[Multiple abdominal hydatid disease. Case report]. / Hidatidoza abdominala cu localizare multipla. Prezentare de caz.

Hydatid disease, a parasitic infection caused by Echinococcus granulosus is relatively frequent in our country. Imaging techniques like ultrasound and CT made possible an early and accurate diagnosis prior to serious complications. Hydatid cysts can be ruptured spontaneously or following trauma. The authors report a case of multiple abdominal hydatid disease (hepatic, splenic and peritoneal) in a 11-year-old boy admitted into the Bacau County Hospital with severe abdominal pain and history of abdominal trauma 7 months ago in the right hypochondriac region. The case was managed surgically being performed pericystectomy, splenectomy and omentectomy. Albendazole was administered before and after surgery. The recovery course was uneventful and the evolution favorable. Although ruptured hydatid cyst of liver and multiple abdominal hydatid disease are rare clinic entities, in an endemic region as Romania, they should be taken into account when making the differential diagnosis of abdominal pain.

[Hepato-pulmonary syndrome]. / Sindromul hepato-pulmonar (shp).

The hepato-pulmonary syndrome (HPS) is a rare complication of liver cirrhosis, with poor outcome; the term includes liver disease, increased alveolo-arterial gradient and intrapulmonary vascular dilations, described by Fluckiger, Kennedy and Knudson. HPS impairs survival in cirrhotic patients and the posttransplant outcome is altered in correlation with severity of HPS. Combined determination of SaO2 in clino- and orthostatic position by a pulsoximeter is a simple test for HPS identification in patients with chronic liver disease or non-cirrhotic portal hypertension.

[Arachnoid cyst associated with pyloric stenosis in a young boy]. / Chist arahnoidian asociat cu stenoza pilorica la un copil de vârsta mica.

An unusual association between an arachnoid cyst and a decompensated pyloric stenosis in a three years-old boy is presented. The little patient was admitted into hospital with haematemesis, melena, influenced generally condition and acute posthemorrhagic anaemia following aspirin intake for hypertermia. Specific intensive care was successful and the little patient was discharged but without an upper digestive endoscopy(parents refusal, technical reasons). After one week he returned with progressive worsening vomitings and an intracranial hypertension was suspected. CT documented an arachnoid cyst in the right middle cranial fossa and the patient is directed to the Neurosurgical Clinic where a cyst fenestration was done. Subsequent to operation the vomitings reinstaled with severe dehydration and an upper GI series showed a decompensated pyloric stenosis. He was operated on underwenting an antrectomy. Finally the child recovered with good short and long-term evolution. The coincidental presence of an intracranial congenital mass and a complicated aspirin-induced peptic ulcer in this young patient, misleaded us and in the lack of an early endoscopy an intempestive neurosurgical operation was initially done.

[Diagnosis and treatment of abdominal hydatid cysts in children. A multicentric study]. / Diagnosticul si tratamentul chistului hidatic cu localizare abdominala la copil--studiu multicentric.

UNLABELLED: Echinococcosis is one of the most frequent parasitosis and is endemic in Romania. MATERIAL AND METHOD: The data on 111 children with abdominal localization of hydatidosis who underwent exploration and treatment in 3 pediatric surgical clinics were reviewed. The study evaluated 59 patients who were treated at "Sf. Maria" pediatric hospital Iasi during 2004 and 2009, 47 at "Marie Curie" pediatric hospital from Bucharest during 2000 - 2009 and 5 children at Bacau General Hospital 2004-2009. The medical records were reviewed for: demographics, age, gender, location of the cyst, operative procedure, medical treatment, outcome, length of hospital stay and postoperative follow up. RESULTS: Age ranged between 2 and 17 years and male/female ratio was 1,1/1.67% of patients lived in rural areas. The liver was the most common organ involved: in 69 cases it was the only organ involved and there were 2 kidney cyst cases, 8 spleens involved, 2 cases in broad ligament, 13 peritoneal cases and 26 cases of cyst located in great omentum. The preferred surgical procedure was Lagrot partial pericystectomy. For medical antihelminthic treatment it was used Albendazole. As complications there were: biliary fistulas, postoperative cholangitis, infection of the residual cavity, anaphylactic reactions. The mortality rate was 0%. CONCLUSIONS: Most of the patients were from rural area. The liver was the major organ involved. The treatment includes both surgical and medical means. There is a relatively high rate of postoperative complications (although some of them being minor) in 31 patients.

Immunoproliferative small intestinal disease versus colonic monoblastic sarcoma in a 2-year-old boy.

The authors present a case of colonic monoblastic sarcoma, previously treated for other digestive abnormalities (malabsorbtion, Hirschprung's disease). Important similitudes with immunoproliferative small intestinal disease (IPSID) lymphoma were demonstrated for this patient (male, 2-year-old). His main admission complaints were failure to thrive, recurrent episodes of enterocolitis and malabsorbtion syndrome. Some particularities of this case are the young age and the extremely rapid development of the malignant disease in a patient with no previous signs of acute non-lymphoblastic leukemia. The initial diagnosis was of malabsorbtion syndrome, based on the clinical exam at presentation, and then the patient was thought to have a form of Hirschprung's disease, due to a functional intestinal disorder (slow transit). After the necropsy, pathologists diagnosed an immunoproliferative small intestinal disease, and four years later, they performed a more appropriate pathological exam, which explained better clinical symptoms associated to this complex case.

[Treatment of aseptic ulnar non-union in a patient with spastic hemiparesis by Ilizarov method]. / Tratamentul pseudartrozei aseptice de cubitus prin metoda Ilizarov la un pacient cu hemipareza spastica.

Both-bone diaphyseal forearm fractures in children are common lesions. Non-union is very rare, almost exclusively in the ulna. We present a case of forearm fracture in a patient with spastic hemiparesis involving the injured forearm, treated initially with open reduction and intramedullary nailing. Ulnar deviation of both bones, with bending of intramedullary implants, occurred during postoperative period, due to spasticity of forearm flexors. An aseptic non-union of the ulna also developed. Both complications were treated by compression osteogenesis using a Ilizarov circular frame, the end results being excellent. The unusual and rare association between a preexisting neurologic spastic disorder and a forearm fracture can lead to malunion or/and nonunion, a more rigid method of initial osteosynthesis (locked compression plate) being an alternative in such cases.

[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.

[Statistical study of the evolution over ten years of the clinical and therapeutic approach in childhood soft tissue sarcoma]. / Studiul statistic clinico-terapeutic si evolutiv pe 10 ani in sarcoamele de tesuturi moi la copii si tineri.

UNLABELLED: Soft tissue sarcoma has a primitive mesenchymal origin and represents a heterogeneous group of malignant entities with a continuous rising frequency in the age range below 18. Rhabdomyosarcoma (RMS) constitutes 5.8% from the whole amount of pediatric solid tumors, taking the fourth place after CNS tumors, neuroblastoma, and Wilms tumors. The other category of non-rhabdomyosarcoma tumors in children and teenagers represents 3% of the solid malignancies under 18 years old. Our study looks at the particularities of the pathological, clinical, therapeutic aspects and the statistical correlation with prognosis. We included in the study a well-known category of soft tissue tumors called of uncertain malignancy. MATERIAL AND METHOD: The study was made between January 1995 and July 2005 in the Pediatric Department of Hematology and Oncology of the "Sf. Maria" Clinical Emergency Hospital Iasi on a group of 58 de patients ranging between 0 and 18 years old. RESULTS: Positive diagnostic confirmation was established on pathological grounds in optic microscopy and immuno-histo-enzymology performed on bioptic samples in Department of Pediatric Surgery and analyzed in Pathology Laboratory of "Sf. Maria" Clinical Emergency Hospital Iasi. Based on histological examination 19 cases (32.75%) were of rhabdomyosarcoma type with following subtypes: alveolar--7 patients, embryonic-- 9 cases, fusiform - 2 cases, bothrioid--1 case), 8 cases were undifferentiated soft tissue sarcomas and one patient had a tumor of pleiomorphic type; 13 children (22.41%) had non-rhabdomyosarcoma soft tissue sarcomas: 6 fibrosarcomas, 2 synovial sarcomas, 1 leiomyosarcoma, 1 Kaposi sarcoma, 1 case of malignant peripheral nerve sheath tumor, 1 case of angioma tumor, one liposarcoma; 16 cases were included in soft tissue tumors of uncertain origin (fibromatosis--6 cases, fibrous histiocytoma--4 cases, hamartoma--cases, myoblastoma--1 case, fibro-xanthoma--1 case, hemangioendothelioma--1 case); 1 PPNET (Askin tumor). CONCLUSIONS: The continuously augmented incidence of soft tissue sarcoma in young ages and the advanced stages initial presentations of tumors require a much more serious and rhythmic survey at general practitioner level. An improvement of diagnostic means is useful, taking into account the limits of optic microscopy. Therapy must be stage and histology adapted; lowering risk toxicity of good prognosis cases and enhancing doses when required are the only reasonable options to avoid over treatment and to have a much better survival rate.

[Congenital oropharyngeal tumors in the newborn: problems in team diagnosis and treatment]. / Tumori congenitale cu localizare orofaringiana la nou nascut: probleme de diagnostic si tratament în echipa.

There are a great variety of lesions of oral cavity which may require surgical intervention in neonatal period. The differential diagnoses include tumors (malignant, teratoma, cystic hygroma, lymphangioma, hemangioma), congenital epulis, dermoid cysts, ranula. Congenital epulis of the newborn is a rare tumour which is usually benign. Epulis is also known as a congenital gingival granular cell tumour because of its histological features. Female babies are affected 8-10 times more often than males. Epulis is located on the maxillary ridge twice as often as on the mandible, mostly as single tumours but rarely as multiple tumours. The histogenesis of the tumour is unknown. Spontaneous regression of congenital epulis has been reported in a few cases. However, surgical excision is generally indicated due to interference with feeding or respiration. Recurrence of the tumour after surgery has not been reported yet. We report two cases of congenital epulis, one in 2 hour female neonate and one in a 7 days male neonate. In spite of the rarity of this pathology, the interval between presentation in this two cases was ten days. In one case it was an antenatal diagnosis by ultrasonography, in the other it was associated a genital anomalies (hypospadias). The treatment was surgical excision. The intra- and postoperative course was uneventful.

Complications following gastric tube esophagoplasty in children.

Surgery in children with caustic esophageal burns, esophageal atresia or other esophageal disorders can be performed using gastric tube esophagoplasty. Between 1991 and 1999, a number of 41 such procedures have been performed in our department, using the original technique developed by Gavriliu. The results were assessed as good and very good in 83% of the cases, and fair or bad in the rest of 17%. We recorded 13 cases with significant complications, 4 of which ended with exitus. The paper present our experience in using gastric tube esophagoplasty and the management of the complications related to this procedure.

[Limitations in the histopathologic diagnosis and prognosis of neuroblastoma]. / Limite în diagnosticul histopatologic si prognosticul neuroblastoamelor.

Neuroblastoma is the most common nonhematopoietic solid tumor of childhood and has been intensively studied for at least 4 decades. Despite this, few predictive histopathologic clues to its behavior exist. Ages, anatomic sites of occurrence, histopathology of the tumor and clinical stage have traditionally been the only reliable prognostic factors in this disease. In the present study we analyzed these prognostic factors in 72 neuroblastic tumors and our histopathological possibilities of diagnosis.

[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 endoscopic sclerotherapy of esophageal varices in children]. / Sclerozarea endoscopica a varicelor esofagiene la copil.

The injection sclerotherapy of esophageal varices is an important path in the treatment of acute bleeding. This procedure is carried out either in emergency conditions concerning bleeding varices or in the chronic status, the sclerotic drug being injected into and round the dilated infraesophageal veins. This study shows the authors' experience beginning with 1992; since then, at Children's Hospital of Iasi the injection sclerotherapy has become an usual method in the management of the oesophageal varices, especially in the chronic status. This method turns out to be very useful, because nu matter the etiology would be, allows the postponement of decompressive procedures until the child has a proper age.

[Modelling longitudinal ureteroplasty in children]. / Ureteroplastia longitudinala modelanta la copil.

On the basis of their personal experience acquired in the total of 29 modelling interventions in the ureters of 16 children, the authors discuss the value, the technique and the indications of modelling longitudinal ureteroplasties--or the Hendren operation. This intervention was performed in 8 patients for secondary megaureter, and in another 8 patients it was performed for primary megaureters. When it was necessary modelling was performed simultaneously on both sides. In patients without previous derivations systematic use was made of ureter splintering after modelling--when it was re-implanted. Some technical details are discussed. The authors stress the necessity to know exactly before the intervention, the true functional value of the kidney the ureter of which will undergo modelling. Otherwise inutile modelling interventions will be performed (one case). In 3 of the patients, at 4--6 months after surgery, modelling of the upper segment of the ureter was necessary, together with pyeloplastia. The series analysed confirmed the value of this technique aimed at direct correction of the large dilatations of the ureters.