Treatment of the dens fractures in children

The anatomical and biomechanical features of the immature cervical spine make the upper segments at C1–3 especially susceptible to injury. Material and method From 2000 to 2016, 10 patients (3 boys, 7 girls) with C2 dens fractures were treated. The average age of each child was 11 years (3–17). According to the Anderson classification, there were 6 patients with a type III fracture and 4 with a type II. 4 patients were treated conservatively using the Minerva cervical brace for 75 days (66–125) and 6 patients by means of the Halo-Vest for 79 days (64–87) and followed by the Schantz collar for 17 days (2–35). Results The follow up lasted 78 months (12–180). The NDI (Neck Disability Index) score was calculated for each patient, except for section 8 (driving the car). The scores ranged from 1/45 (2.22%) to 20/45 (44.44%). The mean score for 9 out of the 10 patients (one patient died) was 4.77 (10.61%). Conclusion The C2 dens fracture is a rare injury in children. The classification system of dens fractures developed by Anderson is useful in choosing the mode of treatment of dens fractures

Perinatal hospice care in the opinion of nurses and midwives

Objectives: Perinatal medicine is a relatively new, dynamically developing branch of medicine. Its main purpose is takingcare of a woman in the pre-conception period, pregnancy and delivery, as well as taking care of a newborn baby.The main aim of the study was to assess the state of knowledge and opinion on hospice perinatal care of professionallyactive nurses and midwives.Material and methods: An original and anonymous questionnaire containing 30 questions was used for the study. 572 nursesand midwives from the Silesian Voivodeship took part in the study. The obtained data were analyzed.Results: Only 31.6% of respondents defined the level of their knowledge of pregnancy and neonatal care as high. 12.8%of respondents were able to indicate the definition of perinatal care and accurately determine its goals. The women participatingin the study were in favor of enclosing the information about not attempting resuscitation (DNAR) in medicalrecord of children with incurable disease diagnosed in fetal life (99.3%).Conclusions: The study showed deficits in practical and theoretical knowledge of nurses and midwives in the area ofhospice perinatal care. Lack of proper preparation is also one of the most frequently mentioned difficulties in taking careof a child and family with poor prognosis

Neurologic Outcome Comparison between Fetal Open-, Endoscopic- and Neonatal-Intervention Techniques in Spina Bifida Aperta

Introduction: In spina bifida aperta (SBA), fetal closure of the myelomeningocele (MMC) can have a neuroprotective effect and improve outcomes. In Europe, surgical MMC closure is offered by fetal-open (OSBAR), fetal-endoscopic (FSBAR), and neonatal (NSBAR) surgical techniques. Pediatric neurologists facing the challenging task of counseling the parents may therefore seek objective outcome comparisons. Until now, such data are hardly available. In SBA, we aimed to compare neurologic outcomes between OSBAR, FSBAR, and NSBAR intervention techniques. Methods: We determined intervention-related complications, neuromuscular integrity, and neurologic outcome parameters after OSBAR (n = 17) and FSBAR (n = 13) interventions by age- and lesion-matched comparisons with NSBAR-controls. Neurological outcome parameters concerned: shunt dependency, segmental alterations in muscle ultrasound density (reflecting neuromuscular integrity), segmental motor-, sensory- and reflex conditions, and the likelihood of intervention-related gain in ambulation. Results: Compared with NSBAR-controls, fetal intervention is associated with improved neuromuscular tissue integrity, segmental neurological outcomes, reduced shunt dependency, and a higher chance of acquiring ambulation in ≈20% of the operated children. Children with MMC-lesions with a cranial border at L3 revealed the most likely intervention-related motor function gain. The outcome comparison between OSBAR versus FSBAR interventions revealed no significant differences. Conclusion: In SBA, OSBAR- and FSBAR-techniques achieved similar neuroprotective results. A randomized controlled trial is helpful in revealing and compare ongoing effects by surgical learning curves.</p

Open fetal surgery for myelomeningocele — is there the learning curve at reduction mother and fetal morbidity?

Objectives: We aimed to show how increased experience of a surgery team in fMMC repair influences maternal andfetal/neonatal outcomes.Material and methods: We compare perinatal results of fMMC repair in our Fetal Surgery Center (FSC) in cohort groups forthe early period (2005–2011 year; previous — PFSC, n = 46) and current period (2012–2015 year; current — CFSC, n = 74)to results of the randomized Management of Myelomeningocele Study (MOMS, 78 patients).Results: The maternal morbidity due to fMMC repair was low and there was no difference comparing CFSC to PFSC andMOMS. The frequency of iatrogenic preterm labor (iPTL) ≤ 30 weeks of gestation decreased from 34.1% in PFSC to 23.9%in CFSC. Iatrogenic preterm premature rupture of membranes (iPPROM) was a common complication after fMMC repair inall cohorts. The total reduction rate of hindbrain hernation (HH) was similar in CFSC — 90.3% and PFSC — 82.1%.Conclusions: The increasing experience of our surgery team in fMMC repair majorly decreased the risk of iPTL

Urazy układu moczowego u dzieci

Background: As shown by literature data, abdominal trauma in children is responsible for 14% of deaths, whereas in adults for 10%. Although abdominal traumas in children can be severe and lead to massive blood loss, most children die because of accompanying traumas of the thorax and head. It validates the surgical rule concerning abdominal traumas "investigate aggressively, manage conservatively". Posttraumatic injury of the urinary system is not frequent in children and its specificity (compared with adults), depends on greater susceptibility to external aggressive factors. Blunt trauma is the cause of renal parenchyma injury and acceleration/deceleration injury affects the excretory system and vessels. Extension mechanism is the cause of ureter avulsion and/or thrombus formation in stretched renal vessels - it is characteristic in children with non-accidental traumas. Bladder and urethra injuries are rare in children. During car accidents, a rupture of full bladder (seat belt injury) or bladder perforation by fractured bones of the pelvis is possible. Material/Methods: We analyzed all hospitalizations of abdominal trauma in our surgical ward in the year 2004 (70 cases). Renal injuries were found in 6 children (8.6%). Thanks to five-year clinical experience of our hospital, on the average only 1-2 cases per annum needed operation. The management of renal injuries involves first of all conservative treatment. This publication has educational character and may serve as a valuable reminder of the useful knowledge in daily cooperation between the emergency room, radiology department and surgical ward. Based on available literature from recent few years, we quote suggested renal injuries classifications and procedures.This publication contains only images from our department of radiology archives. Results/Conclusions: Clinical symptoms are often not appropriate for blunt abdominal traumas diagnosis. Owing to clinical status, which is difficult to interpret, fast and complete radiological diagnosis is necessary for proper treatment of children after abdominal trauma. Further complications of renal injuries may affect the further growth of the child

Ropne zapalenie mięśni szkieletowych w przebiegu ostrej białaczki limfoblastycznej

Pyomyositis is a term used to asses pyogenic infection of the skeletal muscle and develops as the result of bacteriemia and occurs most commonly in patients with various immunosuppressive diseases. Pyomyositis should be considered in the differential diagnosis in patients complaining of intensive muscle pain and fever. The usual causative organism is Staphylococcus aureus. We present a 3-year-old boy with acute lymphoblastic leukemia (ALL) and pyomyositis caused by Pseudomonas aeruginosa diagnosed in the course of induction therapy. The diagnosis of pyomyositis in the crural muscles of both legs was given based on imaging examinations: ultrasonography and magnetic resonance

Torbiele jajnika wykrywane prenatalnie u płodu – postępowanie i rokowanie

Summary We present 6 case reports of ovarian cysts, diagnosed in the prenatal and postnatal period, as well as treatment. There was no need for invasive prenatal therapy in any of the reported fetuses. Most of the cysts disappeared spontaneously (in one case uncomplicated cyst rupture in fetus have been observed), only in one case laparoscopy was performed after birth.Streszczenie W pracy przedstawiono opis 6 przypadków prenatalnie rozpoznanych torbieli jajnika, postępowanie w trakcie ciąży oraz po porodzie. W żadnym przypadku nie stosowano terapii inwazyjnej u płodu. Większość torbieli zresorbowała się samoistnie (w 1 przypadku obserwowano pękniecie cysty u płodu), tylko w jednym przypadku wymagane było wykonanie laparoskopii u dziewczynki po porodzie

Developmental changes in ACLs and semitendinosus tendons dimensions according to age in children

Purpose: Managing anterior cruciate ligament (ACL) injuries in skeletally immature patients remains difficult. The main aim of this study was to retrospectively compile normative data on the cross-sectional area (CSA) of the semitendinosus tendon (ST) and the diameter of the ACL in children and young adults. Methods: Knee magnetic resonance imaging (MRI) examinations were performed for a 2-year period in 132 patients (83 female and 49 male patients). The mean age was 14.9 years (8-18 years). Measurements of the ST CSA were performed on axial views in greyscale by two independent researchers. The ACL diameter was measured as well. Results: The results show the CSA of the ST was related to age, and its growth was not linear. The highest growth rate of the CSA of the ST occurred at age 12–13 at the level of the femoral growth plate and at the level of the tibial plateau. The growth of the ACL diameter was linear until 18 years of age. Conclusions: ST growth (measured in CSA increments) is almost complete at the age of 13, even though the growth is not linear. ACL growth measured in diameter increments proceeds linearly from 8 to 18 years of age. MRI is a clinically useful tool for assessing hamstring tendon grafts preoperatively