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Cilj istraživanja: Laparoskopska eksploracija glavnog žučovoda u kombinaciji s laparoskopskom kolecistektomijom sve je češće primjenjivana metoda liječenja koledoholitijaze. Cilj je ovog istraživanja bio analizirati ishode laparoskopske eksploracije glavnog žučovoda u pedijatrijskoj populaciji te ih usporediti sa ishodima liječenja endoskopskom retrogradnom pankreatoduodenografijom (ERCP). Ispitanici i metode: U razdoblju od siječnja 2000. do siječnja 2022. godine 84 djece (78,5% djevojčice) podvrgnuto je laparoskopskoj kolecistektomiji sa medijanom praćenja 11,4 (raspon 8, 14) godina. Šest je djece liječeno od koledoholitijaze kombinacijom laparoskopske kolecistektomije i ERCP-a, dok je 14 djece podvrgnuto laparoskopskoj kolecistektomiji u kombinaciji s eksploracijom glavnog žučovoda. Primarni je cilj studije bio ispitati uspješnost liječenja koledoholitijaze. Podciljevi su studije bili karakteristike kamenaca, prisutni simptomi, trajanje kirurškog zahvata i duljina trajanja bolničkog liječenja. Rezultati: Većina su bolesnika iz obiju skupina bile djevojčice (83,5% naprama 85,7%) povišene tjelesne mase sa medijanom 27,9 kg/m2 i 27,4 kg/m2 . Najučestaliji su simptomi u objema skupinama bili opstrukcijska žutica, grčevita bol nalik na kolike, akutni pankreatitis te opstrukcija papile Vateri. Prosječni je promjer glavnog žučovoda u objema skupinama bio devet milimetara. Zahvat je uspješno izveden u svih bolesnika podvrgnutih ERCP-u. U skupini bolesnika liječenih laparoskopskom eksploracijom glavnog žučovoda ekstrakcija je kamenca Dormijevom košarom uspješno izvedena u 10 bolesnika (71,4%), dok su u preostalih četvero bolesnika (28,6%) kamenci prethodno usitnjeni laserom jer je prvotna ekstrakcija Dormijevom košarom bila nemoguća. Prosječno je trajanje laparoskopske eksploracije glavnog žučovoda bilo 79 minuta (interkvartilni raspon 68, 98 min), dok je izvođenje ERCP-a trajalo neznatno duže, 85 minuta (interkvartilni raspon 74, 105 min) (p=0,125). Duljina je bolničkog liječena u bolesnika liječenih laparoskopskom eksploracijom glavnog žučovoda bila značajno kraća (2 naprama 4 dana, p=0,011). Nije zabilježena nijedna komplikacija laparoskopske eksploracije glavnog žučovoda, dok su u skupini bolesnika liječenih ERCP-om zabilježene dvije komplikacije (40%) pankreatitis i kolangitis (p=0,078). Zaključci: Ekstrakcija kamenaca laparoskopskom eksploracijom glavnog žučovoda sigurna je i učinkovita metoda u pedijatrijskoj populaciji pri liječenju koledoholitijaze. Primjenom ove metode liječenja, koledoholitijaza i kolelitijaza mogu biti izliječene u jednom potezu bez potrebe za papilotomijom ili fluoroskopijom. Laparoskopska je eksploracija glavnog žučovoda u usporedbi s laparoskopskom kolecistektomijom i ERCP-om povezana sa kraćim trajanjem bolničkog liječenja. Učestalost je komplikacija je bila manja, ali ne i statistički značajna., Objectives and background: Recently, incidence of a biliary tract diseases in children has been rising in pediatric population. The aim of this study was to look into the outcomes of LCBDE in pediatric patients and to compare them with the other treatment option, an endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods: In the course of January 2000 to January 2022, 84 children (78.5% female) were treated with laparoscopic cholecystectomy with a median follow-up of 11.4 (IQR 8, 14) years. First group of 6 patients was treated with a combination of laparoscopic cholecystectomy (LC) and ERCP, while the other group of 14 children underwent LCBDE for choledocholithiasis. The main end point of the study was to investigate success rate of both treatment options in the matter of complications, recurrence and reoperation rate. Additional endpoints were presenting symptoms, gallstone characteristics, duration of surgery and time of hospital stay. Results: Nearly all of patients in both study groups were overweight females (83.5% vs. 85.7%), with a median body mass index of 27.9 kg/m2 and 27.4 kg/m2 . The most frequent symptoms were colicky abdominal pain, obstructive jaundice, obstruction of the papilla Vateri and acute pancreatitis. The average radius of the common bile duct was 9 mm in both groups. The treatment was successfully finished in all patients in the ERCP group. On the other hand, in the LCBDE group, extraction of the gallstone with a Dormia basket was successful in ten patients (71.4%). The remaining four patients (28.6%) had their stones fragmented with a laser because extraction with a Dormia basket was unfeasible. The median duration of the LCBDE was 79 minutes (IQR 68, 98), while the median time for ERCP was 85 minutes (IQR 74, 105) (p=0.125). The average duration of postoperative hospital stay was notably shorter in the LCBDE group (2 vs. 4 days, p=0.011). The LCBDE group didn't develop any complications, while two complications (40%) occured in the ERCP group pancreatitis and cholangitis (p=0.078). Conclusions: Exploration of the common bile duct and extraction of gallstones by LCBDE is dependable and practicable method in treating choledocholithiasis in the pediatric population. By performing this procedure, a two-stage procedure is avoided so the fluoroscopy and papillotomy are left unexecuted. LCBDE is related to shorter postoperative hospital stay. The incidence of complications was relatively low but not statistically apparent.

Cilj rada je pružiti pregled i utvrditi razinu zadovoljstva pacijenata Opće bolnice Pula kvalitetom pružene usluge na odjelu Službe za kirurgiju. Jedan od ključnih čimbenika kvalitete je zadovoljstvo bolesnika pruženom zdravstvenom uslugom. Osnovno pravo svakog pacijenta je pravo na poštovanje, razumijevanje i privatnost. Pacijenti očekuju i stručnost osoblja i ostvarenje kvalitetne komunikacije sa zdravstvenim osobljem. Osnovna vrijednost u zdravstvu je pružiti najbolju moguću njegu svakom pojedincu. Pacijent bi uvijek trebao biti na prvom mjestu. Upravo iz tog razloga potrebno je analizirati dosadašnje ishode i u sinergiji sa suvremenim tehnikama komunikacije i njege raditi na povećavanju očekivane kvalitete zdravstvene usluge od strane pacijenata. Istraživanje je provedeno nad 50 bolesnika koji su bili liječeni na odjelu Službe za kirurgiju Opće bolnice Pula primjenom anketnog upitnika koji je dobrovoljan i anoniman. Ispitanici su uz anketni upitnik dobili i obrazac informiranog pristanka. Anketni upitnik sadržavao je ukupno 48 pitanja i 8 cjelina. Istraživanje potvrđuje da pacijenti postavljaju sve veća očekivanja od zdravstvenih djelatnika tako je da samim tim i razina zadovoljstva zdravstvenom njegom izražena u tom kontekstu. The aim of this paper is to give an overview and determine the level of patient satisfaction of the Pula General Hospital with the quality of the service provided at the Department of Surgery. One of the key quality factors is patient satisfaction with the health service provided. The basic right of every patient is the right to respect, understanding and privacy. Among other things, patients expect staff expertise and quality communication with healthcare staff. The basic value in healthcare is to provide the best possible care to each individual. The patient should always come first. It is precisely for this reason that it is necessary to work on increasing the expectations of the quality of health care services by patients. The research was conducted on 50 patients who were treated at the Surgery Department of the Pula General Hospital using a voluntary and anonymous questionnaire. Along with the questionnaire, the respondents received an informed consent form. The survey questionnaire contained a total of 48 questions and 8 parts. The study confirmed that the patients have higher expectations from health care providers which results that the level of satisfaction with health care also expresseds in this context.

Kožni melanom je z vidika zdravljenja kirurška bolezen, saj kirurgija predstavlja zelo pomemben način zdravljenja pri vseh stadijih bolezni. Ločimo kirurško zdravljenje primarne lezije, regionalnih, in-transit in oddaljenih zasevkov. Pri primarni leziji ločimo diagnostično in široko (radikalno) ekscizijo. Varnostni rob je pri prvi do 5 mm, pri drugi pa med 1 do 2 cm, odvisno od debeline melanoma. Pri regionalnih zasevkih melanoma govorimo glede na njihovo velikost o klinično okultnih in klinično prepoznavnih zasevkih. Prve ugotovimo s pomočjo biopsije sentinel bezgavke in jih nato zdravimo tako kot klinično prepoznavne zasevke z radikalno limfadenektomijo regionalne bezgavčne lože. In-transit zasevke lahko zdravimo s preprosto ekscizijo ali pa v primerih, ko jih je več in so locirani na ekstremitetah s pomočjo tehnično zahtevnih izolirane ekstremitetne perfuzije ali infuzije. Pri sistemskem razsoju je kirurško zdravljenje vedno prvi izbor zdravljenja, v kolikor je možno zasevke odstraniti v celoti. From the treatment perspective, skin melanoma is a surgical disease, as surgery is a very important treatment modality for all stages of this disease. We distinguish between surgical treatments of primary lesions and regional, in-transit and distant metastases. Considering the primary lesion, we distinguish between diagnostic and wide (radical) excision, with the safety margin being up to 5 mm and 1-2 mm, respectively. Depending on their size, locoregional melanoma metastases are either clinically occult or clinically apparent. The first are detected with the help of sentinel lymph node biopsy and are afterwards treated in the same manner as clinically apparent metastases, namely with radical lymphadenectomy of the regional lymph node basin. In-transit metastases can be treated with a simple excision or, in cases of multiple metastases located on the extremities, with the help of technically demanding isolated limb perfusion or infusion. In a systematic assessment, surgical treatment is always the first choice if metastases can be removed completely.

Namen: Proučiti vpliv specifičnih predoperativnih in intraoperativnih napovednih dejavnikov na subjektivni izid kirurškega zdravljenja nestabilnosti pogačice. Metode: V prospektivno raziskavo je bila vključena kohorta 116 bolnikov (138 kolen), ki so bili operirani zaradi nestabilnosti pogačice med letoma 2012 in 2019 na Ortopedski kliniki UKC Ljubljana: 34 primerov izolirane rekonstrukcije medialnega pogačičnega ligamenta (MPFL), 92 primerov rekonstrukcije MPFL in prestavitev tibije ter 12 primerov rekonstrukcije MPFL in trohleoplastike. Uspešnost operativnega zdravljenja smo vrednotili s standarniziranimi subjektivnimi vprašalniki: za specifično funkcijo kolena – vprašalnik KOOS, za splošno kakovost življenja – vprašalnik EQ-5D in za stopnjo aktivnosti – Tegnerjeva lestvica. Beležili smo pooperativne zaplete, revizijske operacije ter spremljali višino pogačice v zgodnjem in poznem pooperativnem obdobju. S parnimi statističnimi testi smo primerjali vrednosti subjektivnih vprašalnikov med pred- in pooperativnimi vrednostmi. Kot potencialne napovedne dejavnike za izid zdravljenja smo z multivariatnimi linearnimi regresijskimi modeli preverjali naslednje parametre: a) demografske (spol, starost, indeks telesne mase), b) radiološke (predoperativni: višina in nagib pogačice, razdalja med tuberositasom tibije in trohlearnim žlebom, stopnja trohlearne displazije, stopnja osteoartroze kolena pooperativni: mesto fiksacije presadka MPFL), c) intraoperativne: izolirani ali kombinirani postopki stabilizacije pogačice, makroskopski hrustančni status kolena (angl. Chondropenia Severity Score – CSS). Rezultati: Mediani čas spremljanja bolnikov je bil 4,4 (1,0–8,9) leta. Subjektivni rezultati zdravljenja so se pooperativno statistično pomembno povečali pri vseh treh vprašalnikih: KOOS kumulativno z 71 (15) na 78 (16), EQ-5D-3L-TTO z 0,68 (0,20) na 0,78 (0,21), aktivnost na Tegnerjevi lestvici s 3 (0–10) na 4 (0–10). Nihče od preiskovancev ni potreboval revizijske operacije zaradi nestabilnosti pogačice. Preiskovanci, ki so potrebovali pooperativno manipulacijo kolena v anesteziji ali artroskopski debridement mehkih tkiv in hrustanca, so pooperativno manj napredovali pri vrednostih kumulativnega KOOS in EQ-5D-3L-TTO. Ugotavljali smo statistično značilne negativne povezave z določenimi deli pooperativne lestvice KOOS, pooperativnimi vrednostmi EQ-5D-3L-TTO in pooperativnimi vrednostmi Tegnerjeve lestvice aktivnosti. Mesto fiksacije presadka MPFL na stegnenico, medializacija in/ali distalizacija TT ter trohleopastika niso vplivali na izid zdravljenja. Razlik v višini pogačice pred operacijo, takoj po operaciji in ob zadnji kontroli nismo ugotavljali. Sklepi: Operativna stabilizacija pogačice z rekonstrukcijo MPFL, izolirana ali kot kombiniran poseg s prestavitvijo tuberositas tibije ali trohleoplastiko, je bila varna in je bistveno izboljšala funkcijo kolena, kakovost življenja ter stopnjo aktivnosti bolnikov. Starost, višji indeks telesne mase, slabše stanje patelofemoralnega hrustanca pred operacijo in ženski spol so negativno vplivali na izid operativnega zdravljenja. Bolniki, ki so po operaciji potrebovali manipulacijo kolena ali artroskopski debridement, so imeli slabše subjektivne kazalnike uspešnosti zdravljenja. Mesto fiksacije presadka MPFL na stegnenico ni vplivalo na subjektivno funkcijo kolena po operaciji. Resni neželeni dogodki so bili redki, ponovnih izpahov in sprememb v višini pogačice nismo beležili. Purpose: To investigate factors predicting patient-reported outcomes and revision interventions after surgical treatment of patients with patellofemoral instability. Methods: From a prospective database of a university orthopaedic department, 138 knees of 116 patients who had undergone surgery for patellofemoral instability between 2012 and 2019 were included in the analysis: 34 cases of isolated MPFL reconstruction, 92 cases of MPFL reconstruction plus tibial tuberosity transfer, and 12 cases of MPFL reconstruction plus trochleoplasty. Patient-reported outcome measures (PROMs) were recorded for knee-specific function (KOOS), general quality of life (EQ-5D) and activity level (Tegner scale). Postoperative revision procedures were also recorded. Preoperative and postoperative PROMs values were compared using paired statistical tests. Potential predictive factors included patient demographics (sex, age, BMI), radiological data (preoperative: patella height and inclination, tuberosity-trochlear groove distance, trochlear dysplasia, knee osteoarthritis postoperative: MPFL insertion point) and intraoperative parameters (isolated vs. combined procedures, macroscopic cartilage condition of the knee using Chondropenia Severity Score - CSS) were analysed using multivariate linear regression models. Results: After a median follow-up of 4.4 (1.0-8.9) years, all patient-reported outcome measures had significantly increased from preoperative to postoperative values: KOOS cumulative, from 71 (15) to 78 (16) EQ -5D-3L-TTO, from 0.68 (0.20) to 0.78 (0.21) and Tegner activity scale, from 3 (0-10) to 4 (0-10). No revision surgery was performed for patellofemoral instability. Patients who required postoperative knee manipulation under anaesthesia or arthroscopic debridement showed lower postoperative improvement in KOOS cumulative and EQ -5D-3L-TTO. Age, BMI, patellofemoral knee osteoarthritis and shorter follow-up time showed significant negative correlations with some of the postoperative KOOS subscales. Age was negatively correlated with postoperative EQ-5D-3L-TTO, while postoperative Tegner activity scale was negatively correlated with female sex and patellofemoral CSS. The femoral MPFL insertion point, tibial tuberosity transfer or trochleoplasty showed no association with any outcome measures. There were no differences in patellar height before surgery, immediately after surgery, and at last follow-up, except in patients who underwent intentional TT distalisation. Conclusion: Surgical treatment of patellofemoral instability using isolated or combined (with tibial tuberosity transfer or trochleoplasty) MPFL reconstruction was safe and significantly improved patients' subjective knee function, overall quality of life and activity level. Older age, higher BMI, poorer preoperative patellofemoral cartilage status and female gender had negative effects on outcome. Patients who required postoperative knee manipulation or arthroscopic debridement had less postoperative improvement in subjective measures, whereas the femoral MPFL insertion point was not associated with any of these factors. Serious adverse events were rare, with no recurrence of patellofemoral dislocation or changes in patellar height.

Objective: Pelvic exenteration in women with recurrent vulvar carcinoma is associated with high morbidity and mortality and substantial treatment costs. Because pelvic exenteration severely affects the quality of life and can lead to significant complications, other treatment modalities, such as electrochemotherapy, have been proposed. The aim of this study was to evaluate the feasibility and suitability of electrochemotherapy in the treatment of recurrent vulvar cancer. We aimed to analyze the treatment options, treatment outcomes, and complications in patients with recurrent vulvar cancer of the perineum. Methods: A retrospective analysis of patients who had undergone pelvic exenteration for vulvar cancer at the Institute of Oncology Ljubljana over a 16-year period was performed. As an experimental, less mutilating treatment, electrochemotherapy was performed on one patient with recurrent vulvar cancer involving the perineum. Comparative data analysis was performed between the group with pelvic exenteration and the patient with electrochemotherapy, comparing hospital stay, disease recurrence after treatment, survival after treatment in months, and quality of life after treatment. Results: We observed recurrence of disease in 2 patients with initial FIGO stage IIIC disease 3 months and 32 months after pelvic exenteration, and they died of the disease 15 and 38 months after pelvic exenteration. Two patients with FIGO stage IB were alive at 74 and 88 months after pelvic exenteration. One patient with initial FIGO stage IIIC was alive 12 months after treatment with electrochemotherapy with no visible signs of disease progression in the vulvar region, and the lesions had a complete response. The patient treated with electrochemotherapy was hospitalized for 4 days compared with the patients with pelvic exenteration, in whom the average hospital stay was 19.75 (± 1.68) days. Conclusion: Our experience has shown that electrochemotherapy might be a less radical alternative to pelvic exenteration, especially for patients with initially higher FIGO stages.

Objectives: The aim of this study was to determine the parental experiences and satisfaction of their child`s hospital admission at the Department of Pediatric surgery in the University Hospital of Split. Materials and methods: This cross-sectional study included a total of 76 respondents, who were parents of children admitted to the Department of Pediatric surgery in the University Hospital of Split. Data collection was performed in the period of January 2022 to the end of May 2022. The study included a questionnaire, which was voluntary and anonymous, containing 26 questions regarding satisfaction and experiences during hospitalization of their child at the pediatric surgery department in Split hospital. Results: No statistical significance was found between satisfaction among parents and the type of accommodation, satisfaction of parents and whether or not they were paying for the accommodation or type of accommodation and stress level. The study found parental satisfaction with accommodation to statistically significantly increase with increased number of hospitalizations of the child and if the parent had a child with special needs. The level of preferred involvement among parents appears from this study to be involved in most aspects of care and decision-making. The study reports a high level of satisfaction with doctors, nurses, hygiene and meals, all with a median level of satisfaction of 5. Conclusions: The possibility for involvement of parents during the hospitalization of their child is important for parents in the University Hospital of Split, demonstrated by this study, as seen with previous research on this topic. It is of vital importance that the department of Pediatric surgery in Split focuses on creating an environment where parental participation in the care of children in the hospital is facilitated in such a way that it is of beneficence of the ill child. The satisfaction with this department as a whole appears to be high, with certain aspects having potential for improvement., Cilj: Cilj ovog istraživanja bio je utvrditi zadovoljstvo roditelja i njihovo zadovoljstvo boravkom njihovog djeteta u Klinici dječje kirurgije Kliničkog bolničkog centra (KBC) Split. Materijali i metode: Ovo presječno istraživanje obuhvatilo je 76 ispitanika, koji su bili roditelji djece primljene u Kliniku za dječju kirurgiju KBC-a Split, u razdoblju od siječnja 2022. do kraja svibnja 2022. Istraživanje je provedeno dobrovoljnim i anonimnim popunjavanjem upitnika od 26 pitanja o zadovoljstvu i iskustvima roditelja tijekom hospitalizacije njihovog djeteta na Klinici dječje kirurgije splitske bolnice. Rezultati: Statistički nije utvrđena povezanost između zadovoljstva roditelja i tipa boravka uz dijete, kao ni zadovoljstva roditelja u ovisnosti jeu li plaćali smještaj ili ne te na tip boravka uz djete i subjektivnu procjenu razine stresa njihovog djeteta. Istraživanje je pokazalo da zadovoljstvo roditelja smještajem statistički značajno raste s povećanjem broja hospitalizacija djeteta te ako roditelj ima dijete s posebnim potrebama. Čini se da je razina preferirane uključenosti roditelja u ovom istraživanju zadovoljena u većini aspekata tijekom skrbi i donošenja odluka o liječenju njihove djece. Istraživanje je pokazalo visoku razinu zadovoljsva roditelja liječene djece s liječnicima, medicinskim sestrama, higijenom i obrocima na Klinici, sa srednjom ocjenom 5 na skali od 1-5. Zaključak: Ovo istraživanje, kao I slična istraživanja provedena na ovu temu pokazala su važnost mogućnosti roditelja da budu prisutni uz svoju djecu tijekom hospitalizacije u splitskoj bolnici. U Klinici za dječju kirurgiju KBC-a Split je od iznimne važnosti stvaranje mogućnosti za olakšan boravak i sudjelovanje roditelja u skrbi za njihovu djecu tijekom boravka u bolnici na dobrobit bolesnog djeteta. Čini se da je zadovoljstvo roditelja ovim bolničkim odjelom u cjelini visoko u većini promatranih parametara dok poneki možda imaju potencijala za poboljšanje.

To present initial results of a novel, bi-phasic, porous, biodegrade, and cell-free aragonite-based scaffold for treating complex osteochondral lesions of the talus (OLT). Four subjects (2 males and 2 females; 34-61 years old) were operated on their ankles due to chronic and deep OLT-Hepple grades 4 or 5 (1.8-2.2 cm(2)). Three subjects had OLT on the medial central trochlea, and 1 had a combined medial and lateral lesions. OLT were exposed through medial malleolus osteotomy, with an additional lateral arthrotomy in the combined lesions. Bi-phasic porous osteochondral scaffolds (single implant or 2 implants) were implanted in a press -fit manner using a designated surgical toolset. Treatment outcome was followed clinically (Foot and Ankle Outcome Score, EQ-5D 3L, Tegner activity scale) and by medical imaging (radiographs, magnetic resonance imaging) from 18 to 32 months. All Foot and Ankle Outcome Score values increased from preoperative to final follow-up values (Symptoms 62 to 71, Pain 53 to 84, ADL 60 to 89, Sport 19 to 65, and QoL 18 to 47). EQ-5D 3L increased from 0.59 to 0.76, and Tegner activity values increased from 1.5 to 3. Kellgren-Lawrence ankle radiographic scores remained stable (2 to 2). Postoperative MR evaluation demonstrated cartilage defect fill of 75% to 100% respect to the native cartilage in 3 subjects (4 OLTs), while 1 lesion was filled 25% to 50%. No graft related serious adverse events or graft failures were reported. The use of a bi-phasic osteochondral biodegradable aragonite-based scaffold in the treatment of complex OLT during the reported period presented positive and promising clinical and radiologic outcome, without serious adverse events or graft failures. (C) 2020 by the American College of Foot and Ankle Surgeons.

Surgical fistulas have been used to create dialysis access for over 50 years in chronic kidney disease patients. However, due to problems like slow maturation and a high risk of thrombosis or stenosis, results remain sub-optimal with high intervention and surgery rates to maintain patency. Endovascular methods for fistula creation were invented recently to resolve these issues, allowing haemodialysis patients to have an alternative non-surgical option, with two different devices currently available. Endovascular creation of A-V fistulas is involved with minimal vessel trauma, which could be the reason for encouraging initial results demonstrating high technical success rates, low intervention rates, and good patient satisfaction. This article describes the technical aspects of these procedures, patient selection as well as trial results, and the status of endovascular arteriovenous fistula creation., Kirurški napravljene fistule se koriste više od 50 godina za stvaranje pristupa za dijalizu kod pacijenata s kroničnim bubrežnim zatajenjem. Međutim, zbog problema kao što su dugotrajna maturacija te visok rizik tromboze ili stenose rezultati ostaju suboptimalni s učestalim reintervencijama i operacijama kako bi se održala prohodnost fistule. Kako bi se premostilo ove nedostatke od nedavno su stvorene endovaskularne metode za kreiranje fistula, što pacijentima na dijalizi daje dodatnu nekiruršku opciju, s dva različita trenutno dostupna sustava.Endovaskularno kreiranje A-V fistule je povezano s minimalnom traumom krvnih žila što može biti razlog za ohrabrujuće rane rezultate, koji pokazuju visoku stopu tehničke uspješnosti, nisku stopu reintervencija uz dobro prihvaćanje od strane pacijenata. U ovom radu opisujemo tehničke aspekte ovih zahvata, pravilan izbor pacijenata kao i rezultate istraživanja te trenutni status endovaskularnog zahvata stvaranja arteriovenske dijalizne fistule.

Pandemija virusa SARS-CoV-2 je popolnoma presenetila celotni svet. V zelo kratkem času je bilo potrebno reorganizirati zdravstveni sistem v celoti. Bolnišnice, ki sprejemajo bolnike s covidom-19, je bilo treba čez noč prestrukturirati v del bolnišnice za bolnike s covidom-19 in v del bolnišnice z ostalimi bolniki, ki nimajo covida-19. Pri delu s kirurškim bolnikom s covidom-19 je potrebna predvsem popolna in dosledna uporaba zaščitnih sredstev, da ne pride do okužbe zdravstvenega osebja. Prav tako je potrebna posebna klinična pot znotraj bolnišnic, da ne pride do kontaminacije v delu bolnišnice, ki je brez bolnikov s covidom-19. Začasno so bile odpovedane vse elektivne kirurške obravnave. Zdaj se pod posebnimi pogoji za zaščito zdravstvenih delavcev in bolnikov ponovno sproščajo. Pred elektivnimi kirurškimi posegi se priporoča jemanje brisov na covid-19, vendar to ni nujno. Brisi so namreč v 30 % negativni oz. nezanesljivi in se nanje ne moremo popolnoma zanesti. Predvsem je pomembno, da bolnik v zadnjih 14 dneh ni imel znakov prehladne bolezni in prav tako ne člani njegove družine. Znotraj ustanove se moramo vesti do vsakega sprejetega bolnika, kot da je lahko okužen z virusom SARS-CoV-2. Enako velja za osebje. Ravnati se je potrebno glede zaščitnih ukrepov tako, kot da je vsak od zaposlenih okužen z virusom SARS-CoV-2.

Maligne bolesti vjeđa javljaju se rjeđe u odnosu na benigne promjene, ali od velikog su značaja zbog blizine vitalnih struktura oka i lokalizacije navedenih tumora. Obzirom na patohistološki nalaz mogu se podijeliti na primarne, sekundarne i metastatske maligne tumore. Najčešći maligni epitelni tumori vjeđa su bazocelularni karcinom i planocelularni karcinom. Bazocelularni karcinom je ujedno najčešći zloćudni tumor vjeđa. Češće zahvaća donju vjeđu, učestaliji je u starijoj populaciji, iako je sve veći broj pripadnika mlađe populacije kod kojih se javlja tumor. Najvažniji rizični faktor je prolongirana izloženost ultraljubičastom zračenju. Planocelularni karcinom maligni je epitelni tumor koji se javlja rjeđe od bazocelularnog, češće u starijih hipopigmentiranih osoba koje se pretjerano izlažu ultraljubičastom zračenju. Započinje u stratificiranom dijelu epidermisa, može prodirati u dublje dijelove dermisa te metastazirati najčešće limfogenim putem. Adenokarcinomi lojnih žlijezda su izrazito maligni tumori. Uglavnom potječu od Meibomovih žlijezda te se rjeđe javljaju u odnosu na epitelne maligne tumore. Češće se javljaju u starijoj životnoj dobi, u ženskoj populaciji. Skloni su lokanom metastaziranju, češće limfogenim putem. Ostali češći maligni tumori su Merkelov tumor vjeđe te melanomi vjeđe. Klinička slika navedenih tumora ovisi o lokalizaciji i stupnju invazivnosti tumora, a u glavnini se očituje promjenom izgleda i oblika, oteknućem, zadebljanjem vjeđe, pojavom uzdignuća ili ulceracija koji ometaju funkciju vjeđe. Terapija malignih tumora vjeđa također ovisi o veličini i agresivnosti te lokalizaciji same promjene. Nastoje se koristiti metode koje istodobno pružaju radikalnost odnosno ograničavaju daljni tumorski rast i oštećenje okolnog tkiva, ali istovremeno čuvaju strukturu i funkciju vjeđe. Započinje se sa incizijskom ili ekscizijskom biopsijom kao dijagnostičkim postupkom nakon čega se tkivo šalje na patohistološku analizu kako bi se otkrio maligni potencijal. Nakon toga se odabire adekvatna terapija koja osim radikalne kirurške ekscizije može uključivati: radioterapiju, kemoterapiju, krioterapiju, imunomodulaciju i druge konzervativne metode liječenja., Malignant eyelid tumors occur less often than benign tumors, but they are of great importance due to the proximity of vital eye structures and localization of these tumors. By pathohistological features, they can be classified into primary, secondary and metastatic malignant tumors. The most common malignant eyelid epithelial tumors are basocellular carcinoma and planocellular carcinoma. Basocellular carcinoma is the most common malignant eyelid tumor. It occurs more often in the lower eyelid, and it is more common in the older population, although the incidence among the younger population is on the rise. The most important risk factor of disease is prolonged exposure to ultraviolet radiation. Planocellular carcinoma is a malignant epithelial tumor that occurs less often than basocellular carcinoma, more often in older hypopigmented people who over-expose themselves to ultraviolet radiation. It begins in the stratified part of the epidermis, can penetrate into the deeper parts of the dermis and metastasize through lymphatic spread. Sebaceous gland adenocarcinomas are extremely malignant tumors. They are mainly derived from Meibomiam glands and occur less frequently than epithelial malignant tumors. Sebaceous gland adenocarcinomas occur more often in older age of female population. They are prone to local aggressive metastasizing, more often by lymphatic spread. Other more common malignant tumors are Merkel's eyed tumor and melanoma. The clinical presentation of these tumors depends on the localization and degree of invasiveness of the tumor. It is manifested by a change in appearance and shape of eyelids, swelling, eyelid thickening, appearance of elevations or ulcerations that interfere with eyelid function. Eyelid malignant tumor therapy also depends on the size and aggressiveness and localization of the change itself. The aim is to use methods that simultaneously provide radical tumor removal and inhibit further tumor growth and damage to surrounding tissue, but at the same time preserve eyelid function and structure. It begins with an incision or excision biopsy as a diagnostic procedure after which the tissue is sent to pathohistological analysis in order to search for malignant potential of the tissue. After that, therapy is selected such as radiotherapy, chemotherapy cryotherapy, immunomodulatory therapy and other conservative methods of treatment.

Marjolinov ulkus (MU) je redka, vendar izjemno agresivna oblika ulcerativnega ploščatoceličnega karcinoma, ki nastane iz kronične rane, najpogosteje po opeklinski poškodbi. Naš cilj je opozoriti na nevarnost maligne preobrazbe nestabilne brazgotine kot kronične rane (nastanek Marjolinovega ulkusa) ter možnosti njenega zdravljenja pri nas ter drugod po svetu. V Univerzitetnem kliničnem centru Ljubljana na Kliničnem oddelku za plastično, rekonstrukcijsko, estetsko kirurgijo in opekline smo v obdobju zadnjih 13 let obravnavali 5 bolnikov, operiranih zaradi nestabilne brazgotine, ki se je izkazovala kot kronična rana. Za potrebe članka smo opravili pregled angleške literature na temo ulceracije nestabilne opeklinske brazgotine. Marjolinov ulkus je epiteliomska sprememba, ki jo je možno preprečiti. Vsaka večja rana, ki se prepusti sekundarnemu celjenju, ima potencial za razvoj v kronično rano, ki lahko ulcerira in vodi v maligno spremembo. Še posebej moramo biti pozorni pri opeklinskih ranah ter brazgotinah. Če se pojavi kronična rana, je potrebna biopsija in kasnejše zdravljenje. Uspešnost zdravljenja je bila največja, kadar se je rana obravnavala, še preden se je preobrazila.

Sveučilišni udžbenik Kirurgija cjelovit je višemedijski udžbenik koji se sastoji od tiskanog udžbenika i njegove digitalne inačice obogaćene višemedijskim sadržajima, a napisala su ga i uredila 53 nastavnika Medicinskog fakulteta Sveučilišta u Zagrebu. Njegova je svrha pomoći studentima medicine u svladavanju opširnog znanja iz kirurgije na jednostavan, brz i suvremen način. Namijenjen je studentima dodiplomske i poslijediplomske nastave na svim medicinskim fakultetima u Hrvatskoj, specijalizantima i specijalistima raznih kirurških i srodnih grana medicine. Udžbenik je specijalistički, posebno stoga što se u kirurškoj propedeutici, a i na srodnim kirurškim kolegijima svladavaju tipični postulati opće kirurgije, pa nisu posebno obrađeni u ovoj knjizi. Višemedijski udžbenik Kirurgija koristan je za nastavak gotovo svake liječničke karijere te za daljnju potrebnu edukaciju iz kirurgije i njoj komplementarnih grana medicine. Nudi sadržaje iz suvremene medicine uz mnoštvo slika, tablica i medicinskih fotografija koje ga tako čine zanimljivijim i preglednijim. Ovaj format udžbenika, posebno digitalni, idealno se uklapa u neminovan hibridni tip nastave, pa i nastavnicima, a ne samo studentima nastavnog predmeta Kirurgija, omogućuje lakšu, višemedijsku pripremu za predavanje i/ili seminar, i to ne samo danas nego i u godinama koje dolaze. Udžbenik Kirurgija veliko je integralno djelo utemeljeno na dugoj tradiciji pripremanja udžbenika za nastavni predmet Kirurgija. Na suvremen i inovativan način nudi čitatelju niz informacija iz opsežnoga gradiva koje obuhvaća suvremena kirurgija. Autorski tim, sastavljen od mnogo vrhunskih stručnjaka i kirurga, spojio je svoja znanja i iskustva u vrijedno djelo koje će dati neprocjenjiv doprinos teoriji i praksi kirurgije na nacionalnoj i međunarodnoj razini.

In this case, a mass located subcutaneously in the perineal subvulvar region of a six-year-old Simmental cow was examined clinically, pathomorphologically and immunohistochemically. Macroscopically, the solitary, hitishyellow- tumor mass was 19x15x6 cm in size, weighed 1610 grams, and had a lobular structure with a few small cystic formations in the section. Histopathological examination revealed that the tumor parenchyma had smooth muscle-like cells with abundant cytoplasm, pleomorphic cells with blunt-ended or cigar-shaped nuclei, anisocytosis, anisokaryosis and karyomegaly. Immunohistochemically, strong positive expression for α-SMA, vimentin, Ki67 and slight positive for desmin were found, while immulolabeling for pancytokeratin (AE1/AE3), S-100, CD31 and CD34 were negative. In conclusion, on the basis of these findings, the tumor was diagnosed as leiomyosarcoma., U šest godina stare krave simentalske pasmine klinički, patomorfološki i imunohistokemijski obrađena je tvorba smještena supkutano u perinealnoj subvulvarnoj regiji. Solitarna, žutobjelkasta tumorska tvorba bila veličine 19 x 15 x 6 cm i težila je 1610 g. U režnjevitoj građi uočeno je nekoliko manjih cističnih formacija. Histopatološka pretraga pokazala je da tumor parenhima ima stanice nalik na glatke mišićne stanice s obilnom citoplazmom i pleomorfne stanice sa zaobljenom jezgrom ili jezgrom u obliku cigare, te s anizocitozom, anizokariozom i kariomegalijom. Imunohistokemijski je pronađena jaka pozitivna ekspresija za α-SMA, vimentin, Ki67 i slabo pozitivna za dezmin, dok je imunoobilježavanje za pancitokeratin (AE1/AE3), S-100, CD31 i CD34 bilo negativno. Na temelju ovih rezultata zaključujemo da se radi o tumoru leiomiosarkomu.

Stapes surgery is generally performed to treat otosclerosis, and there are numerous surgical techniques and prosthesis materials available. Critical evaluation of postoperative hearing outcomes is crucial for identification and further improvement of treatment options. This study is a non-randomized retrospective analysis of hearing threshold levels before and after stapedectomy or stapedotomy in 365 patients during a twenty-year period. The patients were classified into three groups depending on the prosthesis and surgery type: stapedectomy with Schuknecht prosthesis placement and stapedotomy with either Causse or Richard prosthesis. The postoperative air-bone gap (ABG) was calculated by subtracting the bone conduction pure tone-audiogram (PTA) from the air conduction PTA. Hearing threshold levels were evaluated preoperatively and postoperatively from 250 Hz to 12 kHz. The results showed air-bone gap reduction, Stapedotomija ili stapedektomija su metode izbora za liječenje otoskleroze, a postoji velik broj proteza koje se koriste u obje kirurške tehnike. Konstantna evaluacija postoperativnih ishoda sluha ključna je za vrednovanje najboljeg tipa i materijala za korištenih u kirurškom liječenju otoskleroze. Ovo je istraživanje nerandomizirana retrospektivna analiza pragova sluha prije i nakon stapedektomije ili stapedotomije u 365 pacijenata tijekom desetogodišnjeg razdoblja. Pacijenti su na temelju tipa operacije i proteze svrstani u tri grupe; stapedektomija s postavljanjem Schuknechtove proteze, stapedetomija s Causse ili Richardovom protezom. Postoperativni ABG izračunat je oduzimanjem BC PTA od AC PTA. Tonskim audiogramom su evaluirani pragovi sluha prijeoperativno i postoperativno u rasponu od 250 Hz do 12 kHz. Rezultati pokazuju smanjenje zračno-koštanog prozora na

Procesi starenja tijela utječu na način djelovanja anestezije na kardiovaskularni i respiratorni sustav, bubrežnu funkciju i živčani sustav, ali i ostale procese u organizmu. Anesteziolozi prije odabira farmakoloških sredstava moraju napraviti preoperativnu procjenu kojoj je svrha procijeniti i priopćiti medicinske popratne bolesti pacijenta prije anestezije. Preoperativno savjetovanje bitno je za procjenu perioperacijskih rizika i planiranje preventivnih perioperativnih radnji. Stariji pacijenti često imaju prateće bolesti za koje uzimaju nekoliko lijekova koji mogu imati negativne konotacije. Polifarmacija se može povezati s povećanim rizikom od nuspojava, problematičnim interakcijama lijekova i pogreškama u uzimanju lijekova. Ljudi različito stare, zbog čega se zdravstveno stanje starijih pacijenata značajno razlikuje od pojedinca do pojedinca. Kliničari bi trebali biti posebno svjesni prilagođavanja skrbi i podrške potrebama pojedinačnih pacijenata, a za starije osobe to može uključivati pažljivo razmatranje o tome kako spriječiti funkcionalni pad i invaliditet. Odluka o tome koju tehniku anestezije koristiti ovisi o vrsti operacije koja će se izvesti, kao i o čimbenicima specifičnim za pacijenta. Opća razmatranja za anesteziju kod starijih osoba uključuju pozicioniranje, praćenje/intravenozni pristup, sedaciju/premedikaciju, termoregulaciju i neuraksijalnu blokadu. Cilj rada je opisati učinke anestezije na starije osobe, posebno opis poslova anesteziologa i medicinske sestre u anesteziološkom timu. Kirurgija i anestezija imaju relativno veće štetne učinke na starije osobe nego na mlađi mozak, što se očituje većom prevalencijom postoperativnog delirija i kognitivnom disfunkcijom. Postoperativni delirij i kognitivna disfunkcija odgađaju rehabilitaciju, a povezani su s povećanjem morbiditeta i mortaliteta među starijim kirurškim pacijentima. U radu su prikazane vrste anestezije te najbolje mogućnosti za starije osobe. U radu je objašnjena etiologija mogućih postoperativnih komplikacija te aspekti zdravstvene njege u anesteziji. Opisana je uloga medicinske sestre u anesteziološkom timu koja mora biti profesionalac za pružanje ili sudjelovanje u primjeni anestezioloških postupaka bolesniku te njene dužnosti u prijeoperacijskoj, perioperacijskoj i poslijeoperacijskoj skrbi bolesnika. U radu su opisane najčešće sestrinske dijagnoze, mogući faktori rizika za komplikacije, njihovo prepoznavanje i intervencije medicinske sestre u njihovom upravljanju te upravljanje i drugim kritičnim postoperativnim područjima koja uključuju bol, nutritivni status, fizikalnu terapiju i edukaciju pacijenta prije otpusta.

Background The outcomes of patients with both lung cancer and idiopathic pulmonary fibrosis (IPF) are unfavorable. Therapeutic interventions for lung cancer such as surgery can cause acute exacerbation of IPF (aeIPF). This study aimed to assess the frequency of IPF in a group of patients with early-stage non-small-cell lung cancer (NSCLC) and to report clinical characteristics and outcomes of this cohort of patients. Patients and methods This observational cohort retrospective study analyzed 641 pathological records of patients after surgical resection of early-stage non-small-cell lung cancer (NSCLC) at University Clinic Golnik from May 2010 to April 2017. Pathological records of NSCLC with coexisting IPF were reviewed. CT scans and biopsy specimens for this group of patients were analyzed by a thoracic radiologist and pathologist, independently. We searched radiological and pathological features of usual interstitial pneumonia (UIP) pattern in this group of patients. We report the clinical characteristics and outcome of this cohort of patients. Results Out of 641 patients with early-stage NSCLC, only 13 (2.0%) had histologically and radiologically proven coexisting UIP/IPF. Squamous cell carcinoma was the most common type of lung cancer (7/13 patients). The majority of tumors were small size (all being pT1 or pT2), stage I–II (11/13 patients), located in the lower lung lobes (11/13 patients). Almost all patients were current or ex-smokers (11/13 patients). There were two pathologically confirmed fatal cases (15.4%) due to aeIPF in the first two months after radical treatment, one after adjuvant radiotherapy and the other after surgery. Out of 13 patients, one patient had a lung cancer relapse. Conclusions Frequency of UIP/IPF in surgically treated early stage NSCLC is rather low. Our observational study shows that radical treatment of lung cancer can cause aeIPF with dismal outcome in this group of patients. The standard of care in these mostly elderly patients still remains unresolved.

Cilj: Cilj ovoga rada je prikazati pacijenta s intersticijskim cistitisom u kojega je došlo do stvaranja kamenaca u novoformiranom urinskom spremniku. Prikaz slučaja: Pacijent star 48 godina obrađivan je zbog recidivnih infekcija mokraćnog sustava. Prethodno mu je zbog intersticijskog cistitisa, koji je znatno utjecao na njegovu kvalitetu života, učinjena cistektomija uz oblikovanje urinskog spremnika (Mainz-pouch I). Urološkom obradom pronađena su u području urinskoga spremnika dva velika kamenca dimenzija 77 × 74 mm te 76 × 62 mm uz obostranu hidronefrozu. Kako bi se riješio uzrok rekurentnih urinarnih infekcija, učinjena mu je otvorenim pristupom ekstrakcija oba kamenca. Poslijeoperacijski tijek bio je uredan te je pacijent nastavio s provođenjem intermitentne samokateterizacije uz značajno poboljšanu kvalitetu života. Zaključak: U pacijenata s teškim oblikom intersticijskog cistitisa u obzir dolazi učiniti cistektomiju s urinarnom derivacijom. Pojava kamenaca u urinskome spremniku u takvih pacijenata nije česta, a liječenje ovisi o veličini litijaze (otvoreni odnosno endoskopski pristup)., Aim: The aim of this study is to present a patient with interstitial cystitis who has had a stone formation in a newly formed urinary reservoir. Case report: A 48-year-old patient was treated for recurrent urinary tract infections. Previously, due to interstitial cystitis, which significantly affected his quality of life, a cystectomy was performed with the formation of a urinary reservoir (Mainz-pouch I). Diagnostic evaluation revealed two large stones in the urinary reservoir whose dimensions were 77 × 74 mm and 76 × 62 mm with bilateral hydronephrosis. To resolve the cause of recurrent urinary infections, extraction of both stones was done by open access. The postoperative course was uneventful and the patient continued with the implementation of intermittent self-catheterization with a significantly improved quality of life. Conclusion: In patients with severe interstitial cystitis, cystectomy with urinary diversion must be considered. The occurrence of calculus in the urine reservoir is not common in such patients and treatment depends on the size of calculi (open or endoscopic approach).

Tehnike za zbrinjavanje rane rođene su i kaljene iz umijeća ratnih kirurga, a svoju renesansu doživljavaju u moderno doba. Danas su akutne rane jedno od najčešćih stanja koje zahtijevaju zbrinjavanje u hitnom prijemu. Rana se u kirurgiji definira kao anatomski i funkcionalni prekid cjelovitosti tkiva ili organa. Pacijenti koji su zadobili akutnu traumatsku ranu navode kako je najvažniji ishod liječenja, odnosno obrade akutne traumatske rane, sprječavanje infekcije. S liječničke strane bitno je procijeniti koje vrste rana, odnosno njezine karakteristike, ili stanja pacijenta, povećavaju rizik za razvoj infekcije. Kako bi se rana mogla detaljno pregledati, učiniti adekvatan debridman iste te kako bi pacijentu smanjili bolnost i nelagodu, potrebno je ranu učiniti bezbolnom primjenom lokalnih anestetika. Indikacije za korištenje antiseptika u cilju smanjena mikrobiološke kontaminacije u akutnoj kožnoj rani ostaju nejasne u usporedbi s čišćenjem rane sterilnom fiziološkom otopinom. Glavni razlog za izbjegavanje korištenja antiseptika u rani može biti njihova dokazana in vitro citotoksičnost, dok in vivo primjeni nedostaju sigurni dokazi za određene antiseptike. Rana se u kirurškoj praksi najčešće zatvara šivanjem korištenjem različitih kirurških konaca, dok su tkivna ljepila i adhezivne trake rjeđe korištene tehnike. Često podcijenjeni, ali prijeko potrebni koraci u zbrinjavanju akutnih rana su prevoj rane nakon obrade i njega rane nakon otpusta iz hitnog bolničkog prijema. Neadekvatan prevoj rane ili neadekvatna njega iste mogu, unatoč najboljoj obradi, dovesti do puno lošijeg ishoda cijeljenja. Svrha ovog diplomskog rada je dati uvid u umijeća obrade rane temeljenih na znanstvenim dokazima i ukazati na ustaljena kirurška pravila (dogme) u tom području., Techniques for wound management were born from the arts of war surgeons, today these techniques are having a new renaissance in the era of modern medicine. Acute wounds are one of the most common conditions requiring treatment in the emergency departments. Wounds are in surgery defined as an anatomical and functional disruption of tissue or organ integrity. Patients sustaining acute traumatic wounds reported prevention of wound infection as the single most important treatment outcome. For a physician, it is important to identify the characteristics of wound and patient conditions that will interfere with wound healing by increasing the risk for developing infection. In order to inspect the wound in detail, make an appropriate debridement, and alleviate the patient’s pain and discomfort, the wound should be anesthetized using local anesthetics. Indications for the use of antiseptics to reduce microbiological contamination in the acute cutaneous wound are still unclear in comparison with wound cleansing using a sterile saline solution. The main reason to avoid usage of antiseptics in wounds is probably their proven in vitro cytotoxicity, whereas, in vivo evidence is lacking for certain antiseptics. In surgical practice, the wounds are most often closed by suturing using various surgical sutures, while tissue adhesives and adhesive tapes are less commonly used techniques. Often underestimated but necessary steps in the management of an acute wound are wound dressings, wound bandaging and wound aftercare proceeding discharge from an emergency department. Inadequate wound dressing or inadequate wound aftercare may worsen, despite the best surgical management, wound healing outcomes. This graduate thesis aims to provide an overview of evidence-based wound management techniques and to point out established surgical rules (dogma) in the field of wound management.