6 research outputs found
HYPERTROPHIC PYLORIC STENOSIS ā FIVE-YEAR RETROSPECTIVE ANALYSIS
Iako nam u 21. stoljeÄu etiologija bolesti joÅ” nije u potpunosti razjaÅ”njena, kliniÄko znaÄenje bolesti je veliko jer je bolest u novoroÄenaÄkoj dobi Äesta u usporedbi s ostalim stanjima s kojima se bavi novoroÄenaÄka kirurgija. Uz suvremenu dijagnostiku hipertrofiÄnu stenozu pilorusa danas lako razlikujemo od ostalih diferencijalnih dijagnoza koja se oÄituju povraÄanjem kao glavnim simptomom. Klinika za djeÄju kirurgiju Klinike za djeÄje bolesti Zagreb uspjeÅ”no se nosi sa suvremenim izazovima kako ovoga tako i niza drugih stanja koja pogaÄaju novoroÄenÄad. Kako bismo približili ovo stanje retrospektivno smo analizirali podatke 40-ero hospitalizirane djece iz bolniÄkog informacijskog sustava (BIS) u razdoblju od 2010. do 2015. godine te ih iznijeli kao temelj za algoritme postupanja te daljnja istraživanja. AnalizirajuÄi niz parametara doÅ”li smo do konkretnih zakljuÄaka. Bolest se u prosjeku poÄela manifestirati 28-og dana nakon roÄenja, 63 % djece je razvilo sliku metaboliÄke alkaloze. Debljina miÅ”iÄne stijenke verifi cirane ultrazvukom kretala se u rasponu od 3,1 mm do 7 mm. Nakon stabilizacije acidobaznog statusa sedmog dana se pristupalo kirurÅ”kom zahvatu koji je u prosjeku trajao 48 minuta. ProsjeÄna duljina hospitalizacije iznosila je 11,64 dana, od Äega 2 dana u jedinici intenzivnog lijeÄenja. 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 Childrenās 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
HipertrofiÄna stenoza pilorusa jedno je od najÄeÅ”Äih kirurÅ”kih stanja u djece, koje se obiÄno otkriva unutar prvih 12 tjedana života.Nepoznate je etiologije, ali se smatra da veliki utjecaj imaju genski Äimbenici i okoliÅ”, uz hipergastrinemiju i hiperaciditet želuca. ÄeÅ”Äaje u muÅ”ke novoroÄenÄadi s omjerom 4-6:1. Hipertrofija i hiperplazija miÅ”iÄnog sloja pilorusa uzrokuju opstrukciju lumena, Å”torezultira karakteristiÄnim povraÄanjem u mlazu bez primjesa žuÄi. Zlatni standard u postavljanju dijagnoze je ultrazvuk. Terapija jekirurÅ”ka, a prije operacije potrebna je nadoknada tekuÄine i elektrolita radi sprjeÄavanja perioperativnih komplikacija.Cilj: Svrha ovog rada je prikazati korelaciju promjene acidobaznog statusa i ultrazvuÄne debljine miÅ”iÄa u novoroÄenÄadi s kongenitalnom hipertrofiÄnom stenozom pilorusa te povezanost duljine trajanja simptoma i nastanka težih metaboliÄkih poremeÄaja.Metode: Provedeno je retrospektivno istraživanje u kojem je promatrano 41 dijete hospitalizirano zbog sumnje na stenozu pilorusa. Podatci su obraÄeni metodama deskriptivne statistike u programu TIBCO Statistica 13.4. Rezultati: Pokazalo se da nema statistiÄki znaÄajne povezanosti izmeÄu ultrazvuÄno izmjerene debljine miÅ”iÄa i stupnja alkaloze. Duljina trajanja simptoma i promjena pH vrijednosti nisu linearno povezane, ali je u dvoje djece s viÅ”im stupnjem alkaloze zamijeÄena teža hipokloremija, pa je to dvoje bolesnika imalo i komplikacije nakon kirurÅ”kog zbrinjavanja.ZakljuÄak: Iako je hipertrofiÄna stenoza pilorusa stanje koje može dovesti do teÅ”kih metaboliÄkih poremeÄaja, oni se u danaÅ”nje 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 patoloÅ”ke tvorbe u pedijatrijskoj populaciji. ObiÄno su asimptomatske te su sporadiÄan
nalaz na radioloÅ”kim pretragama. No kad promjerom prelaze veliÄinu od 5 cm, mogu uzrokovati simptome kompresije susjednih
organa te zahtijevati kirurÅ”ko lijeÄenje. 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 ultrazvuÄno praÄena cista desne nadbubrežne žlijezde kroz prethodne dvije godine. Pacijentica je kirurÅ”ki zbrinuta
ekscizijom te drenažom cistiÄne tvorbe otvorenom medijalnom laparotomijom. PatohistoloÅ”ki nalaz verifi cira tumorsku tvorbu kao
hemoragiÄnu pseudocistu nadbubrežne žlijezde. PraÄenje Å”est 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 Childrenās Hospital
Cilj ovog Älanka je dati pregledni prikaz endoskopskog lijeÄenja primarnog vezikoureteralnog refluksa u djece, u razdoblju od 2012.do 2013. godine, koja su lijeÄena u Klinici za djeÄju kirurgiju Klinike za djeÄje bolesti Zagreb.Metode: Kratkom presjeÄnom retrospektivnom analizom obradili smo ukupno 66-ero bolesnika koji su endoskopski lijeÄeni na Klinici zbog primarnog VUR-a. Rezultat se smatrao zadovoljavajuÄim ako su dijagnostiÄki nalazi upuÄivali na odsutnost VUR-a ili ako je od posljednjeg zahvata proÅ”lo viÅ”e od dvije godine bez recidiva.Rezultati: Od ukupnog broja uretera 96,5% je uspjeÅ”no izlijeÄeno endoskopskim naÄinom lijeÄenja, 3,5% nije bilo izlijeÄeno. Nakon prvog endoskopskog zahvata izlijeÄeno je 50,9%, nakon drugog postotak raste na 75,4%, a nakon treÄeg zahvata na 92,1%, a postotakod 96,5% postignut je Äetvrtim zahvatom kod probranih bolesnika. Kod 3,5% uretera uÄinjena je otvorena antirefluksna plastika prema Lich-Gregoiru. ZakljuÄci: Endoskopski naÄin lijeÄenja zbog svog visokog postotka uÄinkovitosti, brzog oporavka i kratkog boravka u bolnici, ima prednost pred ostalim metodama lijeÄenja, pa je zato postao novi zlatni standard u lijeÄenju 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 Childrenās 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