Stanko Ćavar

Intestinal duplications--experience in 6 cases.

Intestinal duplications are rare congenital anomalies, and most of them are detected in the first 2 years of life or antenatally. The clinical presentation depends on location, size, and the presence of ectopic gastric mucosa. Ultrasound scans during pregnancy result in a higher rate of antenatally detected duplications which allows early treatment and avoidance of possible complications. Resection of the duplication without adjacent bowel should be the treatment of choice. En bloc resection or partial excision with mucosectomy is advised in some cases. We present our experience with 6 patients treated in our institution from February 2002 to October 2005.

Treatment outcomes of both-bone diaphyseal paediatric forearm fractures.

BACKGROUND Elastic-stable intramedullary nailing (ESIN), is an accepted method for stabilization of unstable forearm shaft fractures in children. This study analyzed the radiographic and functional outcomes of intramedullary nailing of forearm diaphyseal fractures in children. MATERIALS AND METHODS A retrospective analysis was performed of children with forearm shaft fractures and open epiphyseal plates, treated with ESIN between 2000 and 2012 in our institution. Evaluation of cases was conducted minimum 14 months after osteosynthesis. Clinical results were evaluated according to the criteria developed by Price et al. and Flynn et al. RESULTS The study included 88 (42 boys) children. The average age of children at day injury was 10.5 ± 2.59 years (range 4-16), and at the review clinic was 13.4 ± 1.85 years (range 7-18). Forty six (52.3 %) had right forearm and 42 (47.7%) had left fracture respectively. Open reduction was required in 20 (22.7%) children. Primarily surgically were treated 62 (70.5%) children and 26 (29.5%) were operated as a second procedure after failed conservative management. There was one delayed union. Rotational forearm restriction with values between 11 and 20 degrees was present in nine children. Six children developed radial nerve hypoesthesia which eventually resolved with time. After removal of the implant one child sustained a re-fracture. The overall complication rate was 25%. Complete recovery to the original condition was noted in 76 (86.4%) children, eleven children (12.5%) had good and only one (1.1%) had poor outcome. CONCLUSION Our study suggests that ESIN osteosynthesis for diaphyseal forearm fractures remains a valid technique with very good functional results.

The life-threatening hemodialysis catheter heparin lock caused bleeding in a child after peritoneal catheter removal

Hemodialysis catheter patency is regularly maintained by high-concentration heparin filling, according to manufacturers recommendation. Surprisingly, there are only few reports on serious bleeding complications in children on dialysis. A case of serious, life-threatening hemorrhage in a child after tunneled peritoneal catheter removal because of hemodialysis catheter heparin lock flushing is described. Discussion of the literature data is presented. Further investigations are needed to develop the guidelines for pediatric dialysis catheter care, including the optimal concentration for heparin lock as the possible heparin alternatives, but until that moment, previously suggested guidelines to prevent hemorrhagic complications in dialyzed children should be emphasized.

Endoglin (CD 105) as a potential prognostic factor in neuroblastoma

Endoglin (CD105) is a cytokine that modulates angiogenesis by regulating different cellular functions, including endothelial proliferation, differentiation, migration and formation of microvessels. CD105 is expressed strongly in the tumor vasculature, and intratumoral microvessel density (IMVD), as determined by the use of antibodies to CD105, it has been found to be an important prognostic indicator for outcome in various malignances. This study aims to determine if the clinical outcome of children with neuroblastoma is correlated with IMVD, as determined by CD105 staining and other prognostic factors.

Abdominal Aortic Thrombosis in a Healthy Neonate

Abdominal aortic thrombosis is a rare entity in neonates and has mostly been associated with umbilical artery or cardiac catheterization. We present a complicated case of an otherwise healthy neonate who developed thrombosis of abdominal aorta with renal failure. Therapy with intravenous heparin was unsuccessful, and thrombolysis was contraindicated because of disseminated intravascular coagulation so we decided to perform open thrombectomy using the left retroperitoneal approach. The following day, thrombosis recurred in the same extent and despite high risk of bleeding Alteplase was eventually given, which resulted in recanalization of the aorta 6 hours later. Renal function recovered, dialysis was discontinued, and further course was uneventful. The treatment of abdominal aortic thrombosis in neonates should be considered on a case-by-case basis because the available data on the condition are limited to case report and series. If open thrombectomy is performed, retroperitoneal approach should be preferred because it allows for easy institution of peritoneal dialysis should the need arise.

Kakvoća komunikacije na Zavodu za dječju kirurgiju KBC Zagreb

Komunikacijske vještine u zdravstvu, osim medicinske sve su češće tema koja je vezana za psihološku problematiku. Komunikacija u zdravstvu specifi čna je obzirom na to gdje se odvija (razina zdravstvene zaštite), na vrstu bolesti (akutna, kronična, prirođena), fazu bolesti (postavljanje dijagnoze, pojedina faza u liječenju) i s obzirom na bolesnikovu dob. Kvalitetna komunikacija je uvijek u zajedničkom interesu liječnika i bolesnika, odnosno bolesnikove obitelji (1). Osnovna načela primjerene komunikacije u zdravstvu temelje se na teorijskim postavkama, kliničkom opažanju i istraživanjima, a odnose se na komunikaciju s bolesnikom općenito. Specifi čne okolnosti i bolesnikovi problemi (npr. priopćenje loših vijesti, komunikacija s bolesnicima s malignim bolestima, komunikacija s „teškim“ bolesnicima i dr.) određuju način komunikacije s bolesnikom i njegovom obitelji (2). Primjerena komunikacija podrazumijeva pomno slušanje, razumijevanje, informiranje, empatiju, uzimanje u obzir kulturnih razlika, osobnosti bolesnika i osobitosti pojedine situacije vezane za liječenje.