and ISS values, the injuries of other organs in abdominal cavity and in the rest of the body, the state of consciousness on admission, arrival within “golden hour“. All these parameters influence the selection of treatment methods, so the patients who are hemodynamically unstable will mainly be treated surgically. Hemodynamic stability, the state of consciousness, AIS and ISS values have proved to be good predictors of survival after traumatic injuries of abdomen

OUTCOMES FACTORS IN TRAUMATIC INJURY OF ABDOMINAL PARENCHYMAL ORGANS IN THE DEPARTMENT OF PEDIATRIC SURGERY BEETWEN 2000 – 2013 : HISTORY INTERSECTION STUDY

Cilj istraživanja. Istražiti utjecaj etiologije, vrste ozljede, stanja svijesti, “zlatnog sata“ i AIS i ISS vrijednosti na odabir metode liječenja i preživljenje. Ispitanici i metode. Bolesnici koji su imali traumatsku ozljedu parenhimnih organa trbuha u razdoblju od 1. siječnja, 2000. do 31. prosinca, 2012. godine. Istražili smo udio bolesnika koji su liječeni operacijski i konzervativno. Zatim smo u obje skupine raščlanili bolesnike na hemodinamski stabilne i nestabilne pri prijemu. Idući korak bila je raščlamba u odnosu na spol, dob, etiologiju, stanje svijesti, te na one dovedene u “zlatnom satu“ i na one dovedene nakon. Izračunali smo ISS vrijednost, također bodovali težinu ozljede AIS vrijednošću, te uspoređivali dobivene vrijednosti u odnosu na etiologiju i stanje svijesti, preživljenje i vrijeme dolaska u bolnicu. Proučili smo operacijski tijek svakog bolesnika koji je liječen operacijski, te izdvojili najčešće operacijske metode. Rezultati. Istraživanje je obuhvatilo 89 bolesnika, od čega je većina bila muškog spola. Prosječna dob bila je 11.11 godina. Bilo je 50,5 % politrauma. Bolesnika koji su liječeni transfuzijom krvnih pripravaka bilo je 16 (17.9 %). Preživjelo je 88 bolesnika. Etiološki je najviše bolesnika stradalo pri padu. Slezena je najčešće ozlijeđen organ, uglavnom se radilo o rupturi. AIS i ISS niže su u bolesnika koji su preživjeli, te u onih koji su dovedeni u “zlatnom satu“ i bili pri svijesti pri prijemu. Bolesnik koji nije preživio bio je hemodinamski nestabilan, sa pridruženim ozljedama. Zaključci. Na preživljenje utječu hemodinamska stabilnost pri prijamu, AIS i ISS vrijednosti, ozljede ostalih organa u trbušnoj šupljini i ostatku tijela, stanje svijesti pri prijamu, dolazak u “zlatnom satu“. Svi ti parametri utječu i na odabir metode liječenja, pa će se bolesnici koji su hemodinamski nestabilni sukladno tome uglavnom liječiti operacijski. Hemodinamska stabilnost, stanje svijesti i AIS i ISS vrijednosti pokazali su se kao kvalitetni prediktori preživljenja nakon traumatskih ozljeda trbuha.Objectives and background. To research the influence of ethiology, the types of injury, states of consciousness, “golden hour“, AIS and ISS values in selecting the method of treatment and survival. Patients and Methods. Patients who had a traumatic injury of parenchymal organs in the abdomen in the period between January 1, 2000. and December 31, 2012. We examined the proportion of patients who were treated surgically or conservatively. Then, in both groups we divided the patients in hemodynamically stable ones and those unstable on admission. The next step was the analysis in relation to gender, age, ethiology, state of consciousness and those brought in the “golden hour“and those brought after. We calculated the ISS value and we assessed the severity of injury by AIS value, and compared the obtained values in relation to ethiology and state of consciousness, survival and the time of arrival at the hospital.We studied the operational course of each patient treated surgically, and we separated the most common surgical methods. Results. The study included 89 patients, most of whom were male sex. The average age was 11,11 years. There were 50,5% of polytrauma. There were 16 (17,9%) patients treated with transfusion of blood products. 88 patients survived. Ethiologically most patients got injured falling. The spleen is the most commonly injured organ; it was mainly about the rupture. AIS and ISS are lower in the patients who were brought within “golden hour“ and were conscious on admission. The patient who did not survive was hemodynamically unstable, with associated injuries. Conclusions. Survival is influenced by hemodynamic stability on admission, AIS and ISS values, the injuries of other organs in abdominal cavity and in the rest of the body, the state of consciousness on admission, arrival within “golden hour“. All these parameters influence the selection of treatment methods, so the patients who are hemodynamically unstable will mainly be treated surgically. Hemodynamic stability, the state of consciousness, AIS and ISS values have proved to be good predictors of survival after traumatic injuries of abdomen

Unusual Mechanism of Facial Nerve Palsy Caused by Penetrating Neck Trauma

We present a case of a low energy penetrating neck injury with only facial nerve (FN) palsy in the clinical finding. A 32-year-old male patient was admitted to the emergency department with a penetrating injury on the right side of the neck just behind the right ear, accompanied by evident right (FN) palsy, evaluated as House Brackmann grade IV. Computed tomography demonstrated an isolated soft tissue injury in the right retroauricular region without bone fracture, parotid gland lesion, or vascular structure involvement. The FN palsy was treated with corticosteroids (CS), and the patient had an uneventful and complete recovery. This case report presents an unusual mechanism of isolated, extratemporal, blunt injury of the FN after a penetrating neck injury followed by complete recovery

Factors of parenchymal organ injury treatment outcome in children at Department of Pediatric Surgery, Split University Hospital Center during the 2000-2015 period

Cilj ovog rada bio je istražiti čimbenike ishoda liječenja i preživljenje u bolesnika s ozljedom parenhimskih organa trbuha. U vremenskom razdoblju od siječnja 2000. do siječnja 2015. retrospektivno su pregledane povijesti bolesti bolesnika koji su imali traumatsku ozljedu parenhimskih organa. Istražili smo udio bolesnika koji su liječeni operacijski i konzervativno. Zatim smo u obje skupine raščlanili bolesnike na hemodinamski stabilne i nestabilne pri prijmu. Idući korak bila je raščlamba u odnosu na spol, dob, etiologiju, stanje svijesti te na one dovedene u “zlatnom satu” i na one dovedene nakon njega. Izračunali smo ISS (engl. injury severity score) vrijednost, također bodovali težinu ozljede AIS (engl. abbreviated injury scale) vrijednošću te uspoređivali dobivene vrijednosti u odnosu na etiologiju i stanje svijesti, preživljenje i vrijeme dolaska u bolnicu. Istraživanje je obuhvatilo 89-ero bolesnika, od kojih je većina bila muškog spola. Prosječna dob je bila 11 godina. Od ukupnog broja ozlijeđenih udio politraumatiziranih bolesnika iznosio je 50,5%. Bolesnika koji su liječeni transfuzijom krvnih pripravaka bilo je 16 -ero (17,9%). Preživjelo je 88-ero (98,8%) bolesnika. Etio loški je najviše bolesnika stradalo prilikom pada. Slezena je najčešće ozlijeđen organ, uglavnom je posrijedi bila ruptura. AIS i ISS niže su u bolesnika koji su preživjeli te u onih koji su dovedeni u “zlatnom satu” i pri prijmu bili pri svijesti. Na preživljenje utječu hemodinamska stabilnost pri prijmu, AIS i ISS vrijednosti, ozljede ostalih organa u trbušnoj šupljini i ostatku tijela, stanje svijesti pri prijmu, dolazak u “zlatnom satu”. Hemodinamska stabilnost, stanje svijesti i AIS i ISS vrijednosti pokazali su se kao kvalitetni prediktori preživljenja nakon traumatskih ozljeda trbuha.The aim of this study was to determine treatment outcome and survival in patients with blunt abdominal trauma. From January 2000 to January 2015, medical histories of patients treated for traumatic injury of parenchymal organs were retrospectively reviewed and the proportion of patients treated surgically or conservatively was estimated. In both categories, patients were divided into two groups of hemodynamically stable and hemodynamically unstable on admission. The following parameters were analyzed: gender, age, etiology, state of consciousness, and time from injury to admission. Regarding time to admission, patients were divided in those brought within the ‘golden hour’ and those brought beyond it. The Injury Severity Score (ISS) was calculated and the severity of injury assessed by Abbreviated Injury Scale (AIS). The values obtained were compared according to the etiology and state of consciousness, survival, and time to hospital admission. The study included 89 patients, most of them male, average age 11 years. There were 50.5% of polytrauma cases. Sixteen (17.9%) patients were treated with transfusion of blood products. Eighty-eight (98.8%) patients survived. Etiologically, most patients were injured by falling. Spleen was the most commonly injured organ and rupture was the most common type of injury. AIS and ISS were lower in patients brought within the ‘golden hour’ and those that were conscious at admission. The patient who did not survive was hemodynamically unstable, with associated injuries. Survival is infl uenced by hemodynamic stability at admission, AIS and ISS values, injuries of other organs in abdominal cavity and the rest of the body, state of consciousness at admission, and arrival within the ‘golden hour’. Hemodynamic stability, state of consciousness, AIS and ISS values were proved to be good predictors of survival after traumatic injuries of the abdomen