[Therapeutic algorithm of idiopathic scoliosis in children]. / Algoritm terapeutic al scoliozelor idiopatice ale copilului.

Acquired deformations of spinal cord (scoliosis, kyphosis, lordosis) represent a frequent pathology in child; their treatment is complex, with variable results which depend on various parameters. Mild scoliosis, with an angle less than 30 degrees, is treated with physiotherapy and regular follow-up. If the angle is higher than 30 degrees, the orthopedic corset is required; the angle over 45 degrees impose surgically correction. The indications of every therapeutic method depend on many factors, the main target of the treatment is to prevent the aggravation of the curvature; concerning the surgery, the goal is to obtain a correction as normal as possible of the spinal axis.

[Caudal anesthesia in pediatric surgery]. / Anestezia caudala in chirurgia pediatrica. Experienta noastra pe 150 de cazuri.

UNLABELLED: The study analyses the efficacy and the safety of caudal anesthesia for the intra and postoperative pain management in children. MATERIAL AND METHOD: A retrospective study was conducted over a five years period enrolling 150 children scheduled for various surgical procedures. We used the standard technique ("loss of resistance", "single shot", lateral decubitus). RESULTS: The most important age groups were 1 month - 1 year, 64 cases (42.66%) and 1-6 years - 71 cases (47.33%). We performed 144 caudal blocks associated with general anesthesia, 3 associated with sedation and 3 simple caudal blocks. In 129 cases, we used bupivacaine 0.25% as a single analgetic substance, in five cases bupivacaine 0.25% with lidocaine 1%, and in 16 cases bupivacaine 0.25% with fentanyl 1 mcg/kg. The quality of the analgesia was very good in 128 cases (85.33%), good in 12 (8%) and poor in 10 cases (6.66%). The morbidity rate was 13.33% (20 cases), the most frequent complication being urinary retention (8 cases - 5.33%). CONCLUSIONS: The caudal block is an efficient procedure for intra and postoperative analgesia in children. Associated with general anesthesia it is very useful for the management of the age groups 1 month - 1 year and 1-6 years.

[The psycho-social impact of the locomotor deformations in school-aged child]. / Impactul PSIHO-social la copilul de vârsta scolara suferind de deformatii ale aparatului locomotor.

Depending on their severity, congenital or acquired, the deformations of the locomotor system affect more or less the child's mental status. Adolescence is the time when their impact is most important. When the physical, mental or functional suffering become a disability, professional and psycho-social integration problems occur. The role of the team treating such a patient is to orientate him toward a specific job corresponding to his abilities, while the social services must support him in achieving this goal. The psychotherapist is the most important person in his fight against depression and, more important, suicide.

[The results of the Sommerville-Petit procedure in the treatment of the typical congenital hip dislocation]. / Rezultatele metodei Sommerville-Petit în tratamentul luxatiei congenitale tipice a soldului.

The studied group from the Pediatric Surgery and Orthopedics Clinic, Iasi, consisted of 87 cases, which means that a total of 118 hips were treated between September 1998-September 2004. In 116 cases, the extension was performed with trans-femoral Kirschner wire, in a period of 3-7 weeks. After 7-14 days of extension, the authors performed adductor and sometimes psoas tenotomy. The stable orthopedic reduction was obtained in 34 hips, while the 15 cases with inadequate results required open reduction. This method, performed from the beginning after a period of extension, was applied to 69 cases. In 13 patients the iterative open reduction was required. None of the cases associated femoral diaphysis shortening resection.

[Profound necrosis--complication of the orthopedic treatment in congenital club foot. A case report]. / Necroza profunda--complicatie a tratamentului ortopedic în piciorul varus equin congenital prezentare de caz.

The treatment of congenital club foot implies orthopaedic and operative methods. The complications of the treatment may result, in particular cases, from lack of follow-up and cooperation between the child parents and the doctor. These cases are a challenge for the orthopaedic surgeon, requiring multiple interventions and with a high morbidity. We present the case of a congenital club foot with profound necrosis secondary to a cast compression, which was not recognized by the parents.

[The importance of Dunn's procedure in the treatment of slipped femoral epiphysis]. / Utilitatea operatiei Dunn în tratamentul epifiziolizei extremitatii superioare a femurului.

The slipped upper femoral epiphysis (SUFE) is a condition also known as 'coxa vara' of the adolescent, in which lesions of the growth plate are responsible for the development of sudden or gradual displacement of the femoral head. The disease is most frequent in the 10-15 years' age group, usually in boys who also have endocrine disorders. Both acute and chronic presentations are described. The clinical symptoms and especially the X-Ray features are diagnostic. Treatment options include orthopedic (conservative) measures or surgery, depending on several conditions, such as: the clinical picture, the degree of the femoral displacement, and the age of the patient. The chronic, long-lasting cases are generally associated with poor results. The paper presents our experience in using the Dunn's procedure in 7 chronic cases of slipped upper femoral epiphysis in children. It appears that surgery by using Dunn's procedure is an effective treatment in patients with SUFE.

[Primary obstructive megaureter- diagnosis and treatment]. / Modalitati de diagnostic si tratament în megaureterul primar obstructiv.

The authors have treated 13 cases of primary obstructive megaureter (POM) in children, presenting without vesicoureteric reflux. The diagnostic possibilities and the surgical approach options are discussed. Both Cohen and Leadbetter--Politano uretero-vesical reimplantation techniques proved to be successful in this series. Ureteric folding was done in 2 cases. Reported final results are good in 10 cases.

[Intestinal occlusion by persistence of the omphalo-enteric conduct in a 10-year old child]. / Ocluzie intestinala prin persistenta de canal omfalo-enteric la un copil de 10 ani.

The persistence of the omphalo-enteric conduct is a rare, but possible, cause of pathology in children. Haemorrhage and intestinal occlusion are the most frequent clinical presentations, usually in infants. We describe the case of a 10 year old boy, who was admitted in our department for what seemed first to be an acute appendicitis. During hospitalization, the clinical picture turned on to an intestinal occlusion, and the patient finally required surgery. We performed exploratory laparotomy and we discovered a mechanical occlusion by persistence of the omphalo-enteric conduct, which was treated according to standard protocols. The post-operative course was good, and the child was discharged 8 days after surgery. This case emphasizes that the persistence of the omphalo-enteric conduct should be sought as the source of symptoms in any child presenting with intestinal occlusion.

[Chronic scapulo-humeral instability in children]. / Instabilitatile cronice scapulo-humerale la copil.

The recurrent dislocation of the shoulder is a rare condition during childhood, and it should benefit from an early treatment in order to prevent secondary lesions of the humeral head from appearing. Osteoarthritis in adulthood is a potential complication of this disease. A number of 10 children (5 boys and 5 girls) were treated in our department between 1989 and 1998; 8 of them had the anterior type of dislocation, while 2 children had the posterior type. All children were older than 10. We performed the anterior Bankart procedure in 6 children, the posterior Bankart procedure in 3 cases and Putti-Platt procedure in 2 children, respectively. Surgery was followed by casting for 3 weeks and physical therapy afterwards. We obtained very good results in 4/6 cases. Recurrence appeared in 2 cases--one of them failed to respond again to surgery, the other one refused reintervention. We conclude that a simple and well performed surgical procedure is recommended in children, followed by physical therapy. Psychotherapy can be required if a voluntary component is implicated in producing the dislocation.

[Achalasia in children: Diagnostic opportunities and therapeutical options]. / Acalazia cardiei la copil--posibilitati diagnostice si optiuni terapeutice.

Achalasia is a functional disorder of the distal esophagus, which fails to relax during swallowing. Although being rare, this disorder is the source of a significant morbidity, including developmental disorders in children. Several therapeutical options are available: myorelaxants administration, esophageal dilations and surgery--distal esophageal myomectomy followed by an antireflux procedure. The paper introduces our experience in treating a number of 5 children between 1991 and 1998.

[The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum]. / Rezultate dupa tehnica Ravitch-Sutherland pentru corectia chirurgicala în pectus excavatum.

The aim of our study was to assess the functional and cosmetic results after performing a modified Ravitch-Sutherland procedure in children presenting with excavatum. A series of 31 children with ages ranging between 5 and 16 years, presenting with pectus excavatum, were operated between 1986-1996 in our service. In 5 cases surgical treatment was required by the presence of respiratory and/or cardiac functional impairment due to the malformation. In the other 23 cases operation was performed mainly for cosmetic reasons. In all cases a modified Ravitch-Sutherland procedure was performed. Modification consisted in renouncing at the plicature of the perichondra and in associating a diaphragmatic elongation and Bedouelle laparoplasty in all cases. Longitudinal sternotomy was performed in 2 cases with severely impaired ventilatory capacity. Functional and cosmetic results were good in all cases. In 2 cases, in which recurrence of the condition was observed, a second identical procedure was performed, with a good result. The interval between the operation and the moment of long-term evaluation ranged between 3 months and 11 years. We conclude that the modified Ravitch-Sutherland procedure represents an effective method for the treatment of pectus excavatum cases, offering good functional and cosmetic long-term results.

[The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum]. / Rezultate dupa tehnica Ravitch-Sutherland pentru corectia chirurgicala în pectus excavatum.

The aim of our study was to asses the functional and cosmetic results after performing a modified Ravitch-Sutherland procedure in children presenting with pectus excavatum. A series of 31 children with ages ranging between 5 and 16 years, presenting with pectus excavatum, were operated between 1986-1996 in our service. In 5 cases surgical treatment was required by the presence of respiratory and/or cardiac functional impairment due to the malformation. In the other 23 cases operation was performed mainly for cosmetic reasons. In all cases a modified Ravitch-Sutherland procedure was performed. Modifications consisted in renouncing at the plication of the perichondrium and in associating a diaphragmatic elongation and Bedouelle laparoplasty in all cases. Longitudinal sternotomy was performed in 2 cases with severely impaired ventilatory capacity. Functional and cosmetic results were good in all cases. In 2 cases, in which recurrence of the condition was observed, a second identical procedure was performed, with a good result. The interval between the operation and the moment of long-term evaluation ranged between 3 months and 11 years. We conclude that the modified Ravitch-Sutherland procedure represents an effective method for the treatment of pectus excavatum cases, offering good functional and cosmetic long-term results.

[Displaced fractures of the middle third of the forearm in children. The therapeutic considerations]. / Fracturile cu deplasare ale 1/3 medii a antebratului la copil. Consideratii terapeutice.

There been studied 100 cases of fractures of the middle third of both bones of forearm in child for to assess the correctitude of the therapy, based on the analysis of results. The most correct surgical techniques consist of osteosynthesis with Kirschner wire of the both bones, knowing the particularities of the fracture linea in child and the minimal tissues' damages. In the child younger then 10 years old, the open reduction is rarely necessary. Any displaced fracture of middle third of both bones of forearm, whatever the age of the child would be orthopedically reduced, before performing the surgical therapy. The unstable osteosynthesis such as simple screw "osteosynthesis" with wire or thread are contraindicated.

[Surgical treatment in osteochondritis of the femur head in children]. / Orientarea terapeuticii chirurgicale în osteocondrita capului femural la copil.

The goal of surgery in the femoral head osteochondritis of children is, in the cases progressing towards extrusion, to ensure a good coverage of femoral head. Under the age of 5-6 years, the evolution being more commonly benign, the surgical containment is rarely indicated. In the child over 7 years, the extrusion of femoral head being common, a surgical intervention for correcting it is necessary. This paper is based on a statistics on 36 children operated upon at the Clinic of Pediatric Surgery and Orthopedics of Iasi between 1980 and 1990. Eighteen femoral osteotomies, 10 Chiari pelvic osteotomies and 8 triple pelvic osteotomies were performed. It is assumed that femoral osteotomy is rarely indicated and Chiari osteotomy is required for hip salvage when other techniques cannot be used. The triple pelvic osteotomy, when indicated, has to be used more frequently, leaving aside the reticences towards this method.