Nonvenereal Sclerosing Lymphangitis of the Penis

No abstract availabl

Intermittent claudications of the hand after supracondylar humeral fracture in a 2-year old boy

Supracondylar humeral fractures (SHF) are the most common fractures associated with concomitant neurovascular injuries in children. Pink pulseless hand (PPH) labels SHF presenting without a pulse in a wellperfused hand. Management of PPH after successful SHF reduction remains controversial. Some advocate „watchful waiting”, whereas others favor early exploration. We present a case of a 2-year-old boy with PPH and intermittent claudications 6 weeks after successful SHF reduction

Thoracoscopic plication in an infant with eventration of the diaphragm

Eventracija ošita je abnormalna elevacija dijela ili cijele hemidijafragme. Može biti kongenitalna i stečena. Oboljelih je 2 do 7 na 100000 živorođenih, a češće se javlja kod dječaka. Eventracija se prezentira simptomima respiratornog ili gastrointestinalnog sustava, a dijagnoza se postavlja na temelju slikovnih radioloških pretraga. Kirurško liječenje indicirano je kod svih simptomatskih pacijenata, a cilj liječenja je ojačati tanku i oslabljenu dijafragmu plikacijom. Pristupi kirurškom liječenju su različiti. Prikazujemo osmomjesečnog dječaka kojemu je eventracija otkrivena obradom tijekom prolongiranog respiratornog infekta, a kojeg smo potom liječili torakoskopskom plikacijom s dobrim dugoročnim ishodom.Diaphragmatic eventration is an abnormal elevation of part or the entire hemidiaphragm. It can be congenital or acquired. It occurs in 2 to 7 in 100000 live births and it is more common among boys. Symptomatic eventration is presented with different respiratory or gastrointestinal symptoms. The diagnosis is based on radiological images. Surgical treatment is indicated for all symptomatic patients. The goal is to strengthen the thin and weak diaphragm by plicating the diaphragm itself. Surgical approaches may differ. We present an eight month old boy with eventration who was diagnosed during prolonged respiratory infection. Our treatment approach was thoracoscopic plication of the diaphragm with good long-term outcome

Thoracoscopic plication in an infant with eventration of the diaphragm

Eventracija ošita je abnormalna elevacija dijela ili cijele hemidijafragme. Može biti kongenitalna i stečena. Oboljelih je 2 do 7 na 100000 živorođenih, a češće se javlja kod dječaka. Eventracija se prezentira simptomima respiratornog ili gastrointestinalnog sustava, a dijagnoza se postavlja na temelju slikovnih radioloških pretraga. Kirurško liječenje indicirano je kod svih simptomatskih pacijenata, a cilj liječenja je ojačati tanku i oslabljenu dijafragmu plikacijom. Pristupi kirurškom liječenju su različiti. Prikazujemo osmomjesečnog dječaka kojemu je eventracija otkrivena obradom tijekom prolongiranog respiratornog infekta, a kojeg smo potom liječili torakoskopskom plikacijom s dobrim dugoročnim ishodom.Diaphragmatic eventration is an abnormal elevation of part or the entire hemidiaphragm. It can be congenital or acquired. It occurs in 2 to 7 in 100000 live births and it is more common among boys. Symptomatic eventration is presented with different respiratory or gastrointestinal symptoms. The diagnosis is based on radiological images. Surgical treatment is indicated for all symptomatic patients. The goal is to strengthen the thin and weak diaphragm by plicating the diaphragm itself. Surgical approaches may differ. We present an eight month old boy with eventration who was diagnosed during prolonged respiratory infection. Our treatment approach was thoracoscopic plication of the diaphragm with good long-term outcome

Diferencijalna dijagnostika i kliničko značenje pneumobilije ili zraka u portalnoj veni na rendgenskoj snimci abdomena

The purpose of the article is to present the differential diagnostic criteria between pneumobilia (air in the biliary system) and portal vein gas on abdominal x-ray. Differential diagnosis is essential because of its influence on patient management. Two patients are presented, one with pneumobilia and the other with portal vein gas on abdominal x-ray, with review of the relevant literature. Pneumobilia is often iatrogenic and even in cases of cholecystitis it is never a sole indication for emergency surgery. Patients with pneumobilia on abdominal x-ray can always be investigated further. On the other hand, the presence of air in portal vein is in most cases a sign of acute mesenteric ischemia. In adults with abdominal pain indicating intestinal ischemia (pain that is ‘out of proportion’ to clinical abdominal examination findings), it is an indication for emergency exploratory laparotomy. It is vital to act early when intestinal ischemia is suspected.Cilj rada je prikazati diferencijalno-dijagnostičke kriterije između pneumobilije i zraka u portalnom venskom sustavu na rendgenskoj snimci nativnog abdomena. Ti kriteriji su ključni, jer o njima ovisi daljnje postupanje s bolesnikom. Prikazane su dvije bolesnice, jedna s nalazom pneumobilije, a druga s nalazom zraka u portalnoj veni na rendgenskoj snimci nativnog abdomena, te je pretražena literatura. Pneumobilija je često jatrogena i čak u slučajevima kolecistitisa nije isključiva indikacija za hitan kirurški zahvat. Bolesnike kod kojih je nađena pneumobilija na snimci nativnog abdomena se uvijek može uputiti na daljnji dijagnostički postupak. Međutim, prisutnost zraka u portalnoj veni je u većini slučajeva znak mezenterijske ishemije. U odraslih bolesnika koji se žale na bol koja bi mogla odgovarati mezenterijskoj ishemiji (vrlo jaka bol uz mekan trbuh) zrak u portalnoj veni je indikacija za hitnu eksplorativnu laparotomiju. Od vitalne važnosti je djelovati brzo kada se sumnja na mezenterijsku ishemiju

Increased number of ruptured aortic aneurysms during SARS-CoV-2 pandemic

Background and purpose: The aim of the study was to verify whether ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic or Coronavirus disease (COVID-19) vaccination has any influence on established increased number of ruptured aortic aneurysms (RAA) during SARS-CoV-2 pandemic (years 2020-2021) regarding two-year of pre-pandemic period (2018-2019). Materials and methods: Medical records of patients treated for the ruptured abdominal aortic aneurysm (RAAA) by surgical or endovascular reconstruction at the Department of Surgery, University Hospital Center Zagreb, between 2018 and 2021, were retrospectively analyzed. Categorical variables were analyzed using Fisher’s exact test, while numerical variables were analyzed using Student’s t-test or Mann-Whitney U test, depending on the normality of the distribution. Results: The analysis revealed an increase in number of RAAAs by 55.56% in pandemic time (28 versus 18 in pre-pandemic years), decrease in their 30-day mortality by 18.65 % (53.57% vs. 72.22% respectively) and decrease in outpatient examinations during pandemic by 13.82%, but the differences were not statistically significant. Conclusion: No statistically significant relation between SARS-CoV-2 pandemic or the COVID-19 vaccination and the number of treated RAAAs could be established. History of COVID-19 positivity or vaccination were not associated with RAAA outcome. The increase of RAAAs in pandemic along with decrease of its 30-day mortality compared to pre-pandemic time suggests patients’ hesitance to go to elective surgery and avoidance of regular check-ups in the hospitals, where lots of patients with SARS-CoV-2 are presumed to be concentrated, since hospital service policy and protocols remained the same. The patients were never directly asked to answer this question, so even if the fear of getting SARS-CoV-2 infection remains the most plausible answer, it should be verified by an independent survey

Outpatient surgery

Podloga: Dnevna bolnica (DB) je oblik organizacije, ali i način pružanja dijagnostičko-terapijskih postupaka izvanbolničkih bolesnika uz dnevni boravak u bolnici (u trajanju do 22 sata). Dnevna bolnica može se organizirati kao organizacijski dio pojedine djelatnosti u bolnici, poliklinici i trgovačkom društvu za obavljanje zdravstvene djelatnosti. Vlada Republike Hrvatske pravilnikom propisuje minimalne uvjete za rad u Dnevnoj bolnici, a Hrvatski zavod za zdravstveno osiguranje (HZZO) ugovara kirurške postelje, plaća usluge i prati iskorištenost ugovorenih kapaciteta. Metode: Autori u ovom radu dostupnom stručnom literaturom, pravilnicima i statističkim izvješćima analiziraju brojnost i iskorištenost posteljnih kapaciteta kirurških dnevnih bolnica u javnom zdravstvenom sustavu Republike Hrvatske. Analizirano je razdoblje od 2013. Do 2014. godine. Rezultati: Od ukupno 25 219 bolničkih postelja u Hrvatskoj, u 2015. godini HZZO je ugovorio 3811 postelja dječjih bolnica (278 za potrebe opće i 33 za potrebe dječje kirurgije). U 2014. godini bolnice su imale 155 ugovorenih postelja opće i 13 postelja dječje kirurgije. U 2013. godini, bilo je 20930 dana liječenja u dnevnim bolnicama opće kirurgije i 2844 dana u dječjoj kirurgiji, a u 2014. godini bilo je 22946 dana liječenja u dnevnim bolnicama opće kirurgije i 2488 dana u dječjoj kirurgiji. Zaključak: Ukupno sudjelovanje kirurških postelja dječjih bolnica u posteljnom kapacitetu naših bolnica je niska, a popunjenost tih kapaciteta na godišnjoj razini kreće se u rasponu 5487%. Postelje dječje kirurgije u dječjim bolnicama većim se postotkom koriste nego one opće kirurgije. Zakonodavac i HZZO učestalo mijenjaju pravilnike kojima propisuju okvire rada kirurške dnevne, a bolnice teško prate te zadane okvire minimalnih uvjeta.Background: Day Hospital (DH) is a type of organization for providing diagnostic and therapeutic outpatient procedures for patients who are hospitalized and discharged within one day (within 22 hours). It can be organized in a hospital, clinic or healthcare company. The government of the Republic of Croatia prescribes minimum requirements for work on an outpatient basis, and the Croatian Health Insurance Fund (HZZO) contracts the number of surgical beds, pays for the provided services and monitors the hospital bed usage. Methods: The authors, using available literature, regulations and statistical reports, analyzed the number and hospital bed usage in surgical DH units in the public health system in Croatia for the 2013/2014 period. Results: Of 25219 hospital beds in Croatia, in 2015 HZZO contracted 3811 DH beds (278 for general surgery and 33 for pediatric surgery). In 2014 there were 155 beds for general and 13 beds for pediatric surgery. In 2013 there were 20930 days of hospitalization in general day surgery and 2844 days in pediatric day surgery. In 2014 there were 22946 days of hospitalization in general day surgery and 2488 days in pediatric day surgery. Conclusion: The percentage of surgical DH beds in overall number of surgical beds in our hospitals is low, and the utilization of capacity ranges from 54 to 87%. Pediatric day surgery beds are utilized better than general surgery. The Government and HZZO often change regulations regarding DH facilities. This makes it difficult for hospitals to maintain minimal requirements for the organization of surgical DH units

Aortoduodenalna fistula tri godine nakon aorto-bifemoralne premosnice: prikaz slučaja i pregled literature

Secondary aortoenteric fistulas (SAEF ) are a relatively rare but dangerous complication of aortal reconstructive surgery. We present a patient that underwent aortobifemoral bypass three years before developing the signs of aortoenteric fistula, and we reviewed the literature on the topic. Since the clinical signs are nonspecific, physicians should have a high index of suspicion for SAEF in patients who underwent aortal reconstructive surgery. The most useful diagnostic tools for stable patients are upper gastrointestinal endoscopy and computed tomography scan with contrast that can, in combination with history and clinical signs, enable accurate diagnosis in more than 90% of patients. Unstable patients with suspected aortoenteric fistula should undergo exploratory laparotomy. The treatment of choice is open surgery with graft excision, wide debridement of infected tissue, bowel repair or resection followed by an extra-anatomic bypass or in situ placement of a new graft. Early postoperative mortality remains high, around 30% in most analyses. Currently there are no guidelines for the diagnosis and management of SAEF , so individualized approach is necessary for each patient.Sekundarne aorto-enteralne fistule su rijetka ali opasna komplikacija aortne rekonstruktivne kirurgije. Prikazuje se bolesnik kod kojega su se razvili simptomi aorto-enteralne fistule tri godine nakon ugradnje aorto-bifemoralne premosnice, uz pregled literature. S obzirom na to da su klinički znaci vrlo nespecifični kod ovih bolesnika, važno je rano posumnjati na moguć razvoj sekundarne aorto-enteralne fistule kod bolesnika koji su bili podvrgnuti aortnoj rekonstruktivnoj kirurgiji. Od dijagnostičkih metoda najkorisnije su ezofagogastroduodenoskopija i kompjutorizirana tomografija s kontrastom koji, u kombinaciji s anamnezom i kliničkim znacima, omogućavaju postavljanje dijagnoze u preko 90% bolesnika. U nestabilnih bolesnika kod kojih postoji sumnja na razvoj ovoga stanja indicirana je eksplorativna laparotomija. U liječenju metoda izbora je laparotomija, ekscizija proteze, debrideman upaljenog tkiva, popravak defekta na crijevu ili resekcija zahvaćenog segmenta, te ekstraanatomska premosnica ili postavljanje nove proteze. Poslijeoperacijska smrtnost je oko 30%. Kako zasad nema smjernica za dijagnostiku i liječenje bolesnika sa sekundarnim aorto-enteralnim fistulama nužan je visoko individualizirani pristup za svakog bolesnika

Prophylactic gonadectomy in children with mixed gonadal dysgenesis – a nine-year-old girl

Gonadna disgeneza embrionalna je anomalija gonada. Može biti čista (Turnerov sindrom) ili miješana (mozaicizam). Miješani oblik s lozom stanica u kojoj se nalazi Y spolni kromosom, sklon je pojavi gonadoblastoma u displastičnim gonadama. U takve djece indicirano je učiniti profi laktičku bilateralnu gonadektomiju, prije maligne alteracije. Stoga je važna rana dijagnoza miješane gonadne disgeneze. No djeca s gonadnom disgenezom različitih su fenotipskih osobina, katkad potpuno neupadljiva u predpubertetskoj dobi. U radu prikazujemo fenotipski neupadljivu, tek nešto nižeg rasta devetogodišnju djevojčicu s miješanom gonadnom disgenezom, kojoj smo načinili profi laktičku laparoskopsku gonadektomiju. Zaključno, miješana gonadna disgeneza može se očitovati jedino niskim rastom u djece predpubertetske dobi.Gonadal dysgenesis is an embryonal disorder of the gonads. It can be pure (Turner’s syndrome) or mixed (mosaicism). The mixed form, which also has Y chromosome, is prone to the occurrence of gonadoblastomas in dysplastic gonads. In such children, it is indicated to make prophylactic bilateral gonadectomy before malignant transformation. Therefore, early diagnosis of mixed gonadal dysgenesis is important. However, children with gonadal dysgenesis have variable phenotype. In rare cases, these children cannot be distinguished phenotypically at the pre-pubertal age from children with normal karyotype. We report on phenotypically unremarkable nine-year-old girl with short stature and mixed gonadal dysgenesis, submitted to prophylactic laparoscopic gonadectomy. In conclusion, short stature may be the only phenotypic sign of mixed gonadal dysgenesis in pre-pubertal children