The Importance of Primary Reconstruction in the Treatment of Blast Related Hand Injuries During Childhood.

INTRODUCTION: Blast injuries are common during wartime but are also related to various holiday festivals worldwide. Despite strict legislations, these devices still cause serious injuries leaving permanent disabilities. Children are affected in numerous cases with the hand being the most affected body region. The aim of our study was to profile the blast related hand injuries and to review treatment modalities that we used. METHODS: A retrospective study of patients treated for blast-devices related hand injuries between 2006 and 2015 was performed. RESULTS: 112 patient with blast related hand injuries were treated in our department during the 10-year period. Most of the patients were male. The dominant hand was injured in 83.9% of the patients. Associated injuries were observed in 14.3% of patients. 90 children were treated on an out-patient basis, mostly due to hand burns (86.7%) or uncomplicated blast injuries (13.3%). 22 children required hospitalization due to severe blast and crush injuries and amputations. Surgery was carried out as the urgent procedure and involved debridement with primary repair. In the case of amputations debridement and sufficient skin ensuring complete wound coverage was the procedure of choice. CONCLUSION: Blast related injuries of the hand during childhood are frequent and can cause different and complex defects. Besides prevention of these injuries, primary reconstruction of the affected hand is of outmost importance in preventing long-term consequences.

Abdominal Aortic Thrombosis in a Healthy Neonate.

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.

[Congenital hyperinsulinism--novel insights into etiology, diagnosis and treatment]. / Kongenitalni hiperinzulinizam- -novosti o nastanku, dijagnosticiranju i lijecenju bolesti.

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.