Zlatan Zvizdic

Testicular volume and testicular atrophy index as predictors of functionality of unilaterally cryptorchid testis.

ABSTRACT Goal: The goal of this study was to determine relationship between the sensitivity and specificity of testicular volume (TV) and testicular atrophy index (TAI) in the indirect assessment of functional ability of cryptorchid testicles. Material and Methods: The study included sixty children with unilateral cryptorchidism who were treated surgically at the Clinic of Pediatric Surgery, Clinical Center University of Sarajevo. We evaluated the correlation of the size of cryptorchid testicles with its locations in various age groups. Results: The results showed a significant decrease in TV and TAI in the all cryptorchid groups after the sixth month of age compared with the same parameters in control group (p<0.001). It is also determined a strong correlation between the TV and TAI of cryptorchid testicles with its locations in various age groups. Conclusion: Our results showed that the average volume of cryptorchid testicles decreased after the sixth month as well as that the reduction of testicular size correlated with increasing distance of cryptorchid testicles from the scrotum.

Relationship of Nosocomial Infections with the Development of Necrotizing Enterocolitis in Preterm Infants

Objective: The aim of this study was to determine the association between the number of nosocomial infections prior to necrotizing enterocolitis (NEC) diagnosis as well as to evaluated how it contributed to development of NEC in premature infants. Material and methods: The study included 51 preterm infants diagnosed with NEC and 71 preterm infants without NEC hospitalized in the neonatal intensive care unit (NICU) of Clinical Center University of Sarajevo. We evaluated the correlation of the number of nosocomial infections prior to NEC diagnosis with the development of NEC. Results: There was a statistically significant association of the number of nosocomial infections prior NEC diagnosis with the development of NEC (odds ratio, 3.32; 95% confidence interval, 1.09-10.01). Conclusion: Increased number of nosocomial infections prior to NEC diagnosis is associated with increased risk of necrotizing enterocolitis.

The Role of the Appendix Testis in Normal Testicular Descent: Is There a Connection?

Objective The presence of testicular appendices was prospectively evaluated in 89 boys with 96 undescended testes who underwent orchidopexy over the period of 4 years. Results The patients were divided into two groups. Group A included 42 boys with 49 undescended testes positioned close to the internal inguinal ring, and Group B included 47 boys with 47 undescended testes close to the external inguinal ring. The incidence of appendix testis (AT) in Group A was 57.1% (28 in 49) and 78.7% (37 in 47) in Group B. The results of our study showed significantly decreased incidence of testicular appendices in undescended testes positioned close to the internal inguinal ring compared with undescended testes positioned close to the external inguinal ring (p < 0.05). Conclusion AT may play a role in normal testicular descent and the undescended testis positioned close to the external inguinal ring can be considered as a separate entity of the true congenital undescended testis.

Female Epispadias Presenting as Urinary Incontinence

Isolated female epispadias without bladder exstrophy is a rare congenital anomaly affecting 1 in 484,000 females. The presenting features of female epispadias are urinary incontinence and abnormal anatomical features. A 6-year-old girl presented with primary urinary incontinence who on physical examination had a bifid clitoris and labia minora. The vagina and hymen were normal. Voiding cystourethrogram showed no reflux and a funnel shaped proximal urethra. With the diagnosis of isolated female epispadias, one-stage reconstruction of the urethra, bladder neck, labia minora and clitoris was performed.

CONTRIBUTING FACTORS FOR DEVELOPMENT OF NECROTIZING ENTEROCOLITIS IN PRETERM INFANTS IN THE NEONATAL INTENSIVE CARE UNIT.

Background: necrotizing enterocolitis is a serious condition that affects mostly preterm infants, with high mortality rate. Aim: to estimate the influence of potentially contributing factors of this multifactorial disease. Methods: the study group included 51 necrotizing enterocolitis infants who were less than 37 week gestation who were hospitalized in NICU during a five year period. The control group consisted of 71 patients with approximately the same gestational age and birth weight. Average gestational age in the study group was 30.2 weeks (SD 3.7), average birth weight 1502g (SD 781.5). Average postnatal age in the time of the presenting NEC was 18.2 days (SD 12.8). Results: Logistic regression estimates the influence of risk factors, which in our study related to the treatment of preterm infants on the likelihood of NEC development. Our regression model consisted of seven independent variables (nosocomial infections, mechanical ventilation, nasal continuous positive pressure, morphine, inotropes, blood transfusions, and H2 blockers), which were shown to have a statistically significant impact, X2 (7, n=1222) = 49.522, p<0.0001; two independent variables (nosocomial infection and H2 blockers use) were statistically significant. Preterm infants with nosocomial infection had a three times greater chance of developing NEC, and infants who received H2 blockers had a 1.5 higher risk. Conclusions: Underlying pathology of very low birth weight infants and their treatment in NICU contribute to NEC development. Identifying risk factors can be crucial for the early diagnosis and outcome of disease. Awareness of risk factors should influence changes in practice to reduce the risk of NEC.

Quality and Safety of General Anesthesia with Propofol and Sevoflurane in Children Aged 1-14 Based on Laboratory Parameters

Introduction: Knowledge of anatomic, physiological, biochemical and physical characteristics of children of all age groups, the existing illness and possible pathological response of the organism to the existing situation, require a pediatric anesthesiologist to participate in the preparation of a child for surgical treatment, to choose the best anesthesia technique and medications, and manipulative techniques to enable the scheduled surgical treatment with minimum anesthesia risks. The aim of this clinical study was to prove reliability and quality of propofol or sevoflurane general anesthesia in children in the age group of 1-14 years from the ASA I group and in the elective surgical treatments in duration of 60 minutes, based on preoperative and postoperative levels of laboratory findings (transaminases, blood sugar, urea and creatinine). Materials and methods: the study included 160 patients randomized in two groups based on different approaches: total intravenous anesthesia was used for the propofol group (n=80) (TIVA) and the inhalation technique was used for the sevoflurane group (n=80). Results: statistical evaluation of the obtained results indicates stability of laboratory findings in the immediate postoperative course (after 24 hours) in respect to the preoperative period. Based on the Mann Whitney test (P), preoperative and postoperative blood sugar levels in the sevoflurane vs. propofol group were P=0.152 vs. 0.021; creatinine levels P=0.113 vs. 0.325; urea levels P= 0.016 vs. 0.900; AST levels P=0,031 vs. 0,268 and ALT levels P=0.021 vs. 0.058. Level of significance was P<0.5. Conclusion: Analysis of the examined laboratory parameters show that propofol and sevoflurane provide full security and quality of general anesthesia in children age group 1-14 years, from the ASA I group. All analyzed laboratory levels in the postoperative course remained in their referential values in both groups of participants.