[Clinical and therapeutical considerations regarding the diagnosis and treatment in meconial disease]. / Consideratii clinico-terapeutice privind diagnosticul si tratamentul bolii meconiale.

The meconium disease represents a problem of great impact over the vital prognosis of the newborn, the mortality of this disease being rated in various studies between 30 and 50%. The meconial disease that reunites the meconial ileus and the meconial peritonitis is often associated with cystic fibrosis a disease of general impact over the entire organism increasing the gravity and influencing the vital prognosis of these patients. The authors' purpose is to evaluate the results obtained after the treatment of the meconial disease in the Pediatric Surgery Clinic of the Emergency Hospital of Craiova over a period of 10 years. The study has been made on a number of 16 cases of meconial ileus, plug and peritonitis analising the difficulty of the diagnostic process, the preoperative care as well as the possibilities of surgical treatment. The surgical treatment is composed of multiple procedures including simple suture of the bowel defect and segmentary bowel resections with primary anastomosis and/or secondary anastomosis after ileostoma. The mortality on the studied cases was of 37.5% despite recent progresses achieved in postoperative care of these type of patients.

[Clinical and therapeutical considerations regarding a rare case of pre-pyloric stenosis]. / Consideratii clinico-terapeutice privind un caz rar de stenoza prepilorica.

The neonatal obstacle caused by a pre-pyloric diaphragm represent a rare cause of high oclusion in new-born. We present the case of a 6 days old new-born admitted in our department for nonbilious vomiting and feeding intolerance in which the clinical exam and the imagistic explorations (plain and contrast abdominal X-Rays, and ultrasound) could not reveal an evident cause for the oclusion. The surgical intervention imposed by the simptoms revealed the existece of a complete diaphragm in the prepyloric region. The initial excision of the diaphragm was not sufficient, the patient undergoing a second surgical intervention of gastrojejunal anastromosis with favorable evolution this time. The authors are presenting diagnosis and theraputical management peculiarities of this rare condition.

[Evolutive particularities of appendicular plastron in children]. / Particularitati evolutive ale blocului apendicular la copil.

This paper analyses the experience of the Paediatric Surgery Department from the Emergency Hospital in Craiova regarding the clinical and therapeutical evaluation of 55 cases with appendicular plastron admitted in our department between 1997-2006. We analyse both the evolution and the complications in managing these cases, together with particular aspects of differential diagnosis related to this group of age. These 55 cases were children aged between 2 and 15 years with a 15 days average hospitalization period. Applying a standard treatment we had favorable results in 85% of cases with 15% cases underwent surgical treatment from the first admission. Comparative to a study realised in our dept. between 1975-1996, which registered 30 cases with a mortality of 6.70%, the present one revealed in the latest years an important increase of the number of appendicular plastron with a significant low mortality.

[Update in diagnosis and treatment of esophageal atresia]. / Actualitfati în diagnosticul si tratamentul atreziei de esofag.

The paper present a number of 17 cases of esophageal atresia, hospitalised and operated in a period of 4 years (2001-2004). The authors are underlining the importance of the prenatal diagnosis, preoperative and postoperative care, the chance for primary anastomosis for type III A of the disease, complications and prognosis related to the type of atresia. Esophageal atresia is a success of a complex team where the role of the neonatologist and anesthesiologist, next to the surgeon, is very important.

[The gastroschisis: clinical and therapeutic considerations]. / Laparoschizisul: consideratii clinico-terapeutice.

Gastroschisis is a severe congenital malformation of the abdominal wall, with relative low incidence. The authors are analysing different therapeutic methods, in a group of 17 cases, hospitalised and operated in Department of Pediatric Surgery, Emergency Hospital of Craiova. They are underlining the importance of the ultrasound prenatal diagnosis of the malformation, close related to different therapeutic methods applied in this period of time and also are advising secondary closure of the abdominal wall, using a synthetic material (Silo-bag) for temporary coverage of the intestine developed outside the peritoneal cavity. This method helped with the decreasing of mortality in gastroschisis but with high costs of treatment.

[Surgical management of clinical problems in children with HIV infection]. / Elemente de patologie chirurgicala la copilul infectat HIV.

HIV infection is a very actual disease widespread all over the world (40 million people), including up to 10 thousand Romanian, are infected with HIV; there are 950 HIV-infected patients in Oltenia, 450 of them are in our county (Dolj area), 80% of the HIV-infected persons are children. The authors are studying a group of 17 cases of HIV-infected children with surgical problems (Acute appendicitis, acute cholecystitis, pulmonary and kidney abscess, lymphadenophlegmons, abdominal tumours), which have been transferred to our department from the Infectious Diseases Clinic, between 1995-2004. The medical records of all patients were reviewed: strategies of management, particularity of antiretroviral therapy of children, and also strategies of prevention the perioperative HIV transmission. The most frequent cases were the lymphadenophleg mons (40%) and chronic abdominal pain (25%). The acute abdominal pathology consisted in 2 cases of acute appendicitis and 1 case of acute cholecystitis, which were successfully treated. The HIV infection remains in actuality, because there is not an efficient antiretroviral therapy. Surgeons planning treatment must consider the risks of the patient against the potential benefits of surgery.

[Rectal lesions in children. Clinico-therapeutic considerations of 12 cases]. / Leziunile rectului la copil. Consideratii clinico-terapeutice pe marginea a 12 cazuri.

The lesions of the anus and the rectum are not very really found in children, representing even a appreciable percentage; in the Pediatric Surgery Clinic of the University Hospital no. 1 of Craiova were admitted and operated 12 patients with lesions of the rectum between 1986 and 1998. The causes of these lesions were: polytraumatism--3, falls in different sharp things--7, rectal perforations on the septic base from the peritoneal cavity--1, iatrogenic cause--1. The surgical treatment were consisted in: the suture of wounds on the perineal way, lavage, drainage, antibiotherapy--6 cases, the iliac left anus with the re-establishing of the continuity--3 cases, the suture of wounds on the perineal and abdominal ways--2 cases. The conditions were good in 9 cases--cured, and 3 deceases (2 polytraumatism, 1 case malformed new-born with perforation produced by using haegar).

[Sacrococcygeal teratoma in children. Anatomo-clinical, therapeutic and prognostic considerations]. / Teratomul sacro-coccigian la copil. Consideratii anatomo-clinico-terapeutice si prognostice.

Presentation of potentially malignant tumours, highly frequently found in children, developed out of embrionary remnants. Study of clinical observation files, iconography resources, histopathological samples and surgical operation notes, corroborated with patient's reexamination several years later. There are presented nine clinic cases of tumours found in newborn, babies and even in young children, with teratome-like structure, that have malignant potential if excised late. Histopathological laboratory tests of the biotic sample are of paramount importance in establishing the structure of the tumour, its malignization abilities and the therapeutical conduct to be adopted. Other useful investigations: radiographs of the vertebral column, abdominal echographs, computerized tomography. Besides sacrococcygian, large and anesthetic, location in newborn, there are presented cases of intra-abdominal teratomes and one case of ovarian teratome. The study also contains a general opinion upon the patients operated on the reexamined several years later.

[Posttraumatic duodenal lesions in children. The therapeutic considerations]. / Leziunile posttraumatice ale duodenului la copil. Consideratii terapeutice.

The posttraumatic lesions of the duodenum in children represent rare cases in the surgical field. 4 cases of duodenal lesions were registered and operated upon in the Pediatric Surgery and Orthopedic Clinic, in cooperation with the ICU Clinic, 2 of them having postoperative complications (duodenal fistulae), these cases being initially situated in a retroperitoneal position (lateral and posterior). The ICU therapy was directed in the first step towards the traumatic and septic shock, in the second one to the immediate postoperative care and in the third step towards late complications. For the 2 cases having postoperative complications, the care was directed towards the elements of local complications (retroperitoneal abscess, fistulae), MSOF, sustaining the immune system correcting the nutritional deficiencies. Surgical methods used for sustaining the ICU therapy were: endovenous catheterisation, gastro-duodenal aspiration, solving the fistulae through catheters and suture. The results, using the methods described above, were good.

[Follow-up evaluation of omphalocele treatment in children. The experience of the department of Pediatric Surgery and Orthopedics No.1 University Hospital Craiova]. / Evaluare în timp a tratamentului omfalocelului la copil. Experienta Clinicii de Chirurgie si Ortopedie Pediatrica Spitalul Clinic Universitar Nr.1 Craiova.

Abdominal wall malformations are a frequent category of congenital malformations in the last years in all Departments for Pediatric Surgery from our country. The authors are presenting a serie of 35 cases of newborns admitted and treated in the Pediatric Surgery and Orthopedics Department of the Clinical University Hospital No. 1 Craiova and in the same time they are evaluating in time the results after different surgical technics. From the point of view of the surgical techniques applied in the last 20 years the authors are communicating their results with the following procedures: Gross, Allen-Wren, Fufezan, and also their results with a nonsurgical procedure (Grob). The authors are manchenning that it is possible to combine (depending on the anatomo-clinical) the surgical approach with the non-operative management of the case. Clinical parameters such as sex, birthweight, immaturity, associated malformations, size of the abdominal deffect are the main element to predict the outcome of these patients and to choose the right management strategy, thus it is very important to investigate the pregnancy evolution and the birth period. The good results (82.9% surviving) are representing the prove of a good therapeutic decision being impossible to use synthetic materials for substitution (silicon, dacron, teflon, etc.) and in the same time an important guide for our future activity.

[Elements of gynecology pathology in girls before and during puberty age]. / Elemente de patologie ginecologica la fetite înainte si la vârsta pubertatii.

PURPOSE: The annexial pathology in little girls is representing a more and more frequent form of acute and chronic abdomen, especially in girls around the age of puberty with dysfunction of the menstrual cycle correlated with disturbance of growing and the occurrence of secondary sexual characters. If this kind of pathology is frequent in the period of puberty, there are cases diagnosticated at small ages. MATERIAL & METHODS: The authors are communicating a number of 25 cases with anexial pathology some of them manifesting the symptoms of the acute abdomen (most of them with torsion of the normal or pathological annexes) others having a chronic aspect. The clinical examination correlated with the imagistic investigations were the main elements for the diagnosis. RESULTS & CONCLUSIONS: The results were good, the follow-up of the patients is including social therapy with the girls and their families, for integration in the family, evaluating the chance of giving birth. The occurrence of some forms of acute abdomen was frequent on a pathologic annexes (malformated annexes), causing sometimes the excision of it, extended to the uterus. The presence of a malign tumour can be related with different malformations, also caused by exposure to some risk factors: radiation, pollution, chemical agriculture, deficitary alimentation, stress etc.).

[Intestinal tuberculosis in children. Differential diagnosis and treatment]. / Tuberculoza intestinala la copil. Diagnostic diferential, conduita terapeutica.

Lately, tuberculosis has became a top priority problem in health all over the world. The actual level of epidemiological indicates of tuberculosis Shaw that Romania is the country that has the most unfavorable situation in Europe except for Bosnia-Herzegovina. Tuberculosis incidence from 1996 to 1997 ranks Dolj county second in Romania from the point of view of the increasing rate (154.3% + 25.4% versus 107% + 4.3%). The National Programme of Controlling Tuberculosis for 1997-2000 has as main object the neutralization of a least 85% of the discovered contamination sources. At the same time with the pulmonary tuberculosis were discovered 17.2% extrapulmonary localizations. The purpose of these works is that of presenting in the frame of extrapulmonary TBC the localization of intestinal TBC with children (peritonitic form with infants and pseudotumoral with child). In class cooperation with the veterinary Medicine Service we have also studied the possibility of same sources of TBC infection of animal origin, knowing the fact that besides the human Koch bacillus were discovered bovine, ovine, poultry sources. Presenting a number of 16 cases of intestinal tuberculosis with children, rare cases of extra pulmonary tuberculosis, the authors also present 2 cases with children whose differential diagnosis had to be made ou a histopathological base between tuberculosis with an abdominal lymphoma or peritonitic carcinomatosis. The results of the surgical treatment that made the diagnosis with the help of the histopathological examination and the tuberculostatic treatment were very good, the evolution and the control in true of all the patients, proving that intestinal tuberculosis extrapulmonary form with children can be cured.

[Errors and difficulties in the diagnosis and management of acute and chronic abdomen in children]. / Intre dificultati si confuzii de diagnostic în abdomenul acut si cronic la copil.

The authors are reviewing on a lot of 2844 cases between 1996 and 2000 the difficult problems of differential diagnosis between acute surgical abdomen in children and intestinal tuberculosis, abdominal tumors and inflammatory diseases such as acute osteomielitis. They are presenting 13 particular cases in which the acute abdomen diagnosis was difficult or even omitted.

[Bowel intussusception on the child: clinical therapeutical study]. / Invaginatia intestinala la copil. Studiu clinico-terapeutic.

Intussusceptions is the most common cause of bowel obstruction in children between 5 months and 1 year of age. Intussusceptions occurs when a portion of the bowel folds like a telescope, with one segment slipping inside another segment. This study refers to a group of 72 children, with intussusceptions diagnosis between 1975-2000 in our clinic. The authors are also analyzing these cases from the point of view of frequency on years, seasons, age, sex, residence, clinical forms, time since the intussusceptions occurred until the treatment begun.