IMPLEMENTATION OF BIGDATA TECHNOLOGIES IN HEALTHCARE SYSTEMS

U radu se prezentira utjecaj tehnologije velikih podataka na primjeru zdravstvenog sustava. Detaljnije se objašnjava sam koncept tehnologije kako bi se kasnije lakše shvatila primjena iste. Osim teoretskog dijela, u radu su prikazani i konkretni primjeri zdravstvenih aplikacija, te se detaljnije, s tehničkog aspekta objašnjava na koji način prezentirana tehnologija funkcionira. Prvotni rezultat rada bio bi prikazati na koji način suvremeni sustavi mogu unaprijediti svoje poslovanje koristeći aktualne tehnologije velikih podataka poput onih navedenih u radu (Map Reduce, Hadoop, Bigtable,…), a finalni da s pomoću tih istih tehnologija maksimiziraju profit i minimaliziraju troškove, uz što veći naglasak na kvalitetu usluge i što bolju skrb prema krajnjem korisniku, pacijentu.The thesis presents the impact of Big data technologies in the healthcare systems. In addition to the theoretical part, the thesis presents concrete examples of healthcare applications, and detailed explains the technical aspect of technology itself. The first reason of the thesis is to “put accent“ on which way can modern systems improve their business by using current Bigdata technologies such as Map Reduce, Hadoop, Bigtable, etc, and the final one is usage of the same technologies to maximize system’s profit and minimize system’s costs, with a bigger emphasis on the quality of service, and to provide as best as possible care for the end user, the patient

Treatment of atelectasis in children

Atelektaza oznacava bezracni dio veceg ili manjeg dijela pluca. Popratna je pojava u tijeku niza plucnih bolesti. Najcešci uzrok atelektaze je opstrukcija dišnog puta, kompresija plucnog parenhima, nedostatak ili disfunkcija surfaktanta. Lijecenje ovisi o uzroku. Najcešce se provodi respiratorna fizioterapija, inhalacije bronhodilatatora, sekretolitika, razlicite tehnike povišenog ekspiracijskog tlaka, fleksibilna bronhoskopija, te kirurško lijecenje. U radu su prikazana tri bolesnika s atelektazom. Kod jednog bolesnika radilo se o akutnoj atelektazi u tijeku egzacerbacije astme, koja je riješena fleksibilnim bronhoskopom. Kod dva bolesnika radilo se o kronicnoj atelektazi, gdje je bilo indicirano kirurško lijecenje – lobektomija, koja je ucinjena kod jednog bolesnika, dok kod drugoga roditelji nisu prihvatili kirurško lijecenje.Atelectasis is a collapsed or airless state and may involve all or part of the lung. Many lung diseases can be associated with atelectasis. It occurs most commonly with bronchoobstruction, lung parenchyma compression, surfactant deficiency or disfunction. Atelectasis treatment depends on the cause. Chest physiotherapy is carried out most often. Bronchodilatator and secretolytics inhalation, various techniques of increased expiratory pressure, flexibile bronchoscopy and surgery, respectively, are often performed. In the present paper three cases of atelectasis in children are presented. In the first patient atelectasis appeared during acute asthmatic exacerbation, and it was cured by flexibile bronchoscopy. Lobectomy was indicated in the other two children with chronic atelectasis, but it was performed in one patient, while the parents of the second child did not give their consent for surgical treatment

Tumorous form of lung tuberculosis in children: case report

U radu je prikazan djecak u dobi od dvije godine i osam mjeseci s tumoroznim oblikom plucne tuberkuloze. Na temelju rendgena pluca, te racunalne tomografije toraksa (CT), postavljena je dijagnoza ekspanzivne tvorbe u podrucju desnog gornjeg sredoprsja. Izvršena je lobektomija desnog gornjeg plucnog režnja, a patohistološki nalaz glasio je: granulomatozna upala, u prvom redu tuberkuloza. Kod tumoroznih tvorbi u podrucju sredoprsja, diferencijalno dijagnosticki uvijek treba misliti i na tuberkulozu, posebice kada se nade i središnja nekroza.A 2 year and 8 month-old boy with a tumorous form of lung tuberculosis is presented. Both, chest X-ray and thoracic CT, respectively showed an expansive formation in the right upper mediastinum. Right upper lung lobe lobectomy was performed, and granulomatous inflammation (tuberculosis) was confirmed pathohystologically. In the case of mediastinal tumorous formation (especially accompanied with central necrosis), tuberculosis has to be considered in differential diagnostics

Tumori jetre u dječjoj dobi

Liver tumors count for approximately 2% of all childhood tumors and almost 70% of them are malignant. Most of them present as palpable abdominal mass. Correct diagnosis considering type, size and localization of the tumor is crucial for the right treatment strategy. Although surgical resection still remains the most important factor for survival, when combined with chemotherapy, the survival rates will raise. Liver transplantation is also considered in some cases of liver tumors. From 1991 to 2008 we treated 13 children with liver tumors. Our experience together with the review of recent literature is presented here.Tumori jetre čine ukupno 2% svih tumora dječje dobi, a preko dvije trećine su zloćudni. Većina se prezentira kao palpabilna tvorba u abdomenu. Za odabir ispravnog plana liječenja nužno je postaviti točnu dijagnozu i odrediti stupanj bolesti. Iako je kirurška resekcija i dalje najbitniji faktor prognoze, u kombinaciji s kemoterapijom postotak preživljenja značajno raste. U određenim slučajevima neresektabilnih tumora transplantacija jetre daje dobre rezultate. Od 1991. godine do 2008. liječili smo 13 djece s tumorom jetre i u ovom radu prikazujemo naše rezultate uz pregled recentne literature

RESULTS OF TREATMENT OF TIBIAL FRACTURES IN CHILDREN

Prijelomi dijafize obiju kosti potkoljenice najčešći su prijelomi donjih ekstremiteta i čine oko 15% svih prijeloma dugih kostiju u djece. To su većinom nestabilni prijelomi, teški za repoziciju i retenciju ulomaka, a postupak njihova liječenja nije posve usuglašen. U radu se analiziraju kasni rezultati liječenja 234-ero djece s prijelomima dijafize kostiju potkoljenice, ovisno o načinu liječenja (operacijska i konzervativna metoda). Otvoreni prijelom imala su 23 bolesnika, što čini 9,8% od ukupnog broja. U 194 bolesnika primijenili smo konzervativne metode, dok smo u njih 40 primijenili neke od operacijskih metoda liječenja. Najčešća korištena operacijska metoda bila je zatvorena repozicija ulomaka, na ekstenzijskom stolu i perkutana elastična stabilna intramedularna osteosinteza titanskim žicama. Za procjenu uspješnosti liječenja mjerene su zaostale kutne deformacije i razlike dužine zdrave i liječene noge. Sekundarni pomak ulomaka nakon započetoga konzervativnog liječenja, imala su 32 djeteta, što čini 15,2% od ukupnog broja konzervativno liječenih. Ukupno je 80-ero djece imalo zaostalu kutnu deformaciju liječene noge, njih 68 (35,0%) liječeno je konzervativno, a 12-ero (30,0%) operacijski. Bez razlike u dužini bolesne i zdrave noge bilo je 131 (67,5%) konzervativno liječeno dijete i 29-ero (72,5%) operacijski liječene djece. Ove razlike nisu statistički značajne. Rezultati liječenja ovih prijeloma u naše djece i autora sa sličnim serijama potvrđuju da nema statistički značajne razlike kasnih učinaka ovisno o načinu liječenja.Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length beetwen treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods

SURGICAL TREATMENT OF THYROID GLAND DISEASES IN CHILDHOOD – OUR RESULTS

Bolesti štitne žlijezde jedna su od najčešćih endokrinopatija u djece. Većina njih uspješno se liječi konzervativnom terapijom, no u određenim slučajevima potrebno je kirurško liječenje. Odluka o kirurškom liječenju rezultat je suradnje pedijatra endokrinologa i kirurga, ovisi o prirodi bolesti, a opseg kirurškog zahvata o patološkoanatomskim promjenama u žlijezdi. Prikazani su rezultati kirurškog liječenja 41 djeteta provedenog u Zavodu od 1991. do 2009. godine te današnja stajališta u kirurškom liječenju djece s različitim bolestima štitne žlijezde.Thyroid gland diseases are the most common endocrinopathies in children. Vast majority of these conditions are treated with medical therapy but in individualised cases surgery is indicated. Decision about surgical treatment is made in cooperation of pediatric endocrinologist and surgeon, treatment options depend on the nature of the disease while the extent of surgical procedure is determined by the pathological changes present in the gland. In this paper we represent the results of surgical treatment of 41 children at our department from 1991 to 2009 and current trends in surgical treatement of thyroid gland disease

CONGENITAL HYPERINSULINISM – NOVEL INSIGHTS INTO ETIOLOGY, DIAGNOSIS AND TREATMENT

Kongenitalni hiperinzulinizam (KHI) najčešći je uzrok tvrdokornih hipoglikemija u novorođenačkom i ranome dojenačkom razdoblju. Iako je bolest razmjerno rijetka s pojavnosti od oko 1 : 25 000–50 000 živorođene djece, bolest se ne smije podcijeniti zbog trajnih neuroloških oštećenja do kojih dolazi ako se bolest brzo ne otkrije i ne započne promptno liječiti. Uzrok su mutacije nekog od 7 gena, ključnih u regulaciji inzulinske sekrecije u b-stanicama gušterače. Odmah nakon postavljanja dijagnoze nužno je u terapiju uvesti antihipoglikemike koji djeluju specifično na -stanice gušterače. Kod teških neonatalnih oblika nerijetko postoji rezistencija na antihipoglikemike. Tada preostaje kirurško liječenje prije kojeg je potrebno odrediti histološki oblik bolesti, što se danas uspješno postiže kombinacijom genskog testiranja i scintigrafske pretrage. Kirurškim se zahvatom najčešće postiže izlječenje kod fokalnog KHI, dok difuzni oblik ima lošiju prognozu. Ovaj je tekst pregled novijih spoznaja o KHI, kojim želimo naglasiti važnost što ranijeg postavljanja dijagnoze kao preduvjeta uspješnoga ciljanog liječenja bolesti, koje je posljednjih godina obogaćeno novim mogućnostima.Congenital hyperinsulinism (CHI) is a major cause of persistent hypoglycemia in the neonatal and early infancy periods. Althought the disease is relatively rare with incidence of about 1: 25 000–50 000 live births, the importance of the disease should not be underestimated. Namely, prompt recognition and management of patients with CHI is essential, if permanent neurological impairment is to be avoided. CHI is caused by mutations in one of the 7 genes involved in the regulation of insulin secretion in pancreatic b-cells. It is important to introduce specific medical therapy as soon as diagnosis is established. Severe, neonatal forms of CHI are often resistant to medications, thus they require surgical procedure. The preoperative genetic testing and scintigraphy are indicated to distinguish histological subtypes of the disease (focal vs. diffuse CHI). Patients with focal disease are usually cured after pancreatic resection, while diffuse disease has much worse prognosis. This manuscript offers novel insights into CHI and emphasizes the role of early diagnosis as crucial for succesful treatment that was recently enriched with novel options

Rezultati liječenja prijeloma potkoljenice u djece [Results of treatment of tibial fractures in children]

Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length between treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods

Tumori jetre u dječjoj dobi

Liver tumors count for approximately 2% of all childhood tumors and almost 70% of them are malignant. Most of them present as palpable abdominal mass. Correct diagnosis considering type, size and localization of the tumor is crucial for the right treatment strategy. Although surgical resection still remains the most important factor for survival, when combined with chemotherapy, the survival rates will raise. Liver transplantation is also considered in some cases of liver tumors. From 1991 to 2008 we treated 13 children with liver tumors. Our experience together with the review of recent literature is presented here.Tumori jetre čine ukupno 2% svih tumora dječje dobi, a preko dvije trećine su zloćudni. Većina se prezentira kao palpabilna tvorba u abdomenu. Za odabir ispravnog plana liječenja nužno je postaviti točnu dijagnozu i odrediti stupanj bolesti. Iako je kirurška resekcija i dalje najbitniji faktor prognoze, u kombinaciji s kemoterapijom postotak preživljenja značajno raste. U određenim slučajevima neresektabilnih tumora transplantacija jetre daje dobre rezultate. Od 1991. godine do 2008. liječili smo 13 djece s tumorom jetre i u ovom radu prikazujemo naše rezultate uz pregled recentne literature