Fingertip injuries in children treated in Department of Pediatric Surgery and Oncology in the years 2008-2010.

BACKGROUND: Fingertip injuries are the most common hand injuries in children seeking medical advice at trauma care centres. Most cases are treated conservatively and hospitalisation is not necessary. However, surgery under general anaesthesia is often required on account of severity of the injuries and the patients' young age. The aim of the paper is to discuss a series of patients treated in the Department of Paediatric Surgery and Oncology between 2008 and 2010, and present the problems associated with surgical care in fingertip injuries in children. MATERIAL AND METHODS: A total of 76 children were treated in the Department of Pediatric Surgery and Oncology between 2008 and 2010 because of fingertip injuries. This group is estimated to represent approx. 10% of all patients admitted to the Emergency Unit. Fingertip injuries were treated with situation sutures, V-Y-plasty, suturing back the amputated fingertip and by suturing into thenar skin. Data were extracted from medical files and presented as percentages. RESULTS: There were 50 boys in the group of 76 children (65.79%). Mean age was 7 years. Most of the patients were children aged 1 to 5 years (36 patients, 47.37%). In 45 children (59%), the right hand was injured. Injury to fingers responsible for the pincer grasp occurred in 29 children (38.16%). CONCLUSIONS: Fingertip injuries are among the most common injuries in children and preservation of the hand's motor abilities depends on thorough surgical care. Most children with fingertip injuries are treated in Emergency Units and only 10% of patients need surgery under general anaesthesia after hospital admission. A number of surgical techniques can be used in the management of fingertip injuries in children. These techniques represent adaptations of methods used in adults. A model for the evaluation of severity and management of fingertip injuries in children should be established.

Soluble cytokine receptors sTNFR I and sTNFR II, receptor antagonist IL-1ra, and anti-inflammatory cytokines IL-10 and IL-13 in the pathogenesis of systemic inflammatory response syndrome in the course of burns in children.

BACKGROUND: This is a prospective clinical study focusing on cytokine inhibitors (sTNFR I, sTNFR II, IL-1ra) and anti-inflammatory cytokines (IL-10, IL-13) following burn injury in children. The aim of the study was to evaluate the prognostic values of the selected cytokine-related molecules. MATERIAL/METHODS: Fifty-one patients (29 burned children and 22 controls) admitted to the Department of Pediatric Surgery and Oncology were included in this study. Serum sTNFR I, sTNFR II, IL-1ra, IL-10, IL-13, and CRP concentrations were evaluated twice using ELISA, the first determination being performed within 6-24 hrs after the burn and the second following completion of treatment and normalization of the CRP level. RESULTS: With the exception of IL-13, significantly higher cytokine and cytokine inhibitor levels were observed within 6-24 hours after burn compared with controls (p<0.05). Moreover, a significant attenuation of the burn-induced increases in sTNFR I, sTNFR II, IL-1ra, and IL-10 concentrations was recorded after burn therapy (p<0.05). TNF-alpha soluble receptor levels correlated significantly with serum CRP concentrations. Similarly, the levels of sTNFR I, sTNFR II, and IL-1ra significantly correlated with TBSA of the burned children. CONCLUSIONS: The results confirm the involvement of these markers in the pathogenesis of SIRS in this clinical entity. Their monitoring simultaneously with CRP level allows evaluating the generalized inflammatory response and may clinically support diagnostic and prognostic methods.

Features of impaired seminiferous tubule differentiation are associated with germ cell neoplasia in adult men surgically treated in childhood because of cryptorchidism.

Seminiferous tubule differentiation was related to the occurrence of germ cell neoplasia in 38 men, aged 17-47, treated surgically in childhood for cryptorchidism. Tissues from 46 testes obtained from biopsies taken as a neoplastic preventive procedure or whole testes removed because of GCT were evaluated quantitatively. Paraffin sections were treated with antibodies against placental like alkaline phosphatase (PLAP), a marker of germ cell neoplasia, and cytokeratin 18 (CK-18), a marker of immature Sertoli cells. Quality of spermatogenesis and number Leydig cells were assessed with a score count. Seminiferous tubules diameter, thickness of basal membrane and size of intertubular spaces were measured with image analysis software. In 17.4% of testes spermatogenesis was normal (9.9 points) (N) and neoplasia was not found there. In the other 38 specimens (83%) spermatogenesis was abnormal (A). When spermatogenesis was arrested or when germ cells were absent (3.7+/-1.8 points), neoplastic lesions were found in 13.1% of the specimens. In A group 5.1+/-7.1% of tubules contained immature Sertoli cells, while in N they were not found. Tubular diameter was significantly lower in A (161.5+/-31.8 microm) than in N (184.6+/-24.3 microm) and the percentage of seminiferous tubules with the thickening of tubular basal membrane was also greater in A. Intertubular spaces were significantly larger in A (49.9+/-18.6%) in comparison to N group (32.6+/-12.5%). Mean number of Leydig cells was similar in both groups. To conclude, in most of the formerly cryptorchid testes, despite surgical treatment, impaired seminiferous tubules differentiation is predominant. Germ cell neoplasia is present in testes with retarded seminiferous tubules differentiation. Retardation of seminiferous tubule differentiation consists of inhibited spermatogenesis, presence of tubules with immature Sertoli cells, decreased tubular diameter, increased thickness of basal membrane and enlarged intertubular spaces. Examination of testicular biopsy with respect to the state of seminiferous tubule differentiation may be helpful to predict the appearance of germ cell neoplasia in adult men with cryptorchidism in anamnesis. Orchiopexy of cryptorchid testes may not prevent the occurrence of features of testicular dysgenesis and the associated germ cell neoplasia.