Diana Butković

Comparison of laser acupuncture and metoclopramide in PONV prevention in children

Background : Postoperative nausea and vomiting (PONV) are frequent side effects of general anesthesia in children. The aim of this study was to compare the effectiveness of laser acupuncture with metoclopramide in prevention of PONV in children after sevoflurane anesthesia.

Experience with gabapentin for neuropathic pain in adolescents: report of five cases

Gabapentin is an antiepileptic drug indicated for the treatment of partial seizures in children. Many studies have proved its analgesic action in the treatment of neuropathic pain in adults and we have noticed an analgesic action of gabapentin in neuropathic pain in children. Five patients treated in the Childrens Hospital Pain Control Service for intractable neuropathic pain were included in gabapentin treatment. Four were cancer patients and one suffered from neuropathic pain in the neck (C3). The visual analog scale (VAS) scores of pain were compared before and during treatment with gabapentin. We noticed a rapid improvement, in 1 week, of our patients’ VAS scores (from 9 or 10 to 4 or 3) with minimal adverse effects. In the follow‐up period of 6 months we gradually reduced the dose of gabapentin. Our findings are that gabapentin should be included earlier in the treatment of neuropathic pain in adolescents, because it rapidly improves analgesia and has minimal side effects.

Serious complications of an obstructive upper airway infection in a young child.

A 15-month old boy was admitted to our intensive care unit (ICU) cyanotic, unresponsive, apneic, pulseless, with fixed, dilated pupils and a Glasgow Coma Score (GCS) of 3/15. Prompt cardiopulmonary resuscitation (CPR) was initiated and cardiac function was resumed after 10 minutes. The boy was intubated but could not be ventilated because of a thick, viscous secretion obstructing the trachea and causing total airway obstruction. Bronchoscopy revealed laryngotracheitis as the reason for airway obstruction. A computed tomography (CT) scan of the brain showed diffuse edema and ischemic brain injury, which were considered responsible for the boy’s comatose situation. Clinical status remained unchanged for 11 days, after which the boy was transported to another hospital. In children presenting with upper airway obstructing syndromes, not responding to therapy, the diagnosis of bacterial tracheitis should be considered and the child should be monitored in a pediatric intensive care unit. SANDRA KRALIK• IVA ICA ŠKARI • DIANA BUTKOVI • LILI MIKECIN • KARMEN KONDŽA • JASMINKA JAKOBOVI

Giant intracranial cyst reduction after shunting

A male newborn was admitted with in utero diagnosed giant intracranial cyst. The cyst was located in the left cerebral hemisphere. In utero ultrasound findings suggested extreme ventriculomegaly of the left lateral ventricule. At admission, the newborn had discrete right-sided motor weakness and macrocephaly (haed circumference at the 98th percentile) with diastasis of coronal, sagittal and lambdoid sutures. The MR images show a giant cyst of the left cerebral hemisphere with a very thin cerebral mantle over the frontal, parietal and temporal lobes, a minimal rightward shift and expansion of the left side of the calvaria, unusually low positioned basal ganglia, herniation of the ventricle into the posterior fossa and compression with caudal displacement of the vermis and cerebellar hemispheres. After insertion of a cystoperitoneal shunt (medium pressure valve)successive ultrasound controls revealed good regression of the cyst volume. A CT scan performed 1 year after shunting showed good position and function of the inserted shunt with excellent recovery of the cerebral mantle over the cyst wall. At 1 year of age, the child has no visible neurogical deficits.