Anko Antabak

Intestinal duplications--experience in 6 cases.

Intestinal duplications are rare congenital anomalies, and most of them are detected in the first 2 years of life or antenatally. The clinical presentation depends on location, size, and the presence of ectopic gastric mucosa. Ultrasound scans during pregnancy result in a higher rate of antenatally detected duplications which allows early treatment and avoidance of possible complications. Resection of the duplication without adjacent bowel should be the treatment of choice. En bloc resection or partial excision with mucosectomy is advised in some cases. We present our experience with 6 patients treated in our institution from February 2002 to October 2005.

Treatment outcomes of both-bone diaphyseal paediatric forearm fractures.

BACKGROUND Elastic-stable intramedullary nailing (ESIN), is an accepted method for stabilization of unstable forearm shaft fractures in children. This study analyzed the radiographic and functional outcomes of intramedullary nailing of forearm diaphyseal fractures in children. MATERIALS AND METHODS A retrospective analysis was performed of children with forearm shaft fractures and open epiphyseal plates, treated with ESIN between 2000 and 2012 in our institution. Evaluation of cases was conducted minimum 14 months after osteosynthesis. Clinical results were evaluated according to the criteria developed by Price et al. and Flynn et al. RESULTS The study included 88 (42 boys) children. The average age of children at day injury was 10.5 ± 2.59 years (range 4-16), and at the review clinic was 13.4 ± 1.85 years (range 7-18). Forty six (52.3 %) had right forearm and 42 (47.7%) had left fracture respectively. Open reduction was required in 20 (22.7%) children. Primarily surgically were treated 62 (70.5%) children and 26 (29.5%) were operated as a second procedure after failed conservative management. There was one delayed union. Rotational forearm restriction with values between 11 and 20 degrees was present in nine children. Six children developed radial nerve hypoesthesia which eventually resolved with time. After removal of the implant one child sustained a re-fracture. The overall complication rate was 25%. Complete recovery to the original condition was noted in 76 (86.4%) children, eleven children (12.5%) had good and only one (1.1%) had poor outcome. CONCLUSION Our study suggests that ESIN osteosynthesis for diaphyseal forearm fractures remains a valid technique with very good functional results.

Successful Early Pyeloplasty in Infants

BACKGROUND Early pyeloplasty for the treatment of congenital ureteropelvic junction obstruction to maximize nephron salvage is justified only if potential hazards of operating on small infants are avoided. METHODS The records were analyzed of all infants who underwent pyeloplasty over a 5-year period. Open pyeloplasty was performed if collecting systems had deteriorated or were demonstrated to be obstructed; it was also performed for severe cases of hydronephrosis. Outcome of surgery in the younger infant (patients <2 months of age) was compared with the older infant group (patients >2 months of age). Preoperative evaluation in case of mild or moderate hydronephrosis was directed toward ruling out a non-obstructed collection system and included voiding cystourethrography, and serial ultrasonography and/or dual isotope diuretic renography. Postoperative assessment consisted of serial ultrasonography and/or nuclear imaging to confirm decompression and relief of obstruction. RESULTS A total of 24 pyeloplasties were performed on 22 patients in the younger infant group (two bilateral) and 30 were performed on 27 infants in the older infant group (three bilateral). The only significant differences between the groups were as follows: patients in the younger infant group were likely to present in utero (75%, p = 2.69), whereas those in the older infant group were more likely to present with a urinary tract infection (48%, p = 4.12). During follow-up examination, 23 renal units in the younger infant group and 24 in the older infant group were judged to be stable or improved. Four kidneys were not salvaged after pyeloplasty, one in the younger infant group and three in the older infant group. CONCLUSIONS Good results of pyeloplasties performed in the infants in this series support early correction of ureteropelvic junction obstruction in infants.

Medical thermography (digital infrared thermal imaging – DITI) in paediatric forearm fractures: a pilot study

Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all paediatric fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the paediatric population. This type of fracture represents an everyday problem for the paediatric surgeon. The three phases of fracture healing in paediatric trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday practice. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched.

What Is the Acceptable Rate of Negative Appendectomy? Comment on Prospective Evaluation of the Added Value of Imaging within the Dutch National Diagnostic Appendicitis Guideline - Do We Forget Our Clinical Eye?

ing to Dutch guidelines, such rates may be considered unacceptable. So what is the acceptable NAR? When searching through the literature, one may find reports with considerably low NAR, that is, below 10%. However, there are several factors that apparently decrease NAR. The three largest series on pediatric appendectomy within the last two years are by Bachur that included 55,227 appendectomies (NAR 3.6%), Oyetunji that included 250,783 appendectomies (NAR 6.7%), and Cheong that included 78,625 children from US and 41,492 children from Canada (NAR 6.3 and 4.3%) [2–4] . Large database analyses report only the discharge letter diagnosis or intraoperative appearance of the appendix without analyzing the histology report. This is present in all three previously mentioned reports. Had we used this criterion, the rate of negative appendectomy in our series would be 3% since of 47 negative appendectomies, 32 (68%) were initially during operation diagnosed as inflamed appendicitis and were later on histological examination found to be non-inflamed. Further, even if histology reports are used, the histological definition of appendicitis also differs. Histological definition of inflamed appendix is not described in many reports that have low negative appendecWe read with interest the article of Schok et al. [1] . In 2014 we did an audit of our results on pediatric appendectomy (0– 18 years) in the form of a cross-sectional retrospective study that was conducted using hospital database that reviewed all appendectomies in our department in two twoyear periods (1999–2000 and 2012–2013) to see the changes after introduction of ultrasound and CT scan into practice. There were a total of 380 appendectomies performed: 154 as laparoscopic and 226 as open procedures. Regarding the pathological outcome of the operation, negative appendectomy rate (NAR) was 12% (47 patients) and perforation rate (PR) was 18% (69 patients). In children younger than 5 years of age (26 patients) PR was 30% and NAR 8%. Regarding imaging, 83 patients (22%) received preoperative ultrasound examination, and 2 received a CT scan (0.5%). The NAR and PR among children who received preoperative imaging were 8.4% (7/ 83) and 15.7% (13/83), respectively, which did not differ significantly (p > 0.05) from children who did not receive any imaging. To evaluate our results we searched Pubmed and found that NAR and PR in our series were comparable to other similar reports, including the report from Schok et al. As mentioned by the authors, accordPublished online: March 28, 2015

Postoperative Gastric Perforation in a Newborn with Duodenal Atresia

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.

Tumor angiogenesis as an important prognostic factor in advanced non-small cell lung cancer (Stage IIIA)

The aim of the present study was to evaluate angiogenesis by determining the micro vascular density (MVD) and the expression of vascular endothelial growth factor (VEGF-A) in advanced non-small cell lung cancer (NSCLC) tumor samples, and to analyze their associations with clinical parameters and survival. Tumor tissue specimens of fifty patients (41 males and 9 females), who underwent radical surgical treatment for NSCLC in stage IIIA (T1-3N2) were collected for immunohistochemical analysis. MVD evaluation was performed using an anti-CD31 monoclonal antibody and VEGF-A expression using a polyclonal anti-VEGF-A antibody. The results were associated with two-year survival. Statistical analysis revealed significant associations in the level of angiogenesis (high MVD) and shorter survival of patients with NSCLC (P=0.0007). VEGF-A expression showed no association with micro vascular density (P=0.51) or survival (P=0.68). There was no significant association between MVD and VEGF-A. The measurable, clinical MVD parameters could be used as a reliable prognostic factor for the survival of patients with advanced NSCLC.

Bilateral Leg Replantation in a 3-Month-Old Baby After a Knee Level Crush Amputation—A 2-Year Follow-up

We present a case of a successful bilateral leg replantation in a 3-month-old baby after a knee-level crush amputation with the loss of both knee joints. The legs were replanted after 4 hours of warm and an additional 2.5 and 3.5 hours of cold ischemia time. Both legs show motor and sensory reinnervation, without additional procedures performed on the right leg, and after a nerve reconstruction with cadaveric allografts on the left leg. Both replanted legs exhibit excellent bony and soft tissue growth. Two years after the injury, the patient is progressing well with rehabilitation, with favourable odds of having knee reconstructions performed at a later age. This is the youngest patient reported to have had successful replantation of both legs.

Abdominal Aortic Thrombosis in a Healthy Neonate

Abdominal aortic thrombosis is a rare entity in neonates and has mostly been associated with umbilical artery or cardiac catheterization. We present a complicated case of an otherwise healthy neonate who developed thrombosis of abdominal aorta with renal failure. Therapy with intravenous heparin was unsuccessful, and thrombolysis was contraindicated because of disseminated intravascular coagulation so we decided to perform open thrombectomy using the left retroperitoneal approach. The following day, thrombosis recurred in the same extent and despite high risk of bleeding Alteplase was eventually given, which resulted in recanalization of the aorta 6 hours later. Renal function recovered, dialysis was discontinued, and further course was uneventful. The treatment of abdominal aortic thrombosis in neonates should be considered on a case-by-case basis because the available data on the condition are limited to case report and series. If open thrombectomy is performed, retroperitoneal approach should be preferred because it allows for easy institution of peritoneal dialysis should the need arise.

Kakvoća komunikacije na Zavodu za dječju kirurgiju KBC Zagreb

Komunikacijske vještine u zdravstvu, osim medicinske sve su češće tema koja je vezana za psihološku problematiku. Komunikacija u zdravstvu specifi čna je obzirom na to gdje se odvija (razina zdravstvene zaštite), na vrstu bolesti (akutna, kronična, prirođena), fazu bolesti (postavljanje dijagnoze, pojedina faza u liječenju) i s obzirom na bolesnikovu dob. Kvalitetna komunikacija je uvijek u zajedničkom interesu liječnika i bolesnika, odnosno bolesnikove obitelji (1). Osnovna načela primjerene komunikacije u zdravstvu temelje se na teorijskim postavkama, kliničkom opažanju i istraživanjima, a odnose se na komunikaciju s bolesnikom općenito. Specifi čne okolnosti i bolesnikovi problemi (npr. priopćenje loših vijesti, komunikacija s bolesnicima s malignim bolestima, komunikacija s „teškim“ bolesnicima i dr.) određuju način komunikacije s bolesnikom i njegovom obitelji (2). Primjerena komunikacija podrazumijeva pomno slušanje, razumijevanje, informiranje, empatiju, uzimanje u obzir kulturnih razlika, osobnosti bolesnika i osobitosti pojedine situacije vezane za liječenje.