Nosocomial meningitis caused by Staphylococcus other than S. aureus in children: multicentre study.

Analysing 101 cases of nosocomial meningitis due to staphylococci other than S. aureus within last 15 years, coagulase negative staphylococci represented the commonest pathogen. Major risk factor for staphylococcal meningitis was prior neurosurgery, mainly ventriculoperitoneal shunt insertion. Ten of 101 cases were caused by glycopeptide intermediate resistant strains in patients pretreated with multiple combination of antibiotics including vancomycin and shunt exchanges: 76% of strains were also oxacillin resistant.

Neuroinfections complicating foreign body implants after perinatal trauma or meningitis in 60 children.

Meningitis after artificial implants in 60 children, mainly after foreign body infections (FBI) was caused more frequently by coagulase negative staphylococci and Ps. aeruginosa than other organisms and was significantly associated with perinatal trauma, hydrocephalus, haemorrhage or VLBW and had more neurologic sequels despite mortality was similar to other nosocomial meningitis.

Bacteremia due to Pseudomonas aeruginosa: results from a 3-year national study in the Slovak Republic.

Risk factors, mortality and antimicrobial susceptibility of Pseudomonas aeruginosa bacteremias isolated from 148 patients from all University Hospitals in Slovakia were analyzed. Only 1.2% of 169 strains of P. aeruginosa were resistant to meropenem, 4.1% to piperacillin/tazobactam, 7.7% to ceftazidime as well as cefepime and 12% to amikacin. More than 30% of P. aeruginosa were resistant to ciprofloxacin. Our analysis of risk factors for antimicrobial resistance to the particular antimicrobials, indicated no difference in risk factors and outcome in cases infected with P. aeruginosa bacteremias resistant to amikacin, piperacillin/tazobactam or ceftazidime in comparison to episodes caused by P. aeruginosa due to susceptible isolates. When comparing risk factors for P. aeruginosa bacteremia in children vs. adults, cancer vs. non-cancer patients, several differences in risk factors were observed. Neither antimicrobial resistance to amikacin, ceftazidime or piperacillin/tazobactam, nor appropriateness of therapy according to two separate analyses were associated with better outcome.

Separation of Siamese twins in Bratislava.

At the pediatric surgical clinic in Bratislava, in the year 2000, we successfully carried out the separation of Siamese twins, which we classified as "ischiopagus tetrapus"+. The pelvic ring, the gastrointestinal tract and the urogenital system were all malformed. There was a common terminal ileum and only a short segment of the large intestine with a blind end. This was a case of non-developed anal segment and rectum. Each of the twins had two kidneys and two commonly shared urinary bladders. There were two uteruses, which were both bicornuate in nature with a fallopian tube arising from each of the horns as well as an ovary. The orifices of both urinary bladders and those of the two uteruses joined into a common urogenital sinus. The external ostia of this sinus represented a bizarre fissure with a single skin fold similar to the labium majus, located dorsally at the point of fusion of the pelvic structures. The act of separation was performed in two stages. Separation of the gastrointestinal tract was urgent due to the severe ileus caused by aplasia of the anus and the rectum. This first stage procedure was performed on the third day of admission (24.2.2000) after the babies had spent a month in other health institutions. The definitive separation was carried out a month after the first procedure (28.3.2000) following the optimal stabilization of the functions of the gastrointestinal tract. The uropoietic and genital systems were separated. A new pelvic ring and a pelvic floor were formed. The anterior abdominal wall was reconstructed and plastic correction of the skin in the gluteal and perineal regions was performed. The colostomies are functioning well and the twins pass well-formed stools. Lucia has long dry intervals between mictions. Andrea has shorter dry intervals. The girls have recently celebrated their third birthday. Their mental development is excellent; they speak Slovak and Hungarian languages. They have a well-developed locomotive apparatus, without any movement impairments. (Tab. 1, Fig. 16, Ref. 10.)

Trisomy 18 mimicking Smith-Lemli-Opitz syndrome in the immediate neonatal period.

The study describes a dysmorphic newborn infant with life-threating anomaly, later diagnosed as trisomy 18, mimicking Smith-Lemli-Opitz syndrome in the immediate neonatal period. The establishment of the correct diagnosis in the first days of life is very important for the decision-making process, because trisomy 18 has a poor prognosis, and treatment is not instituted, whereas cholesterol supplementation may be of benefit to patients with Smith-Lemli-Opitz syndrome. Ultraviolet spectrophotometry showed very easy and rapid method for differentiation of both syndromes, where gas chromatography/mass spectrometry analysis is not available. (Fig. 2, Ref: 18.)

[Surgical treatment of children with necrotizing enterocolitis]. / Chirurgická starostlivost' o deti s nekrotizujúcou enterokolitídou.

Necrotizing enterocolitis is an acute neonatal disease. It affects in particular premature neonates with a birth weight lower than 1500 g. Despite extensive research the etiology of the disease remains obscure. The majority of authors assume multifactorial causes. Research workers try to detect various laboratory and clinical factors which could serve as criteria for surgical intervention. The sensitivity and specificity of these tests and laboratory examinations detect the disease only in an advanced stage and in the stage of perforation of the gastrointestinal tract (GIT). The main surgical approach to the treatment of this disease remains laparotomy and resection of the necrotic portion of the gut with enterostomy. In a limited number of children resection of a portion of the necrotic gut with primary anastomosis is possible. In some very serious conditions and in infants with a birth weight below 1000 g peritoneal drainage and subsequent "second look" surgery should be sufficient. It is a disease with calls for a maximum individual approach and there are no accurate defined instructions for surgical treatment. The surgeon's experience and the standard of preoperative and postoperative care are decisive.

[Diastematomyelia and the tethered spinal cord syndrome. Case report]. / Diastematomyélia a syndróm pripútanej miechy. Kazuistika.

The authors present a patient with diastematomyelia and associated congenital malformations of the spinal cord. They caused tethering of the spinal cord. Patient had cutaneous marks of malformation from birth. The congenital malformation was operated at the age 5 years. MRI and surgical findings confirm the existence of diastematomyelia together with thick tethered filum terminale and lipoma of filum terminale. On surgery the bony septum was removed, the filum terminale was resected and the lipoma was excised. Each of the anomalies caused the tethering of the spinal cord and restricted its physiological ascent. Only careful surgical revision with subsequent removal of all causes of the tethering of the spinal cord produced good result. Diastematomyelia is a congenital malformation with some morphological variations and coexistence of other malformations. The presented case is a typical example of malformations associated with diastematomyelia.

[Traumatic injuries of the urethra in children]. / Traumatické poranenia uretry u detí.

Authors presented their experience in diagnosis and treatment of 5 cases of traumatic rupture of urethra. Clinical symptoms of the closed type of the urethra are frequently not clear. In 70% of patients, outer urethral orifice bleeding is usually omitted. When this injury could be suspected, urethral catheterization is not recommended because it might extend level of damage. Urethrography is recommended as it would offer sufficient information on the injury. Pulling the balloon catheter to approach proximal and distal part of the injured urethra will result in creating fibrous channel between the ruptured parts of urethra however, this fibrotic part tends to develop dilatation resistant stricture.

[An unusual case of gastroschisis combined with dysganglionosis]. / Neobvyklý prípad gastroschízy kombinovanej s dysganglionózou.

Authors describe a child with gastroschisis, which was associated with dysganglionosis. Therapy required an uncommon surgical treatment in connection with a long term parenteral and enteral nutrition.

[Blunt tracheobronchial injuries in children]. / Tupé tracheobronchiálne poranenia u detí.

Blunt tracheobronchial injuries in children are rare and are associated with many diagnostic problems. Based on the successful outcome in a seven- and a twelve-year-old patient operated within 12 hours after the accident the authors discuss the development of the symptomatology and early clinical, X-ray, bronchoscopic and CT diagnosis of rupture which are, if intensive care and early treatment of the injury are ensured, the basis for preserving normal pulmonary function and ensure prevention of sequelae due to obstruction and infection. The children were admitted to hospital for 22 and 14 days resp. and discharged in a good condition. The check-up examinations of both patients are within the normal range and there are no limitations as compared with healthy children of the same age.

[Treatment of blunt injuries of the spleen in children]. / Liecba tupého poranenia sleziny v detskom veku.

The authors report study of patients with blunt splenic trauma treated at Paediatric Surgery Department in years 1991-1999. During 9 years period 50 patients (36 males, 14 females) with demonstrated rupture of the spleen were analyzed. 46 patients (92%) were treated conservatively (group A). Complications appeared in 7 patients (15.22%), rebleeding in two patients, arterio-venous fistula in early posttraumatical period in one patient and during control in one patient, fluidothorax in two patients and posttraumatic pseudocyst of the spleen in one patient. Four patients (8%) were operated (group B). Two of them submitted splenectomy, one patient was treated by splenorrhaphy and one patient by partial splenectomy. Period of the hospitalization in average lasted in group A 12,67 days, in group B 15 days. With regard to the immunologic functions of the spleen especially in childhood authors prefer conservative treatment, in case that laparotomy is inevitable authors try to preserve the spleen.

[Subacute appendicitis in children]. / Subakútna apendicitída u detí.

Over the period of 4 years from 1993 to 1996 the authors recorded a 6% incidence of patients with periappendicular mass (PM) in a group of 786 patients with acute appendicitis. The aim of the study is to compare the two methods in the management of patients (operation-A, conservative treatment-B) by applying the same criteria. In the subacute phase of the disease 22 patients (group A) were operated on, while 24 patients (group B) were successfully treated conservatively, with recommendation of elective appendectomy after 6 months. In group A indication for operation was PM in 7 patients, diagnostic problems (tumour, hydronephrosis) or complications (peritonitis, intestinal obstruction) in 15 patients. Antibiotic therapy was nearly the same in both group. Peritoneal drainage in postoperative care was performed in 10 patients of group A for 4.7 days on the average. In this group, secondary wound healing was recorded in 3 patients. In group B, elective appendectomy was performed only in 12 patients (50%). In 2 patients, however, a diagnostic error was revealed, i.e. Crohn's disease and an ovarian cyst had been suspected to be a periappendicular mass. Conservative treatment with subsequent elective appendectomy after 6 months seems to be an effective method in the treatment of patients with a typical clinical picture and well bordered periappendicular mass. Appendectomy in the subacute phase of the disease appears to be a safety technique of PM treatment in patients with complications or diagnostic problems.

[Diagnosis and surgical treatment of tracheoesophageal fistulas without esophageal atresia]. / Diagnóza a chirurgické riesenie tracheoezofageálnej fistuly bez atrézie pazeráka.

Tracheooesophageal fistulae (TEF) without atresia of the oesophagus cause in children relapsing respiratory diseases. The authors present diagnostic and therapeutic procedures in seven children. The symptoms of aspiration with attacks of non-productive cough and suffocation when fed were recorded in all children since birth. In five the diagnosis was made late. In four children the diagnosis was established by oesophagoscopy, in two by cinematooesophageography and in one by Fabian's test (Koop's test). All seven children were operated by a transcervical approach. After surgery all children are in a good condition and have no respiratory complaints.

[Improvised reconstruction of the esophagus in concurrent atresia and nonrotation]. / Improvizovaná náhrada ezofagu pri súcasnej atrézii a nonrotácii.

In the course of three years, 1985-1987, 21 children with congenital atresia of the oesophagus were operated, incl. four where the oesophagus had to be replaced by the large intestine. Each operation had unforeseen complications, all children survived, however, and are thriving. The authors describe the case of a girl with atresia type Vogt 1 who had moreover hypochromic anaemia, was a twin, premature, hypotrophic and had harelip. During the planned operation when the oesophagus was to be replaced by the large intestine at the age of 8 months, it was, however, revealed that the child has a narrow mesenterium commune with incomplete rotation. They had to perform a completely modific and improvised selection of the portion of the gut for transposition, a part of the ileum and caecum with another portion, as only that portion could be transplanted with preservation of the nurture. The gut could not be stretched because of the short mesentery. The child is now two years after the operation and development corresponds to age.