RESUMEN
Femur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children's Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Non-operative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods.
Asunto(s)
Fracturas del Fémur , Fijación Intramedular de Fracturas , Accidentes por Caídas , Niño , Preescolar , Fracturas del Fémur/epidemiología , Fracturas del Fémur/cirugía , Fémur , Fijación Interna de Fracturas , Humanos , Lactante , Recién Nacido , Estudios RetrospectivosRESUMEN
Abdominal aortic thrombosis is a rare entity in neonates and has mostly been associated with umbilical artery or cardiac catheterization. We present a complicated case of an otherwise healthy neonate who developed thrombosis of abdominal aorta with renal failure. Therapy with intravenous heparin was unsuccessful, and thrombolysis was contraindicated because of disseminated intravascular coagulation so we decided to perform open thrombectomy using the left retroperitoneal approach. The following day, thrombosis recurred in the same extent and despite high risk of bleeding Alteplase was eventually given, which resulted in recanalization of the aorta 6 hours later. Renal function recovered, dialysis was discontinued, and further course was uneventful. The treatment of abdominal aortic thrombosis in neonates should be considered on a case-by-case basis because the available data on the condition are limited to case report and series. If open thrombectomy is performed, retroperitoneal approach should be preferred because it allows for easy institution of peritoneal dialysis should the need arise.
Asunto(s)
Aorta Abdominal , Enfermedades de la Aorta/terapia , Fibrinolíticos/administración & dosificación , Trombectomía , Terapia Trombolítica , Trombosis/terapia , Activador de Tejido Plasminógeno/administración & dosificación , Administración Intravenosa , Anticoagulantes/administración & dosificación , Aorta Abdominal/diagnóstico por imagen , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Aortografía/métodos , Angiografía por Tomografía Computarizada , Heparina/administración & dosificación , Humanos , Recién Nacido , Masculino , Diálisis Peritoneal , Recurrencia , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/terapia , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Resultado del TratamientoRESUMEN
The purpose of this study was to compare the results of body temperature measurements obtained by standard axillary thermometers with the results of infrared tympanic and frontal skin thermometry in afebrile children. This study comprises a single-center, prospective comparison trial. A total of 345 afebrile children aged 4 to 16 years hospitalized in the pediatric surgery department for elective surgery were included. One thousand axillary, tympanic and frontal measurements were obtained and compared. We used two different infrared thermometers in this study; one type measured the tympanic temperature, the other the temperature on the forehead. The axillary temperature measured with the glass thermometer was set as the standard. Each patient was exposed to a constant environmental temperature for a minimum of 10 min before simultaneous temperature measurements. The mean-frontal temperature 36.9 ± 0.38 °C was equal to the axillary temperature 36.9 ± 0.16 °C. The mean tympanic temperature was 36.3 ± 0.98 °C. The mean difference between the tympanic and axillary temperatures was -0.4 °C. The tympanic temperature had a threefold greater dispersion than frontal and a fivefold greater dispersion than axillary temperature. The results of this study suggest that the axillary temperature measured with glass thermometer has the least dispersion. Somewhat less reliable is the frontal temperature measured with infrared thermometer. The least reliable is tympanic temperature measurement.
Asunto(s)
Temperatura Corporal/fisiología , Fiebre/diagnóstico , Fenómenos Fisiológicos de la Piel , Termografía , Termómetros , Adolescente , Axila , Niño , Preescolar , Investigación sobre la Eficacia Comparativa , Diseño de Equipo , Femenino , Frente , Humanos , Masculino , Estudios Prospectivos , Reproducibilidad de los Resultados , Termografía/instrumentación , Termografía/métodos , Termografía/normas , Membrana TimpánicaRESUMEN
Empyema, an accumulation of infected fluid in the thoracic cavity, is commonly secondary to bacterial pneumonia in children. Despite the high prevalence and availability of many medical treatment options, there is no general consensus on the optimal management approach, which would lead to full and rapid recovery. Especially, there are the big differences in treatment options for the child with empyema. Regardless of the differences in the procedures, the ultimate outcomes are good. This article reviews the current literature and discusses the important considerations in managing these patients. This paper describes thoracoscopic and open thoracic surgery procedures in children. The authors present their own observations based on years of experience in the treatment of thoracic empyema.
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Empiema Pleural/terapia , Niño , Empiema Pleural/diagnóstico , HumanosRESUMEN
Today's understanding of the pathophysiological mechanisms of delirium is still limited, but there are several promising hypotheses. It is believed that biomarkers sensitive to death of neurons or glial cells indicate delirium. Several neurotransmitters are considered to be involved in the state of delirium, with greatest emphasis on acetylcholine and dopamine acting in opposite ways; acetylcholine reduces, while dopamine increases neuron excitability. Other neurotransmitters that probably play a role in the pathogenesis of delirium are GABA, glutamate and monoamines. Sepsis leading to systemic inflammatory response syndrome often presents with delirium and perhaps is the most common causal factor for delirium in intensive care unit; sedatives and analgesics are also common iatrogenic risk factors. Patients receiving benzodiazepines are more likely to have postoperative delirium than those who do not. Postoperative cognitive changes are more common in older than in younger patients, and they can be categorized as postoperative delirium, postoperative cognitive dysfunction and dementia. The mechanisms responsible for postoperative cognitive changes are not fully understood, but it is certain that they are multifactorial. Risk factors may be associated with patient characteristics, type of surgery and type of anesthesia.
Asunto(s)
Delirio/fisiopatología , Biomarcadores/análisis , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/fisiopatología , Delirio/diagnóstico , Delirio/etiología , Humanos , Unidades de Cuidados Intensivos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/psicologíaRESUMEN
Capillary hemangiomas of the testis are extremly rare tumors. We reported a case of intratesticular hemangioma, unusually localisation of this vascular benign neoplasm. The patient was 12 year old boy, with hydrocele and a palpabile testicular mass. Scrotal sonography revealed varicocele and hydrocele in the left scrotal sac. There was a solid hypoechogenic zone 5 mm in diameter in the left testis. Tumor markers like serum level of beta human chorionic gonadotropin and alpha fetoprotein were normal. The patient underwent surgery, and intraoperativ frozen section showed a capillary hemangioma. The lesion was completly removed, but testis was preserved. Accordingly tu the literature, tumors of vascular origin are extremly rare. Capillary hemangiomas of the testis are similarity to malignant testicular solid tumors during physical examination, ultrasound examination and MR imaging. Before operation, it's hardly differentiate tumors of testis, but intraoperativ frozen section cuold be helpfull to differentiate a hemangioma from other testicular mass. Hemangioma is benign, but lesion must be complete removed to avoid recurence. In cases capillarx hemangimas, tumor enucleation with preservation tissue of the testis is possible if intraoperative frozen section examination can be performed.
Asunto(s)
Hemangioma Capilar/diagnóstico , Neoplasias Testiculares/diagnóstico , Niño , Hemangioma Capilar/patología , Hemangioma Capilar/cirugía , Humanos , Masculino , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugíaRESUMEN
Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length between treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods.
Asunto(s)
Fracturas de la Tibia/cirugía , Adolescente , Niño , Preescolar , Femenino , Fijación de Fractura , Fijación Intramedular de Fracturas , Fracturas Abiertas/cirugía , Humanos , Lactante , MasculinoRESUMEN
Thyroid gland diseases are the most common endocrinopathies in children. Vast majority of these conditions are treated with medical therapy but in individualised cases surgery is indicated. Decision about surgical treatment is made in cooperation of pediatric endocrinologist and surgeon, treatment options depend on the nature of the disease while the extent of surgical procedure is determined by the pathological changes present in the gland. In this paper we represent the results of surgical treatment of 41 children at our department from 1991 to 2009 and current trends in surgical treatement of thyroid gland diseases.
Asunto(s)
Bocio Nodular/cirugía , Enfermedad de Graves/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adolescente , Niño , Preescolar , Femenino , Humanos , MasculinoRESUMEN
Congenital hyperinsulinism (CHI) is a major cause of persistent hypoglycemia in the neonatal and early infancy periods. Althought the disease is relatively rare with incidence of about 1:25 000-50 000 live births, the importance of the disease should not be underestimated. Namely, prompt recognition and management of patients with CHI is essential, if permanent neurological impairment is to be avoided. CHI is caused by mutations in one of the 7 genes involved in the regulation of insulin secretion in pancreatic beta-cells. It is important to introduce specific medical therapy as soon as diagnosis is established. Severe, neonatal forms of CHI are often resistant to medications, thus they require surgical procedure. The preoperative genetic testing and scintigraphy are indicated to distinguish histological subtypes of the disease (focal vs. diffuse CHI). Patients with focal disease are usually cured after pancreatic resection, while diffuse disease has much worse prognosis. This manuscript offers novel insights into CHI and emphasizes the role of early diagnosis as crucial for succesful treatment that was recently enriched with novel options.
Asunto(s)
Hiperinsulinismo Congénito , Hiperinsulinismo Congénito/diagnóstico , Hiperinsulinismo Congénito/genética , Hiperinsulinismo Congénito/terapia , Humanos , Recién NacidoRESUMEN
Supracondylar fractures of humerus are the most common fractures in children. The management of severely displaced, unstable fractures of the humerus in children continues to be controversial. We undertook a retrospective study of 48 children with displaced supracondylar fractures (8 were treated with plaster and 40 with cross percutaneous Kirschner wire pinning). Only three children were treated with open reduction and percutaneous cross-pin fixation. Clinical outcome was evaluated by loss of elbow motion and change of carrying angle. According to Flynn s criteria, results were good or excellent in 93.7% patients. The cubitus varus is the most frequent long-term complication (16.7%). Closed reduction with percutaneous pin fixation is believed to represent a safe, reliable, and efficient method of managing displaced supracondylar fractures.
Asunto(s)
Fijación Interna de Fracturas , Fracturas del Húmero/cirugía , Niño , Femenino , Fijación Interna de Fracturas/efectos adversos , Curación de Fractura , Humanos , Fracturas del Húmero/diagnóstico por imagen , Masculino , RadiografíaRESUMEN
Gastric perforation (GP) in neonates is a rare entity with high mortality. Although the etiology is not completely understood, it mostly occurs in premature neonates on assisted ventilation. Combination of duodenal atresia and gastric perforation is very rare. We present a case duodenal atresia who developed gastric perforation after operetion for duodenal atresia. Analysis of the patient medical record and histology report did not reveal the etiology of the perforation.
RESUMEN
BACKGROUND: Elastic-stable intramedullary nailing (ESIN), is an accepted method for stabilization of unstable forearm shaft fractures in children. This study analyzed the radiographic and functional outcomes of intramedullary nailing of forearm diaphyseal fractures in children. MATERIALS AND METHODS: A retrospective analysis was performed of children with forearm shaft fractures and open epiphyseal plates, treated with ESIN between 2000 and 2012 in our institution. Evaluation of cases was conducted minimum 14 months after osteosynthesis. Clinical results were evaluated according to the criteria developed by Price et al. and Flynn et al. RESULTS: The study included 88 (42 boys) children. The average age of children at day injury was 10.5 ± 2.59 years (range 4-16), and at the review clinic was 13.4 ± 1.85 years (range 7-18). Forty six (52.3 %) had right forearm and 42 (47.7%) had left fracture respectively. Open reduction was required in 20 (22.7%) children. Primarily surgically were treated 62 (70.5%) children and 26 (29.5%) were operated as a second procedure after failed conservative management. There was one delayed union. Rotational forearm restriction with values between 11 and 20 degrees was present in nine children. Six children developed radial nerve hypoesthesia which eventually resolved with time. After removal of the implant one child sustained a re-fracture. The overall complication rate was 25%. Complete recovery to the original condition was noted in 76 (86.4%) children, eleven children (12.5%) had good and only one (1.1%) had poor outcome. CONCLUSION: Our study suggests that ESIN osteosynthesis for diaphyseal forearm fractures remains a valid technique with very good functional results.
Asunto(s)
Diáfisis/cirugía , Traumatismos del Antebrazo/cirugía , Fijación Intramedular de Fracturas/métodos , Fracturas Óseas/cirugía , Adolescente , Clavos Ortopédicos , Niño , Preescolar , Diáfisis/diagnóstico por imagen , Femenino , Traumatismos del Antebrazo/diagnóstico por imagen , Humanos , Masculino , Traumatismo Múltiple/cirugía , Radiografía , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Proteínas Morfogenéticas Óseas/administración & dosificación , Proteínas Morfogenéticas Óseas/efectos adversos , Vértebras Cervicales/cirugía , Trastornos de Deglución/inducido químicamente , Discectomía/métodos , Edema/inducido químicamente , Cetonas , Polietilenglicoles , Complicaciones Posoperatorias/inducido químicamente , Prótesis e Implantes , Seudoartrosis/prevención & control , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Fusión Vertebral/métodos , Titanio , Factor de Crecimiento Transformador beta/administración & dosificación , Factor de Crecimiento Transformador beta/efectos adversos , Femenino , Humanos , MasculinoRESUMEN
Intestinal duplications are rare congenital anomalies, and most of them are detected in the first 2 years of life or antenatally. The clinical presentation depends on location, size, and the presence of ectopic gastric mucosa. Ultrasound scans during pregnancy result in a higher rate of antenatally detected duplications which allows early treatment and avoidance of possible complications. Resection of the duplication without adjacent bowel should be the treatment of choice. En bloc resection or partial excision with mucosectomy is advised in some cases. We present our experience with 6 patients treated in our institution from February 2002 to October 2005.