Božidar Župančić

Isolated fallopian tube torsion with partial hydrosalpinx in a premenarcheal girl: a case report

IntroductionIsolated fallopian tube torsion as a complication of a preexisting hydrosalpinx is a rare finding in pediatric patients. The obvious rarity of this condition, its subtle diagnostic features and dissonant previous reporting about the appropriate therapeutic approach according to age, future conception capacity and potential complications of possible pregnancies make the decision about which surgical approach to use very difficult. In this report, we describe the case of a patient with such a presentation and review the literature. Very few similar reports of neosalpingostomy in pediatric patients have been published to date.Case presentationIn our present report, we describe the case of an 11-year-old Caucasian prepubertal girl who presented to our hospital with complaints of abdominal pain in the right lower quadrant, nausea and vomiting. The diagnostic workup led us to conclude that she had a torsion of the right ovary, which was cystically altered. Exploratory surgery revealed a partial hydrosalpinx and consecutive isolated torsion of the fimbrial part. The proximal isthmic part of the fallopian tube was intact and vital. Restorative surgery was performed to create a neosalpingostomy on the viable isthmic part of the tube and remove the cystic and twisted fimbrial and infundibular parts.ConclusionThe surgical procedure described in this report is technically simple and feasible, but leaves doubts about the final outcome.

Suicide Attempt by Swallowing Sponge or Pica Disorder: A Case Report

INTRODUCTION There are many ways how children with mental illness have actually tried to hurt themselves. Suicidal thinking or attempts always indicate that professional help is needed (2). Every object which can be potential dangerous should be removed but this is very difficult to do. Some of children with these symptoms had Pica diseases. Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal, coal, soil, feces, paper, soap, gum, etc.) or an abnormal appetite for some things that may be considered foods. MATERIAL AND METHODS The patient swallow sponge from a pillow over a long period of time and she came into our hospital with abdominal pain. She was 16 years old and had abdominal distension, vomiting, abdominal cramping and failure to pass gas or stool. Immediately we suspected mechanical blockade of the intestine. Diagnosis was clinically confirmed by X-rays of the abdomen and with ultrasound. RESULTS The operative treatment was indicated and we found the proximal bowel distended and the distal segment collapsed. The part of bowel necrosis was removed and anastomosis was done. CONCLUSION When patients are determined to attempt suicide or have Pica disorder it is very difficult to prevent.

Venomous snakebites in the Croatian North Dalmatia region

ZusammenfassungZIEL DER STUDIE: Analyse der epidemiologischen, klinischen und labormäßigen Attribute von giftigen Schlangenbissen mit dem Ziel, die rechtzeitige und wirksame Behandlung vor Ort oder im klinischen Setting zu ermitteln. METHODEN: Es wurden die epidemiologischen und klinischen Daten sowie die Laborergebnisse der Leute, die im Zeitraum von 11 Jahren (1999–2009) von giftigen Schlangen gebissen und im Allgemeinen Krankenhaus von Zadar behandelt worden waren, retrospektiv analysiert. ERGEBNISSE: Im untersuchten Zeitraum sind 93 Leute (57 (62 %) Männer und 36 (38 %) Frauen) von giftigen Schlangen gebissen worden. In 82 Fällen (90 %) war der Biss auf den Extremitäten der Patienten lokalisiert. Die restlichen 11 Patienten wurden an anderen Stellen gebissen. Bei 31 Patienten (33 %) erfolgte der Biss bei der Ausübung von Freizeitaktivität, bei 44 (47,3 %) während der Arbeit. Die häufigsten lokalen Zeichen des Schlangenbisses sind Schwellung und Schmerz an der Biss-Stelle (bei 100 %) sowie Hämatome und Ekchymosis (87 Patienten = 89 %). Acht der gebissenen Patienten erlitten ein Kompartment Syndrom und eine Person (0,97 %) verstarb. SCHLUSSFOLGERUNGEN: Die Gegengift-Behandlung zur Vorbeugung möglicher allergischer Reaktionen eines Schlangenbisses sollte in der medizinischen Institution, in die das Opfer gebracht wird, stattfinden. Wenn aber der Transport nicht gleich möglich ist oder das Opfer bereits Zeichen der Vergiftung zeigt, sollte die Gegengift-Behandlung sofort (vor Ort) erfolgen, da ihre Wirkung schwächer ist, wenn das Gift bereits wirkt.SummaryAIM: The aim of this research project is to analyze the epidemiological, clinical and laboratory attributes of venomous snakebites and to ascertain the timely and efficient treatment at the location where the incident took place or in varying clinical conditions. METHODS: Epidemiological, clinical and laboratory data were collected from people who were bitten by venomous snakes as well as treatments at Zadar General Hospital during a span of eleven years (1999–2009) which were analyzed retrospectively. RESULTS: During that period, 93 people were bitten by venomous snakes of which 57 patients (62%) were male and 36 (38%) were female. In 82 cases (90%), the bite area was localized on the limbs while in the remaining 11 cases the bite area was located elsewhere. At the time of the venomous snakebite, 31 (33%) patients were performing leisure activities and 44 (47.31%) of them were at work. The most common local snakebite signs are swelling and pain at the bite site (93 patients; 100%), hematomas and ecchymoses (87 patients; 89%). Of the affected patients, 8 suffered from compartment syndrome and one person (0.97%) expired. CONCLUSION: Antivenom treatment for preventing possible allergic reactions should take place at the medical institution where the victim was transported. However, when transport is not immediately available or in cases where the victim shows clear signs of envenomation, antivenom treatment should be used immediately because its effect is weaker if the venom is allowed to run its course.

From Ataxia to Diagnosis of Askin Tumor – a Case Report

Peripheral primitive neuroectodermal tumors (pPNET) are a group of extremely rare, aggressive, malignant tumors that are most often found in the thorax (Askin tumor), abdomen, pelvis, extremities and less frequently in the head and neck. The most important prognostic factor is the stage of the tumor. Significant progress both in surgery and in neoadjuvant and adjuvant chemotherapy and radiotherapy, as well as the improvement in diagnosis by cytogenetic and immunohistochemical analysis, should improve the survival rate. We report a case of a 14-year-old girl, with ataxic gait, cardiopulmonary compensated, without respiratory symptoms, who was referred to our hospital for further examination and treatment of newly discovered tumor of the left hemithorax. After a detailed radiological and laboratory investigation, next step was an extensive thoraco-neurosurgical surgery. After histopathological, cytological and molecular analysis, a diagnosis of Askin tumor was made.

Torsion of a mesenchymal hamartoma of the liver in a 1-year-old boy

Abstract We report a case of a one-year-old boy who was referred to our clinic suspected of having acute abdomen. On physical examination, the abdomen was soft, diffusely tender with weak peristalsis. Ultrasonography and MRI of the right hemiabdomen demonstrated a well-defined, solid, expansive formation with slightly lobulated contours and an interspersed inhomogeneous structure with overall dimensions of 59 × 45 × 50 mm. After midline laparotomy was performed, a cystic tumor was found, twisted around a pedicle which was arising from the falciform ligament and it measured 5–6 cm in diameter. The tumor appeared to be necrotic. The mass was ligated and extirpated on the pedicle and sent for histopathological analysis. After the surgery, the boy was hemodynamically stable, without respiratory complications and all laboratory findings were within normal limits. Histopathological analysis showed that the tumor was composed of mesenchymal stroma with sparse glimpses of hepatocytes and bile ducts with partly cystic changes lined by orderly epithelium. Given the clinical data, histology and immunohistochemistry analysis (alpha-fetoprotein, CK8/18, hepatocyte, desmin and CD31) a diagnosis of a twisted mesenchymal hamartoma of the liver was made.

Bilateral Ovarian Torsion during Follow-up for Antenatally Detected Ovarian Cysts

Ovarian torsion is a surgical emergency demanding timely diagnosis and treatment to prevent loss of the ovaries which if happens may result in functional and emotional consequences. Simple (less than 5cm in size) ovarian cysts require follow-up for potential self-resolution. We describe a case of antenatally detected bilateral ovarian cysts that developed bilateral ovarian torsions on follow-up, postnatally.

Minimalno invazivna urološka kirurgijadječje dobi - Što možemo učiniti danas?

Urološka minimalno invazivna kirurgija danas se u većini centara rutinski primjenjuje za bazične operativne zahvate. U posljednje vrijeme počinje njena sve veća primjena u složenijim operativnim zahvatima u odabranim centrima diljem svijeta. Iznosimo pregled urološke patologije koja se trenutno liječi minimalno invazivnim pristupkom te izdvajamo pojedine relevantne članke o kojima se raspravljalo i usporedilo s iskustvom Klinike za dječju kirurgiju Klinike za dječje bolesti Zagreb. Od početka primjene minimalno invazivne kirurgije u Klinici za dječju kirurgiju Klinike za dječje bolesti Zagreb operirano je više od 1300 djece različite urološke patologije. primijenjena su tri pristupa: transperitonealni, retroperitonelani i transvezikalni. Najveći broj operacija pripada endoskopskom liječenju vezikoureteralnog refl uksa (VUR-a). Indikaciju za primjenu minimalno invazivnih postupaka osim VUR-a imaju nepalpabilni testisi, varikokela, nefrektomija te adrenalektomija. Čak i najsloženije urološke operacije mogu se izvoditi služeći se minimalno invazivnim pristupom, premda većina opisanih slučajeva pripada kategoriji „case report-a“. U posljednje vrijeme svjedoci smo mnogih publikacija o ablativnoj i rekonstruktivnoj minimalno invazivnoj kirurgiji. Transperitonealni i retroperitonelani pristup primjenjuju se s približno istim rezultatima. Transvezikoskopska kirurgija trebala bi se brzo razvijati i postati standardni pristup za Cohenovu reimplantaciju. Smatra se da će tehnički napredak osigurati priliku pedijatrijskim urolozima za razvijanje minimalno invazivnih postupaka.

Duodenal Duplication Cyst: A Rare Differential Diagnosis in a Neonate with Bilious Vomiting.

Bilious vomiting is a relevant sign in neonates that requires immediate evaluation and diagnosis. A duplication of the intestinal tract is a possible cause of obstruction if located distally to the major duodenal papilla of Vater and most of them involve the jejunum, stomach, or colon. Duodenal duplications are very rare and can have an endoscopic or surgical treatment after diagnosis. We present a case of a 16-day-old term newborn that consulted because of bilious vomiting and after evaluation with imaging and upper endoscopy, a duodenal duplication cyst was found at the level of the third portion causing compression of the intestinal lumen that required surgical resolution with duodenocystostomy.