Results. Fifty pediatric patients between May 1997 and October 2000 required ECMO for cardiopulmonary support after cardiac operation. Patients ranged in age from 1 day to 11 years (median age, 40 days). Forty-eight patients underwent... more
Results. Fifty pediatric patients between May 1997 and October 2000 required ECMO for cardiopulmonary support after cardiac operation. Patients ranged in age from 1 day to 11 years (median age, 40 days). Forty-eight patients underwent repair of congenital cardiac lesions and 2 were ...
Research Interests: Medicine, Congenital Heart Defects, Cardiac arrest, Humans, Child, and 15 moreOperating Room, INTENSIVE CARE, Female, Male, Infant, Clinical Sciences, Newborn Infant, Cardiopulmonary Resuscitation, Intensive Care Unit, Hospital Mortality, Heart Transplantation, Overall Survival, Extracorporeal Membrane Oxygenation, Cardiopulmonary bypass, and Cardiovascular medicine and haematology
Background Pressure ulcers are a well-known old and immobile patient’s problem, but are also considered a poor nursing care consequence. They are a serious and expensive complication of critically ill children’s care. Aim Two critically... more
Background Pressure ulcers are a well-known old and immobile patient’s problem, but are also considered a poor nursing care consequence. They are a serious and expensive complication of critically ill children’s care. Aim Two critically ill children are presented, both mechanically ventilated, aged 3 years, with the same nursing care conditions. The first was a child after open heart surgery and the other was a child with non-identified neuromuscular disease. The first patient had pressure ulcers stage 2–4, the second patient had only skin breakdown. These examples help us to identify the importance of intrinsic and extrinsic factors for the appearance of pressure ulcers. We scored both of the patients for the risk of pressure ulcers by the Norton scale and Braden Q scale. Both of them on the Norton scale had a score of 4 but on the Braden scale they had a score of 9 for the first patient and 15 for the patient with neuromuscular disease. Results In spite of adequate nursing care, dominant intrinsic factors can cause skin breakdown in critically ill children. We also find that the Braden Q scale is more appropriate for the scoring of critically ill children than the Norton scale. Conclusion Pressure ulcers are relatively common complications of critically ill children’s treatment. Paediatric intensive care unit admission has to be the beginning of pressure ulcer or skin breakdown preventive measures. Particular nursing skills for prevention, on time recognising, scoring, and treatment of lower stages of pressure ulcers are emphasised.
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In the past 40 years liver transplantation has become a method of choice for treating end-stage liver disease in children and thus offers an opportunity for long and healthy life. Graft and patient survival have continued to improve as a... more
In the past 40 years liver transplantation has become a method of choice for treating end-stage liver disease in children and thus offers an opportunity for long and healthy life. Graft and patient survival have continued to improve as a result of better surgical techniques and anesthetic management, organ availability, development of immunosuppressive therapy and solutions for transplant preservation, and identification and treatment of postoperative complications.
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Sindrom produženog QT ntervala (LQTS) uzrokovan je abnormalnoscu srcanog elektricnog sustava iako je mehanicka funkcija srca u osnovi normalna. Elektricki problemi nastaju zbog patoloskih promjena na razini stanicnih ionskih kanala. Ovi... more
Sindrom produženog QT ntervala (LQTS) uzrokovan je abnormalnoscu srcanog elektricnog sustava iako je mehanicka funkcija srca u osnovi normalna. Elektricki problemi nastaju zbog patoloskih promjena na razini stanicnih ionskih kanala. Ovi defekti mogu biti uzrokom pojave vrlo brzog srcanog ritma (aritmije) s nazivom "Torsade de Pointes” (TdP) koji dovodi do naglog gubitka svijeti (sinkopa-syncope) sto može izazvati naglu srcanu smrt (sudden cardiac death). Od prvog opisa (Meisner 1856) do spoznaje o utjecaju gena na nastanak bolesti (poznato 10 gena) proslo je mnogo vremena. Uz moguci poremecaj u protoku iona kroz ionske ka-nale u fazi repolarizacije koji su uvjetovani nasljednim genskim poreme-cajima ili svježim mutacijama (chanelopatije), spomenuti oblik ventriku-larne tahikardije može nastati i zbog preosjetljivosti na kateholamine (ka-teholaminopatije), a opisuje se tranzitorna pojava produženog QT interva-la s istim simptomima. S obzirom na otežano dokazivanje etiologije TdP...
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A significant improvement has been noticed over the last 20 years in children in whom shock syndrome has developed. This has been attained through the application of technological advances in respiratory, cardiovascular, renal,... more
A significant improvement has been noticed over the last 20 years in children in whom shock syndrome has developed. This has been attained through the application of technological advances in respiratory, cardiovascular, renal, nutritional support and improved antibacterial and antifungal therapy, but mostly through a better understanding of the physiology of shock. Newer concepts of the pathophysiology of sepsis and septic shock are presented, with clinical definitions referring to the pediatric patient. Innovative therapeutic modalities designed to modulate the systemic inflammatory response triggered by bacterial infection are discussed.
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Perkutana perikardiocenteza (PP) rutinski je, ali ne cest zahvat u pedijatrijskoj jedinici intenzivne medicine. Prvi put je opisana jos 1840.-e godine, a tijekom proteklog toljeca postala je postupkomizbora ulijecenju bolesnika s... more
Perkutana perikardiocenteza (PP) rutinski je, ali ne cest zahvat u pedijatrijskoj jedinici intenzivne medicine. Prvi put je opisana jos 1840.-e godine, a tijekom proteklog toljeca postala je postupkomizbora ulijecenju bolesnika s perikardijalnimizljevom. Prije uvođenja 2-dimenzijske ehokardiografije zahvat se radio na slijepo, subksifoidnim pristupomuz nerijetke ozbiljne komplikacije. Direktna vizualizacija srcanih struktura, kao i ookolnih organa, danas omogucava njegovo izvođenje uz minimalan rizik. Najcesci uzroci perikardijalnog izljeva su infekcija (perikarditis) i trauma (ukljucujuci i kirurski zahvat-postperikardiektomicni sindrom), javlja se i u sklopu malignih i autoimunih bolesti, a može biti uzrokovan i lijekovima. Klinicka slika ovisi o kolicini alii o brzini nakupljanja tekucine u perikardijskog vreci. Simptomi su: bol u prsnom kosu, dispneja, kasalj, vrucica i promuklost uz tahikardij, tahipneju , nabrekle vene na vratu, suženi pulsni tlak, paradoksalni puls i poviseni centralni venski tlak. Veliki izljev može uzrokovati znacajnu hemodinamsku nestabilnost ometajuci punjenje klijetki (srcana tamponada). Komplikacije zahvata vrlo su ozbiljne i ukljucuju punkciju miokarda ili koronarnih krvnih žila, pluca, jetre ili želuca, pneumoperikard, aritmije, te unos infekcije (perikarditis). Uposljednjih 5 godina (1999.-2003.) PP je u nasoj Jedinici izvedena 15 puta. Najcesce se radilo o stanju nakon kardiokirurskog zahvata (8 bolesnika), u njih 4 radilo se o gnojnomperikarditis (u jednog se djeteta radilo o imunodeficijenciji), u 2 bolesnika rijec je bila o primarnoj malignoj bolesti (akutna limfaticka leukoza i Non Hodkin limfo), a u 1 bolesnika o mezenhimopatiji. Zahvati su protekli bez komplikacija
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Background: The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options include heart... more
Background: The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options include heart transplantation or implantation of durable ventricular assist devices (VADs). To start the VAD program, it was necessary to train core team members, invite experienced proctors and adjust the organizational approach. Methods: We present our first seven pediatric patients who underwent a VAD implantation with primary indication end-stage dilated cardiomyopathy. Results: The median age on implant was four and a half years and the median duration of VAD support was 39 days with long term survival achieved in three patients. The causes of death were multiorgan failure, thromboembolic events, sepsis, and low cardiac output syndrome. Ischemic stroke was the reason for successful neurointervention during VAD support in two patients. Conclusions: To establish a VAD p...
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Biopsija bubrega je invazivna dijagnosticka metoda u koje se uzima uzorak bubrežnog tkiva za histolosku analizu. Uzorak tkiva se pregledava svjetlosnom mikroskopijom, imunohistokemijom, imunofluorescencijom i elektronskom mikroskopijom.... more
Biopsija bubrega je invazivna dijagnosticka metoda u koje se uzima uzorak bubrežnog tkiva za histolosku analizu. Uzorak tkiva se pregledava svjetlosnom mikroskopijom, imunohistokemijom, imunofluorescencijom i elektronskom mikroskopijom. Indikacije za biopsiju bubrega su idiopatski nefrotski sindrom, glomerulopatije nepoznatog uzroka, brzo progresivne glomerulopatije, vaskulitisi i sistemski eritemski lupus s oboljenjem bubrega, bolesnici s transplantiranim bubregom, perzistentna proteinurija i/ili hematurija nepoznatog uzroka, nasljedna bubrežna oboljenja, pojedine anomalije urotrakta. Biopsija bubrega daje podatke o dijagnozi bolesti, prosirenosti procesa sklerozacije glomerula sto indirwktno govori o mogucoj prognozi bolesti.
Research Interests: Medicine and Gynecology
Tirozinemija tip 1 je autosomno recesivni poremecaj metabolizma tirozina uzrokovan manjkom enzima fumarilacetoacetaze. Zbog njega u stanicama jetre i bubrega dolazi do nakupljanja toksicnih metabolita, posebno dijagnosticki... more
Tirozinemija tip 1 je autosomno recesivni poremecaj metabolizma tirozina uzrokovan manjkom enzima fumarilacetoacetaze. Zbog njega u stanicama jetre i bubrega dolazi do nakupljanja toksicnih metabolita, posebno dijagnosticki patognomonicnog sukcinilacetona. Bolest jetre najcesce zavrsava smrcu u prvim godinama života. Obilježava je izraziti poremecaj koagulacije s nesrazmjerno niskim aminotransferazama, visokim vrijednostima alfa-fetoproteina i direktnom hiperbilirubinemijom. Ostecenje bubrega obicno se ocituje kao hipofosfatemicni rahitis. Ako se dijagnoza postavi rano, bolest se može ucinkovito lijeciti nitisinonom, koji inhibira metabolizam tirozina prije manjkave enzimske reakcije, i dijetom s ogranicenim unosom tirozina i fenilalanina. Prikazujemo dvoje dojencadi u koje je specificni dijagnosticki postupak zapocet u razlicitim fazama bolesti sto je rezultiralo i razlicitim ishodima. Cilj nam je upozoriti na potrebu sto hitnijeg pocetka metabolicke obrade u svakog djeteta s nejas...
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Hemoliticko uremicki sindrom je klinicki sindrom mikroangiopatske hemoliticke anemije, trombocitopenije i akutnog bubrežnog zatajenja. Dijagnoza se postavlja putem klinicke slike i laboratorijskih nalaza u kojima dominira hemoliza i... more
Hemoliticko uremicki sindrom je klinicki sindrom mikroangiopatske hemoliticke anemije, trombocitopenije i akutnog bubrežnog zatajenja. Dijagnoza se postavlja putem klinicke slike i laboratorijskih nalaza u kojima dominira hemoliza i akutno bubrežno zatajenje. Lijecenje je zahtjevno sa davanjem svježe smrznute plazme/izmjenama plazme i po potrtebi akutnom dijalizom, te u slucajevima atipicnog hemolitickog sindroma i lijekom Eculizumab
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Case report: We present a girl at age of 15 years with ptosis, proxymal muscle weakness, neuromyotonia hyperhidrosis, short memory loss and confusion. Anti-AChR antibodie were found. Electromyography showed neuromyotonic discharges.... more
Case report: We present a girl at age of 15 years with ptosis, proxymal muscle weakness, neuromyotonia hyperhidrosis, short memory loss and confusion. Anti-AChR antibodie were found. Electromyography showed neuromyotonic discharges. Cerebrospinal fluid analysis revealed oligoclonal ...
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Introduction. Occupational stress is an important factor affecting health. Difficult working conditions, unexpected situations, and emotional engagement are psychological strains of healthcare workers. Adverse event (AV) is unintended... more
Introduction. Occupational stress is an important factor affecting health. Difficult working conditions, unexpected situations, and emotional engagement are psychological strains of healthcare workers. Adverse event (AV) is unintended harm to the patient caused by medical management rather than by the underlying disease or condition of the patient. Resilience after AVs is one’s capacity to cope with those stressors. We present a Croatia case study in this paper. Material and Methods. This study will cover the regulations and quality standards related to adverse events, register of adverse events in University Hospital Centre Zagreb (UHC Zagreb) and survey for healthcare workers. Results. In Croatia, the law on quality of healthcare requires management of adverse events. Within the documentation of the quality management system in hospital, there is a procedure on the adverse events management (AEs), which clearly defines how to report AEs. Department for quality created a register for AEs and collect the data. Commission on quality of UHC Zagreb discusses AVs and preventive measures. Every year Department for quality research stress at work in a hospital. Employees give high marks to their clear role at work. During the COVID 19 pandemic, significantly more employees stated that they needed psychological support due to emotionally demanding work. A te for psychological support starts to work for all employees at the beginning of the pandemic. At the international level, UHC Zagreb is part of the European researchers' network working on second victims (ERNST), which is important for future activities to increase employee.
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Research Interests: Engineering and Medicine
Podrucje nasljednih metabolickih bolesti zadnjih se godina razvija vrlo brzo. Otkrivaju se nove bolesti, nove dijagnosticke metode i nove mogucnosti lijecenja. Glavna tema ove knjige su nasljedne metabolicke bolesti koje zahvacaju krvne... more
Podrucje nasljednih metabolickih bolesti zadnjih se godina razvija vrlo brzo. Otkrivaju se nove bolesti, nove dijagnosticke metode i nove mogucnosti lijecenja. Glavna tema ove knjige su nasljedne metabolicke bolesti koje zahvacaju krvne žile.
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Pregled bibliografske jedinice broj: 538108. Časopis. Autori: Bilić, Ernest; Konja,Josip; Jurković, Vlatka; Dobrota, Savko; Perkov, Dražen; Novak, Milivoj; Femenić, Ranka; Vrkić-Kirhmajer, Majda, Skorić, Boško; Rajić, Ljubica. ...
Background There has been no in-depth research of public attitudes on withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. The aim of this study was to examine these... more
Background There has been no in-depth research of public attitudes on withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. The aim of this study was to examine these attitudes and their correlation with sociodemographic characteristics, religion, political orientation, tolerance of personal choice, trust in physicians, health status, experiences with death and caring for the seriously ill, and attitudes towards death and dying. Methods A cross-sectional study was conducted on a three-stage random sample of adult citizens of the Republic of Croatia, stratified by regions, counties, and locations within those counties (N = 1203). In addition to descriptive statistics, ANOVA and Chi-square tests were used to determine differences, and factor analysis (component model, varimax rotation and GK dimensionality reduction criterion), correlation analysis (Bivariate correlation, Pearson’s coefficient) and multiple regres...
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Background and Objectives: Working in pediatric and neonatal intensive care units (ICUs) can be challenging and differs from work in adult ICUs. This study investigated for the first time the perceptions, experiences and challenges that... more
Background and Objectives: Working in pediatric and neonatal intensive care units (ICUs) can be challenging and differs from work in adult ICUs. This study investigated for the first time the perceptions, experiences and challenges that healthcare professionals face when dealing with end-of-life decisions in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) in Croatia. Materials and Methods: This qualitative study with focus groups was conducted among physicians and nurses working in NICUs and PICUs in five healthcare institutions (three pediatric intensive care units (PICUs) and five neonatal intensive care units (NICUs)) at the tertiary level of healthcare in the Republic of Croatia, in Zagreb, Rijeka and Split. A total of 20 physicians and 21 nurses participated in eight focus groups. The questions concerned everyday practices in end-of-life decision-making and their connection with interpersonal relationships between physicians, nurses, patients an...