Mirko Žganjer

Surgery for Abdominal Wall Pain Caused by Cutaneous Nerve Entrapment in Children-A Single Institution Experience in the Last 5 Years

Background Chronic abdominal pain (CAP) is a serious medical condition which needs to be approached with great attention. Chronic abdominal pain may be caused by entrapment of cutaneous branches of intercostal nerves (ACNES). Objectives The aim of this study is the surgery for abdominal wall pain which caused by cutaneous nerve entrapment in children during last 5 years. Materials and Methods In all children with ACNES, we tried conservative treatment with anesthetic and steroid injections. In children who were refractory to conservative treatment, we received surgical procedure like sectioning the entrapped nerve to obtain relief. Results In 12 pediatric patients with chronic abdominal pain, we diagnosed ACNES. Each presented with abdominal pain and a positive Carnett sign. Local nerve blocks using anesthetic and steroid injections are the treatment. In all patients, we tried with local nerve block. In 3 patients, pain improvement occurs in the few minutes, and they were without pain after 5 days. In other 4 patients required a reinjection for pain recurrence. In one patients pain was gone. The maximum reinjection was 3. In other 5 patients, we did operative treatment like sectioning the entrapped nerve. Conclusions Some children with CAP have ACNES. In all children with ACNES, we recommended local nerve blocks. If the local block in 3 times is not helping, neurectomy of the peripheral nerve is method of choice.

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.

Primary Spontaneous Pneumothorax in Pediatric Patients: Our 7-Year Experience

BACKGROUND Primary spontaneous pneumothorax in children is a significant clinical problem. The majority of these patients will require immediate surgical therapy, such as tube thoracostomy. PATIENTS AND METHODS We conducted a retrospective review of 16 patients with a diagnosis of primary spontaneous pneumothorax over a period of 7 years. RESULTS In the last 7 years, we had 16 patients with spontaneous pneumothorax. Patient age ranged from 11 to 18 years (median, 15.4). We had 12 boys and 4 girls. Pneumothorax occurred on the right side in 9 patients, on the left side in 6 patients, and on both sides in 1 patient. The first choice of treatment was tube thoracostomy. The main symptoms were chest pain, shortness of breath, and cough. In all patients, we made X-ray and computed tomography scan. In 10 children, we detected apical bullas; in 2 patients, we found giant bullas in the lower part of the lung. In 4 patients, we did not find any pathologic signs on the lung. Two patients with spontaneous pneumothorax had tube drainage without recurrence. Eleven patients were operated on with video-assisted thoracoscopic surgery (VATS). Three patients were operated with open thoracotomy. Two of them had giant bullas, and 1 patient had recurrence after VATS. One patient had pneumothorax on both sides of the pleural cavity. DISCUSSION VATS is an effective, safe method for spontaneous pneumothorax in children. In 11 children with pneumothorax, we made a wedge resection of the apical part of the lung with an endostapler device plus mechanical pleurodesis.

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.

Predictors of pediatric surgeons’ career satisfaction: a national survey

ObjectiveA survey was performed to identify factors for professional career satisfaction and for dissatisfaction. MethodsDuring General Assembly of CSPS, attendees answered the 37-question form grouped into the following categories: demographic, professional activity and organizational issues, type of service, education, and compensation and status. Data were analyzed using the Pearson &khgr;2 test (P<0.05). ResultsThe response rate was 74.5% (n=44/59). The average age was 46 years, and 91% were male. The average participant had 17 years of surgical practice, worked 8.5 hours daily and 208 hours monthly, in children’s (49%), university (35%), or community (16%) hospital. Pediatric surgeons were satisfied with professional career (77%), and 88% would chose the same profession again. Patient satisfaction (85%), quality of care (79%), and professional achievements (76%) were rated very high. Dissatisfaction responders pointed at shortage of time for effective communication (69%), excessive administrative work (88%), too many working hours (73%), professional burnout (66%), and technical issues – IT technology (73%) and equipment (79%) out of date or old/unsuitable facilities (73%). An overall 57% of responders had presented paper on international congresses, and 32% had published paper in indexed journals. Two major concerns about education are insufficient training (61%) and lack of time for continuous education (79%). ConclusionPediatric surgeons are satisfied with professional career. Patient care is a leading area of satisfaction. Educational, organizational, technical, and structural issues need improvements. A large pay gap exists between expectations and real income.