To assess the number of visits to pediatric emergency departments in Croatia and reasons for visiting before and during the coronavirus disease 2019 (COVID-19) pandemic.
We reviewed the medical ...records of pediatric patients visiting emergency departments of four tertiary medical centers between February 25 and April 25, 2018 and 2019, and between February 25 and April 24, 2020. Antimicrobial prescription was analyzed as well.
There were altogether 46 544 visits - 18218 in 2018, 19699 in 2019, and 8634 in 2020. The overall number of visits in 2020 significantly decreased compared with 2018 and 2019 (52% and 56% reduction, respectively), mostly due to a decreased number of visits due to certain infectious diseases: acute gastroenteritis (89.2%), sepsis/bacteremia (81.2%), urinary tract infections (55.3%), and lower respiratory tract infections (58%). Most visits were self-referrals regardless of the analyzed period, and the majority of patients did not require hospitalization. There were no significant differences in the number of visits requiring urgent medical care, such as those due to seizures and urgent surgery. The most frequently prescribed antibiotic in all periods was amoxicillin, followed by amoxicillin/clavulanate and oral cephalosporins.
A significant reduction in the number of pediatric emergency department visits and hospital admissions is indirectly related to the COVID-19 pandemic. Most of the reduction was due to a decreased number of infectious disease cases. However, the number of visits requiring urgent medical intervention did not change.
Cilj: Prikazati pacijenta s kongenitalnom bilateralnom hidronefrozom i posljedičnim unilateralnim afunkcionalnim bubregom kao jednom od rijetkih razvojnih anomalija urotrakta te ukazati na važnost ...primjene ultrazvuka sa svrhom ranog otkrivanja i prevencije daljnjih ireverzibilnih oštećenja bubrežnog parenhima. Prikaz slučaja: Muško novorođenče zaprimljeno je na Zavod za intenzivno liječenje i neonatologiju zbog prenatalno dijagnosticirane obostrane hidronefroze u 26. tjednu gestacije. Tijekom boravka u bolnici učinjen je ultrazvuk bubrega koji je pokazao hidronefrozu IV. stupnja desno, s dilatiranim kaliksima i baloniranim pijelonom te blago reduciranim parenhimom. Na očekivanom mjestu lijevog bubrega prikazala se nepravilna, vrećasta formacija u očekivanom području kanalnog sustava, dok se parenhim bubrega nije razaznao. U dobi od jednog mjeseca rađena je dinamička scintigrafija bubrega koja je pokazala usporenu drenažu iz desnog bubrega na području PU ušća. Lijevi se bubreg tijekom pretrage nije prikazao. S obzirom na opisani nalaz, zauzet je konzervativan stav u liječenju ovog pacijenta. Dječak je bio urednog rasta i razvoja. U dobi od dvije godine učinjena je kontrolna scintigrafija koja je ponovno pokazala značajno usporenu spontanu drenažu u području PU ušća, bez poboljšanja nakon aplikacije diuretika. S obzirom na pogoršanje nalaza, pacijent je podvrgnut kirurškom načinu liječenja. Metoda izbora bila je unutrašnja drenaža protezom „double J“. Uslijedilo je ambulantno praćenje parametara bubrežne funkcije. Zaključak: Hidronefroza se može liječiti kirurški, postavljanjem proteze „double J“ i time potencijalno izbjeći invazivnije metode kirurškog liječenja. Međutim, svakom je pacijentu potrebno pristupiti individualno, uzimajući u obzir indikacije i moguće komplikacije.
Aim: To present a patient with congenital bilateral hydronephrosis and the consequent unilateral afunctional kidney as one of the rare developmental anomalies of the urotract, and to point out the importance of using ultrasound for the purpose of early detection and prevention of further irreversible damage to the renal parenchyma. Case report: A male newborn was admitted to the Department of Intensive Care and Neonatology due to prenatally diagnosed bilateral hydronephrosis in the 26th week of gestation. During the stay, an ultrasound of the kidneys was performed, which showed hydronephrosis of the IV degree on the right, with dilated calyces and ballooned pyelon, and slightly reduced parenchyma. At the expected location of the left kidney, an irregular, bag-like formation was shown in the expected area of the duct system, while the kidney parenchyma was not discernible. At the age of 1 month, a dynamic scintigraphy of the kidneys was performed, which showed slow drainage from the right kidney in the area of the P-U junction. The left kidney was not shown during the examination. Given the described finding, the patient was treated with conservative methods. The boy was of regular growth and development. At the age of two years, a control scintigraphy was performed, which again showed significantly slowed spontaneous drainage in the area of the P-U junction, without improvement with the application of diuretics. Given that the findings deteriorated, the patient underwent surgical treatment. The method of choice was internal drainage with a “double J” prosthesis. This was followed by outpatient monitoring of renal function parameters. Conclusion: Hydronephrosis can be treated by double J surgical placement and thus potentially avoids more invasive methods of surgical treatment. However, it is necessary to approach each patient individually, taking into account the indications and possible complications.
Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a ...number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patients in the study group exhibited a better result on a visual scar scale. The patients in the control group had a shorter hospital stay. Based on the recorded results, we were able to make treatment recommendations.
Cilj: Castelmanova bolest rijetko je oboljenje koje karakterizira benigna hiperplazija limfnih čvorova. Glavni je cilj prikazati Castelmanovu bolest kao mogući uzrok retroperitonealne tvorbe u ...pedijatrijskoj populaciji. Prikaz slučaja: Na Zavod za hematologiju, onkologiju i kliničku genetiku Klinike za pedijatriju Kliničkog bolničkog centra Rijeka zaprimljen je petnaestogodišnji dječak radi verifikacije ekspanzivne tvorbe u području burze omentalis, koja je utvrđena ultrazvukom prilikom obrade recidivirajućeg povraćanja. Naime, dječak je deset dana pred prijam svakodnevno povraćao ujutro nakon doručka u tri do četiri navrata. Ultrazvučno je bila prikazana dobro ograničena tvorba promjera 4 x 3 cm između duodenuma i pankreasa. Kompjutoriziranom tomografijom prikazala se tvorba koja se utiskivala u želudac bez znakova infiltracije okolnih struktura. Prema karakteristikama tvorbe vidljivih magnetskom rezonancijom zaključilo se da se radi o solitarnoj benignoj tvorbi. Učinjena je iglena punkcija pod kontrolom endoskopskog ultrazvuka, a na temelju citološkog nalaza postavila se klinička sumnja na Castelmanovu bolest hijalino-vaskularne varijante. Napravljena je kirurška ekstirpacija tvorbe što je ujedno i standard liječenja unicentrične Castelmanove bolesti. Patohistološka analiza potvrdila je radnu dijagnozu unicentrične Castelmanove bolesti miješane varijante. Poslijeoperacijski tijek prošao je uredno i dječak je otpušten kući dobrog općeg stanja. Na redovnim kontrolama nije bilo znakova recidiva osnovne bolesti. Zaključak: Iako je Castelmanova bolest rijetka, pogotovo retroperitonealne lokalizacije i u pedijatrijskoj populaciji, treba je uvrstiti u diferencijalnu dijagnozu pri pronalasku tumorske tvorbe na toj lokalizaciji.
Aim: Castelman’s disease is a rare condition characterized by benign lymph node hyperplasia. The aim of this paper is to present Castelman’s disease as a possible cause of retroperitoneal mass in the pediatric population. Case report: A fifteen-year-old boy was admitted to the Department of Pediatric Hematooncology for verification of an expansive formation in the area of omental bursa. The formation was detected by ultrasound during diagnostics due to recurrent vomiting. The boy complained of vomiting during ten days before admission, three to four times daily, usually after breakfast. Ultrasound showed a well-limited formation 4 x 3 centimeters in diameter located between the duodenum and pancreas. Computed tomography confirmed localisation of the tumor showing no signs of infiltration of surrounding structures and magnetic resonance imaging reported benign characteristics. Endoscopic ultrasound guided needle biopsy was preformed and a clinical presumption of a hyaline-vascular variant Castelman’s disease was made. Surgical extirpation was performed. Complete tumor resection is a standard treatment for unicentric Castelman’s disease. The pathological analysis confirmed the diagnosis of unicentric mixed variant Castelman’s. Postoperative recovery went smoothly and the boy was discharged home in good general condition.There were no signs of recurrence of the underlying disease at regular check-ups. Conclusion: Although Castelman’s disease is rare, especially localized retroperitoneally and in pediatric population, it should be included in the differential diagnosis when considering retroperitoneal tumorous formations.
Aim: To present a case of intestinal pseudo-obstruction in a paediatric patient with Kleefstra syndrome type 1 as a new clinical feature of this rare genetic disorder. Case report: A seven-year-old ...patient was admitted to the emergency department for nausea and vomiting. Clinical examination showed distended, meteoristic abdomen without detectable peristaltic sound. Abdominal X-ray revealed air-fluid levels and possible right subdiaphragmatic air collection. An urgent exploratory laparotomy was indicated. Intraoperatively, extremely dilated loops of small and large intestine up to the distal sigmoid colon were noted. No anatomical or mechanical causes of obstruction were found. The postoperative course was complicated by dysfunctional intestinal motility and urinary catheter-related infection which required prokinetics and intravenous antibiotic therapy. The patient was transferred to a paediatric centre specialized in intestinal motility disorders for further treatment. Conclusion: This is the first case of intestinal pseudo-obstruction described as a part of clinical presentation of Kleefstra syndrome type 1. Further research and re-evaluation of patients with KS1 is needed to determine if intestinal pseudo-obstruction is a new clinical manifestation depending on the size of the deletion or a repercussion of hypotonia sequential to an underlying syndrome.
Cilj: Prikazati slučaj sedmogodišnjeg pacijenta sa sindromom Kleefstra tipa 1 i akutnim nastupom intestinalne pseudoopstrukcije. Prikaz slučaja: Sedmogodišnji pacijent primljen je u hitnu medicinsku službu zbog mučnine i povraćanja. Kliničkim pregledom utvrđen je distendiran, meteorističan abdomen, nečujne peristaltike. Nativni radiogram abdomena prikazao je aerolikvidne nivoe i srpoliku transparenciju ispod desne kupole dijafragme. Sukladno kliničkoj slici i radiološkom nalazu postavljena je sumnja na ileus i moguću perforaciju šupljeg organa te je
indicirana hitna eksplorativna laparotomija. Intraoperativno su uočene ekstremno dilatirane vijuge tankog i debelog crijeva sve do završnog dijela sigmoidnog kolona. Eksplorativnom laparotomijom nije pronađena perforacija šupljeg organa niti mehanički uzrok opstrukciji pasaže pa se
postavila sumnja na intestinalnu pseudoopstrukciju u sklopu osnovnog sindroma. Poslijeoperacijski tijek zakomplicirao se otežanim uspostavljanjem peristaltike i uroinfekcijom kao posljedicom duže kateterizacije, što je zahtijevalo uvođenje prokinetika i terapiju antibioticima. Pacijent je prebačen u uže specijaliziranu ustanovu na daljnje liječenje. Zaključak: U prikazanom slučaju intestinalna pseudoopstrukcija po prvi je put opisana u sklopu sindroma Kleefstra tipa 1. Budući da je ovo prvi takav opisani slučaj, potrebna su daljnja istraživanja i reevaluacija pacijenata sa sindromom Kleefstra tipa 1 kako bi se utvrdilo radi li se o novoj kliničkoj manifestaciji ovisnoj o
veličini delecije ili posljedici generalizirane hipotonije u sklopu osnovnog sindroma.
Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a ...number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patients in the study group exhibited a better result on a visual scar scale. The patients in the control group had a shorter hospital stay. Based on the recorded results, we were able to make treatment recommendations.
Cilj: Osvijestiti o mogućnosti postojanja sindroma Rapunzel u adolescentica s akutnim pankreatitisom. Prikaz slučaja: U hitnu pedijatrijsku ambulantu javila se petnaestogodišnja djevojka zbog ...povremenih bolova u gornjem dijelu abdomena koji su se intenzivirali par dana pred dolazak. Prilikom fizikalnog pregleda nađena je u epigastriju i lijevom hipohondriju bolna rezistencija veličine otprilike 10 cm u promjeru. Opsežnom laboratorijskom analizom našle su se povišene koncentracije enzima gušterače te se postavila dijagnoza akutnog pankreatitisa. Daljnjom obradom indicirala se gastroskopija kojom se prikazala masa kose na ulazu u želudac. Kompjutoriziranom tomografijom uočilo se da ona seže sve do bulbusa duodenuma. Nakon provedenog konzervativnog liječenja pankreatitisa abdominalni bolovi su regredirali, došlo je do normalizacije enzima gušterače te je bilo indicirano operativno liječenje. Učinila se eksplorativna laparotomija i gastrotomija. Ekstirpirao se trihobezoar težine 1 kg i dužine 25 cm oblika odljeva lumena želuca i početnog dijela duodenuma. Postavila se dijagnoza sindroma Rapunzel. Dječji psihijatar potvrdio je prisutnu trihotilomaniju i trihofagiju te se djevojku uključilo u psihoterapijski tretman. Zaključak: Sindrom Rapunzel vrlo je rijetko stanje, ali treba biti uključeno u diferencijalnu dijagnozu akutnog pankreatitisa u adolescenata. Specifični simptomi trihotilomanije i trihofagije u kombinaciji s nespecifičnim simptomima, poput dugotrajnog bola u abdomenu, trebali bi pobuditi sumnju na razvoj trihobezoara.
Aim: To raise awareness about the existence of Rapunzel syndrome in female adolescents with acute pancreatitis. Case report: A 15-year-old girl came to the emergency pediatric clinic due to the occasional pain in the upper abdomen, which had intensified a few days before her arrival. During physical examination, a painful resistance of approximately 10 cm in diameter was palpated in the epigastrium and the right hypochondrium. Extensive laboratory analysis revealed raised concentrations of pancreatic enzymes so a diagnosis of acute pancreatitis was made. Further examination indicated gastroscopy, which showed a mass of hair at the entrance to the stomach. Computed tomography revealed that the mass reached all the way to the duodenal bulbus. After the conservative treatment of pancreatitis, the abdominal pain regresses and the pancreatic enzymes returned to normal so the operative treatment was indicated. Exploratory laparotomy and gastrotomy were performed. A kilogram heavy and 25 cm long trichobezoar in the shape of the gastric lumen and the initial part of the duodenum were exploited. Rapunzel syndrome was diagnosed. The child psychiatrist confirmed the presence of trichotillomania and trichophagia, so the girl was referred to the psychotherapy treatment. Conclusion: Rapunzel syndrome is a very rare condition but should be included in the differential diagnosis of acute pancreatitis in adolescents. Specific symptoms of trichotillomania and trichophagia in combination with non-specific symptoms such as prolonged abdominal pain should raise the suspicion of the development of trichobezoars.
A case of 16-year-old female with secondary psoas abscess as the complication of the Crohn’s disease was analysed. Her pre-hospital, long lasting, non-specific symptoms led to ultrasound (US) and ...radiologic imaging confirming the diagnosis. The antibiotic treatment was insufficient and worsening of the patient’s condition required surgical treatment including descendent colectomy, abscess drainage and negative pressure wound therapy (NPWT). In spite of numerous complications the condition of the child gradually improved and she was discharged from the hospital on the 71st postoperative day. Two years after the colectomy, the occlusion of her colostomy was performed.
Cilj: Prikazati pedijatrijskog bolesnika s retroperitonealnim limfangiomom koji se prezentirao kao akutni abdomen.
Prikaz slučaja: Dvanaestogodišnji dječak hospitaliziran je zbog akutnih grčevitih ...bolova u trbuhu praćenih povraćanjem i povišenim laboratorijskim upalnim parametrima. Zbog sumnje na akutni apendicitis učinjena je hitna klasična apendektomija. Drugog postoperativnog dana nastupilo je pogoršanje općeg stanja s febrilitetom i difuznim abdominalnim bolovima. Slikovnim pretragama abdomena prikazana je pseudocistična septirana tvorba koja je sugerirala limfangiom. Po provedenoj energičnoj potpornoj terapiji i poboljšanju općeg stanja učinjena je kompletna kirurška resekcija tumora. Postoperativni tijek protekao je uredno. Patohistološki nalaz potvrdio je dijagnozu limfangioma. Šest mjeseci nakon operativnog zahvata dječak je bez tegoba s urednim kliničkim i ultrazvučnim nalazom.
Zaključak: Akutni abdomen je hitno kirurško stanje vrlo različite etiologije, koje posebice u djece zahtjeva pažljiv pristup. U diferencijalnoj dijagnozi akutnog abdomena treba razmišljati i o limfangiomu. Detaljna anamneza, pažljiv klinički pregled, radiološka i laboratorijska obrada značajno utječu na izbor terapije i prognozu bolesti.
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