Differential expression of ABH histo-blood group antigens and LAMPs in infantile hemangioma.

Although infantile hemangioma (IH) are the most common tumors of infancy, the mechanism of their proliferation and involution remains vague. Proliferation, differentiation and death of endothelial cells are the basic processes involved in their pathobiology. Here we hypothesize that the glycoconjugates ABH histo-blood group antigens (HBGA) and lysosome-associated membrane proteins (LAMPs) might be implied in both the differentiation and death of endothelial cells during vascular remodeling in IH. Proliferating and involuting IH were examined immunohistochemically for HGBA and LAMP expression together with vWF and CD31. Proliferative and apoptotic indices were determined. LAMPs were found in immature endothelium of proliferating IH. In involution an increased number of immunopositive cells stained with higher intensity was detected. The enhanced expression might be associated with augmented autophagy required for tissue remodeling during tumor involution. HBGA presented an opposite pattern of expression--they stained intensely the endothelium of mature capillaries, while the immature ones were positive for vWF. The presence of HBGA in endothelial cells of IH may be related to the differentiation process only, as well as to endothelial adhesion and angiogenesis. Novel evidence for differential expression of HBGA and LAMPs in proliferative and involutive phases of IH is presented.

Hydatid bone disease: a case report and review of the literature.

Hydatid disease may develop in almost any part of the body and can be identified with a combination of clinical history, imaging findings, and serologic results; however, the diagnosis of bone hydatidosis is primarily based on radiographic findings. Bone hydatid disease is often asymptomatic, and its diagnosis is usually made at an advanced stage when lesions have become extensive. We present a case of a 45-year-old woman who was admitted to the University Hospital, Stara Zagora, Bulgaria complaining of pain in her left tibia. Radiographs revealed an oval cyst with a diameter of 3.5 cm, located in the diaphyseal part of the tibia. The cyst was excised, and no recurrence was observed on follow-up. Functional outcome was excellent.

CIRCULAR EXCISION AND "PURSE-STRING" TECHNIQUE IN SURGICAL TREATMENT OF HEMANGIOMAS.

UNLABELLED: Hemangiomas are the most common benign vascular lesions in childhood. Surgical removal of hemangiomas in childhood is usually delayed till intralesional blood flow spontaneously decreases, but the fibroadipose tissue and atrophic skin remain even after general involution. The aim of our study is to provide such a technique and method that can redistribute the tension around the defect after the excision and achieve complete and simple closure. METHODS AND MATERIALS: Six children with hemangiomas of different size and location on the face underwent circular excision of the defects and subsequent closure using the "purse-string" method. RESULTS: All skin defects were completely closed without subsequent complications requiring reoperations. No deformation occurred in the nearby tissues and the final aesthetic appearance of the scar was excellent. CONCLUSION: Circular excision combined with a "purse-string" technique is an effective method of achieving complete closure of the skin defect with excellent results.

Histochemical study on hemangiomas in childhood.

The study was carried out on a material obtained by a biopsy from 18 children having different types of hemangiomas (capillary, cavernous and combined). Histochemical reactions were applied for the following enzymes: Succenatedehydrogenase (SDH), lactatdehydrogenase (LDH), cytochromoxidase, acid phosphatase, alkaline phosphatase and paraspecific esterases. Differently reduced activity of the succenatedehydrogenase and the cytochromoxidase in the endothelial cells and the pericytes was established. A reduced enzyme activity was observed also in a large part of the cases of acid phosphatase. The activity of the alkaline phosphatase and paraspecific esterases was greatly increased. Based on their observations the authors relate the hemangiomas to the tumour formations with a good prognosis.

Ultrastructural study of hemangiomas in children.

An electron microscopic study was carried out of different kinds of hemangiomas (capillary, cavernous and combined) in 18 children at the age of two months up to one year. Centers of differently expressed proliferation both of the endothelial cells and pericytes were found. The proliferation was most distinctly expressed in the capillary and cavernous hemangiomas. At the later stages, regressive and involutive changes, presented better in the capillary hemangiomas, were observed. The authors consider that hemangiomas, irrespective of their active cell growth, are tumours with a good prognosis.

On combination treatment of hemangiomas in childhood.

We present 18 children with torso hemangiomas of predominant facial location in whom a combination treatment was used because of the rapid infiltrative growth, critical location and extent of the hemangiomas. The combinations of treatments used were: surgery plus sclerotherapy in three of the children; surgery plus corticosteroids--in three children; surgery plus cryotherapy in one; surgery, hormonal treatment and cryotherapy in one child; cryotherapy plus sclerotherapy in five children; cryotherapy plus hormonal treatment in two, beta-therapy and cryotherapy in three children. We assess the results of the treatments and discuss in details the combined treatment of giant hemangiomas in five children.

Peptic esophageal stricture in children.

INTRODUCTION: Peptic esophageal stricture as a complication of gastroesophageal reflux disease (GERD) occurs in 5% of the affected children. MATERIAL AND METHODS: Case histories of 6 children treated successfully in the Department of Pediatrics and Clinic of Pediatric Surgery were studied. The diagnosis in each case was based on clinical symptoms (vomiting leading to hypothrophy, hematemesis, and anemia), and esophagoscopy, esophageal pH-metry (according to ESPGAN recommendations), and contrast X-ray examination. After evaluation medical treatment was applied in 3 and bougienage with a hard bougie in 6 patients. Because of failure of this treatment Nissen fundoplication and postoperative bougienage were performed in all patients. RESULTS: In all surgically treated patients complete recovery without postoperative complications was achieved. DISCUSSION: The authors give interpretation of the pathogenesis and outline the primary symptoms of the disease. Terms of performance and reliability of the instrumental methods of diagnosing are discussed. The experience in treatment of peptic esophageal stricture in children is presented. CONCLUSIONS: Medical treatment combined with bougienage yields poor results in peptic esophageal stricture and Nissen fundoplication appears to be the treatment of choice.

Treatment of congenital lung cysts in childhood.

Congenital lung cysts are congenital anomaly of the trachea-bronchial tree, known as "bronchogenic" cysts. In this research study, the staff of the Department of Pediatric surgery - UMHAT "St.George" - Plovdiv, shares its experience in the treatment of four children with congenital bronchogenic cysts. Methods and ways of treatment are revealed precisely, also including other alternatives of surgical treatment. Thoracotomy and cystectomy are the methods of choice, while the Seldinger puncture of the cyst under ultrosonography control has been used in the case of one child. Results and outcome of the treatment are discussed.

Advantages and disadvantages of Seldniger transthoracic drainage in purulent-destructive diseases of the lung and pleura in childhood.

BACKGROUND: Suppurative-destructive diseases of the lung and pleura are prevalent kind of diseases occurring in children. They represent 9.1% of thoracic surgical diseases in this age. In such diseases, the pleural drainage is the most commonly used at present time. One of the methods is the transthoracic drainage by Seldinger. MATERIAL AND METHODS: Over the period of 13 years (2000-2012), 101 children with different forms of acute purulent destructive processes of the lung and pleura were treated in the Department of Pediatric Surgery of the University Hospital "St. George "- Plovdiv. We used percutaneous (transthoracic) drainage (Seldinger method) in the case of three children with lung abscess complicated pleuropneumonia with empyema. RESULTS: We achieved positive effect in treatment with all three children, without introducing additional operating procedures. CONCLUSION: There is still no consensus regarding the surgical treatment of various forms of acute suppurative-destructive diseases of the lungs and pleura (ASDDLP). Some authors attach great importance to the puncture method of treating ASDDLP, whilst they recommend the application of another treatment in case of failure.

Treatment of pediatric wounds with vacuum assited technology.

Vacuum Assisted Therapy (VAC) is a new technic in treatment of acute and chronic wounds. This new way of treatment is widely used in the late decades due to the good results. The authors present five cases with different types of wounds, successfully treated with VAC therapy. This method is proposed because of short time of treatment and value reduction. Each surgical team should be acquainted with VAC therapy method. Their experience and results will contribute to the pediatric wounds treatment.

USAGE OF VACUUM ASSISTED TECHNOLOGY IN A NEWBORN WITH OMPHALOCELE.

Omphalocele is a congenital abdominal wall defect. The treatment is surgical on one or multiple stages for the giant forms of the anomaly. It is a challenge for the pediatric surgeons while omphalocele is a giant one and it is impossible to insert all the organs in the abdominal cavity. The treatment and the hospitalization of the child are quite long. The authors present a case--a newborn with a omphalocele and share their experience. This method gives good results, shorten the treatment and the stay in hospital.

[A combined posterior sagittal and transabdominal approach for the treatment of children with high type of anal atresia].

The authors present 7 cases (4 girls and 3 boys) with a high type of imperforate anus. Combined posterior sagittal and transabdominal approach was applied. In all 7 cases the height of the malformation, determined by x-ray and ultrasonography was more than 30 mm. One stage surgical procedure, without colostomy, was applied in two of the cases. One child was treated by a two stage and the other four by a three stage operation. The operation is described and the postoperative complications and the results are discussed.