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Prikazujemo analizu naših rezultata i komplikacija pri postavljanju Tenckhoffova katetera za peritonejsku dijalizu laparoskopskom metodom i usporedbu s objavljenima u literaturi. Retrospektivna analiza uključila je 50 bolesnika koji su podvrgnuti postavljanju katetera za peritonejsku dijalizu laparoskopskom tehnikom u Klinici za kirurgiju Kliničkog bolničkog centra Rijeka od siječnja 2000. do studenog 2010. godine. Analizirani su uspješnost rezultata, rane i kasne postoperacijske komplikacije, konverzija u otvoren pristup te stopa reoperacije. Ranim komplikacijama su smatrane one nastale u prvih 4 tjedna od operacije. Komplikacije su se javile u 23 bolesnika (29 komplikacija). Ranih komplikacija bilo je 18, od toga 2 akutna peritonitisa, 2 ileusa, 4 krvarenja, 4 infekcije izlaznog mjesta katetera, 3 propuštanja dijalizata oko peritonejskog katetera, 2 malpozicije katetera te 1 genitalni edem. Kasnih komplikacija je bilo 11, od toga 5 akutnih peritonitisa, 1 recidivni peritonitis, 1 krvarenje, 1 infekcija izlaznog mjesta katetera, 1 malpozicija katetera, 1 propuštanje dijalizata oko peritonejskog katetera i 1 hernija u području implantacije peritonejskog katetera. Nije bilo smrtnih ishoda nakon operacije niti je bilo komplikacija koje su onemogućile provođenje peritonejske dijalize. Zaključujemo da se u liječenju bolesnika s terminalnim renalnim zatajivanjem laparoskopska tehnika pokazala prikladnom i sigurnom metodom postavljanja peritonejskog katetera., The aim was to analyze our results and complications in laparoscopic-assisted placement of the Tenckhoff catheter for peritoneal dialysis in comparison with results reported in the literature. Fifty patients were included in this retrospective analysis. From January 2000 to November 2010, they underwent laparoscopic-assisted placement of catheter for peritoneal dialysis at the University Department of Surgery, Rijeka University Hospital Center. The results of this approach, early and late postoperative complications, conversions to open technique, and reoperation rate were analyzed. The complications that occurred within the fi rst 4 weeks were considered as early complications. In 23 patients, 29 complications were recorded. There were 18 early complications, of which 2 acute peritonitis, 2 ileus, 4 bleeding, 4 catheter infection, 3 fl uid leakage, 2 catheter malpositioning and 1 genital edema. There were 11 late complications, of which 5 acute peritonitis, 1 recurrent peritonitis, 1 bleeding, 1 catheter infection, 1 catheter malpositioning, 1 fl uid leakage and 1 port site hernia. There were no deaths after surgery or any complications disabling the implementation of peritoneal dialysis. In patients with end-stage renal disease, laparoscopic-assisted placement of catheter for peritoneal dialysis is a safe and appropriate method of treatment.

Zbog iznimne važnosti koronarnih arterija, osobito u patogenezi srčanih bolesti, istraživanja srčanih vena desetljećima su bila zapostavljena. Napretkom moderne medicine uvođenje inovativnih dijagnostičkih i terapeutskih postupaka dovelo je do potrebe za alternativnim putovima pristupa oštećenom srcu, gdje vene srca imaju značajnu ulogu. Dok se ranije za prikaz krvnih žila srca koristila samo sekcija srca, danas su zbog primjene novih metoda prikaza krvnih žila srca prisutne različite podjele srčanih vena. Većina srčanih vena završava u desnom atriju. Istaknutu ulogu u odvođenju krvi iz srca ima koronarni sinus, sinus coronarius i njegove pritoke te prednje srčane vene, vv. cardiacae anteriores. Ove vene pripadaju velikom srčanom sustavu, dok mali srčani sustav čine Thebesijeve žile. One su predmet stalnih istraživanja jer se prilagođavaju različitim potrebama prokrvljenosti miokarda ovisno o životnoj dobi i promjenama u različitim srčanim bolestima. Varijacije srčanih vena su uobičajene. Poznavanje varijacija i anastomoza srčanih vena osobito je važno za razumijevanje i tumačenje slikovnih prikaza srčanih vena prilikom izvođenja dijagnostičkih i terapeutskih postupaka., The investigation of the cardiac veins have been neglected for decades because of the great importance of the coronary arteries in the pathogenesis of coronary heart disease. Advances in modern medicine and the introduction of innovative diagnostic and therapeutic procedures have led to the alternative routes to the access of the damaged heart, where the cardiac veins play an important role. Before the application of the new imaging methods for cardiac vessels, only dissection of the hearts were used. Now, with the help of these new diagnostic methods, the different classifications of cardiac veins was present. Most cardiac veins drain into the right atrium. The coronary sinus and its tributaries and the anterior cardiac veins have an important role in collecting and returning blood from the heart has. These veins constitute the greater cardiac venous system, while smaller cardiac venous system consists of the Thebesian vessels. They are the subject of an ongoing research in order to adapt to the different needs of myocardial drainage depending on the age and changes in various heart diseases. Variations of cardiac veins are common. The knowledge of cardiac vein variations and anastomoses have become important for understanding and interpretation of the heart vein images during performing diagnostic and therapeutic procedures.

The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year old girl who developed the incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a signifi cant shift of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive sutures (TiCron) size 2-0 with a previous control and ventilated expansion of the well-developed left lung. In postoperative course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax.