Epidemiology and structure of congenital anomalies of the newborns in the region of Novi Sad (Vojvodina, Serbia) in 1996 and 2006.

BACKGROUND/AIM: According to the World Health Organization (WHO) definition, congenital anomalies are all disorders of the organs or tissues, regardless of whether they are visible at birth or manifest in life, and are registered in the International Classification of Diseases. The aim of this study was to compare the incidence and structure of prenatally detected and clinically manifested congenital anomalies in the newborns in the region of Novi Sad (Province of Vojvodina, Serbia) in the two distant years (1996 and 2006). METHODS: This retrospective cohort study included all the children born at the Clinic for Gynecology and Obstetrics (Clinical Center of Vojvodina) in Novi Sad during 1996 and 2006. The incidence and the structure of congenital anomalies were analyzed. RESULTS: During 1996 there were 6,099 births and major congenital anomalies were found in 215 infants, representing 3.5%. In 2006 there were 6,628 births and major congenital anomalies were noted in 201 newborns, which is 3%. During 1996 there were more children with anomalies of musculoskeletal system, urogenital tract, with anomalies of the central nervous system and chromosomal abnormalities. During the year 2006 there were more children with cardiovascular anomalies, followed by urogenital anomalies, with significant decline in musculoskeletal anomalies. The distribution of the newborns with major congenital anomalies, regarding perinatal outcome, showed the difference between the studied years. In 2006 the increasing number of children required further investigation and treatment. CONCLUSIONS: There is no national registry of congenital anomalies in Serbia so the aim of this study was to enlight this topic. In the span of ten years, covering the period of the NATO campaign in Novi Sad and Serbia, the frequency of major congenital anomalies in the newborns was not increased. The most frequent anomalies observed during both years implied the musculosketelal, cardiovascular, urogenital and central nervous system. In the year 2006 there was a significant eruption of cardiovascular anomalies and a significant decrease of musculoskeletal anomalies, chromosomal abnormalities and central nervous system anomalies, while the number of urogenital anomalies declined compared to the year 1996.

CHRONICLE OF THE "ANGLO-YUGOSLAV CHILDREN'S HOSPITAL" IN SREMSKA KAMENICA.

As a peacetime work of Katherine S. Macphail (Glasgow, 1887- St.Andrews, 1974) MB ChB (Bachelor of Medicine and Surgery), the Anglo-Serbian Children's Hospital in Belgrade was established after World War I, and the English-Yugoslav Children's Hospital for Treatment of Osteoarticular Tuberculosis was founded in Sremska Kamenica in 1934. Situated on the Fruska Gora slope, the hospital-sanatorium was a well-equipped medical institution with an operating theatre and x-ray machine providing very advanced therapy, comparable to those in Switzerland and England: aero and heliotherapy, good quality nourishment, etc. In addition, school lessons were organized as well as several types of handwork as the work-therapy. It was a privately owned hospital but almost all the children were treated free of cost. The age for admission was up to 14. During the period from 1934 to 1937, around 458 children underwent hospital treatment, most of them with successful results. During the war years the Sanatorium was closed but after the war it was reactivated. In 1948 by the act of final nationalization of all medical institutions in the communist Yugoslavia, the hospital was transformed into a ward of orthopedic surgery under the supervision of the referent departments in Belgrade and Novi Sad. Today, hospital is out of work and deprived of its humanitarian mission. The building is neglected and in ruins although it has been proclaimed the national treasure by the Regional Institute for Protection of Monuments of Culture.

Burns treatment in ancient times.

Discovery of fire at the dawn of prehistoric time brought not only the benefits to human beings offering the light and heat, but also misfortune due to burns; and that was the beginning of burns treatment. Egyptian doctors made medicines from plants, animal products and minerals, which they combined with magic and religious procedures. The earliest records described burns dressings with milk from mothers of male babies. Goddess Isis was called upon to help. Some remedies and procedures proved so successful that their application continued for centuries. The Edwin Smith papyrus (1500 BC) mentioned the treatment of burns with honey and grease. Ebers Papyrus (1500 BC) contains descriptions of application of mud, excrement, oil and plant extracts. They also used honey, Aloe and tannic acid to heal burns. Ancient Egyptians did not know about microorganisms but they knew that honey, moldy bread and copper salts could prevent infections from dirt in burns healing. Thyme, opium and belladona were used for pain relief. In the 4th century BC, Hippocrates recorded that Greek and Roman doctors used rendered pig fat, resin and bitumen to treat burns. Mixture of honey and bran, or lotion of wine and myrrh were used by Celsus. Honey was also known in Ayurveda (Indian medicine) time. Ayurvedic records Characa and Sushruta included honey in their dressing aids to purify sores and promote the healing. Burn treatment in Chinese medicine was traditional. It was a compilation of philosophy, knowledge and herbal medicine. The successful treatment of burns started in recent time and it has been made possible by better knowledge of the pathophysiology of thermal injuries and their consequences, medical technology advances and improved surgical techniques.

[Reminiscence on the municipal out-of-hospital maternity unit and the motherhood home in Novi Sad].

INTRODUCTION: In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. OUT-OF-HOSPITAL MATERNITY UNIT: One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women's health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. MOTHERHOOD HOME: After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children's health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. EPILOGUE: The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.

Ectopic adrenocortical tissue: an incidental finding during inguinal surgery in children.

Adrenal rests are usually unrecognized during operation, and the incidence of ectopic adrenal cortical tissue in pediatric patients during inguinal surgery procedures is unknown. We performed 3028 groin surgical explorations in 2680 patients aged 1 month to 17 years. Ectopic adrenal tissue was found in 69 inguinal operations (2.2%): 37 during 1.524 orchiopexy (2.4%), 23 during 1.115 herniectomy (2.0%), and 9 during 389 hydrocoela operation (2.3%). Statistically there were no significant differences among those three groups. No adrenal rests were detected in females. Although a few reported cases with hormonal activity of ectopic adrenocortical tissue (EACT), the recommendation is to remove them if found.

[Prepuce in boys and adolescents: what when, and how?].

INTRODUCTION: The prepuce envelops the glans as a variant of a mucocutaneous tissue presenting with a lot offunctions, the most important of them being to protect the infant's glans from feces and ammonia in diapers, to protect the glans from abrasions and trauma throughout life, and to provide sufficient skin in erection. Circumcision was recognized as a method of solving foreskin problems a long time before Christ. Practicing male circumcision in history was customary several thousand years ago and has spread worldwide. Today it depends on races, and it is often an initiation ceremony near the age of puberty. In everyday practice in pediatric urology outpatient department the foreskin problems have been noticed as a phimosis in 9.91% cases and prepuce adhesions in 3.98%. Congenital anomalies are present in different numbers. Other problems, such as paraphimosis, balanoposthitis, are recorded as accidental cases. Over-all prepuce pathology can be observed in 12%-25% of patients. The article presents a review of foreskin conditions, clinical manifestation, therapy and arguments for patient's benefits. CLINICAL PRESENTATION: The term phimnosis describes a foreskin that is unable to retract. It is necessary to distinguish normal anatomic situation in neonate and infantile period, when prepuce has not been separated yet from true pathologic phimosis due to fibrosis and sclerosis. Up to six years of age the tip of the prepuce is elastic and might be retracted by gentle manipulations. In cases when the foreskin is trapped behind the glans penis and cannot be pulled back to normal position, paraphimosis is present and can be treated as a medical emergency by manual manipulation, or by dorsal slit (incision). Many studies have demonstrated that frequency of urinary tract infection increases in uncircumcised males and that is a reason for routine circumcision. The others are against routine circumcision. The contraindications are newborns, especially prematurely born. and congenital penile anomalies. Condition in which the frenulunm of penis is short with consequent restriction of movement of the prepuce can be easily treated by frenulotomy. Hooded prepuce is a condition of incomplete circumferential formation of foreskin with a dorsal component present and ventral component absent. In cases without any penile anomalies this is only a cosmetically unattractive appearance and could be corrected by circumcision. Infection of the foreskin due to bacterial colonization could be both prevented and treated easily However, an infection due to peno-preputial incisions in adolescent age is serious and has to be cured promptly. CONCLUSION: As a part of external genitalia, the foreskin has a lot of functions. Despite its natural role many advocates routine circumcision due to problematic condition that can develop. Routine circumcision is not generally recommended. Improved education for physicians and parents with regard to the foreskin development and management is required.

[Historical review of congenital foot deformity treatment].

INTRODUCTION: There is still no good solution for the treatment of all the forms of clubfoot. HISTORY OF THE TREATMENT IN THE WORLD: The first written description of the treatment of this deformity was given by Hippocrates. In the Middle Ages, Galenus, Celsus and Averroe only reviewed the lessons of Hippocrates's principles. The first description of orthopedic prosthetic for the treatment of clubfoot was published in "Opera Chirurgica" by Amboise Peréa in 1575. In 1796, Bruckner wrote the first monography about clubfoot. The biggest contribution to the modern way of treating clubfoot was given by Abel Mix Phelebs, who described the medial "release" in 1890. Since 1980 an advantage has been given to early non-operative treatment. The progressive operative approach (use of "release procedures") was introduced. THE HISTORY OF TREATMENT IN OUR COUNTRY: The first procedures were performed by D. Jovcic and S. Stojanovic in Belgrade in 1937. In the period from 1960 to 1970, more and more orthopedic and pediatric surgeons became interested in clubfoot treatment. In 1970 one of the main topics of the 5th Congress of Orthopedics and Traumatology in Belgrade was "Foot Surgery". Many specialists from Belgrade were engaged in clubfoot treatment: D. Rakic, S. Rajic, S. Popovic, L. Stojanovic among pediatricians, and B. Radulovic, P. Klisic among orthopedic surgeons, as well as R. Brdar, Z. Vukasinovic and G. Cobeljic with their assistants. In Novi Sad, in 1967, D. Pajic began diagnosis and treatment of clubfoot. Very soon D. Pajic became a symbol of clubfoot treatment followed by hardworking assistants L. Petkovic and V. Tomasevic. CONCLUSION: The treatment of clubfoot is still controversial and continues to be one of the most interesting fields in pediatric orthopedics.

Accessory scrotum attached to a peduncular perineal lipoma.

In this study, we report on the case of a newborn boy diagnosed after birth with an accessory scrotum attached to a peduncular type of perineal lipoma without any other associated congenital anomalies. The neonate underwent a simple surgical excision of the lipoma and accessory scrotum in the first month of life, and his postoperative course was uneventful. Histologic examination revealed normal scrotal skin and adipose tissue. Accessory scrotum has a high incidence of association with perineal lipoma (83% of reported cases) and other urogenital and anorectal anomalies, but urogenital or anorectal anomalies were not seen in our patient.

Varicocele in adolescents.

Varicocele is the condition of abnormal venous dilatation of the pampiniform venous system presented at the upper pole of the testicle, sometimes associated with intratesticular varices. Dominantly presented on the left testicle, it is rarely noted on the right one or bilaterally. According to one interpretation, higher incidence in puberty can be accounted for by testicular blood flow increase in the testicular veins. Whatever the primary etiological factor may be, venous hypertension in the venous cord due to renospermatic venous reflux is a constant feature and is responsible for different pathological changes which occur in both the cord veins and the testicle. Vein congestion and heat exchange disturb and increase scrotal temperature having a negative effect on spermatogenesis and also induce irregular apoptosis in germ cells. Recently, reactive oxygen species production in association with decreased antioxidant capacity have been put under suspicion of deteriorating spermatogenesis. Varicoceles in adolescents are usually asymptomatic and the diagnosis is most frequently made according to the typical appearance by the routine annual school physical examination. Ultrasonography and Doppler mode are the most practical and non- invasive examinations. Semen analysis is possible three years after the onset of puberty when semen parameters reach adult values. Deterioration of spermatogenesis and infertility in adults could be accepted as a distant complication of adolescent varicocele. Many agree that indications for surgical intervention in adolescent are: pain, large varicoceles, hypotrophy of the involved testicle, bilateral varicocele, intratesticular varicocele and patients with abnormal semen parameters on serial evaluation. The ideal method for treating adolescent varicocele still remains controversial, but the main task is to decrease the number of recurrences and complications, while retaining optimum testicular function. Because of that, many surgeons respect the attitude "catch up growth".

[The use of peritoneal dialysis in newborns].

INTRODUCTION: Acute renal failure is a common complication in critically ill newborn infants. The therapy of acute renal failure is conservative and etiological. Patients not responding to this kind of therapy require peritoneal dialysis. MATERIAL AND METHODS: This retrospective study included 6 newborn infants undergoing peritoneal dialysis during the period from January 2004 to June 2006, at the Nephrology Department of the Institute of Child and Youth Health Care in Novi Sad. All patients presented with complications of acute renal failure including hypercalemia and uremic encephalopathy. RESULTS: Complete restoration of kidney function was evident in four patients on peritoneal dialysis. Three patients are still alive, but in one patient acute renal failure progressed to chronic renal failure. One patient died in the third month of life due to multiple organ dysfunction, after just two days of dialysis. Several complications were reported: intra-abdominal hemorrhage, dialysate leakage, peritonitis and dialysis catheter obstruction. DISCUSSION: Periotoneal dialysis catheter placement is a great problem due to the size of the newborn. If it is estimated that it will be a long-lasting dialysis, Tenckhoff catheter is recommended. In very low birth weight newborn infants, in poor overall condition, general anesthesia is too risky, and acute peritoneal dialysis catheter should be placed (i.v. cannula, venous catheter). CONCLUSION: Peritoneal dialysis is the method of choice in newborns with acute renal failure, and it is used in the treatment of neonatal asphyxia till the restoration of kidney function is achieved.

[Constipation--a common problem in childhood].

INTRODUCTION: Constipation in children is defined as the infrequent and difficult passage of hard stool, not necessarily associated with in-frequent stools. All healthy newborns have their first stool within the first 24 to 48 hours after birth. Intestinal transit time increases with age, therapy decreasing the frequency of stooling. ANATOMY AND PHYSIOLOGY OF ANUS AND RECTUM: Acquisition of fecal continence requires: normal internal and external anal sphincters, puborectal muscle as well as intact sensory input from both the rectal vault and anal canal. ETIOLOGY AND DIFFERENTIAL DIAGNOSIS: During the first year of life, failure to have bowel movement every other day warrants evaluation. During infancy, constipation is usually due to dietary manipulations, malnutrition or some other functional abnormalities. Anatomic causes are found only in 5% of patients. DIAGNOSIS AND THERAPY: Diagnosis relies on history and physical examination. Digital rectal examination usually reveals a shorter anal canal with decreased sphincter tone. The rectal ampulla is dilated and filled with stool. Anorectal manometry is helpful in differentiating functional constipation from aganglionosis or other neurologic problems. Treatment varies depending on the underlying cause. Bowel retraining, aimed at establishing regular daily bowel movement, is of utmost importance in children. The response to treatment is usually dramatic. CONCLUSION: Constipation in children causes anxiety in the family and successful treatment requires persistent reassurance and repeted reevaluation.

[Clinical evaluation of fecal continence after posterior sagittal anorectoplasty in anorectal abnormalities]. / Klinicka procena fekalne kontinencije nakon posteriorne sagitalne anorektoplastike kod anorektalnih anomalija.

INTRODUCTION: Posterior sagittal anorectoplasty (PSARP) was introduced in 1982, by Pena and de Vries, as a new surgical procedure for patients with anorectal malformations. It was supposed to provide better chance for normal fecal continence. MATERIAL AND METHODS: Between 1991 and 2000, 50 patients with anorectal abnormalities underwent PSARP. In 43 patients PSARP was primary operation and in 7 it was a secondary procedure. At the time of study patients were not younger than 3, and not older than 13 years. Patients and their parents were interviewed, and fecal continence was graded as follows: voluntary bowel contractions, soiling less than once a week, soiling more than once a week, daily soiling and constipation. RESULTS: Amongst patients who underwent primary surgical correction, 74% had voluntary bowel contractions. Babies with perineal fistula, rectal atresia and stenosis presented with best results in term of voluntary bowel contractions (100%), as with vestibular fistula, ten of eleven patients. Only 18% of patients (atresia without fistula, vestibular fistula and bulbourethral fistula) had soiling. Patients with perineal fistula and rectal atresia and stenosis 40% were totally continent (voluntary bowel movements without soiling). The most frequent sequel was constipation, which appeared in 48%, without coincidence with frequency of soiling. The problem of constipation was surprisingly more frequent in patients with expected better prognosis in fecal continence. CONCLUSION: Although PSARP offers a good esthetic result, only two third of patients have voluntary bowel movements and in about half there exists a problem with constipation, with necessary further treatment.

[External genital abnormalities in male schoolchildren: an epidemiological study]. / Ucestalost anomalija spolgasnjih genitalija kod decaka skolskog uzrasta.

INTRODUCTION: External genital abnormalities represent the most common congenital anomalies. Proper, not delayed diagnosis and treatment of certain abnormalities (undescended testis, hypospadia, varicocele) is of great importance for future fertility potential of children. MATERIAL AND METHODS: An epidemiological study, that consisted of an urological checkup, was performed among school-aged boys in two elementary schools. Prevalence of external genital, and inguinal region was examined. RESULTS: A total of 1229 elementary school boys were examined. The incidence of external genital abnomalities was 27.8%. Certain anomalies were already surgically treated in 7.8% of boys. Phimosis wasfound in 66 patients (5,5%), which represents 26.6% of all abnomalities. DISCUSSION: In this study the incidence of undescended testis was 2.0%. Although it is similar to literature data, the fact that undescended testis was found in 25 boys older than 7 years (two of them 15 years old!) suggests that the primary health care is not satisfactory. The incidence of inguinal hernia and hydrocele varies according to different authors from 0.8-4.4% to 13.44%. In this study the incidence was 2.4%. Varicocele represents a developmental anomaly and the incidence is increasing with age. It is rare in boys up to 10 years of age, but the incidence of varicocele in boys aged 15 years (15.8%) reaches the level of incidence in adults (19.82%). The incidence of phimosis in this study was 5.5%. CONCLUSION: High incidence of external genital abnormalities in school aged boys suggests a need for further education of physicians in primary health care services as well as of parents.

[Possibilities of endoscopic treatment of primary vesicoureteral reflux]. / Mogucnosti endoskopske korekcije primarnog vezikoureteralnog refluksa.

INTRODUCTION: Vesicoureteral reflux, urinary infection and pyelonephritic scarring represent a well known triad in pediatric practice that may lead to severe scarring of kidneys, and development of so called reflux nephropathy. Apart from standard therapeutic options (conservative treatment and surgical therapy), endoscopic correction of refluxing vesicoureteral junction has been introduced into clinical practice. MATERIAL AND METHODS: This study included endoscopically treated patients with primary vesicoureteral reflux over a 9-year period, as well as certain clinical parameters. RESULTS: Endoscopic correction of primary vesicoureteral reflux with teflon paste has been successful in up to 93.5% of patients. After one application vesicoureteral reflux disappeared in 58.8% of cases. After two applications 86.0% of ureters were cured, whereas the third application had no further effect on existing reflux. Improvement with spontaneous regression of reflux was established in 7.5% of treated ureters. DISCUSSION: Endoscopic correction should be performed in all patients with third grade vesicoureteral reflux, and in selected patients with second and fourth grade reflux. First grade reflux should be treated conservatively, and fifth grade reflux should be treated surgically. CONCLUSION: Endoscopic treatment of primary vesicoureteral reflux is an easy, simple, fast and safe procedure that prevents regurgitation of urine from bladder to upper parts of the urinary system in most of cases.

[Postoperative nausea and vomiting]. / Postoperativna muka i povracanje.

INTRODUCTION: Postoperative nausea and vomiting (PONV) and pain are the most common complaints following anesthesia and surgery, and due to negative emotional impact on patients, they cause prolonged postoperative recovery. The incidence of PONV is 20-30% during the first 24 h after anesthesia. Both peripheral and central mechanisms are involved in control of emesis. FACTORS: Many factors associated with anesthesia and surgery may affect PONV: patient's age and sex, history of PONV after pervious anesthesia, administration of antiemetics prior to operation, type and duration of operation, type of premedication, induction agent, maintenance agent, reversal of muscle relaxation, treatment of postoperative pain and movement of patients. ANTAGONISTS OF 5-HYDROXYTRYPTAMINE-3 (5-HT3) RECEPTORS: Ondansetron is a competitive serotonin type 3 receptor antagonist important in prevention of PONV. However, if 5-HT 3 receptor antagonists are effective against nausea and vomiting after a variety of anesthetic and surgical procedures, then at last we may have the key to the mechanism of PONV. Prophylaxis with a combination of antiemetic drugs is more effective in prevention of PONV.