Massive Dog Bite Injury of the Scalp in One-year Old Boy.

A one-year-old boy was referred to our Department of Pediatric Surgery with extensive scalp injury. He was bitten by a neighbour's mixed-breed dog. The wound of the forehead is primary closed while scalp is reimplanted. Due to non-acceptance on the eighth day a necrectomy of devitalized tissue was done. Before applying Integra®, for 2 days, the wound was treated with a V.A.C.® system. After 14 days, Integra® was accepted and split-thickness skin graft (STSG) was transplanted from left upper leg. After 3 months the local status is satisfactory. A hair transplant is planned in the future.

A 10-year experience in the treatment of intraabdominal cerebrospinal fluid pseudocysts.

The aim of this retrospective study was to assess a ten-year experience in the treatment of rare complications of ventriculoperitoneal shunting--intraabdominal cerebrospinal fluid pseudocysts. At this time there are no data about incidence, clinical course and treatment of these complications in Croatia. Cerebrospinal fluid (CSF) abdominal pseudocyst is an uncommon but important complication of ventriculoperitoneal shunts. Retrospective data were obtained from 5 children with abdominal CSF pseudocysts, treated between 1996 and 2007. The incidence of intraabdominal CSF pseudocysts in our study is 2.9%. All patients were girls ranged in age from 4 to 12 years old (mean 8.8 years). In most cases etiology of hydrocephalus was congenital, idiopathic. Abdominal pain and distension were the most frequent clinical finding (4/5). Although infection has been reported as responsible for pseudocyst formation, we did not found it in our series. Laparotomy with cyst wall excision and catheter replacement was performed in 2/5 cases, and only cyst fluid aspiration with catheter replacement in 3/5 cases. Recurrence of the abdominal cyst was observed in one girl who was in terminal stadium of anaplastic ependymoma. It is our opinion that only catheter replacement and cyst fluid evacuation, as one of the treatment modalities, may be successful, even in large CSF intraperitoneal pseudocysts.

Papillary cystic neoplasm of the pancreas: a rare presentation.

UNLABELLED: Papillary cystic neoplasm is a rare tumor and is usually found in young female patients. PROCEDURE: Here we describe a rare case of PCN in 16 year old girl, which was presented with abdominal pain in last 3 years. Preoperative diagnosis was suggested by ECHO and CT of the abdomen. The sonographic examination of the abdomen showed a tumor measuring 6.5 x 5.5cm in diameter in epigastrium. It was excised totally. Histological description confirmed the diagnosis of PCN. The patient is currently in good health without signs of relapse 3 years after surgery. DISCUSSION: Our patient is one of the very few adolescent patients with PCN who was treated successfully with surgery. ECHO and CT of the abdomen suggested the diagnosis which was confirmed by histopatological examination. CONCLUSION: The diagnosis of PCN is suspected by ECHO and CT of the abdomen and confirmed by specific histologic features. Prognosis is good and tumor should be excised whenever detected.

A 3-year experience of a minimally invasive technique for correction of pectus excavatum in Croatia.

The aim of this study was to assess the early results of a three-year experience with the minimally invasive correction of pectum excavatum, which requires no cartilage incision or excision, and no sternal osteotomy. Since 2001 we have performed 35 minimally invasive pectus excavatum procedures at our hospital. A convex steel bar is inserted under the sternum through small bilateral incisions, and removed after 2 years when permanent remolding had occured, the bar is removed. Complications were pneumothorax in 5 patients (only 1 required a thoracostomy tube, the other 4 resolved spontaneously), pneumonia in 3 patients, and bar displacement in 1 patient. The mean follow-up was 3 months to 3 years. Initial excellent results were maintained in 28 patients (normal postoperative chest), good results in 5patients (mild residual pectus) and poor in 2 patients (severe recurrence requiring further treatment). Poor results occurred because the steel bar was too soft in 1 patient, and the sternum too soft in 1 patient with Marfan's syndrome. Our early results with the minimally invesive technique without cartilage incision and resection or sternal osteotomy showed that the procedure is effective with excellent preliminary results.

Primary spontaneous pneumothorax in pediatric patients: our 7-year experience.

BACKGROUND: Primary spontaneous pneumothorax in children is a significant clinical problem. The majority of these patients will require immediate surgical therapy, such as tube thoracostomy. PATIENTS AND METHODS: We conducted a retrospective review of 16 patients with a diagnosis of primary spontaneous pneumothorax over a period of 7 years. RESULTS: In the last 7 years, we had 16 patients with spontaneous pneumothorax. Patient age ranged from 11 to 18 years (median, 15.4). We had 12 boys and 4 girls. Pneumothorax occurred on the right side in 9 patients, on the left side in 6 patients, and on both sides in 1 patient. The first choice of treatment was tube thoracostomy. The main symptoms were chest pain, shortness of breath, and cough. In all patients, we made X-ray and computed tomography scan. In 10 children, we detected apical bullas; in 2 patients, we found giant bullas in the lower part of the lung. In 4 patients, we did not find any pathologic signs on the lung. Two patients with spontaneous pneumothorax had tube drainage without recurrence. Eleven patients were operated on with video-assisted thoracoscopic surgery (VATS). Three patients were operated with open thoracotomy. Two of them had giant bullas, and 1 patient had recurrence after VATS. One patient had pneumothorax on both sides of the pleural cavity. DISCUSSION: VATS is an effective, safe method for spontaneous pneumothorax in children. In 11 children with pneumothorax, we made a wedge resection of the apical part of the lung with an endostapler device plus mechanical pleurodesis.