[Personal experience with ultrasonic diagnosis of hypertrophic pyloric stenosis in infants]. / Nasa iskustva s ultrazvucnom dijagnostikom infantilne hipertroficke stenoze pilorusa.

Until wide use of ultrasound in diagnostic procedures took its part, the only relevant procedures to diagnose Infantile Hypertrophic Pyloric Stenosis (IHPS) were clinical examination and X-ray of gastroduodenal tract. Use of diagnostic ultrasound avoids harmful effects of X-rays on immature children's tissues. Reliability of the procedure is very high. In the period between July 1993 and January 1999 we diagnosed 12 cases of IHPS in our Hospital by ultrasound examinations. Eleven patients were males between five and eight weeks of age, and one female was six weeks old. In six of them the finding was confirmed by radiological examination (on surgeon's request), in one neither radiological examination not surgery was performed, and five were operated on the basis of only ultrasound finding. In eleven operated patients ultrasound finding is proven by surgery.

[Management accounting in hospital setting]. / "Management accounting" ili poslovodstveno racunovodstvo u upravljanju bolnicom.

The periodic income and expenditure accounts produced at the hospital and departmental level enable successful short term management, but, in the long run do not help remove tensions between health care demand and limited resources, nor do they enable optimal medical planning within the limited financial resources. We are trying to estabilish disease category costs based on case mixing according to diagnostic categories (diagnosis related groups, DRG, or health care resource groups, HRG) and calculation of hospital standard product costs, e.g., radiology cost, preoperative nursing cost etc. The average DRG cost is composed of standard product costs plus any costs specific to a diagnostic category. As an example, current costing procedure for hip artheroplasty in the University Hospital Center Zagreb is compared to the management accounting approach based on British Health Care Resource experience. The knowledge of disease category costs based on management accounting requirements facilitates the implementation of medical programs within the given financial resources and devolves managerial responsibility closer to the clinical level where medical decisions take place.

Arteriovenous fistula of the internal mammary artery (combat injury): transcatheter intravascular coil occlusion.

A case of arteriovenous fistula of the left internal mammary artery occluded by Gianturco coil is reported. A 26-year-old male suffered multiple explosive injuries. Right heart failure developed postoperatively. Digital subtraction angiography demonstrated arteriovenous fistulas between the left internal mammary artery and left subclavian and innominate veins. Considering previous multiple surgical interventions and severe general condition of the patient, both arteriovenous fistulas were successfully occluded by transcatheter placement of a Gianturco coil.

Our 10-year experience with embolized Wilms' tumor.

In the Department of Pediatric Surgery, Clinical Hospital Center Rebro in Zagreb, during the last 10 years a new method of invasive diagnostic and at the same time therapeutic procedure for the treatment of Wilms' tumor has been introduced. The treatment is preoperative Percutaneous Transcatheter Intraarterial Embolization (PTIE) of the renal artery. The aim of this procedure is to reduce vascularization, to decrease the mass of kidney affected by the tumor, to separate it from the surrounding tissue, to decrease intraoperative spillage of malignant cells into the blood stream and their metastasizing. As a result nephrectomy is easier to perform. It has been confirmed that it is best to perform nephrectomy 48 hours after embolization. The authors present their own experience with 33 patients, ranging from 1 to 16 years of age.

[Pulmonary arteriovenous fistula in an adolescent]. / Plucna arterijsko-venska fistula u adolescenta.

We report the case of a patient, a 19-year-old young man, with a rare malformation of the pulmonary blood vessels--a complex arteriovenous (A-V) fistula. The disease was characterized by typical signs of the right-to-left shunt: cyanosis, clubbed fingers and exertional dyspnea. Hypoxemia and polyglobulia were present in the blood examination findings and functional tests showed significantly reduced diffusion lung capacity and progressive dyspnea, while ergometry revealed cyanosis. The physical examination, ECG and ultrasound of the heart were normal as well as aortography. The final diagnosis was made by pulmonary angiography which showed a complex A-V malformation of several feeding arteries and profuse initial multiple venous drainage. Following a successful surgical procedure the diagnosis was also confirmed histopathologically-diffuse teleangiectatic A-V fistula of the lower lobe of the left lung. Following surgery cyanosis, dyspnea, hypoxemia and polyglobulia disappeared and the young man has been well for the following two years.

Percutaneous transhepatic dissolution of gallbladder stones.

The method of percutaneous transhepatic dissolution with methyl tert-butyl ether (MTBE) has been used at the Zagreb Clinical Hospital Department of Medicine since 1989. From December 1989 until December 1991, 69 patients, 51 (74%) females and 18 (26%) males, with symptomatic and cholesterol gallbladder stones were hospitalised at the Department. All patients preferred percutaneous transhepatic dissolution to surgical treatment of gallbladder stones. The gallbladder was successfully punctured and the catheter placed into the gallbladder lumen in 63 (91%) patients, whereas complete dissolution was achieved in 59 (85.5%) patients. In 21 (33.9%) of these 59 patients, after completed dissolution computer-processed roentgenograms and ultrasonic scan of the gallbladder revealed residual particles of debris sized up to 2 mm. Six patients in whom puncture, i.e. the placement of the catheter into the lumen was unsuccessful, were electively operated on the following day without any complications. The mean duration of hospitalisation for 63 patients was 4.5 days.

Extrinsic erosion of the descending aorta by a vertebral fixator.

We report a rare case in which mechanical extrinsic erosion of the descending thoracic aorta resulted in perforation and periaortic hematoma formation in a 16-year-old girl. Five months before admission to our clinic, the patient had undergone surgical spondylosyndesis with inner vertebral fixation, for the correction of scoliosis. Subsequently, a screw on the fixator became loose, eroding and eventually perforating the wall of the descending aorta. The resultant lesion was at first misdiagnosed as a paravertebral abscess; extrinsic perforation of the descending aorta was suspected prior to operation, but was confirmed only upon surgical exploration. After evacuation of the hematoma, the 1.5-cm aortic perforation was closed directly with continuous sutures. Seven months later, the patient continues to do well.

[Embolization therapy of a femoral hemangiolipoma with intra-osseous invasion]. / Embolisationstherapie eines Oberschenkelhämangiolipoms mit intraossaler Ausdehnung.

The paper presents the case of a gigantic inoperable hemangiolipoma of the right upper leg with infiltration into femur. Performed embolization therapy resulted in satisfactory subjective and objective improvement.

Percutaneous transluminal renal angioplasty (PTRA) as a method of therapy for renovascular hypertension in children.

The results of PTRA in treatment of renovascular hypertension in four children aged 5, 7, 13 and 15 are presented. All patients suffered from severe hypertension. Tests showed all of them to have fibromuscular dysplasia stenosis of the main renal artery and significant lateralization of renin levels. One suffered from associated polycystosis of kidneys and in another the renal artery stenosis was bilateral. In all patients successful patency was achieved. In one patient, the arterial pressure after PTRA was normalized, while in the others it was considerably improved. Two patients, tested 8 and 12 months after PTRA, were lost to further follow-up. In one of the remaining two, stenosis and hypertension reappeared 5 years after PTRA. After autotransplantation the patient was normotensive. In the other, also 5 years later, recurrent hypertension appeared related to the associated polycystosis.

[Use of the Varazdinske Toplice mineral water in the treatment of diabetes mellitus]. / Primjena mineralne vode Varazdinskih Toplica u lijecenju diabetesa mellitusa.

We were checking the thermal waters of Varazdinske Toplice--sulfuric mineral calcium natrium hydrocarbonic sulfatic hyperthermic (t: 57.8 st. C, H2S: 8.1 mg/l, min: 955 mg/l mvol uk. 24.70 Ca: 50.12 mvol%, HCO3 54.12 mval%, SO4 26.18 mval%) on the sugar level in the patient's blood, suffering from Diabetes mellitus. We were following the state of 35 patients who were on the peroral therapy with the antidiabetics and ADA diet before coming in our hospital. We excluded the medication therapy at the beginning of the experiment. The patients were drinking 1200 ml of mineral water daily and spent 30 min bathing in the same water. The checking lasted 20 days in the average, and the level of GUK was measured every third day. The results are encouraging, further examinations are still lasting.

Therapeutic embolization of aneurysmal bone cyst.

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.

[Renin levels in renal veins in patients with essential arterial hypertension]. / Vrijednosti renina iz bubreznih vena u bolesnika s esencijalnom arterijskom hipertenzijom.

The data on plasma renin activity (PRA) obtained by catheterization of renal veins in 272 patients with essential arterial hypertension (EH) are reported. In order to exclude a secondary nature of hypertension, all patients were hospitalized and submitted to the extensive clinical and laboratory examinations (according to the protocol) including renal angiography. The aim of the work was to get evidence whether in the apparently homogeneous group of patients with EH there are differences in renin activity between the renal veins giving the quotient (Q) higher than 1.5, and possibly to recognize the clinical meaning of the differences of Q found. In the examined patients as a whole regardless of PRA, 50 of them (18.3%) showed Q greater than or equal to 1.5 and among them in 16 (5.8%) patients Q greater than or equal to 2 was found. The patients were divided according to PRA into those with low, normal and high PRA. In the hyperreninemic group of patients no Q greater than or equal to 2.0 has been found. In the hyporeninemic group 9 patients (9.9%) exhibited Q greater than or equal to 2.0. Although, one does not expect in EH to find differences in PRA between left and right renal vein, we have found the values of Q greater than or equal to 1.5 in nearly 1/5 of our patients. These differences found could be resulting from the existence of asymmetrical angiosclerotic or other renal pathological changes that can not be examined by the available clinical methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Possibilities and limits of computed tomography and angiography in diagnosis of cerebral vascular malformations.

CT findings in 18 patients with cerebral vascular malformations are presented. The following findings were established: 9 angiomas, 4 spontaneous intracerebral haematomas after angioma rupture, 3 aneurysms, 1 aneurysm of vena magna Galeni and 1 megasinus. Contrast medium was administered during every CT screening. All the CT results were controlled by angiography and 10 patients were surgically treated. The authors point out the limits in possibilities of CT to diagnose cerebral vascular malformations. They also discuss the possible errors during CT procedure and deal with the problems of diagnostic differentiation of results. Discussing some cases of cerebral vascular malformations, the authors are trying to evaluate the reliability of the CT diagnostic method had compare it with angiography.