The aim of this study was to examine the impact of different catheter tip positions on catheter duration and dysfunction of tunneled catheters in children. Catheters were evaluated for place of ...insertion, time of insertion, catheter tip depth and position, duration of use, and reason for removal. The mean duration of implanted catheters with tips placed in cavo‐atrial junction/right atrium was significantly longer with significantly lower percentage of complications than tips placed in superior vena cava. Only catheter tips placed in cavo‐atrial junction/right atrium was a predictor of catheter functionality and survival. Shorter catheter survival in children with tunneled catheters is a consequence of a catheter tip depth proximal of CAJ and RA. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth of the catheter tip, which reduces need for future catheter insertions with increased catheter durability.
GoalThe purpose of this study was to characterize the population and evaluate risk factors, surgical treatments and short-term outcomes in preterm infants with surgical necrotizing enterocolitis ...(NEC).MethodsWe retrospectively evaluated premature infants with surgical NEC over a period of 5 years (2015-2019) in a Croatian tertiary referral centre. Data were extracted from medical records.ResultsThis study included 23 outborns aged 23 to 36 weeks of gestation (27.7±3.7). The median age at surgery was 11 days (5-43 days). Male gender (83%) was overrepresented, whereas antenatal steroid exposure was low (61%). The majority of patients (n=15) had a primary laparotomy (65%); two patients had peritoneal drainage (PD) alone (9%) and six patients had PD followed by laparotomy (26%). All patients survived. After referral, the median length of hospitalization was 128 days (15-430 days), one patient developed short bowel syndrome, five (22%) were treated for sepsis, eight patients (35%) received laser photocoagulation due to retinopathy, and grade 3 to 4 intraventricular hemorrhages were diagnosed in seven (30%) patients. There were no differences in outcomes related to surgical approach.ConclusionNEC mortality in our cohort is lower than current literature suggests. Additionally, abdominal drainage seems to be equally successful treatment of NEC as explorative laparatomy and bowel resection in neonates who do not meet the criteria for the latter procedures. Neonates who underwent abdominal drainage do not show increased probability of complications or higher lethality.
Cilj istraživanja: Predstaviti naše inicijalno iskustvo s laparoskopskom pijeloplastikom u djece, procijeniti sigurnost i kratkoročni ishod. Ispitanici i metode: Retrospektivno je analizirana ...medicinska dokumentacija sve djece koja su u trogodišnjem periodu od 2019. do 2022. godine laparoskopski operirana zbog opstrukcije pijeloureteričnog vrata u Kliničkom bolničkom centru Zagreb. Rezultati: Ukupno desetoro djece, dobi od 10 mjeseci do 17 godina (medijan 4,3 godine) operirano je laparoskopski. Četiri djevojčice i šest dječaka. U osmero bolesnika se radilo o lijevom bubregu, a kod dvoje o desnom. Prosječni promjer pijelona je iznosio 35 mm i prosječna separatna funkcija zahvaćenog bubrega je bila 40%. Intrizična stenoza kao uzrok opstrukcije našla se kod osmero djece, a kod dvoje se radilo o aberantnim krvnim žilama za donji pol bubrega. Prosječno vrijeme trajanja operacije bilo je 190 minuta (raspon 120 – 240 min) dok je prosječno vrijeme hospitalizacije bilo 3,2 dana (raspon 2 – 6 dana). Kod dvoje djece stavljen je abdominalni dren. Nije bilo konverzije u otvoreni zahvat, kao ni intraoperativnih i ranih postoperativnih komplikacija. Peroralni unos je započet 4 – 10 sati nakon operacije. Praćenje pacijenata je bilo od 2 do 40 mjeseca (prosječno 7,8). Prosječni postoperativni promjer pijelona u djece kod kojih je prošlo više od 6
mjeseci od operacije bio je 9,5 mm. Zaključak: Laparoskopska pijeloplastika je sigurna i učinkovita metoda u liječenju djece s opstrukcijom pijeloureteričnog vrata.
Supracondylar fractures are the most common humeral fractures in children, comprising 55-80% of all pediatric elbow fractures, with a higher incidence among 5 to 7-year-old boys. A typical mechanism ...of injury is a fall onto the outstretched hand with hyperextensi-on at the elbow. Due to the humerus's proximity to the brachial artery and anterior inte-rosseous nerve, neurovascular complications occur in 5-15% of cases.
Intestinal duplications are congenital anomalies that may occur throughout the gastrointe-stinal tract with an incidence of 1/4500 live births. The duplications are often located on the mesenteric ...side of the bowel and can either be cystic or tubular. Therefore, they most often appear as mesenteric cysts on radiology imaging. Most intestinal duplications are diagnosed within the first two years of life, either as accidental findings or they present as abdominal pain and intestinal obstruction. Surgically treated intestinal duplications have a good prognosis.
A 20-month-old boy was referred to us from another hospital due to deterioration of the respiratory function during right-sided bronchopneumonia and a suspicion of foreign body aspiration. At the ...admission, the boy was subfebrile, tachycardic and tachydispnoic, with normal oxygen saturation in the room air, drenched in sweat and with a productive cough. Inflammatory parameters were elevated and X-ray of the lungs showed a suspected inflammatory infiltrate in the right cardiophrenic angle. Bronchoscopy did not show the presence of a foreign body in the respiratory system. During hospitalization, swelling developed in the right infrascapular region with redness, induration and with palpable foreign body in the central part. A surgical incision in the general anesthesia was performed with foreign body extraction. It was a wall barley grass inflorescence (lat. Hordeum murinum). Due to the characteristic structure, wall barley inflorescence tends to move in only one direction. In the case shown, after aspiration, the barley grass spikelets migrated through the tracheobronchial tree, penetrating into pulmonary parenchyma to the periphery of the lung, through the pleural layers, intercostal muscles and finally protruded on the chest wall.
Eventracija ošita je abnormalna elevacija dijela ili cijele hemidijafragme. Može biti kongenitalna i stečena. Oboljelih je 2 do 7 na
100000 živorođenih, a češće se javlja kod dječaka. Eventracija se ...prezentira simptomima respiratornog ili gastrointestinalnog sustava, a dijagnoza se postavlja na temelju slikovnih radioloških pretraga. Kirurško liječenje indicirano je kod svih simptomatskih pacijenata, a cilj liječenja je ojačati tanku i oslabljenu dijafragmu plikacijom. Pristupi kirurškom liječenju su različiti. Prikazujemo osmomjesečnog dječaka kojemu je eventracija otkrivena obradom tijekom prolongiranog respiratornog infekta, a kojeg smo potom liječili
torakoskopskom plikacijom s dobrim dugoročnim ishodom.
Identification and preservation of testicular artery and lymphatic vessels during microsurgical varicocelectomy can be tedious if adhered encompassing venous network is encountered. A venous bypass ...from internal spermatic to saphenous or inferior epigastric vein, that have been described for varicocele treatment, may be used in such situations. This paper describes a simplified modification of the venous bypass technique that reroutes the testicular blood to the superficial epigastric vein, which can easily be found in the incisional wound. Surgical technique and anastomotic patency test are described, and indications and results are discussed.
During 2020 and 2021, 32 adolescent patients underwent microsurgical varicocelectomy. In eight patients additional microsurgical testicular vein-superficial epigastric vein microvascular bypass was done. The indication for bypass was difficult identification of testicular artery and/or lymphatic vessels due to adhered venous plexus.
Varicocele resolution was noted in all eight patients with clinical and/or semen analysis improvement. There were no complications or recurrences. Average length of procedure was 65 minutes. All patients were discharged within 24 hours and no antiplatelet or anticoagulant therapy was used.
Testicular vein to superficial epigastric vein anastomosis is a useful and simplified venous bypass technique that reroutes the blood from the pampiniform plexus to the femoral vein. It can be done as an adjunct to microsurgical varicocelectomy in selected patients through a standard incision.
Multiple intestinal atresia (MIA) is a congenital malformation disorder in which atresia occurs at multiple levels throughout the gastrointestinal tract, most commonly small bowel. Frequently it ...presents as an isolated anomaly, but also as a part of a complex inherited disorder caused by homozygous or compound heterozygous mutation in tetratricopeptide repeat domain 7A (TTC7A) gene. These patients usually have associated mild or severe combined immunodeficiency.Herein we report an infant with MIA and associated combined immunodeficiency (CID). The female child was born at term by vaginal delivery to a 26-year-old G5P3 mother. The parents are healthy, non-consanguineous couple of Albanian origin. Pregnancy was complicated by polyhydramnios. Fetal ultrasound at 19 weeks of gestation revealed dilated bowel loops. Postpartal abdominal X-ray showed signs of gastric atresia.Surgery revealed widespread atresias, extending from stomach to cecum, and atrophic microcolon. Multiple small bowel resections with end-to-end anastomosis, and ileostomy were done. Histopathological examination showed pseudostratification of the epithelium, increased enterocyte apoptosis, inflammatory eosinophilic infiltrate in lamina propria, decreased small bowel villi, and disrupted apical-basal polarity. At two weeks of age GI obstruction recurred, and she underwent jejunal resection with end ileostomy. The residual small bowel length measured 45cm. Immunological investigation revealed CID: T cell lymphopenia affecting all subsets with lower B cell, natural killer cell count and impaired mitogen response. She experienced several septic episodes. At two months, allogeneic bone marrow transplantation was successfully performed. MIA-CID was suspected and genetic testing confirmed homozygous pathogenic variant in the TTC7A gene (c.315_318del/c.315_318del) causing premature translational stop signal that result with absent protein production. She is now 4 months old, has failure to thrive and parenteral nutrition-induced cholestasis and continues to be dependent on parenteral nutrition for a short gut.MIA-CID is a rare hereditary disease with about 50 reported patients in literature. Abundant expression of TTC7A gene in thymus and colon and its critical role in intestinal and immune homeostasis can explain this severe phenotype and almost invariably poor prognosis. Clinical course may be more favourable if the bone marrow transplantation is done in the first three months of life. Therefore, immunological and genetic testing should be performed in every neonate born with MIA.
Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance ...of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature.
The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period.
A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation.
During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007).
During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required. Display omitted
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