Autogenous cultured growth plate chondrocyte transplantation in the treatment of physeal injury in rabbits.

OBJECTIVES: The aim of this experimental study on New Zealand's white rabbits was to investigate the transplantation of autogenous growth plate cells in order to treat the injured growth plate. They were assessed in terms of measurements of radiological tibial varus and histological characteristics. METHODS: An experimental model of plate growth medial partial resection of the tibia in 14 New Zealand white rabbits was created. During this surgical procedure the plate growth cells were collected and cultured. While the second surgery was being performed, the autologous cultured growth plate cells were grafted at the right tibia, whereas the left tibia was used as a control group. RESULTS: Histological examinations showed that the grafted right tibia presented the regular shape of the plate growth with hypertrophic maturation, chondrocyte columniation and endochondral calcification. Radiological study shows that the mean tibial deformity at the left angle was 20.29° (6.25 to 33) and 7.21° (5 to 10) in the right angle. CONCLUSION: This study has demonstrated that grafting of autogenous cultured growth plate cells into a defect of the medial aspect of the proximal tibial physis can prevent bone bridge formation, growth arrest and the development of varus deformity. Cite this article: Bone Joint Res 2014;3:310-16.

Traumatic rupture of the aorta in adolescence--description of two cases.

Aortic disruption is a well documented cause of death in motor vehicle accidents and falls from heights. These injuries also affect children. About 10 % who survive despite aortic injury could potentially be saved provided the diagnosis is established and surgical intervention is undertaken early enough. We present here 2 cases of adolescents aged 17 years, treated in our hospitals with different results. In the first case, timely diagnosis of aortic pseudoaneurysm could not be made, which resulted in its rupture and the death of the patient. In the other patient an early diagnosis of aortic injury was established already in the Emergency Department. The patient was then transferred for further surgical treatment which proved successful. Diagnosis of traumatic aortic rupture is impossible at the accident site and can also be missed in hospital. The symptoms of aortic rupture are not characteristic. The knowledge of the mechanism of injury is extremely important. The diagnosis is established based on chest X-ray, computed tomography, and transoesophageal echocardiography. In cases of doubt, aortography remains decisive in the identification of an aortic injury.

Results of Nuss procedures for the correction of pectus excavatum.

INTRODUCTION: The principle of the Nuss procedure is remodulation of the chest using a steel bar inserted by means of two small skin incisions along the axillary lines. PURPOSE OF THE STUDY: The assessment of the outcome after treatment. MATERIAL AND METHODS: Between July 1998 and March 2003 66 children were operated on by Nuss technique to correct pectus excavatum in our department. Age ranged from 1 to 19 years (mean 11.8 years). The evaluation prior to surgery included chest X-ray and CT, pulmonology consultation with pulmonary function tests and cardiology consultation. We used a modified technique in which we inserted the supporting bar directly from the right side, with no thoracoscope, no sharp tools and no guiding tape. Intrapleural or epidural bupivacaine was used for postoperative pain control. RESULTS: Duration of the operation was between 20 and 60 min. Complications included wound infections in six children, haemothorax in three and pneumonia in one. In 56 children the early cosmetic results were very good. In 5 children the excavation of the lower part of the sternum has persisted, in 5 children the excavation of the sternum was corrected but asymmetric thickening in the parasternal region persisted. In all cases the results were satisfactory for both the children and their parents. In 24 children the supporting bar was removed two years after the first operation. Postoperative courses were uneventful and the cosmetic results were good. In one child we observed a recurrence of the deformity six months after bar removal. CONCLUSIONS: The early results of the new operation for pectus excavatum are good in most children. The minimal invasiveness of this method suggests that this procedure is indicated in cases where the defects are only cosmetic.

[Extramedullary (bone) relapse 16 months after allo bmt in a 7-year-old girl treated for acute lymphoblastic leukaemia from the second year of life]. / Pozaszpikowa (kostna) wznowa u 7-letniej dziewczynki leczonej od drugiego roku zycia z powodu ostrej bialaczki limfoblastycznej--W 16. Miesiacu po allo bmt.

7-year-old girl treated for acute lymphoblastic leukaemia since June 1995 after marrow relapse (June 1997) presented with painful oedema of the upper part of left hip and limping, 16 months after allogeneic bone marrow transplantation (BMT). Bone marrow examination excluded medullary relapse. Histopathological investigation of periosteum and bone scrapings revealed massive leukemic infiltration. Radiotherapy resulted in local arrest of the malignant process. However, bone marrow relapse was diagnosed in the child two months later with subsequent death after one month.

[Laparoscopic excision of huge spleen in a 5-year-old boy with hypersplenism]. / Laparoskopowe usuniecie olbrzymiej sledziony u 5-letniego chlopca z powodu hipersplenizmu.

Minimally invasive surgery has been recently gaining acceptance as an alternative to "open" surgery. The benefits of video-surgery consist of minor surgical trauma of tissues, shorter hospital stay, quicker return to full activity and better cosmetic effect compared to traditional splenectomy. Less peritoneal adhesions after laparoscopic splenectomy decreases also the risk of strangulation ileus in the future. Authors present laparoscopic splenectomy in 5 year-old boy with hypersplenism. Technical details, intraoperative difficulties, immediate and late outcome were described. The early results, advantages and disadvantages were also discussed.

[High risk Wilms' tumor in children. Clinico-pathological correlation based on 320 patients registered in the Polish Paediatric Solid Tumor Study Group]. / Nerczak plodowy u dzieci z Wysokim ryzykiem zlosliwosci. Korelacje kliniczno-patologiczne u 320 dzieci zarejestrowanych w Polskiej Pediatrycznej Grupie ds. Leczenia Guzów Litych.

The records of 320 patients treated for Wilms' tumour in the first Wilms' Tumour Study (01-92 schedule) were reviewed and 42 children (13,86%) with unfavourable histology (UH) tumours were identified. There were 18 boys and 24 girls. Diffuse anaplasia was found in 26 patients (61,9%), focal anaplasia in 10 children (23,8%), CCSK and MRT were diagnosed in 3 patients each (7,1%). Clinical stages were: CS I - 5 (11,9%) patients, CS II N(-) - 7 (16,7%), CS II N(+) - 9 (21,4%), CS III - 15 (35,7%), CS IV - 5 (11,9%) and CS V - 1 patient (2,4%). Local and metastatic relapses of the disease occurred in 18 patients (43%). Seven of the 42 patients died, in 2 cases due to complications and in 5 from progression of the disease.

[Our experiences in the surgical treatment of vesico-ureteral reflux]. / Nasze doswiadczenia w leczeniu operacyjnym, zewnatrzpecherzowym odplywów pecherzowo-moczowodowych.

In the years 1995-1997 18 patients (20 ureters) were treated by modified Lich Gregoir's technique for vesicoureteral reflux. In this group 3 children had neurogenic bladder. The age of the patients was 2-18 years, on an average 10 years. In the group of operated ureters there were three with reflux grade II, six-grade III, eight-grade IV and three-grade V. Postoperative period was uneventful in all cases. Control imaging studies (voiding cystourethrography and intravenous pyelography) were done after 8-18 months. These studies were performed in 15 patients. In 14 cases complete resolution of the reflux was found and in one case the improvement from grade III to I. No operated child had stricture of the ureterovesical junction and urinary retention in upper urinary tract. In our opinion extravesical modified Lich-Gregoir's antireflux procedure is effective method, with low probability of complication and less aggressive for patients in comparison to intravesical procedures.

[The assessment of nephroblastoma therapy results using the SIOP 92-01 protocol]. / Ocena wyników leczenia nerczaka zarodkowego wedlug programu SIOP 92-01.

43 patients aged between 4 days and 10 years 8 months with Wilms' tumor were treated according SIOP 92-01 protocol. Clinical stage, therapy results and adverse events were analysed. In presented group 9 complete recoveries were obtained in the period of over 30 months, in 94%--without clinical symptoms of disease the during therapy or during observation period shorter than 30 months. There were 14% of deceases. Neoadjuvant chemotherapy allowed to decrease the intraoperative stage of the disease progression. In analysed group stage II N (-) was the most common, what is higher in comparison with other European groups. The problem is the treatment of bilateral and generalized Wilms' tumour.