Repository of the Sestre milosrdnice University Hospital Center
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Meckel Gruber Syndrome
No full textMeckel Gruber Syndrome is an autosomal recessive syndrome characterized by a wide variety of systemic malformations. It is a rare syndrome, the worldwide incidence varies from 1 in 13250 to 1 in 140000 live births. There is great diversity of malformations in this syndrome and it is almost always lethal. We present a case of a patient that had two inducted abortions for Meckel Gruber syndrome. The diagnosis was confirmed pathohystologicaly. She also had two normal term pregnancies. Adequate antenatal care results in early diagnosis of Meckel Gruber syndrome and prompt termination of pregnancy is required
Bronchopulmonary sequestration in adults - a Croatian single institution experience
No full textPulmonary sequestration (PS) is a congenital lung defect rarely diagnosed in adults. PS is often misdiagnosed or not recognized early, delaying surgical management. The aim of this case series analysis was to determine the characteristics of all PS patients with surgical resections occurring over an 8-year period in a single tertiary centre
Brain Metastasis and Epidermal Growth Factor Receptor Mutations in Croatian Caucasians with Lung Adenocarcinoma
No full textThe brain is a common site of metastasis in non-small cell lung cancer (NSCLC). The aim of this study was two-fold: 1) to determine the incidence of brain metastasis (BM) in Caucasian lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations and 2) to evaluate the frequencies and potential relationship of the different EGFR mutations with BM
Cannonball Opacities in the Emergency Department: A Case of Recurrent Malignant Schwannoma in a Long-Term Survivor
No full textMalignant peripheral nerve sheath tumours (MPNSTs), or malignant schwannomas, are extremely uncommon soft-tissue sarcomas of neural origin. They behave aggressively, are rapidly progressive and typically portend a poor prognosis
Pressure ulcer treatment experience at clinical Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital: comparison of results recorded in t he 2011-2016 and 2003-2008 period
No full textPrikazani rezultati kirurškog liječenja dekubitusa na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju KB Dubrava u
vremenu od 2011. do 2016. nisu bitno različiti u odnosu na rezultate kirurškog liječenja iste patologije u studiji iz vremena 2003.-2008., što dokazuje i dalje odličnu planiranost i izvedivost kirurških zahvata, odgovarajuću pripremu bolesnika i adekvatnu postoperacijsku skrb. Unatoč manjem broju hospitaliziranih bolesnika s dekubitusom u studiji 2011.-2016. (31 bolesnik; 42 rekonstrukcijska zahvata) i dalje je učinjen sličan broj rekonstrukcijskih zahvata uspoređujući sa studijom 2003.-2008. (47 bolesnika; 57 rekonstrukcijskih zahvata). Kod rekonstrukcije dekubitusa na sakralnoj regiji kod naših bolesnika najbolje rekonstrukcijske rezultate postigli smo i dalje kliznim fasciokutanim, odnosno mišićnokutanim režnjevima. Kada je god to moguće, ovisno o kliničkoj slici defekta trebalo bi dati prednost mišićnokutanim režnjevima, posebno u slučajevima recidiva dekubitusa. Kod rekonstrukcije dekubitusa u području ishijadičnih zona vrlo dobri rezultati postignuti su uporabom mišićnih režnjeva semimembranozusa i /ili semitendinozusa koji se mobiliziraju u defekt, dok za područje trohanterne regije koristimo transpozicijski režanj fascije late. Liječenje bolesnika s dekubitusom je multidisciplinarno s naglaskom na kirurško liječenje koje se sastoji od radikalnog debridmana, ostektomije i egzaktno planirane i učinjene rekonstrukcije. Konzervativno liječenje mora biti podrška kirurškom liječenju s naglaskom na njegu i visoke higijenske mjere bolesnika. U novije vrijeme (studija 2011.-2016.) sve kvalitetnija uporaba konzervativnog načina tretmana dekubitalnih rana realno je dovela do smanjenja potrebe za hospitalizacijom i kirurškim liječenjem. Daljnjim edukacijama medicinskih sestara u smislu „wound care“-a u zdravstvenim učilištima i bolnicama trebalo bi dati posebno značenje što bi dovelo do prevencije, ali i pravodobnog početka liječenja bolesnika s dekubitusom.Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further ‘wound care’ nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment
Pneumotoraks i pneumomedijastinum – rijetke komplikacije laparoskopske kirurgije
No full textOccurrence of bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during gynecologic laparoscopic procedure is very rare. We report a case of a 23-year-old woman who developed bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during laparoscopic ovarian cystectomy. Carbon dioxide extravasations outside the peritoneal cavity during laparoscopy may have fatal consequences. Careful monitoring, immediate diagnosis and proper treatment are crucial for patient safety.Razvoj obostranog pneumotoraksa, pneumomedijastinuma i supkutanog emfizema je iznimno rijetka komplikacija laparoskopske ginekološke operacije. U ovom radu prikazujemo slučaj 23-godišnje bolesnice u koje se razvio obostrani pneumotoraks, pneumomedijastinum i supkutani emfizem tijekom laparoskopske ovarijske cistektomije. Posljedice nakupljanja ugljičnog dioksida izvan trbušne šupljine tijekom laparoskopskih zahvata mogu biti fatalne. Brza dijagnoza i odgovarajuće liječenje su ključni za povoljan ishod
Mezonefrički adenokarcinom endocerviksa s lobularnom mezonefričkom hiperplazijom: prikaz slučaja
No full textMesonephric adenocarcinoma is a rare variant of cervical adenocarcinoma. We present a case of mesonephric adenocarcinoma of endocervix with cervical and vaginal lobular mesonephric hyperplasia in a 57-year-old woman. Vaginal bleeding persisting for 12 months was the only symptom. Histopathologic findings and characteristic immunophenotype are crucial for the diagnosis. The tumor was composed of papillary formation with a central fibrovascular stroma, villoglandular and densely compact tubular structures containing intraluminal eosinophilic secretion, and coated with one or more rows of cylindrical atypical epithelial cells. There were 30 pathologic mitotic shapes found per 10 HPF. Th e tumor invaded nearly full-thickness of cervical stroma with positive lymphovascular space invasion and clear margins. The case demonstrated characteristic cytokeratin 7, vimentin and epithelial membrane antigen positivity and high Ki-67 proliferation index (60%). Estrogen receptors, progesterone receptors and carcinoembryonic antigen were negative. Intratubular lumen secretion was periodic acid-Schiff positive with periodic acid-Schiff negative carcinoma cells. Differential diagnoses include adenoma malignum, well-differentiated villoglandular adenocarcinoma, endometrioid adenocarcinoma, serous adenocarcinoma, mesonephric adenocarcinoma with a sarcomatous component, clear-cell carcinoma and mesonephric hyperplasia. Radical hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy was performed. Three years after the surgery, the patient remains well. There has not been any evidence of local or distant recurrence. There are no specific recommendations for the treatment of this rare disease. It remains uncertain whether surgical approach is sufficient or the treatment should include additional radio/chemotherapy.Mezonefrički adenokarcinom je rijedak oblik adenokarcinoma vrata maternice. Prikazujemo slučaj pedesetsedmogodišnje bolesnice s mezonefričkim adenokarcinomom vrata maternice, cervikalnom i vaginalnom lobularnom mezonefričkom hiperplazijom. Jedini simptom bilo je vaginalno krvarenje u trajanju od 12 mjeseci. Patohistološki nalaz i imunohistokemijska analiza ključni su u postavljanju konačne dijagnoze. Tumor je bio građen od papilarnih formacija s centralnom fibrovaskularnom stromom, viloglandularnih i gusto kompaktnih tubularnih struktura s eozinofilnom intraluminalnom sekrecijom koje su obložene jednim ili više redova cilindričnih atipičnih epitelnih stanica. Naš slučaj je pokazao karakteristično pozitivan citokeratin 7, vimentin i epitelni membranski antigen, visok Ki-67 indeks proliferacije (60%). Estrogenski receptori, progesteronski receptori i karcinoembrijski antigen bili su negativni. Intratubularna sekrecija bila je PAS (engl. periodic acid-Schiff ) pozitivna, a stanice karcinoma bile su PAS negativne. Diferencijalna dijagnoza uključuje maligni adenom, dobro diferencirani viloglandularni adenokarcinom, endometrioidni adenokarcinom, serozni adenokarcinom, mezonefrički adenokarcinom s komponentom sarkoma, karcinom svijetlih stanica i mezonefričku hiperplaziju. U bolesnice je učinjena radikalna histerektomija s obostranom adneksektomijom, zdjelična i paraaortna limfadenektomija. Tri godine nakon operacije u bolesnice nema znakova lokalnog recidiva niti udaljenih metastaza. Zbog malog broja opisanih slučajeva ne postoje preporuke za liječenje ovoga rijetkog patohistološkog oblika bolesti
Duodenal neuroendocrine tumors (d-NETs): challenges in diagnosis and treatment
No full textDuodenal neuroendocrine tumors (d-NETs) represent 2% of all gastroenteropancreatic neuroendocrine neoplasms. Approximately 40 to 60% of patients at the time of diagnosis have metastases to regional lymph nodes and 10% have liver metastases. D-NETs are mostly incidentally discovered during upper gastrointestinal endoscopy as solitary lesions confined to the mucosa and submucosa. The majority of d-NETs are non-functional, but 10% are gastrinomas and less than 4% present with typical carcinoid syndrome. Measurement of serum gastrin and chromogranin A and screening for the MEN-1 syndrome is mandatory in all patients, while 5-HIAA should be measured only in case of typical symptoms. Magnetic resonance imaging (MRI) may be used to assess tumor spread and to detect primary tumor. Endoscopic ultrasound should be routinely used only for patients who are candidates for endoscopic treatment. Approximately 50% of patients have positive findings on somatostatin receptor scintigraphy (SRS), which should be used only in patients with metastatic disease. Treatment of d-NETs is controversial. Further studies are mandatory in order to detect patients who would benefit from radical surgery, which is associated with high mortality and morbidity rates. Current knowledge suggests that all tumors larger than 20 mm in diameter, sporadic gastrinomas and all periampulary dNETs must undergo radical surgery. Endoscopic mucosal resection is treatment of choice for G1 d-NETs smaller than 20 mm confined to submucosa. Transduodenal surgical resection may be used for patients with d-NETs invading muscularis propria. Additional surgical interventions are recommended after endoscopic treatment in case of G1 or G2 d-NETs with positive margins, G2 or G3 histological grading, invasion into muscular layer or in case of lymphovascular invasion. In case of metastatic disease, cytoreductive surgery should be considered as it improves overall 5-year survival rates. Somatostatin analogs may be used for G1 and G2 tumors, while cisplatin and etopozide should be used for G3 d-NETs. Everolimus may be effective for patients with G2 d-NETs. Peptide receptor radionuclide therapy may be used for patients with positive SRS and progressive disease
