Introduction
During the drilling of the bone, the temperature could increase above 47°C and cause irreversible osteonecrosis. The result is weakened contact of implants with bone and possible loss of ...rigid fixation. The aim of this study was to find an optimal condition where the increase in bone temperature during bone drilling process would be minimal.
Materials and methods
Influence of different drill parameters was evaluated on the increase of bone temperature. Drill diameters were 2.5, 3.2 and 4.5 mm; drill speed 188, 462, 1,140 and 1,820 rpm; feed-rate 24, 56, 84 and 196 mm/min; drill point angle 80°, 100° and 120° and external irrigation with water of 26°C.
Results
Combinations of drill speed and drill diameter with the use of external irrigation produced temperatures far below critical. Without external irrigation, temperature values for the same combination of parameters ranged 31.4–55.5°C. Temperatures above critical were recorded using 4.5 mm drill with higher drill speeds (1,140 and 1,820 rpm). There was no statistical significance of different drill point angles on the increase or decrease of bone temperature. The higher the feed-rate the lower the increase of bone temperature.
Conclusions
The external irrigation is the most important cooling factor. With all combinations of parameters used, external irrigation maintained the bone temperature below 47°C. The increase in drill diameter and drill speed caused increase in bone temperature. The changes in drill point angle did not show significant influence in the increase of the bone temperature. With the increase in feed-rate, increase in bone temperature is lower.
Brojna su propitivanja potrebe rutinskog odstranjenja metalnog implantata nakon saniranja prijeloma kosti. Pretežita indikacija za odstranjenje jest slabljenje mehaničkih svojstava i pucanje ...implantata prije cijeljenja kosti. Cilj ovog istraživanja bio je ispitati mehanička svojstva osteosintetske pločice izrađene od standardnoga kirurškog čelika u simuliranim biološkim uvjetima. U istraživanju smo koristili implantate nehrđajućeg čelika 316L i pohranili ih kroz godinu dana u simuliranome biološkom mediju (engl. SBF – simulated body fluid). Analizirano je 48 pločica standardnoga kirurškog čelika podijeljeno u četiri skupine. Jedna je kontrolna. Ostale su bile uronjene u otopine različitih pH vrijednosti. Uronjene pločice testirane su nakon godinu dana, a kontrolna odmah na početku istraživanja. Tijekom godinu dana analizirala se promjena mikrostrukture uronjenih pločica skenirajući elektronskim mikroskopom (SEM) u pet navrata, a kontrolna grupa samo jednom. Na pločicama koje su bile u biološkim simuliranim uvjetima, bez obzira na pH medija, značajno je veći broj jamičastih korozija kod mjerenja nakon šest mjeseci i godinu dana. Nakon godinu dana pohrane u medijima različite pH mjerene su vrijednosti mehaničkog, statičkog i dinamičkog opterećenja pločica. Niti jedno načinjeno mehaničko testiranje nije pokazalo statistički značajnu razliku između kontrolne skupine pločica i onih koje su bile u biološki simuliranim uvjetima kroz godinu dana. Nepromijenjena mehanička svojstava istraživanih implantata, unatoč značajnim promjenama mikrostrukture nastale kao posljedica jamičaste korozije u biološki simuliranim uvjetima, otklanjaju vjerojatnost slabljenja pločice kao i indikaciju za njezino odstranjenje u tom vremenskom razdoblju.
The aim of this study was to examine the impact of different catheter tip positions on catheter duration and dysfunction of tunneled catheters in children. Catheters were evaluated for place of ...insertion, time of insertion, catheter tip depth and position, duration of use, and reason for removal. The mean duration of implanted catheters with tips placed in cavo‐atrial junction/right atrium was significantly longer with significantly lower percentage of complications than tips placed in superior vena cava. Only catheter tips placed in cavo‐atrial junction/right atrium was a predictor of catheter functionality and survival. Shorter catheter survival in children with tunneled catheters is a consequence of a catheter tip depth proximal of CAJ and RA. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth of the catheter tip, which reduces need for future catheter insertions with increased catheter durability.
Cilj istraživanja: Predstaviti naše inicijalno iskustvo s laparoskopskom pijeloplastikom u djece, procijeniti sigurnost i kratkoročni ishod. Ispitanici i metode: Retrospektivno je analizirana ...medicinska dokumentacija sve djece koja su u trogodišnjem periodu od 2019. do 2022. godine laparoskopski operirana zbog opstrukcije pijeloureteričnog vrata u Kliničkom bolničkom centru Zagreb. Rezultati: Ukupno desetoro djece, dobi od 10 mjeseci do 17 godina (medijan 4,3 godine) operirano je laparoskopski. Četiri djevojčice i šest dječaka. U osmero bolesnika se radilo o lijevom bubregu, a kod dvoje o desnom. Prosječni promjer pijelona je iznosio 35 mm i prosječna separatna funkcija zahvaćenog bubrega je bila 40%. Intrizična stenoza kao uzrok opstrukcije našla se kod osmero djece, a kod dvoje se radilo o aberantnim krvnim žilama za donji pol bubrega. Prosječno vrijeme trajanja operacije bilo je 190 minuta (raspon 120 – 240 min) dok je prosječno vrijeme hospitalizacije bilo 3,2 dana (raspon 2 – 6 dana). Kod dvoje djece stavljen je abdominalni dren. Nije bilo konverzije u otvoreni zahvat, kao ni intraoperativnih i ranih postoperativnih komplikacija. Peroralni unos je započet 4 – 10 sati nakon operacije. Praćenje pacijenata je bilo od 2 do 40 mjeseca (prosječno 7,8). Prosječni postoperativni promjer pijelona u djece kod kojih je prošlo više od 6
mjeseci od operacije bio je 9,5 mm. Zaključak: Laparoskopska pijeloplastika je sigurna i učinkovita metoda u liječenju djece s opstrukcijom pijeloureteričnog vrata.
Kriptorhizam u djece Anko Antabak; Mario Koporčić; Dino Papeš ...
Liječnički vjesnik,
01/2023, Letnik:
145, Številka:
9-10
Journal Article
Recenzirano
Odprti dostop
Kriptorhizam (nespušten testis), izostanak jednog ili obaju testisa u normalnom skrotalnom položaju, može biti kongenitalan ili stečen. Kongenitalni, primjetljiv već pri rođenju, nastao je zastojem ...(intraabdominalno, ingvinalno ili visoko skrotalno) testisa na njegovom normalnom putu spuštanja. Kongenitalni kriptorhizam jedna je od najčešćih kongenitalnih anomalija (4% zdrave terminske novorođenčadi i oko 45% nedonoščadi). Kriptorhični testisi, ako dugo ostanu u abnormalnom položaju, prolaze kroz određene histološke promjene, a koje dovode do smanjene plodnosti i povećanog rizika za razvoj malignih tumora testisa. Stoga je preporuka kirurško liječenje završiti do navršenih 12, najkasnije 18 mjeseci života. Cilj ovog rada bio je utvrditi pratimo li mi te smjernice. Proučavali smo razdoblje od 2011. do 2020. godine. U istraživanje je uključeno 598 djece, a koja su u vrijeme operacije bila u dobi od 0 do 18 godina života. Jednostrano nespušteni testis imalo je 413 (69,1%) djece, od čega 245 desno, a 168 lijevo. Bilateralni kriptorhizam je imalo 158 (26,4%) djece koja su operirana u istom aktu i još 27 (4,5%) djece, kod kojih je prvo operirana jedna strana, a naknadno i druga. U prvih 16 mjeseci života operirano je 110 (18,4 %) sve djece koja su analizirana u ovom radu. U prve tri godine života operirano je 279 (46,7%), a do polaska u školu 431 (72%) djece. Prosječna dob djece pri obavljanju orhidopeksije bila je 57,8 mjeseci. Nema značajne razlike bilo da se radilo o jednostranom ili obostranom kriptorhizmu. Kroz čitavo razdoblje praćenja (deset godina) nema razlike prosječne starosti djece, niti se zamjećuje tendencija pada. Valja zaključiti kako se tek mali broj djece operira unutar prvih 18 mjeseci života, a zabrinjava izostanak tendencije smanjenja životne dobi u vrijeme zahvata u promatranom razdoblju.
Femur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research ...was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children’s Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Non-operative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods.
Gastric perforation (GP) in neonates is a rare entity with high mortality. Although the etiology is not completely understood, it mostly occurs in premature neonates on assisted ventilation. ...Combination of duodenal atresia and gastric perforation is very rare. We present a case duodenal atresia who developed gastric perforation after operetion for duodenal atresia. Analysis of the patient medical record and histology report did not reveal the etiology of the perforation.
- Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due ...to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) - lap
. open (p=0.24); negative appendectomy (adults) - lap
. open (p=0.15); negative-negative appendectomy (children) - lap
. open (p=0.36); negative-negative appendectomy (adults) - lap
. open (p=0.21); negative-positive appendectomy (children) - lap
. open (p=0.53); negative-positive appendectomy (adults) - lap
. open (p=0.56); and laparoscopy group negative appendectomy in children
. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.
Plaster splints are used daily in surgical and orthopedic fields in order to immobilize injured children and adults. The aim of this study was to measure the aerodynamic diameter and concentration of ...dust particles in the air caused by sawing plaster splints (calcium sulfate dehy-drate). We performed fractional measurements of airborne dust particles. The measured particles, which can potentially be inhaled, may have a specific negative effect on human health. Measurements were conducted in laboratory research facilities that simulated hospital conditions within a casting room and the associated waiting room. Measurements within the casting room were made using two particle collector devices and one laser photometer. The measurement for the simulated waiting room was performed using the same principles and devices. The collected plaster dust particles differed in aerodynamic diameter and concentration according to the various locations observed. The highest concentration of particles of all sizes was recorded at the site of cast sawing. There was direct correlation between distance from the source and concentration of airborne particles; this concentration was lowest in the waiting room. The concentrations of plaster dust recorded were lower than the recommended minimal limit values for total and respiratory fractions in Croatia. Accordingly, it can be assumed that sawing of plaster splints has no harmful health effects on the exposed patients and health personnel.
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