Jelena Antic

Peritoneal Dialysis in Very Low Birth Weight Neonates

Background: The aim of this retrospective study is to evaluate clinical characteristics and outcomes of very low birth weight (VLBW) neonates with acute kidney injury (AKI) treated with peritoneal dialysis (PD). Methods: This retrospective study included 10 VLBW neonates treated with PD. Intravenous (IV) cannula and umbilical venous catheter were used for the peritoneal access. Results: Mean age at the moment of starting PD was 14.9 ± 9.3 days. Mean body weight (BW) was 825 ± 215 g. The average gestational age was 26.3 ± 1.1 weeks. The average duration of dialysis was 20.5 ± 14.7 h. The average ultrafiltration was 7.7 ± 4.2 mL/kg/h. At the moment of starting PD, the average BW was 302 ± 317g (22 ± 13%), higher than at birth (in patients who had PD started in first 2 weeks of their lives) or higher than the BW before AKI was diagnosed (patients who had PD started when they were older than 2 weeks). The main cause of AKI was sepsis (n = 8/10). Dialysate leak was registered in 2 patients, 1 patient had peritonitis and the other had a blocked PD catheter. Six patients died during PD (severe sepsis), 1 died due to hypoxic encephalopathy and coma, and 2 patients survived. One patient (with hypoxic encephalopathy and coma) died 10 days after PD was stopped due to sepsis. The overall mortality was 80%. Conclusion: Acute PD is still an appropriate treatment choice for VLBW neonates with AKI. In VLBW neonates, PD can be performed with an improvised PD system and catheters.

Esophageal atresia and situs inversus--an unusual association of abnormalities--a case report.

We present a case report of a neonate with esophageal atresia and tracheoesophageal fistula. In the 31st week of gestation, maternal polyhydramnions was observed by prenatal ultrasonography. Postnatal insertion of an orogastric tube into the stomach was unsuccessful. On auscultation, the apex of the heart was heard at the right side of the thorax, while the liver was palpable 1 cm below the left rib cage. Esophageal atresia with tracheoesphageal fistula and situs inversus of the thoracic and abdominal organs was diagnosed During the first day of life, left transpleural thoracotomy was performed. The fistula was closed and esophageal anastomosis performed. One year after the operation the child had no difficulties when eating solid and liquid foods. More than 50% of infants with esophageal atresia have associated anomalies and the esophagogram showed good passage of contrast with anastomotic stricture. This was the first report of esophageal atresia with tracheoesophageal fistula repair in a patient with situs inversus treated in our Clinic.

Impalpable Testis: Evaluation of Diagnostic and Treatment Procedures and Our Treatment Protocol

Introduction The aim of this study is to present our treatment protocol for impalpable testis. Material and Methods In a retrospective study we analyzed clinical data including diagnostic procedures, intraoperative findings, final diagnosis, treatment modality, and outcome of patients with impalpable testis who underwent surgery from January 2010 until December 2015. Results Ninety-one patients were admitted under the diagnosis of impalpable testis. In 39 patients ultrasound detected testis in the inguinal canal and orchidopexy was done. In 25 patients (48.08%) laparoscopy showed the entrance of the spermatic cord into the inguinal canal. Open exploration of the inguinal canal was done, testicular remnant removed, and appropriate testicular prosthesis implanted. Twenty patients (20/52) underwent orchidopexy of the abdominal testis (46.51%), 4 of which underwent Fowler-Stevens procedure in two stages, and in 16 patients deliberation of the testis and spermatic cord was sufficient to place the testis into the scrotum. Conclusions Excision of the testicular nubbin is highly recommendable, as well as implantation of the testicular prosthesis at the time of orchiectomy.

Simultaneous combined laparoscopic-endoscopic removal of a large gastric trichobezoar and gastric polypectomy

The purpose of this work is to present our positive experience using combined laparoscopicendoscopic procedure and to review current literature in resolving joint appearance of trichobezoars and gastric polyps. A formation of undigested material in the gastrointestinal tract is bezoar [1]. In a situation of a longterm ingestion of hair, i.e. trichophagia, this type of bezoar is called trichobezoar, which is at the same time the most common form of bezoar [2]. Hair cannot be digested and due to its smooth nature also cannot be propulsed by peristalsis, which causes formation of a bezoar within the stomach over a certain period. The hair in a trichobezoar always appears black because of the influence of gastric acid on hair proteins [1, 3]. In literature, the association between bezoars and gastric polyps is relatively frequently described; however, it is not so widely appreciated. Even though biopsies of gastric polyps usually show an inflammatory origin, in some cases their malignant alteration was found [4]. A multidisciplinary approach with early diagnosis and surgical removal of gastric bezoars and polyps are essential [1, 3, 5]. CASE REPORT