HYPERTROPHIC PYLORIC STENOSIS – FIVE-YEAR RETROSPECTIVE ANALYSIS

Iako nam u 21. stoljeću etiologija bolesti još nije u potpunosti razjašnjena, kliničko značenje bolesti je veliko jer je bolest u novorođenačkoj dobi česta u usporedbi s ostalim stanjima s kojima se bavi novorođenačka kirurgija. Uz suvremenu dijagnostiku hipertrofičnu stenozu pilorusa danas lako razlikujemo od ostalih diferencijalnih dijagnoza koja se očituju povraćanjem kao glavnim simptomom. Klinika za dječju kirurgiju Klinike za dječje bolesti Zagreb uspješno se nosi sa suvremenim izazovima kako ovoga tako i niza drugih stanja koja pogađaju novorođenčad. Kako bismo približili ovo stanje retrospektivno smo analizirali podatke 40-ero hospitalizirane djece iz bolničkog informacijskog sustava (BIS) u razdoblju od 2010. do 2015. godine te ih iznijeli kao temelj za algoritme postupanja te daljnja istraživanja. Analizirajući niz parametara došli smo do konkretnih zaključaka. Bolest se u prosjeku počela manifestirati 28-og dana nakon rođenja, 63 % djece je razvilo sliku metaboličke alkaloze. Debljina mišićne stijenke verifi cirane ultrazvukom kretala se u rasponu od 3,1 mm do 7 mm. Nakon stabilizacije acidobaznog statusa sedmog dana se pristupalo kirurškom zahvatu koji je u prosjeku trajao 48 minuta. Prosječna duljina hospitalizacije iznosila je 11,64 dana, od čega 2 dana u jedinici intenzivnog liječenja. Komplikacije su zabilježene kod dvoje pacijenata.Although the etiology of the disease has not yet been fully clarifi ed in the 21st century, clinical signifi cance of the disease is huge because it is frequent in the neonatal period compared with other diseases. Today, owing to advanced diagnostic possibilities, hypertrophic pyloric stenosis is easily distinguished from other differential diagnoses that are manifested by vomiting as the main symptom. At Department of Pediatric Surgery, Zagreb Children’s Hospital, efforts have been invested to successfully manage this and a number of other conditions that affect newborns. We retrospectively analyzed data on 40 hospitalized children retrieved from the hospital information system for the 2010-2015 period and present them as a basis for the respective algorithms and future research. Reviewing a range of parameters, we have come to some concrete conclusions. On average, the disease started manifesting on 28th day after birth; 63% of the children developed metabolic alkalosis. Thickness of the muscle wall verifi ed by ultrasound ranged from 3.1 mm to 7 mm. Surgery was performed seven days after hospitalization and correction of metabolic condition. The average duration of surgery was 48 minutes. The mean length of hospital stay was 11.64 days, of which 2 days in the intensive care unit. Complications occurred in two patients

Correlation between pyloric muscle thickness and changes of acid-base status in children with congenital hypertrophic pyloric stenosis

Hipertrofična stenoza pilorusa jedno je od najčešćih kirurških stanja u djece, koje se obično otkriva unutar prvih 12 tjedana života.Nepoznate je etiologije, ali se smatra da veliki utjecaj imaju genski čimbenici i okoliš, uz hipergastrinemiju i hiperaciditet želuca. Češćaje u muške novorođenčadi s omjerom 4-6:1. Hipertrofija i hiperplazija mišićnog sloja pilorusa uzrokuju opstrukciju lumena, štorezultira karakterističnim povraćanjem u mlazu bez primjesa žuči. Zlatni standard u postavljanju dijagnoze je ultrazvuk. Terapija jekirurška, a prije operacije potrebna je nadoknada tekućine i elektrolita radi sprječavanja perioperativnih komplikacija.Cilj: Svrha ovog rada je prikazati korelaciju promjene acidobaznog statusa i ultrazvučne debljine mišića u novorođenčadi s kongenitalnom hipertrofičnom stenozom pilorusa te povezanost duljine trajanja simptoma i nastanka težih metaboličkih poremećaja.Metode: Provedeno je retrospektivno istraživanje u kojem je promatrano 41 dijete hospitalizirano zbog sumnje na stenozu pilorusa. Podatci su obrađeni metodama deskriptivne statistike u programu TIBCO Statistica 13.4. Rezultati: Pokazalo se da nema statistički značajne povezanosti između ultrazvučno izmjerene debljine mišića i stupnja alkaloze. Duljina trajanja simptoma i promjena pH vrijednosti nisu linearno povezane, ali je u dvoje djece s višim stupnjem alkaloze zamijećena teža hipokloremija, pa je to dvoje bolesnika imalo i komplikacije nakon kirurškog zbrinjavanja.Zaključak: Iako je hipertrofična stenoza pilorusa stanje koje može dovesti do teških metaboličkih poremećaja, oni se u današnje vrijeme rijetko javljaju zbog ranog postavljanja dijagnoze, korekcije elektrolita i kvalitetne zdravstvene skrbi.Introduction: Hypertrophic stenosis of the pylorus is one of the most common surgical conditions in children, which is commonly detected within the first 12 weeks of life. There is no known aetiology, but it is assumed that genetic factors and the environment are key elements, along with hypergastrinaemia and hyperacidity of the stomach. It is more common in male infants with a 4-6:1 ratio. Hypertrophy and hyperplasia of the muscular layer of the pylorus cause luminal obstruction resulting in characteristic explosive vomiting without admixture of bile. The gold standard for diagnosis is ultrasound. Therapy is surgical, but before surgery it is necessary to compensate fluid and electrolyte imbalance to prevent perioperative complications. Objective: The purpose of this paper is to show the correlation between changes of acid-base status and ultrasound muscle thickness in newborns with congenital hypertrophic stenosis of pylorus and the correlation between the duration of symptoms and the severity of metabolic disorders. Methods: In this retrospective study, we analysed medical history of 41 children hospitalized for suspected stenosis of the pylorus. Data were processed using descriptive statistics methods in TIBCO Statistics 13.4. Results: There was no statistically significant correlation between ultrasound muscle thickness and alkalosis level. The duration of symptoms and changes in pH value were not linearly related, but in two children with higher alkaline levels there was a higher degree of hypochloremia, and both patients had complications after surgical treatment. Conclusion: Although hypertrophic pyloric stenosis is a condition that can lead to severe metabolic disorders, they are rarely present owing to early diagnosis, effective electrolyte correction and quality health care

Haemorrhagic pseudocyst of the adrenal gland: case report and literature review

Adrenalne pseudociste su relativno rijetke patološke tvorbe u pedijatrijskoj populaciji. Obično su asimptomatske te su sporadičan nalaz na radiološkim pretragama. No kad promjerom prelaze veličinu od 5 cm, mogu uzrokovati simptome kompresije susjednih organa te zahtijevati kirurško liječenje. U dijagnostici takvih lezija u pedijatrijskoj populaciji izrazito je bitno razlikovati benignu od maligne lezije. Prikazujemo pacijenticu u dobi od 12 godina koja se prezentirala slikom difuznih bolova u abdomenu te febriliteta. Kod pacijentice je ultrazvučno praćena cista desne nadbubrežne žlijezde kroz prethodne dvije godine. Pacijentica je kirurški zbrinuta ekscizijom te drenažom cistične tvorbe otvorenom medijalnom laparotomijom. Patohistološki nalaz verifi cira tumorsku tvorbu kao hemoragičnu pseudocistu nadbubrežne žlijezde. Praćenje šest mjeseci postoperativno pokazalo je dobre rezultate.Adrenal pseudocyst is a rare pathologic fi nding in paediatric population. They tend to be asymptomatic lesions and are usually found sporadically in radiologic fi ndings. However, cysts larger than 5 cm in diameter can cause symptoms of compression on adjacent organs and therefore surgical removal is needed. Regarding diff erential diagnosis, it is crucial to diff er a benign from malignant lesion in paediatric population. We report a case of a 12-year-old girl who presented with acute abdominal pain and fever. She had been diagnosed with a right abdominal cyst two years before and was routinely followed up through our outpatient clinic. Medial laparotomy, surgical excision and drainage of the cystic lesion were performed. Histopathology examination reported a haemorrhagic adrenal pseudocyst. Six-month follow up was uneventful

Endoscopic treatment of primary vesicoureteral reflux at Zagreb Children’s Hospital

Cilj ovog članka je dati pregledni prikaz endoskopskog liječenja primarnog vezikoureteralnog refluksa u djece, u razdoblju od 2012.do 2013. godine, koja su liječena u Klinici za dječju kirurgiju Klinike za dječje bolesti Zagreb.Metode: Kratkom presječnom retrospektivnom analizom obradili smo ukupno 66-ero bolesnika koji su endoskopski liječeni na Klinici zbog primarnog VUR-a. Rezultat se smatrao zadovoljavajućim ako su dijagnostički nalazi upućivali na odsutnost VUR-a ili ako je od posljednjeg zahvata prošlo više od dvije godine bez recidiva.Rezultati: Od ukupnog broja uretera 96,5% je uspješno izliječeno endoskopskim načinom liječenja, 3,5% nije bilo izliječeno. Nakon prvog endoskopskog zahvata izliječeno je 50,9%, nakon drugog postotak raste na 75,4%, a nakon trećeg zahvata na 92,1%, a postotakod 96,5% postignut je četvrtim zahvatom kod probranih bolesnika. Kod 3,5% uretera učinjena je otvorena antirefluksna plastika prema Lich-Gregoiru. Zaključci: Endoskopski način liječenja zbog svog visokog postotka učinkovitosti, brzog oporavka i kratkog boravka u bolnici, ima prednost pred ostalim metodama liječenja, pa je zato postao novi zlatni standard u liječenju VUR-a.Objective: The aim of this paper is to give a preview of primary vesicoureteral reflux (VUR) endoscopic treatment at Department ofPaediatric Surgery, Zagreb Children’s Hospital, in 2012 and 2013.Methods: Sixty-six patients having undergone endoscopic procedure for primary VUR were retrospectively analysed in this shortcross-sectional study. The outcome was deemed satisfactory in the absence of VUR as indicated by diagnostic methods or 2-yearpostprocedural relapse-free period.Results: Endoscopic procedure proved successful in 96.5% and unsuccessful in 3.5% of cases; 50.9% of all patients were successfullytreated in the first procedure, and this percentage increased to 75.4%,92.1% and 96.5% after the second, third and fourth procedurein selected patients, respectively; an open surgical procedure was required in 3.5% of cases. Our procedure of choice is Lich-Gregoirtechnique.Conclusion: Advantages of endoscopic treatment in comparison to other modalities are high-percentage success, faster recovery,and shorter hospital stay, therefore it has become the new gold standard of VUR treatment

HYPERTROPHIC PYLORIC STENOSIS – FIVE-YEAR RETROSPECTIVE ANALYSIS

Iako nam u 21. stoljeću etiologija bolesti još nije u potpunosti razjašnjena, kliničko značenje bolesti je veliko jer je bolest u novorođenačkoj dobi česta u usporedbi s ostalim stanjima s kojima se bavi novorođenačka kirurgija. Uz suvremenu dijagnostiku hipertrofičnu stenozu pilorusa danas lako razlikujemo od ostalih diferencijalnih dijagnoza koja se očituju povraćanjem kao glavnim simptomom. Klinika za dječju kirurgiju Klinike za dječje bolesti Zagreb uspješno se nosi sa suvremenim izazovima kako ovoga tako i niza drugih stanja koja pogađaju novorođenčad. Kako bismo približili ovo stanje retrospektivno smo analizirali podatke 40-ero hospitalizirane djece iz bolničkog informacijskog sustava (BIS) u razdoblju od 2010. do 2015. godine te ih iznijeli kao temelj za algoritme postupanja te daljnja istraživanja. Analizirajući niz parametara došli smo do konkretnih zaključaka. Bolest se u prosjeku počela manifestirati 28-og dana nakon rođenja, 63 % djece je razvilo sliku metaboličke alkaloze. Debljina mišićne stijenke verifi cirane ultrazvukom kretala se u rasponu od 3,1 mm do 7 mm. Nakon stabilizacije acidobaznog statusa sedmog dana se pristupalo kirurškom zahvatu koji je u prosjeku trajao 48 minuta. Prosječna duljina hospitalizacije iznosila je 11,64 dana, od čega 2 dana u jedinici intenzivnog liječenja. Komplikacije su zabilježene kod dvoje pacijenata.Although the etiology of the disease has not yet been fully clarifi ed in the 21st century, clinical signifi cance of the disease is huge because it is frequent in the neonatal period compared with other diseases. Today, owing to advanced diagnostic possibilities, hypertrophic pyloric stenosis is easily distinguished from other differential diagnoses that are manifested by vomiting as the main symptom. At Department of Pediatric Surgery, Zagreb Children’s Hospital, efforts have been invested to successfully manage this and a number of other conditions that affect newborns. We retrospectively analyzed data on 40 hospitalized children retrieved from the hospital information system for the 2010-2015 period and present them as a basis for the respective algorithms and future research. Reviewing a range of parameters, we have come to some concrete conclusions. On average, the disease started manifesting on 28th day after birth; 63% of the children developed metabolic alkalosis. Thickness of the muscle wall verifi ed by ultrasound ranged from 3.1 mm to 7 mm. Surgery was performed seven days after hospitalization and correction of metabolic condition. The average duration of surgery was 48 minutes. The mean length of hospital stay was 11.64 days, of which 2 days in the intensive care unit. Complications occurred in two patients