ENCEPHALOMALACIA AS A RESULT OF TWIN TO TWIN TRANSFUSION SYNDROME – CASE REPORT

Oštećenja mozga kod međublizanačkog »twin to twin« transfuzijskog sindroma (TTTS) su česta. I za davatelja i za primatelja postoji rizik razvoja ishemičnog ili hemoragičnog oštećenja mozga. Naša bolesnica je rođena iz blizanačke trudnoće u 32. tjednu trudnoće nakon unutarmaternične smrti drugog blizanca. Majka je bolovala od gestacijskog dijabetesa. Dijete je po porodu bilo blijedo, hipotonično, bez spontanih respiracija, bradikardno, edematozno, porodne težine 2230 g, Apgar zbroja 4/6. Po kratkoj reanimaciji spontano je prodisalo. Crvena krvna slika pokazala je tešku anemiju, a po transfuziji je normalnog krvnog tlaka. U daljnjem tijeku novorođenče je spontano disalo uz dodani kisik, uredne srčane akcije. U četvrtom danu života pojavile su se konvulzije. Na ultrazvuku (UZV) mozga pokazala se u prvom danu života hiperehogenost bijele i sive tvari. Indeks rezistencije (RI) prednje i srednje cerebralne arterije pokazao je visok sistolički vršak sa skoro nevidljivom dijastolom (edem ili vazoparaliza), a u četvrtom danu reperfuziju s RI od 0,57. Prvi znakovi leukomalacije pojavili su se osmog dana života. Ishemična leukomalacija skoro čitavog telencefalona te hipoplastični korpus kalozum viđeni su na UZV devetnaestog dana života što je potvrđeno magnetskom rezonancijom. Dijete je preživjelo s teškim neurološkim oštećenjem.Cerebral morbidity in twin to twin transfusion (TTTS) occurs often. Both donors and recipients are at risk of developing either ischemic or hemorrhagic lesions. Our patient was born from twin pregnancy at 32nd week of gestational age, after intrauterine fetal death of the second twin. The mother had gestational diabetes. After delivery the baby was pale, hypotonic, without spontaneous respirations, bradicardic, with generalized edema, with birth-weight 2230 grams. The blood count revealed heavy anemia. Seizures appeared at the fourth day of life. Ultrasound imaging (US) noted on first day of life hyperechogenicity of white and gray matter. Resistance index (RI) of anterior and middle cerebral artery revealed high systole spike almost without diastole (edema), and at 4th day of life there was a reperfusion with RI of 0,57. The first sign of leucomalacia appeared on 8th day. Ischemic leukomalacia of almost all telencephalon with hypoplastic corpus callosum were seen by US on 19th day of life. The finding was proved by magnetic resonance imaging. The child survived with serious neurological impairment

Coexistance of Cerebral Sinovenous Thrombosis and Dandy Walker Malformation in Newborn

Cerebral sinovenous thrombosis in neonatal period may cause neurological impairment, epilepsy, and lead to stroke. It is caused primarily by coagulopathy of numerous reasons, occasionally perinatal asphyxia, traumatic delivery and hyperhomocysteinemia. Dandy-Walker malformation is characterized by agenesis or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa. Dandy-Walker malformation, variant, and mega cisterna magna represent a spectrum of developmental anomalies. Insults to developing cerebellar hemispheres and the fourth ventricle are believed to be the cause of malformation. Our patient was born from noncomplicated pregnancy, noncomplicated nontraumatic vaginal delivery at term, excellent Apgar scores, without peculiarities in clinical status. She was brest-fed by the 42nd hour of life when she had rightsided seizures during sleep that repeated for five times in next 24 hours. Brain Ultrasound (US) revealed clot in left lateral ventricle, slight dilatation of left ventricle, both sided periventricular echodensity, ischemia, slight enlargement of forth ventricle and a bit smaller cerebellum. There was no visible flow through left transverse, superior sagittal and straight sinus. Magnetic Resonance (MRI) confirmed the finding and showed thrombosis of left and right transverse venous sinuses and confluence of sinuses. Electroencephalogram (EEG) showed leftsided focal changes. The newborn was treated with phenobarbiton for 8 days and had no convulsions during that period. All coagulation parameters, homocistein, lipoproteins (a) and D-dimers were normal. There were no mutations on FV R506Q, PT 20210A, MTHFR 677C/T. No antiphospholipides were found. Heart US showed no structural anomalies. No other patology or risk factors were present at the time. Before discharge, US showed hydrocephalus. Flow in affected sinuses was visible with color Doppler. MRI showed recanalization of affected sinuses, also hydrocephalus and presentation of Dandy Walker. On EEG there was borderline finding. Due to progression of hydrocephalus ventriculo-peritoneal shunt was placed. In age of 1 year EEG was slower for age but without focus. Neurological development was normal for age. The question is whether this child had intrauterine insult and inception of Dandy Walker with further postnatal progress of thrombosis and evolution to full picture of Dandy Walker with hydrocephalus OR thrombosis that led to development of hydrocephalus and DandyWalker malformation in this child were accidental coexistance

ROLE OF NEGATIVE PRESSURE THERAPY IN THE TREATMENT OF CHRONIC WOUNDS

Terapija negativnim tlakom je potporna metoda liječenja kroničnih rana. Koristi se negativni tlak od 40 do 125 mm Hg. Dokazani su pozitivni rezultati primjene terapije u obliku pojačane angiogeneze i poboljšanja protoka krvi u rani, smanjenja edema, regulacije vlažnosti rane odvođenja suviška eksudata, stimulacije stvaranja granulacijskog tkiva i retrakcije rane. također je smanjen broj bakterija u rani kao i količina štetnih produkata (egzotoksina i endotoksina, citokina i matrične metaloproteinaze). Vrijeme cijeljenja kroničnih rana je ubrzano u usporedbi s ostalim konzervativnim metodama liječenja. terapija je primjenjiva u bolničkim i vanbolničkim uvjetima.Negative Pressure Wound Therapy (NPWT) is one of the supportive options for chronic wound treatment. The level of negative pressure is between 40 and 125 mm Hg below ambient. Good results in increasing angiogenesis, improvement of blood flow in wounds, edema reduction, regulation of moist environment, granulation tissue stimulation and wound retraction have been proved. In addition, bacterial burden in the wound and the amount of harmful products (exotoxins, endotoxins, cytokines and matrix metalloproteinases) are also significantly reduced. Chronic wound healing time is accelerated in comparison with other conservative treatments. The NPWT can be applied in either inpatient or outpatient settings

Clinical Presentation of a Patient with Localized Acquired Cutis Laxa of Abdomen: A Case Report

Background. Cutis laxa (CL) is a rare disorder of elastic tissue characterized by loose, sagging skin with reduced elasticity, and resilience without resulting scarring. CL may be inherited as a dominant, recessive, or X-linked recessive disease, or acquired. The heritable forms of CL predominantly begin at birth, but it may be delayed until puberty or age of 30 years with extracutaneous manifestations including pulmonary emphysema, umbilical and inguinal hernias, and gastrointestinal and vesicourinary tract diverticuli. An acquired form of the disease occurs in adults with no evidence of internal organ involvement. Objective. The aim of this case report was to present our patient suffering from CL, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Case Report. A 30-year-old female patient was admitted to our Hospital due to localized loose and sagging skin of abdomen, induced by prior cesarean section 6 years ago. CL has been diagnosed based on the clinical picture and pathohistological appearance. Conclusion. Reconstructive surgery provides a dramatic cosmetic improvement with significant psychosocial benefit. Repeated surgical procedures may be required to correct the lax skin, which worsens with age

VIDEO-ASSISTED EXTIRPATION OF BREAST FIBROADENOMA WITH IMMEDIATE BILATERAL BREAST AUGMENTATION – A CASE REPORT

Pozadina: Od sredine 1990-ih godina razvila se videoasistirana kirurgija dojke (VABS) za liječenje dobroćudnih i zloćudnih bolesti dojke. Prema studijama koje su provedene uglavnom u Japanu, ova je tehnika sigurna i lako se uči, a njezina je glavna prednost izvrstan kozmetski rezultat poslijeoperacijskog izgleda dojki koji se ne može postići standardnim kirurškim tehnikama. Cilj: Prikazati prvi slučaj videoasistirane kirurgije dojke u Hrvatskoj primijenjene u liječenju fibroadenoma dojke uz neposredno obostrano povećanje dojki. Prikaz bolesnice: Bolesnica u dobi od 39 godina primljena je u našu bolnicu radi elektivnog zahvata povećanja obiju dojki. Tom je prilikom upotrijebljena metoda videoasistirane ekstirpacije fibroadenoma kroz inframamarnu inciziju neposredno nakon koje je učinjeno obostrano povećanje dojki. Zaključak: VABS je izvediva uz očit kozmetski učinak i zbog tog postaje metoda izbora u kirurgiji dojke. Međutim, potrebno je steći daljnja iskustva u ovom području kako bismo adekvatnije mogli procijeniti ovu tehniku.Background: Since mid 1990s video-assisted breast surgery (VABS) has been developed in the treatment of benign and malignant breast diseases. According to studies that are conducted mainly in Japan, this tehnique is safe, easy to learn and his main advantage is excellent cosmetic results on postoperative appearance of breasts that cannot be achived with standard surgical procedures. Objective: To present a first case of video assisted breast surgery in Croatia applied to treatment of breast fibroadenoma and immediate bilateral breast augmentation. Case report: A 39 year old female patient was admitted to our hospital for elective procedure of breast augmentation. On this occasion video assisted extirpation of fibroadenoma was performed through inframammary incision and followed by immediate bilateral breast augmentation. Conclusion: VABS is feasible, cosmetic effects are evident and the VABS deserves attention as a possible surgical option in breast surgery. However further experience on this field must be gained and it remains to evaluate this tehnique on the additional studies

VIDEO-ASSISTED EXTIRPATION OF BREAST FIBROADENOMA WITH IMMEDIATE BILATERAL BREAST AUGMENTATION – A CASE REPORT

Pozadina: Od sredine 1990-ih godina razvila se videoasistirana kirurgija dojke (VABS) za liječenje dobroćudnih i zloćudnih bolesti dojke. Prema studijama koje su provedene uglavnom u Japanu, ova je tehnika sigurna i lako se uči, a njezina je glavna prednost izvrstan kozmetski rezultat poslijeoperacijskog izgleda dojki koji se ne može postići standardnim kirurškim tehnikama. Cilj: Prikazati prvi slučaj videoasistirane kirurgije dojke u Hrvatskoj primijenjene u liječenju fibroadenoma dojke uz neposredno obostrano povećanje dojki. Prikaz bolesnice: Bolesnica u dobi od 39 godina primljena je u našu bolnicu radi elektivnog zahvata povećanja obiju dojki. Tom je prilikom upotrijebljena metoda videoasistirane ekstirpacije fibroadenoma kroz inframamarnu inciziju neposredno nakon koje je učinjeno obostrano povećanje dojki. Zaključak: VABS je izvediva uz očit kozmetski učinak i zbog tog postaje metoda izbora u kirurgiji dojke. Međutim, potrebno je steći daljnja iskustva u ovom području kako bismo adekvatnije mogli procijeniti ovu tehniku.Background: Since mid 1990s video-assisted breast surgery (VABS) has been developed in the treatment of benign and malignant breast diseases. According to studies that are conducted mainly in Japan, this tehnique is safe, easy to learn and his main advantage is excellent cosmetic results on postoperative appearance of breasts that cannot be achived with standard surgical procedures. Objective: To present a first case of video assisted breast surgery in Croatia applied to treatment of breast fibroadenoma and immediate bilateral breast augmentation. Case report: A 39 year old female patient was admitted to our hospital for elective procedure of breast augmentation. On this occasion video assisted extirpation of fibroadenoma was performed through inframammary incision and followed by immediate bilateral breast augmentation. Conclusion: VABS is feasible, cosmetic effects are evident and the VABS deserves attention as a possible surgical option in breast surgery. However further experience on this field must be gained and it remains to evaluate this tehnique on the additional studies

ENCEPHALOMALACIA AS A RESULT OF TWIN TO TWIN TRANSFUSION SYNDROME – CASE REPORT

Oštećenja mozga kod međublizanačkog »twin to twin« transfuzijskog sindroma (TTTS) su česta. I za davatelja i za primatelja postoji rizik razvoja ishemičnog ili hemoragičnog oštećenja mozga. Naša bolesnica je rođena iz blizanačke trudnoće u 32. tjednu trudnoće nakon unutarmaternične smrti drugog blizanca. Majka je bolovala od gestacijskog dijabetesa. Dijete je po porodu bilo blijedo, hipotonično, bez spontanih respiracija, bradikardno, edematozno, porodne težine 2230 g, Apgar zbroja 4/6. Po kratkoj reanimaciji spontano je prodisalo. Crvena krvna slika pokazala je tešku anemiju, a po transfuziji je normalnog krvnog tlaka. U daljnjem tijeku novorođenče je spontano disalo uz dodani kisik, uredne srčane akcije. U četvrtom danu života pojavile su se konvulzije. Na ultrazvuku (UZV) mozga pokazala se u prvom danu života hiperehogenost bijele i sive tvari. Indeks rezistencije (RI) prednje i srednje cerebralne arterije pokazao je visok sistolički vršak sa skoro nevidljivom dijastolom (edem ili vazoparaliza), a u četvrtom danu reperfuziju s RI od 0,57. Prvi znakovi leukomalacije pojavili su se osmog dana života. Ishemična leukomalacija skoro čitavog telencefalona te hipoplastični korpus kalozum viđeni su na UZV devetnaestog dana života što je potvrđeno magnetskom rezonancijom. Dijete je preživjelo s teškim neurološkim oštećenjem.Cerebral morbidity in twin to twin transfusion (TTTS) occurs often. Both donors and recipients are at risk of developing either ischemic or hemorrhagic lesions. Our patient was born from twin pregnancy at 32nd week of gestational age, after intrauterine fetal death of the second twin. The mother had gestational diabetes. After delivery the baby was pale, hypotonic, without spontaneous respirations, bradicardic, with generalized edema, with birth-weight 2230 grams. The blood count revealed heavy anemia. Seizures appeared at the fourth day of life. Ultrasound imaging (US) noted on first day of life hyperechogenicity of white and gray matter. Resistance index (RI) of anterior and middle cerebral artery revealed high systole spike almost without diastole (edema), and at 4th day of life there was a reperfusion with RI of 0,57. The first sign of leucomalacia appeared on 8th day. Ischemic leukomalacia of almost all telencephalon with hypoplastic corpus callosum were seen by US on 19th day of life. The finding was proved by magnetic resonance imaging. The child survived with serious neurological impairment