The natural course of the condition in pediatric trigger thumb is still controversial, and accord... more The natural course of the condition in pediatric trigger thumb is still controversial, and accordingly, the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagn...
Poštovani gospodine uredniče, ovo pismo sastavljeno je s ciljem prezentacije načina rada u jednod... more Poštovani gospodine uredniče, ovo pismo sastavljeno je s ciljem prezentacije načina rada u jednodnevnoj kirurgiji onima koji se nisu imali prilike susresti s izazovom rada u takvoj jedinici. Jednodnevna kirurgija najmlađa je organizacijska jedinica Klinike za kirurgiju Kliničkoga bolničkog centra Zagreb koja omogućuje brzo, efektivno i financijski učinkovito zbrinjavanje pacijenata pridonoseći na taj način boljem funkcioniranju cijele bolnice, a samim time i cjelokupnog zdravstvenog sustava.
Hand is extremely exposed to various loads and traumas of everyday tasks and activities, resultin... more Hand is extremely exposed to various loads and traumas of everyday tasks and activities, resulting in fist fractures being fairly common injuries. The most common mechanism of injury is a direct blow. This retrospective study analyzed the data on 274 children admitted for hand fractures at Clinical Hospital Center Zagreb in the period from 2006 to 2014. The study included 76 girls (28%) and 198 boys (72%). The average patient age was 11.9 years and most were between 10 and 13 years of age. Phalangeal fractures accounted for 80%, metacarpal fractures for 17%, and carpal fractures for 3% of all injuries. Most commonly injuries occurred during recreation (4 1%), at home (37%), at school (18%) and in the street (4%). Direct blow was the major cause of injury (76%), and 24% were caused by fall. Injuries during sport activities are the most common cause of the hand fractures in pediatric population and direct blow is the main mechanism of injury. The peak incidence is at the age of 10-13 ...
Cilj: Evaluirati upotrebu i komplikacije centralnih venskih katetera (CVK) u novorođencadi. Metod... more Cilj: Evaluirati upotrebu i komplikacije centralnih venskih katetera (CVK) u novorođencadi. Metode: Retrospektivna studija u 250-ero konsekutivnih bolesnika lijecenih u jedinici za intenzivno lijecenje od 1. sijecnja 2011. godine. Bolesnici premjesteni u drugu ustanovu ili umrli 24 sata nakon prijma ili stariji od 24 dana (N=25) nisu uvrsteni. Rezultati: Analizirana su 192 katetera (102 UVK-a, 60 PICC-a i 30 ostalih CVK-a) postavljenih u 123-je bolesnika (54, 7%) u traja- nju od 1931 kateter-dana. Sto dvoje (45, 3%) bolesnika nije imalo postavljen CVK. Bolesnici koji su imali postavljen CVK bili su manje rodne mase (RM 2, 4±1, 1 ; 500-4800 g) u odnosu na one koji nisu imali postavljen CVK (RM 2, 9±8, 6 ; 1030-4570 g). 84% nedonoscadi RM <1500 imalo je postavljen CVK (100% onih s RM-om <1000 g). 44-ero bolesnika (35, 8%) imalo je vise od jednog CVK-a (63% RM <1000 g). Kateteri su primijenjeni u prosjeku 10, 2 dana (medijan 8, raspon 1-50). Prosjecno vrijeme primjene bilo je ...
Cilj: Bez obzira na etiologiju portalne hipertonije (PH) konacni klinicki ishod je isti: krvarenj... more Cilj: Bez obzira na etiologiju portalne hipertonije (PH) konacni klinicki ishod je isti: krvarenje iz varikoziteta jednjaka, ascites i splenomegalija s hipersplenizmom. Autori su, u cilju procjene efikasnosti, istražili vlastita iskustva s portosistemskim santovima u djece. Metode: Tijekom posljednje dvije godine ucinili smo portosistemske santove u 6 djece, zbog PH i krvarenja iz varikoziteta jednjaka. Indikacije su bile bilijarna atrezija (1), tromboza portalne vene (1), kavernomportalne vene (2), kongenitalna portalna fibroza (1) i portalna venska tromboza nakon transplantacije segmenta jetre sa živog donora (1). Nacinili smo 2 mezokavalna "H" santa pomocu grafta unutrasnje jugularne vene i 4 distalna splenorenalna santa. Rezultati: Postoperativno su sva djeca pracena u cilju određivanja hipersplenizma, jetrene funkcije i razine serumskog amonijaka. Kod jednog je bolesnika nastala tromboza splenorenalnog santa, te smo ucinili splenektomiju i ezofagogastricnu devaskulari...
Gastroschisis is a defect of the anterior abdominal wall through which viscera can protrude, and ... more Gastroschisis is a defect of the anterior abdominal wall through which viscera can protrude, and can be followed by additional malformations. Three quarters of the gastroschisis malformations are confined to the midgut. Other malformations are urologic and cardiac malformations and malformations of extrahepatic biliary tract. Duplication of gallbladder in general population is relatively rare, occurring once in every 3,000 to 4,000.In this case report we will present a case of an infant with gastroschisis accompanied with the duplication of gallbladder. In the newborn a complete duplication of gallbladder was found with two separate cystic ducts, i.e. type 2 by Boyden. Since the guidelines for duplication of the gallbladder associated with gastroschisis do not exist, we acted according to the guidelines for duplication of the gallbladder in the general population, i.e. nonsurgical intervention was performed on the biliary tree. Duplications of the gallbladder associated with gastros...
Liver tumours count for approximately 2% of all childhood tumours and almost 70% of them are mali... more Liver tumours count for approximately 2% of all childhood tumours and almost 70% of them are malignant. Correct diagnosis considering type, size, and location of the tumour 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 tumours. Since 1991 to 2010 we have treated 16 children with liver tumours. Our experience together with review of recent literature is presented here.
Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall... more Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall onto an outstretched hand. This retrospective study analyzed the data on 201 children admitted for radius fractures at KBC-Zagreb in the period 2011-2013. The study included 85 girls (42.3%) and 116 boys (57.7%) . The average age of the children was 9.6 years. Radius was injured in the distal segment in 79.1% of children. The sites of injuries were: park, campi and beach (24.9% of all children), playground, skate park and swimming pool (23.9%), kindergarten or school (20.9%), at home and around the house (17.9%), in the street (11.4%) and in the store or at a hotel (0.9%). The boys were mostly injured at playgrounds, during skating and at swimming pools (37.1% of all boys), while girls were mostly injured in parks, camps and at beach (42.4% girls). Fall was the major cause of the injury (49.3%), and children usually fell during ice skating and skating (32.3% of all falls). In 20.4% the ...
Every fracture heals in three phases: inflammatory, reparative and remodeling. From clinical expe... more Every fracture heals in three phases: inflammatory, reparative and remodeling. From clinical experience we know that fractures in children heal more rapidly than in adults. The increase in blood flow around the fracture rises the temperature of the surrounding tissue. As the bone heals, and remodeling phase begins, temperature around the fracture site start to decrease. There are no extensive studies of thermal changes during normal bone healing. The authors have tried to determine the difference in dynamics of thermal changes during distal radius fracture healing in children and in adults. Prospective study of 20 children aged from 4–14 years (9.0±3.1), and 25 adults aged 50–80 years (65.9±10.4) with fracture of distal radius. Medical thermography was method of measurement. The contralateral, healthy, forearm was used for comparisment. The temperature difference between fractured and healthy forearm was highest on 7th day in children (1.2 ±0.6 °C), and on 14th day in adults (1.4 ±0.5 °C). After 21st day in children, the temperature difference was 0.2 ±0.4 °C. In adult group was temperature difference was 1.0 ±0.5 °C. Eleven weeks after fracture in adult group difference was 0.5±03 °C, and 23 weeks was 0.2±0.3 °C. Preliminary findings in this research showed significant difference in duration of temperature changes during healing process of pediatric and adult distal radius fractures. Future research may lead to scientific progress in the follow-up of pediatric fractures, with the idea of reducing the number of x- ray scans, children are exposed to, in follow up period.
The natural course of the condition in pediatric trigger thumb is still controversial, and accord... more The natural course of the condition in pediatric trigger thumb is still controversial, and accordingly, the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagn...
The natural course of the condition in pediatric trigger thumb is still controversial, and accord... more The natural course of the condition in pediatric trigger thumb is still controversial, and accordingly, the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagn...
Poštovani gospodine uredniče, ovo pismo sastavljeno je s ciljem prezentacije načina rada u jednod... more Poštovani gospodine uredniče, ovo pismo sastavljeno je s ciljem prezentacije načina rada u jednodnevnoj kirurgiji onima koji se nisu imali prilike susresti s izazovom rada u takvoj jedinici. Jednodnevna kirurgija najmlađa je organizacijska jedinica Klinike za kirurgiju Kliničkoga bolničkog centra Zagreb koja omogućuje brzo, efektivno i financijski učinkovito zbrinjavanje pacijenata pridonoseći na taj način boljem funkcioniranju cijele bolnice, a samim time i cjelokupnog zdravstvenog sustava.
Hand is extremely exposed to various loads and traumas of everyday tasks and activities, resultin... more Hand is extremely exposed to various loads and traumas of everyday tasks and activities, resulting in fist fractures being fairly common injuries. The most common mechanism of injury is a direct blow. This retrospective study analyzed the data on 274 children admitted for hand fractures at Clinical Hospital Center Zagreb in the period from 2006 to 2014. The study included 76 girls (28%) and 198 boys (72%). The average patient age was 11.9 years and most were between 10 and 13 years of age. Phalangeal fractures accounted for 80%, metacarpal fractures for 17%, and carpal fractures for 3% of all injuries. Most commonly injuries occurred during recreation (4 1%), at home (37%), at school (18%) and in the street (4%). Direct blow was the major cause of injury (76%), and 24% were caused by fall. Injuries during sport activities are the most common cause of the hand fractures in pediatric population and direct blow is the main mechanism of injury. The peak incidence is at the age of 10-13 ...
Cilj: Evaluirati upotrebu i komplikacije centralnih venskih katetera (CVK) u novorođencadi. Metod... more Cilj: Evaluirati upotrebu i komplikacije centralnih venskih katetera (CVK) u novorođencadi. Metode: Retrospektivna studija u 250-ero konsekutivnih bolesnika lijecenih u jedinici za intenzivno lijecenje od 1. sijecnja 2011. godine. Bolesnici premjesteni u drugu ustanovu ili umrli 24 sata nakon prijma ili stariji od 24 dana (N=25) nisu uvrsteni. Rezultati: Analizirana su 192 katetera (102 UVK-a, 60 PICC-a i 30 ostalih CVK-a) postavljenih u 123-je bolesnika (54, 7%) u traja- nju od 1931 kateter-dana. Sto dvoje (45, 3%) bolesnika nije imalo postavljen CVK. Bolesnici koji su imali postavljen CVK bili su manje rodne mase (RM 2, 4±1, 1 ; 500-4800 g) u odnosu na one koji nisu imali postavljen CVK (RM 2, 9±8, 6 ; 1030-4570 g). 84% nedonoscadi RM <1500 imalo je postavljen CVK (100% onih s RM-om <1000 g). 44-ero bolesnika (35, 8%) imalo je vise od jednog CVK-a (63% RM <1000 g). Kateteri su primijenjeni u prosjeku 10, 2 dana (medijan 8, raspon 1-50). Prosjecno vrijeme primjene bilo je ...
Cilj: Bez obzira na etiologiju portalne hipertonije (PH) konacni klinicki ishod je isti: krvarenj... more Cilj: Bez obzira na etiologiju portalne hipertonije (PH) konacni klinicki ishod je isti: krvarenje iz varikoziteta jednjaka, ascites i splenomegalija s hipersplenizmom. Autori su, u cilju procjene efikasnosti, istražili vlastita iskustva s portosistemskim santovima u djece. Metode: Tijekom posljednje dvije godine ucinili smo portosistemske santove u 6 djece, zbog PH i krvarenja iz varikoziteta jednjaka. Indikacije su bile bilijarna atrezija (1), tromboza portalne vene (1), kavernomportalne vene (2), kongenitalna portalna fibroza (1) i portalna venska tromboza nakon transplantacije segmenta jetre sa živog donora (1). Nacinili smo 2 mezokavalna "H" santa pomocu grafta unutrasnje jugularne vene i 4 distalna splenorenalna santa. Rezultati: Postoperativno su sva djeca pracena u cilju određivanja hipersplenizma, jetrene funkcije i razine serumskog amonijaka. Kod jednog je bolesnika nastala tromboza splenorenalnog santa, te smo ucinili splenektomiju i ezofagogastricnu devaskulari...
Gastroschisis is a defect of the anterior abdominal wall through which viscera can protrude, and ... more Gastroschisis is a defect of the anterior abdominal wall through which viscera can protrude, and can be followed by additional malformations. Three quarters of the gastroschisis malformations are confined to the midgut. Other malformations are urologic and cardiac malformations and malformations of extrahepatic biliary tract. Duplication of gallbladder in general population is relatively rare, occurring once in every 3,000 to 4,000.In this case report we will present a case of an infant with gastroschisis accompanied with the duplication of gallbladder. In the newborn a complete duplication of gallbladder was found with two separate cystic ducts, i.e. type 2 by Boyden. Since the guidelines for duplication of the gallbladder associated with gastroschisis do not exist, we acted according to the guidelines for duplication of the gallbladder in the general population, i.e. nonsurgical intervention was performed on the biliary tree. Duplications of the gallbladder associated with gastros...
Liver tumours count for approximately 2% of all childhood tumours and almost 70% of them are mali... more Liver tumours count for approximately 2% of all childhood tumours and almost 70% of them are malignant. Correct diagnosis considering type, size, and location of the tumour 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 tumours. Since 1991 to 2010 we have treated 16 children with liver tumours. Our experience together with review of recent literature is presented here.
Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall... more Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall onto an outstretched hand. This retrospective study analyzed the data on 201 children admitted for radius fractures at KBC-Zagreb in the period 2011-2013. The study included 85 girls (42.3%) and 116 boys (57.7%) . The average age of the children was 9.6 years. Radius was injured in the distal segment in 79.1% of children. The sites of injuries were: park, campi and beach (24.9% of all children), playground, skate park and swimming pool (23.9%), kindergarten or school (20.9%), at home and around the house (17.9%), in the street (11.4%) and in the store or at a hotel (0.9%). The boys were mostly injured at playgrounds, during skating and at swimming pools (37.1% of all boys), while girls were mostly injured in parks, camps and at beach (42.4% girls). Fall was the major cause of the injury (49.3%), and children usually fell during ice skating and skating (32.3% of all falls). In 20.4% the ...
Every fracture heals in three phases: inflammatory, reparative and remodeling. From clinical expe... more Every fracture heals in three phases: inflammatory, reparative and remodeling. From clinical experience we know that fractures in children heal more rapidly than in adults. The increase in blood flow around the fracture rises the temperature of the surrounding tissue. As the bone heals, and remodeling phase begins, temperature around the fracture site start to decrease. There are no extensive studies of thermal changes during normal bone healing. The authors have tried to determine the difference in dynamics of thermal changes during distal radius fracture healing in children and in adults. Prospective study of 20 children aged from 4–14 years (9.0±3.1), and 25 adults aged 50–80 years (65.9±10.4) with fracture of distal radius. Medical thermography was method of measurement. The contralateral, healthy, forearm was used for comparisment. The temperature difference between fractured and healthy forearm was highest on 7th day in children (1.2 ±0.6 °C), and on 14th day in adults (1.4 ±0.5 °C). After 21st day in children, the temperature difference was 0.2 ±0.4 °C. In adult group was temperature difference was 1.0 ±0.5 °C. Eleven weeks after fracture in adult group difference was 0.5±03 °C, and 23 weeks was 0.2±0.3 °C. Preliminary findings in this research showed significant difference in duration of temperature changes during healing process of pediatric and adult distal radius fractures. Future research may lead to scientific progress in the follow-up of pediatric fractures, with the idea of reducing the number of x- ray scans, children are exposed to, in follow up period.
The natural course of the condition in pediatric trigger thumb is still controversial, and accord... more The natural course of the condition in pediatric trigger thumb is still controversial, and accordingly, the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagn...
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