[Chest injuries in polytraumatized children]. / Poranení hrudníku u detí s polytraumatem.

Chest injuries in children are part of polytrauma resulting from high-energy violence, most often caused by traffic accidents. Blunt chest injuries (95%) are significantly more frequent than penetrating injuries (5%). Lung contusion, rib fracture, pneumothorax or haemothorax, are the more common injuries, but tracheobronchial rupture, cardiac or diaphragmatic injuries may also occur. The anterior X-ray image remains the basic examination method for isolated chest injuries. CT trauma scan with a contrast medium is done in polytraumatized children. Blunt injuries of intra-thoracic organs in haemodynamically stable children are treated mostly conservatively (85%) under full monitoring at the ICU. Surgical treatment is necessary in a minority of patients. Mortality and morbidity of patients with chest injury depend on the actual combination of multiple body systems injury. The severity of total injury can be predicted using objective scoring systems (Abbreviated Injury Scale=AIS; Injury Severity Score=ISS). Overall mortality ranges from 6 to 20%. Mortality is high but this is mainly due to associated head injuries.Key words: multiple trauma thoracic trauma - paediatric lung contusion Injury Severity Score=ISS.

[Liver transplantations in children using reduced grafts]. / Transplantace jater u detí redukovaným stepem.

AIM: Liver transplantation is a life-saving procedure in patients with end stage liver disease. Five-year survival in patients indicated for transplantation based on standard indication criteria, has reached a rate over 80%. Shortage of suitable grafts remains the main problem in these procedures. While the situation in adult patients is relatively satisfactory, liver transplantations in children, mainly in the low-weight categories, remain a worldwide problem because of the absolute lack of suitable donors. In order to reduce mortality in the youngest patients on the waiting list, a concept of reduction of the adult graft for pediatric use was introduced in the early 1990s. Recent introduction of novel methods, such as split transplantations or transplantations between relatives, has resulted in lower mortality rates in the youngest recipients on the waiting lists. The author assesses a group of patients below 18 years of age, who underwent reduced liver graft transplantations in the Czech Republic. MATERIAL AND METHODS: From 1995 to 2009, a total of 43 patients below 18 years of age underwent transplantations, using 48 liver grafts. Further 17 children were sent abroad for transplantations, where a total of 23 liver grafts were used. Only patients who underwent transplantations using the liver grafts adjusted in IKEM were assessed in the patient group, i.e. 14 patients, resp. 16 liver grafts. Reduction was performed in 13 subjects. One subjects underwent transplantation between relatives and a liver split was used in two subjects. In the lowest weight category up to 10 kgs, 5 liver reductions were performed. OUTCOMES: Out of the total (n = 16), 4 grafts failed (2 were early postoperative failures, ie. within 2 postoperative days and 2 grafts failed in Month 5). The mean graft survival was 65 months. Within the youngest recipient age group (n = 5), no graft failure was recorded. The mean survival time is 26 months. CONCLUSION: Since 2007, the Czech Republic has been providing a program for all patients, including the lowest weight-category pediatric patients. To date data are satisfactory. No graft failure has been recorded in the category of the smallest (up to 10 kgs) pediatric patients.

[Mechanical ventilation on paediatric intensive care units in Czech Republic]. / Kontrollierte Beatmung auf pädiatrischen Intensivstationen in der Tschechischen Republik.

OBJECTIVE: The aims of this study were to evaluate the incidence of mechanically ventilated children in participating units, to find out the demographic data of the patients, to evaluate ventilator settings and to assess the mortality of ventilated children. DESIGN: Prospective observational multicenter study between 1. 2. 2002 and 30. 4. 2002. SETTING: Seven paediatric intensive care units in tertiary hospitals in the Czech Republic. PATIENTS: All children between 1 month and 18 years admitted to the participating paediatric intensive care units who required intubation and mechanical ventilation were enrolled. METHOD: Following parameters were recorded in all patients: demographic data (age, weight, gender), the origin of the admitting diagnosis, severity of illness (Pediatric Risk of Mortality Score - PRISM, Multiorgan System Failure - MOSF, Lung Injury Score - LIS), the origin of respiratory failure, presence of chronic disease and immunosuppression, length of ventilation, length of stay, ventilator setting, the use of unconventional ventilation, outcome (mortality), blood gas analyses and indices (alveoloarterial oxygen difference - AaDO (2), oxygenation index - OI, hypoxemia score - PaO (2)/FiO (2) and ventilation index - VI), deadspace to tidal volume ratio-Vd/Vt and dynamic respiratory system compliance (Cdyn). RESULTS: One hundred and forty four children (42 % girls) were enrolled in total which represent 23 % of all admitted children. The mean age of the patients was 70 months and mean weight was 23 kg. PRISM score and the length of stay were twofold against mean values (11.7 vs. 5.7 and 10.4 vs. 4.8 days respectively). The mean length of ventilation was 117 hours, 66 % of the patients had an extrapulmonary origin of respiratory failure, 19 % of the patients were chronically ill, and 0,7 % had the evidence of immunosuppression. Pressure regulated volume controlled and Biphasic positive airway pressure were the most frequently used ventilator settings. Unconventional ventilation in all was used in 13 % of the patients. Mortality was 3.5 %. CONCLUSION: Children on mechanical ventilation create 23 % of all patients admitted to paediatric intensive care units. The severity of illness and length of stay were twofold against mean values. Mortality rate was 3.5 % and hypoxia was not a cause of death in any patient.

[Acute osteomyelitis in children--modification of scintigraphic examination of the skeleton]. / Akutní osteomyelitida u detí--modifikace scintigrafického vysetrení skeletu.

The authors review diagnostic possibilities of acute osteomyelitis in children. They emphasize above all isotope examinations as the method of choice. In the subsequent part they focus attention on possible differentiation of acute osteomyelitis from inflammations of soft tissues-phlegmons. To this end they used a modified method of Israel published in 1987, based on a chronologically different uptake of 99mTc-MDP in normal bone and bone affected with osteomyelitis. According to this method it is possible to differentiate with a 90% accuracy acute osteomyelitis from phlegmons.

[Abnormal placement of the testes]. / Polohové anomálie varlat.

The authors defined a uniform classification of abnormal positions of the testes. They recommend also a uniform therapeutic procedure: after the first year of life treatment with human chorionic gonadotropin in one or two curves, if orchiopexy fails.

[Prophylactic administration of Klion in acute appendicitis]. / Profylaktické podání Klionu u akutní apendicitidy.

The authors present their experience with the prophylactic administration of metronidazole of Richter Co. Hungary (trade name Klion) in children with phlegmonous appendicitis. The preparation was administered in three doses to 51 children. The bacteriological results were evaluated in 42 children. The results of Klion administration in phlegmonous appendicitis were excellent. In the investigated group there were no wound inflammatory nor intraabdominal complications. For comparison the authors mention a group of 1008 children with phlegmonous appendicitis without prophylactic provisions where the number of inflammatory wound complications was 3.62%. Klion has minimal side-effects, was well tolerated and proved excellent for prophylactic administration.