Marko Bašković

Cervicofacial subcutaneous emphysema after facial cosmetic procedure in an 11-year-old girl

Cervicofacial subcutaneous emphysema resulting from maxillofacial surgery and dental procedures is well described in the literature. Other causes include facial and chest trauma, infections, iatrogenic causes such as endotracheal intubation, positive pressure ventilation and cryotherapy. We report an 11-year-old girl who presented to the emergency department with swelling of her right cheek and neck. The swelling began soon after a cosmetic procedure for acne: mechanical cleaning of the skin pores followed by oxygen facial therapy. She also experienced a popping sensation, along with discomfort and swallowing difficulties. She had no significant medical history. There was no history of other traumatic events. She previously had the same cosmetic procedure four times without complications. On examination she had right hemifacial and neck swelling with crepitus and mild pain on palpation. There were no systemic symptoms of infection or fever. There were no signs of dyspnoea or chest pain. A standard craniogram revealed s.c. air in the right cheek and neck consistent with the diagnosis of cervicofacial s.c. emphysema (Fig. 1a,b). There was no signs of pneumomediastinum on a chest radiogram. Ultrasonography confirmed an echogenic interface anterior to muscles, which obscured the view of the structures other than skin and fat tissue. Her blood test results were unremarkable. The patient was admitted for monitoring and managed conservatively with the antibiotic clindamycin as a prophylaxis for infection. The emphysema gradually resorbed within 2 weeks. S.c. emphysema arises when air is forced beneath the tissues, leading to swelling, crepitus on palpation, and the potential of the air to spread along the fascial planes. Usually cervicofacial s.c. emphysema is a benign and self-limiting condition, although it also may have life-threatening complications such as pneumothorax and pneumomediastinum, cardiac tamponade, air embolism, tracheal compression and mediastinitis. A comprehensive search of medical literature in PubMed showed that s.c. emphysema from a facial injury is rare and its extension into the cervical and mediastinal tissues is uncommon. We could find no case of facial s.c. emphysema caused by cosmetic procedures. Mechanical cleaning of facial skin pores is a commonly used cosmetic procedure for acne, while oxygen facial therapy is a recently introduced method. Oxygen therapy is typically performed using a small pen-like device called an airbrush, which is used to deliver high-pressure oxygen into the epidermis. It is presumed that oxygen has an antibacterial and restorative effect on the skin. We assume that in our patient the s.c. emphysema was a result of a small mechanical skin injury immediately followed by the application of high-pressure oxygen.

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.