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.
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.
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.
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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