Псевдокиста поджелудочной железы у детей

Pancreatic injuries include a variety of injuries from simple contusion to complete rupture of the duct and pancreatic head. Although pancreatic lesions are rare in children, the pancreatic pseudocyst is the most common posttraumatic cystic lesion of the pancreas and is a localized collection containing pancreatic juice and the peripancreatic necrotic test. The management of the pancreatic pseudocyst has evolved from the stage of exclusive surgical treatment exclusively, to the conservative one, respectively the stage of minimally invasive treatment (percutaneous drainage, endoscopic drainage) and laparoscopic treatment. However, the management remains controversial, the approach depending on the type of lesion, size and evolutionary characteristics. This paper presents the case of a pediatric patient, polytrauma due to a rail accident who is diagnosed 3 weeks after hospitalization with a pseudocyst of the pancreas. We will present both he diagnostic means and the management, both medicinal and surgical, as well as the subsequent evolution of the patient.Traumatismele pancreatice includ o varietate de leziuni de la simpla contuzie până la ruptura completă a ductului și capului pancreatic. Deși leziunile pancreatice sunt rare la copii, pseudochistul de pancreas reprezintă cea mai frecventă leziune posttraumatică de tip chistic a pancreasului și este o colecție localizată ce conține suc pancreatic și țestul necrotic peripancreatic. Managementul pseudochistului de panceras a evoluat de la etapa de tratament chirurgical deschis exclusiv, către cel conservator, respectiv etapa de tratament minim invaziv (drenaj percutan, drenaj endoscopic) și tratament laparoscopic. Managementul rămane însă controversat, abordarea depinzând de tipul leziunii, dimensuni și caracteristici evolutive. Lucrarea de față prezintă cazul unei paciente de vârstă pediatrică, politraumatism prin accident feroviar ce este diagnosticată la 3 saptamani dupa internare cu pseudochist de pancreas. Vom prezenta atat mijloacele diagnostice cât și managementul medicamentos, chirurgical respectiv evoluția pacientei.Травма поджелудочной железы включает разнообразные повреждения от простой контузии до полного разрыва протока и головки поджелудочной железы. Хотя поражения поджелудочной железы у детей встречаются редко, псевдокиста поджелудочной железы является наиболее частым посттравматическим кистозным поражением поджелудочной железы и представляет собой локализованное скопление, содержащее панкреатический сок и перипанкреатический некротический тест. Лечение псевдокисты поджелудочной железы эволюционировало от этапа исключительно открытого оперативного лечения к консервативному, соответственно к этапу малоинвазивного лечения (чрескожное дренирование, эндоскопическое дренирование) и лапароскопического лечения. Тем не менее, лечение остается спорным, подход зависит от типа поражения, размера и эволюционных характеристик. В статье представлен случай ребенка с политравмой в результате железнодорожной катастрофы, у которого через 3 недели после госпитализации диагностирована псевдокиста поджелудочной железы. Мы представим как диагностические средства, так и медикаментозное и хирургическое лечение, соответственно эволюцию пациента.Ключевые слова: псевдокиста поджелудочной железы, кистозное поражение, поджелудочная железа, детская травма

NEONATAL NECROTIZING ENTEROCOLITIS: CLINICAL DATA AND TREATMENT POSSIBILITIES

Objectives. The aim of this paper is to identify the correlations between the clinical evolution of the neonates with necrotizing enterocolitis (NEC) and the stage of disease, associated risk factors and the type of treatment used. Material and methods. A 6 years retrospective study was performed based on reviewing the casuistry of the Regional Centre of Neonatal Intensive Care Unit (NICU) „Cuza Voda” and 205 cases of necrotizing enterocolitis were identifi ed from a total number of 6183 neonates admitted there. Patients were divided in to study groups based on the gestational age (GA) and birth weight (BW). The analysis protocol was realized based on a working sheet that included the epidemiological data of the patients, the risk factors, type of nutrition, age at diagnosis, stage of disease according to Bell classifi cation, type of treatment (medical, surgical or combined), complications and the general evolution. The statistical data processing was performed in SPSS Statistics 20 program. Results. NEC had a frequency of 3.3% is the study group and was diagnosed in premature newborns in 75.6% of cases. The mean GA for the study group was 33 weeks. The mean BW was 1896 g with 43% of the cases in very low birth weight (VLBW) group and 31.2% in low birth weight (LBW) group. The percentage incidence of the risk factors was as follows: persistence of ductusarteriossus 19.5%, perinatal asphyxia 13.7% and respiratory distress 100% of cases. 75.5% were treated and discharged from NICU, 16.6% were transferred to Pediatric Surgery Department „Sf. Maria” and 3.9% died in NICU. From the 34 cases transferred19 cases were surgically treated: 8 cases with peritoneal drainage (PD), 8 cases with primary laparotomy (LAP) and 3 cases with PD and LAP. The survival rate in this group was 2.4% and for the medically treated group was 4.9%. Conclusions. Prematurity is statistically correlated with encountering advanced stages of enterocolitis at the time of diagnosis. The option for surgical treatment (peritoneal drainage or laparotomy) does not infl uence the results and early enteral feeding with formula is the most important risk factor for NEC followed by age of gestation and very low birth weight

Necrotizing ulcerative enterocolitis - risk factors, therapeutic interventions

Universitatea de Medicină şi Farmacie “Gr.T.Popa”, Iaşi, Spitalul Clinic de Obstetrică-Ginecologie Cuza-Vodă, Spitalul Clinic de Urgenţă pentru Copii Sf. Maria, IaşiNecrotizing enterocolitis (NEC) is the most frequent digestive emergency in the neonatal period, mainly diagnosed in the premature newborn. In this study, the authors tried to synthesize the correlation among risk factors, stage of disease and outcome. Material and methods: we carried out a retrospective study on 205 neonates with NEC, diagnosed in our NICU over 6 years. We assessed the following parameters: gestational age, birth weight, associated diseases, infection, moment of onset, type of feeding at onset, clinical staging, duration of symptoms, surgical treatment and outcome. Results: the incidence of NEC in the NICU was 3.32%. The mean GA was 33 weeks and the mean BW was 1900 grams. Associated diseases were: PDA – 19.5%, perinatal asphyxia – 13.7%, medium and severe respiratory distress – 67.8%. 39% of the neonates had positive gastric aspirates and infection was correlated with clinical staging. The onset of symptoms was 9 days of age and the mean duration of symptoms was 5 days. Both were correlated with clinical staging. Feeding at onset was predominantly parenteral, with or without enteral supplementation with formula. 16.6% of patients were transferred to Pediatric Surgery, 9.3% were performed surgery and 6.8% were deceased following surgery. Conclusions: Our results show powerful arguments both for the caution regarding nutrition of the premature newborn and for the timely therapeutic intervention in newborns with NEC

Post-traumatic humerus non-union treatment using fibular bone graft in a pediatric patient – case report

Clinica de Chirurgie și Ortopedie Pediatrică, Spitalul Clinic de Urgență pentru Copii ”Sfânta Maria”, Iași, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Pseudartroza de humerus prezintă o incidență de 8-12% în rândul populației pediatrice. Există o varietate largă de opțiuni terapeutice, principiile de tratament bazându-se pe reducere deschisă și osteosinteză sau utilizare de grefon osos, în funcție de caz. Material și metode: Pacientă în vârstă de 15 ani,victimă a unui accident rutier, s-a internat în urgență pentru traumatisme multiple, printre diagnosticele stabilite fiind fractura diafizei humerale stângi, pentru care s-a practicat reducere deschisă și osteosinteză cu placă și șuruburi. La un an postoperator s-a constatat pseudartroză la nivelul focarului de fractură. Rezultate obținute: S-au utilizat numeroase metode de tratament pentru cura pseudartrozei: montarea de fixator extern, injectare perilezională cu factori de creștere, o nouă osteosinteză cu placă și șuruburi și plombajul defectului osos cu ceramică bifazică. Întrucât pseudartroza a persistat, s-a optat pentru o nouă intervenție cu utilizarea grefonului osos peronier fixat centromedular la nivelul humerusului, evoluția postoperatorie fiind favorabilă. Concluzie: Pseudartroza de humerus rămâne una dintre cele mai dificile complicații ale fracturii de humerus din cauza frecvenței sale și a dificultăților de management terapeutic. În cazul de față, tratamentul chirurgical utilizând grefon osos autolog a avut rezultate optime, cu o rată bună de vindecare din punct de vedere anatomo-funcțional.Introduction: Humerus fracture non-union presents 8-12% of all the pediatric population. Treatment options are numerus and is generally based on open reduction with internal fixation or using bone graft depending on each case individually. Material and methods: 15 years old female patient, presented with road traffic crash, was admitted with multiple trauma. Left humerus shaft fracture was one of the established diagnosis, open reduction with internal fixation was performed using a plate and screws. 1 year postoperatively non-union was noticed on the check X-rays at the fracture site. Results: Multiple methods were used for non-union treatment: external fixator, growth factor hormone injection at fracture site, second open reduction with internal fixation attempt and biomaterial usage for bone loss. Fracture non-union persisted despite the usage of the mentioned methods. Decision was taken to use fibular bone graft as an intramedullary fixation of the humerus. Postoperative result and follow up were satisfactory. Conclusion: Humeral fracture non-union is one of the worse complications due to its frequency and difficult therapeutic management. In this presented case, surgical treatment using autologous bone graft reflected in optimal results, high anatomo-functional healing results

The Influence of Cold Rolling on the Microstructure for Drawing Steels

The paper presents the structural changes that appeared in steel for deep drawing, as a result of cold rolling and of recrystallization thermal treatment. The research was conducted on samples taken from the rolled strap, treated and rerolled after the present technology in Arcelor Mittal. For comparison samples sampled from the steel strap before cold deforming (hot rolled) were used as blank tests. The thermal processing was done under industrial conditions in bell furnace. For the chosen steel the critical deformation degree was around the value of 6.5%

NEUROBLASTOMUL CU DISEMINARE METASTATICĂ, PREZENTARE NEONATALĂ-CASE REPORT

Neuroblastoamele sunt tumori cu origine in celule sușe ale sistemului nervos simpatic, derivate din crestele neurale, reprezentând70% dintre tumorile cu localizare la nivelul glandei suprarenale. Neuroblastomul este cea mai frecventă tu- moră solidă la sugar, cu o prevalență de 1:70000 de nou-născuți, insumând aproximativ 20% din cancerele neonatale. Rata de mortalitate se situează la 15%, având ca factor cauzal dificultățile de diagnostic precoce. 1-2% din cazuri prezintă istoric familiar. Neuroblastoamele caracteristici genetice, biologice și morfologice heterogene si un comportament clinic divers.Lucrarea prezintă cazul unui nou-născut de sex feminin, 8 ore de viată, provenit din sarcină nedispensarizată, naștere dificilă cu aplicare de forceps, transferat in sectia de Chirurgie cu suspiciunea diagnostică de hemoperitoneu. Explorările imagistice efectuate in urgență confirmă diagnosticul de hemoperitoneu și relevă prezența unei tumori de glandă suprare- nală dreaptă, multiple diseminări hepatice si hepatomegalie importantă. La internare pacienta prezintă stare generala gravă, abdomen mărit de volum pe seama hepatomegaliei, circulație colaterală abdominală. Se intervine chirurgical, dupa stabilizarea hemodinamică a pacientei, practicându-se laparotomie subcostală dreaptă. Se constată prezența unei rupturi de lob drept hepatic, fără hmoragie activă pe tranșa de ruptură și se practică biopsie metastază tumorală hepatică, tumorsu- prarenalectomie dreaptă, controlul hemostazei. Evoluția postoperatorie este lent nefavorabilă pacienta prezentând anemie importantă, edeme generalizate, oligoanurie și in ciuda tratamentului suportiv maximal dezvoltă stop cardiocircultator ce nu răspunde la manevrele de resuscitare.Neuroblastomul este una dintre cele mai enigmatice tumori în perioada neonatală, putând regresa spontan sau progre- sa fulminant in absența unui plan terapeutic adecvat sau in prezența unui stadiu avansat. Diagnosticul precoce reprezintă o provocare in practica medicală curentă, ca in cazul prezentat in care afecțiunea a debutat in utero, iar pacienta nu a beneficiat de ecografie antenatală. Descoperirea unui neuroblastom fetal crează oportunitatea fie a unui tratament in utero, fie a unor precauții in ceea ce privește momentul nașterii

Biomarkers of the brain injuries - the future diagnosis standard in head trauma? Brief literature review

Acute head trauma is often a clinical challenge in diagnosing the brain damage, assessing its severity and prognosis, and establishing the optimal treatment. Different patients, with brain damage of apparent comparable severity according to the imaging examination, may have different neurological evolution or different response to therapy.Minor traumatic brain injuries can induce a brief loss of consciousness or confusion, are usually benign, but sometimes they cause persistent and progressive brain symptoms in the long run. However, at present, there are no reliable methods that can diagnose properly minor traumatic brain injuries.Biomarkers of the brain injuries allow the monitoring of both physiological and pathological processes. The identification of such biomarkers could allow a better understanding of the pathological processes involved in traumatic brain injuries, their diagnosis, prognosis and may facilitate the establishment of a better treatment regimen for these patients.In this article, the authors make a brief review of the literature in which they analyse the biomarkers of the lesions of the various brain structures identified so far, which can be detected in biological fluids (blood, cerebrospinal fluid) and the advantages and limitations of their use in the current medical practice

Physician-patient relationship in rare diseases: an ethical approach

Rare diseases are a special category of pathology recognized as such relatively recently, starting about 30 years ago in the USA and around the year 2000 in Europe. Rare diseases are clinically and therapeutically heterogeneous, being characterized by a number of common aspects that have a negative impact on patients’ evolution and quality of life, such as: delayed diagnosis, limited scientific knowledge about some of them, lack of treatment or limited availability of treatment. At the same time, information campaigns on rare diseases are limited, and the number of association of patients that promote their interests and rights is also reduced. The quality of physician- patient relationship is particularly important in the management of rare diseases, non-medical aspects, especially the ethical and moral aspects, being often more relevant to patients than the medical aspects. The ethical framework for the analysis of rare diseases encompasses a number of particular aspects, generated on the one hand by the need to properly approach patients suffering from rare diseases in the context of rising expectations for the medical system, and on the other hand, the pro-profit behavior of the pharma companies. This paper analyzes the particular ethical issues identified in the clinical approach on rare diseases, with a focus on the particularities of the physician-patient relationship in this context