Gunshot Abdominal Injuries: A Report of Two Cases and a Review of the Literature.

Abdominal injuries in children caused by guns are a rare clinical entity globally. But, in countries with undefined legal regulations and in war zones, urban violence is a tremendous social problem among older children and adolescents. This manuscript provides details regarding two cases of severe gunshot injuries in young children. The injuries were very complicated and included damage to the parenchymatous and hollow organs and major blood vessels. The clinical presentation on admission was severe and dramatic, but the patients survived. However, one patient developed numerous complications that required repeated surgical interventions and long treatment. This article provides a detailed description of injuries and how to treat them. Patient care requires a multidisciplinary approach, and the initial decision on further treatment depends on the patient's hemodynamic stability.

Consequences of Transplacental Transmission of the SARS-CoV-2 Virus: A Single-Center Experience.

The issues of vertical viral transmission from mother to fetus and the potential complications caused by SARS-CoV-2 coagulopathy are still unclear. There are few literature data about the vertical transmission of SARS-CoV-2 and health outcomes in neonates born to mothers with symptomatic or asymptomatic coronavirus disease, with the existing data based on small sample sizes. This case series study consists of two newborn children (one pre-term and one term) who were born to SARS-CoV-2-positive mothers and admitted to the neonatal intensive care unit a few hours after birth. One child had cyanotic changes that affected the entire left leg and the left forearm, with multiple livid changes on the front of the chest and abdomen, the right upper arm, right thigh, neck, and face, and one child had an altered umbilical cord. The first child was treated conservatively, and the second child was treated surgically.

Neglected Monteggia Fractures in Children-A Retrospective Study.

(1) Background: A Monteggia fracture is an infrequent injury in children. It can be missed during an initial consultation in 20-50% of patients. Chronic radial head dislocation may lead to several complications. Thus, surgical reconstruction of chronic Monteggia injuries is justified. The aim of this study is to analyze the single tertiary center experience in the treatment of neglected Monteggia fractures. (2) Methods: A retrospective study of patients treated for missed Monteggia fractures was conducted. Hospital records, operative charts, follow-up records and a set of X-rays were analyzed for each patient. Radiographic results were graded as good, moderate or poor. The functional status of elbows was estimated using the Mayo Elbow Performance Index. (3) Results: A total of 13 patients (8 boys and 5 girls) aged 4-12 years (mean 7.15) were treated during the study period. An angulation osteotomy of the ulna was performed in ten patients and a radial shortening osteotomy in three patients. A Bell-Tawse annular ligament reconstruction was performed in five patients, and a direct repair was performed in two patients. Eight patients had radiocapitellar trans-fixation. There were nine good radiographic results, three moderate and one poor. The functional result was excellent in nine patients, good in three and poor in one. (4) Conclusions: Our work has many limitations (only 13 patients and different types of operations), and conclusions should be drawn very carefully from such a small and diverse group. The surgical reconstruction of neglected Monteggia fractures in children should be attempted in all patients. Angulation and elongation osteotomies of the ulna are suitable for most patients. If there is a marked overgrowth of the radius, gradual ulnar lengthening and radial head reduction using the Ilizarov method may be a better option. Annular ligament reconstruction is not mandatory.

Clinical Importance of Potential Genetic Determinants Affecting Propofol Pharmacokinetics and Pharmacodynamics.

Interindividual variability in response to drugs used in anesthesia has long been considered the rule, not the exception. It is important to mention that in anesthesiology, the variability in response to drugs is multifactorial, i.e., genetic and environmental factors interact with each other and thus affect the metabolism, efficacy, and side effects of drugs. Propofol (2,6-diisopropylphenol) is the most common intravenous anesthetic used in modern medicine. Individual differences in genetic factors [single nucleotide polymorphisms (SNPs)] in the genes encoding metabolic enzymes, molecular transporters, and molecular binding sites of propofol can be responsible for susceptibility to propofol effects. The objective of this review (through the analysis of published research) was to systematize the influence of gene polymorphisms on the pharmacokinetics and pharmacodynamics of propofol, to explain whether and to what extent the gene profile has an impact on variations observed in the clinical response to propofol, and to estimate the benefit of genotyping in anesthesiology. Despite the fact that there has been a considerable advance in this type of research in recent years, which has been largely limited to one or a group of genes, interindividual differences in propofol pharmacokinetics and pharmacodynamics may be best explained by the contribution of multiple pathways and need to be further investigated.

Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management.

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

Scintigraphy evaluation of the types of functional constipation in children with bowel bladder dysfunction.

PURPOSE: To evaluate the types of constipation according to colonic transit time in chronically constipated children with dysfunctional voiding (bowel bladder dysfunction, BBD group) and to compare the results with transit type in children with chronic functional constipation without urinary symptoms (constipation group) and children with normal bowel habits, but with lower urinary tract symptoms (control group). PATIENTS AND METHODS: One-hundred and one children were included and their medical histories were obtained. The BBD group kept a voiding diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Radionuclear transit scintigraphy was performed in all children according to a standardized protocol. Patients were categorized as having either slow-transit (ST), functional fecal retention (FFR) or normal transit. RESULTS: FFR was diagnosed in 31 out of 38 children with BBD, and 34 out of 43 children in the constipation group. ST was found in seven children with BBD, compared with nine children in the constipation group. The control group children demonstrated normal colonic transit. Urgency, daily urinary incontinence and nocturnal enuresis were noted only in children with FFR. Both children with ST constipation and FFR complained of difficulties during voiding, voiding postponement and urinary tract infections. CONCLUSIONS: FFR is the most common form of constipation in children with dysfunctional voiding. However, some children might suffer from ST constipation. Differentiation between these two types of constipation is clinically significant because they require different treatment. Future studies with larger numbers of patients are needed to confirm the noted differences in urological symptoms in these two groups of constipated children..

Diagnostic importance of pulse oximetry in the determination of the stage of chronic arterial insufficiency of lower extremities.

INTRODUCTION: Chronic arterial insufficiency (CAI) of lower extremities is important socio-economical and healthcare problem, due to its high incidence of morbidity, disability and mortality. OBJECTIVE: The aim of our work was to determine the diagnostic importance of pulse oximetry in the early detection of stage of lower extremities CAI based on peripheral arterial oxygen saturation of haemoglobin (SpO2). METHODS: Prospectively, we analyzed a group of 50 patients, admitted at the Vascular Department of Surgical Clinic in Nis during the period from September 2006 to October 2007, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. RESULTS: Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia SpO2: Fontaine I - 95.33 +/- 1.41%, Fontaine IIa - 92.14 +/- 2.27% and Fontaine IIb - 79.67 +/- 2.73%; in stage critical ischemia SpO2: Fontaine III - 62.54 +/- 4.39% and Fontaine IV - 47.67 +/- 6.16%. In 3 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p < 0.01 between stages). CONCLUSION: Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI.

[Acute appendicitis in the first three years of life].

Acute appendicitis is the most frequent disease in children population that requires an urgent surgical intervention. Only 2% of operated children belong to the group younger than 3 years. Yet, 77% are school children. Appendicitis in young children is characterized by: atypical clinical course, late diagnosis, high percentage of perforations, and high level of mortality and morbidity rates. The commonest symptoms are: vomiting, undefined abdominal pain, and high temperature. Abdominal distention and diffuse abdominal tenderness are the most frequent signs during examination. Our analysis (1991-2000) included all patients younger than 3 years who were hospitalized in Clinic for Pediatric Surgery Nis with diagnosis of the acute appendicitis. Out of 2533 patients with disease, 58 (2.3%) were younger than 3 years, 23 were girls (39.7%) and 35 were boys (60.3%). Perforated appendicitis was found in 55 (94.8%) of 58 children. Thirty five (60.5%) patients were previously treated. Complications developed in 36 (62.1%) cases: purulence (58.3%), dehiscence (22.3%), abdominal wall abscess (13.8%), and ileus (5.6%). Acute appendicitis is very specific condition that needs high attention by all doctors engaged in pediatric health care. Our recommendation is "to admit and observe" by using the physical examination in all suspected cases. Sometimes, even sedation may be used for better palpation results.