Case report: Duplication of gallbladder in a newborn with gastroschisis

Gastroshiza je defekt trbušne stijenke kroz koji protrudiraju trbušni organi i često je udružena s drugim malformacijama. Najčešće se radi o crijevnim (tri četvrtine), rjeđe ju prate urološke, srčane i malformacije ekstrahepatičkog bilijarnog stabla. Duplikature žučnog mjehura u općoj populaciji su relativno rijetke i javljaju se 1 na 3000–4000. U ovom prikazu slučaja prezentirat ćemo slučaj novorođenčeta s gastroshizom udruženom s duplikaturom žučnog mjehura. Kod novorođenčeta je pronađena kompletna duplikatura žučnog mjehura s dva odvojena duktusa cistikusa (tip 2 po Boydenu). Smjernica za postupak kod duplikature žučnog mjehura u novorođenčadi s gastroshizom nema, mi smo postupili po smjernicama za duplikaturu žučnog mjehura u općoj populaciji. Duplikature žučnog mjehura udružene s gastroshizom ne zahtijevaju aktivno kirurško liječenje ako nisu simptomatske ili ako ne postoji druga malformacija bilijarnog sustava.Gastroschisis is a defect of the anterior abdominal wall through which viscera can protrude, and can be followed by additional malformations. Three quarters of the gastroschisis malformations are confined to the midgut. Other malformations are urologic and cardiac malformations and malformations of extrahepatic biliary tract. Duplication of gallbladder in general population is relatively rare, occurring once in every 3,000 to 4,000.In this case report we will present a case of an infant with gastroschisis accompanied with the duplication of gallbladder. In the newborn a complete duplication of gallbladder was found with two separate cystic ducts, i.e. type 2 by Boyden. Since the guidelines for duplication of the gallbladder associated with gastroschisis do not exist, we acted according to the guidelines for duplication of the gallbladder in the general population, i.e. nonsurgical intervention was performed on the biliary tree. Duplications of the gallbladder associated with gastroschisis do not require active surgical treatment, unless they are symptomatic or if there is other malformation of the biliary system

Tumori jetre u dječjoj dobi

Liver tumors count for approximately 2% of all childhood tumors and almost 70% of them are malignant. Most of them present as palpable abdominal mass. Correct diagnosis considering type, size and localization of the tumor is crucial for the right treatment strategy. Although surgical resection still remains the most important factor for survival, when combined with chemotherapy, the survival rates will raise. Liver transplantation is also considered in some cases of liver tumors. From 1991 to 2008 we treated 13 children with liver tumors. Our experience together with the review of recent literature is presented here.Tumori jetre čine ukupno 2% svih tumora dječje dobi, a preko dvije trećine su zloćudni. Većina se prezentira kao palpabilna tvorba u abdomenu. Za odabir ispravnog plana liječenja nužno je postaviti točnu dijagnozu i odrediti stupanj bolesti. Iako je kirurška resekcija i dalje najbitniji faktor prognoze, u kombinaciji s kemoterapijom postotak preživljenja značajno raste. U određenim slučajevima neresektabilnih tumora transplantacija jetre daje dobre rezultate. Od 1991. godine do 2008. liječili smo 13 djece s tumorom jetre i u ovom radu prikazujemo naše rezultate uz pregled recentne literature

Appendicitis within inguinal hernia – case report of a premature newborn with Amyand’s hernia

Upala crvuljka unutar preponske kile ekstremno je rijetka pojava u nedonoščadi s procijenjenom incidencijom od oko 0,08-0,13%. Dijagnoza ovog izuzetnog entiteta, nazvanog Amyandova kila prema autoru koji ga je prvi opisao, najčešće je slučajna i obično se postavlja tek operativnim zahvatom. U prikazanog muškog nedonoščeta rođenog u 28. tjednu gestacije znaci ukliještenja desnostrane preponske kile javili su se tridesetog dana života. Kirurški zahvat je bio i dijagnostička i terapijska metoda. Nalazom neperforiranog, gangrenozno promijenjenog crvuljka unutar preponske kile postavljena je dijagnoza Amyandove kile. Nakon operativnog zahvata i uz dugotrajno antibiotsko liječenje uslijedio je potpuni oporavak. Prikaz bolesnika je podsjetnik na to da unatoč rijetkoj pojavnosti na Amyandovu kilu treba pomisliti u diferencijalnoj dijagnozi ukliještene desnostrane preponske kile u nedonoščadi.Acute appendicitis within an inguinal hernia is an extremely rare condition among premature newborns with estimated incidence ranging from 0.08% to 0.13%. The diagnosis of this extraordinary entity, known as Amyand’s hernia according to the author who fi rst described it, is often accidental and usually established intraoperatively. We report a case of a boy born at 28 weeks of gestation, who presented with incarcerated right inguinal hernia on his thirty day of life. Surgical intervention was both a diagnostic and therapeutic procedure. Intraoperative diagnosis of Amyand’s hernia was established based on the fi nding of non-perforated, gangrenous appendicitis within the inguinal hernial sac. Appendectomy and hernia repair followed by long-term antibiotic treatment led to complete infant’s recovery. This case report reminds that regardless of its rarity, clinicians should be aware of Amyand’s hernia in the evaluation of incarcerated right side inguinal hernia in preterm newborns

Inicijalni rezultati laparoskopske pijeloplastike u djece

Cilj istraživanja: Predstaviti naše inicijalno iskustvo s laparoskopskom pijeloplastikom u djece, procijeniti sigurnost i kratkoročni ishod. Ispitanici i metode: Retrospektivno je analizirana medicinska dokumentacija sve djece koja su u trogodišnjem periodu od 2019. do 2022. godine laparoskopski operirana zbog opstrukcije pijeloureteričnog vrata u Kliničkom bolničkom centru Zagreb. Rezultati: Ukupno desetoro djece, dobi od 10 mjeseci do 17 godina (medijan 4,3 godine) operirano je laparoskopski. Četiri djevojčice i šest dječaka. U osmero bolesnika se radilo o lijevom bubregu, a kod dvoje o desnom. Prosječni promjer pijelona je iznosio 35 mm i prosječna separatna funkcija zahvaćenog bubrega je bila 40%. Intrizična stenoza kao uzrok opstrukcije našla se kod osmero djece, a kod dvoje se radilo o aberantnim krvnim žilama za donji pol bubrega. Prosječno vrijeme trajanja operacije bilo je 190 minuta (raspon 120 – 240 min) dok je prosječno vrijeme hospitalizacije bilo 3,2 dana (raspon 2 – 6 dana). Kod dvoje djece stavljen je abdominalni dren. Nije bilo konverzije u otvoreni zahvat, kao ni intraoperativnih i ranih postoperativnih komplikacija. Peroralni unos je započet 4 – 10 sati nakon operacije. Praćenje pacijenata je bilo od 2 do 40 mjeseca (prosječno 7,8). Prosječni postoperativni promjer pijelona u djece kod kojih je prošlo više od 6 mjeseci od operacije bio je 9,5 mm. Zaključak: Laparoskopska pijeloplastika je sigurna i učinkovita metoda u liječenju djece s opstrukcijom pijeloureteričnog vrata.Objectives: To present our initial experience with laparoscopic pyeloplasty in children, to evaluate the safety and short-term outcome. Materials and methods: A retrospective analysis of medical records of all children undergoing a dismembered pyeloplasty for uteropelvic junction obstruction at the University Hospital Center Zagreb in a three-year period from 2019 to 2022. Results: A total of 10 children, aged 10 months to 17 years (median 4.3 years) underwent laparoscopic pyeloplasty. Four girls and 6 boys. In 8 patients affected was the left kidney, and in two right kidney. The average diameter of the pyelon was 35mm and the average separate function of the affected kidney was 40%. Intrinsic stenosis as a cause of obstruction was found in eight children, and in two there were aberrant blood vessels for the lower pole of the kidneys. The average duration of surgery was 190 minutes (range 120–240 min.) while the average hospitalization time was 3.2 days (range 2–6 days). In two children, an abdominal drain was placed. There was no conversion into an open procedure, as well as intraoperative and early postoperative complications. Oral intake was started 4–10 hours after surgery. Patient follow-up was from 2 to 40 months (an average of 7.8). The average postoperative diameter of pyelon in children who had passed more than 6 months since surgery was 9.5mm. Conclusion: Laparoscopic pyeloplasty is a safe and effective option in the treatment of children with pyelouretheric junction obstruction

RESULTS OF TREATMENT OF DISPLACED SUPRACONDYLAR FRACTURES IN CHILDREN

Prijelomi humerusa u suprakondilarnom području najučestaliji su prijelomi lakta u dječjoj dobi. To su većinom nestabilani prijelomi, teški za repoziciju i retenciju ulomaka, a postupak njihova liječenja nije posve usuglašen. U radu se analiziraju kasni rezultati liječenja 48-ero djece s prijelomima humerusa u suprakondilarnom dijelu s pomakom ulomaka. Repozicijom zatvorenim načinom, fiksacijom s dvije ukriženo postavljene Kirschnerove žice i nadlaktičnom imobilizacijom liječeno je 40-ero, a osmero je djece liječeno samo nadlaktičnom imobilizacijom. Otvorena repozicija ulomaka bila je učinjena u troje djece. Za procjenu uspješnosti liječenja mjerene su kutne deformacije i usporedne razlike gibljivosti zdravog i liječenog lakta. Prema Flynnovu kriteriju 93,7% liječene djece ima vrlo dobre i odlične rezultate liječenja. Najučestalija je komplikacija varus angulacija (16,7%). Kasni rezultati liječenja u naše djece i rezultati autora sa sličnim serijama djece potvrđuju stav da je zatvorena repozicija i perkutana stabilizacija Kirschnerovim žicama metoda izbora u liječenju suprakondilarnih prijeloma humerusa s pomakom ulomaka.Supracondylar fractures of humerus are the most common fractures in children. The management of severely displaced, unstable fractures of the humerus in children continues to be controversial. We undertook a retrospective study of 48 children with displaced supracondylar fractures (8 were treated with plaster and 40 with cross percutaneous Kirschner wire pinning). Only three children were treated with open reduction and percutaneous cross-pin fixation. Clinical outcome was evaluated by loss of elbow motion and change of carrying angle. According to Flynn s criteria, results were good or excellent in 93.7% patients. The cubitus varus is the most frequent long-term complication (16.7%). Closed reduction with percutaneous pin fixation is believed to represent a safe, reliable, and efficient method of managing displaced supracondylar fractures

RESULTS OF TREATMENT OF TIBIAL FRACTURES IN CHILDREN

Prijelomi dijafize obiju kosti potkoljenice najčešći su prijelomi donjih ekstremiteta i čine oko 15% svih prijeloma dugih kostiju u djece. To su većinom nestabilni prijelomi, teški za repoziciju i retenciju ulomaka, a postupak njihova liječenja nije posve usuglašen. U radu se analiziraju kasni rezultati liječenja 234-ero djece s prijelomima dijafize kostiju potkoljenice, ovisno o načinu liječenja (operacijska i konzervativna metoda). Otvoreni prijelom imala su 23 bolesnika, što čini 9,8% od ukupnog broja. U 194 bolesnika primijenili smo konzervativne metode, dok smo u njih 40 primijenili neke od operacijskih metoda liječenja. Najčešća korištena operacijska metoda bila je zatvorena repozicija ulomaka, na ekstenzijskom stolu i perkutana elastična stabilna intramedularna osteosinteza titanskim žicama. Za procjenu uspješnosti liječenja mjerene su zaostale kutne deformacije i razlike dužine zdrave i liječene noge. Sekundarni pomak ulomaka nakon započetoga konzervativnog liječenja, imala su 32 djeteta, što čini 15,2% od ukupnog broja konzervativno liječenih. Ukupno je 80-ero djece imalo zaostalu kutnu deformaciju liječene noge, njih 68 (35,0%) liječeno je konzervativno, a 12-ero (30,0%) operacijski. Bez razlike u dužini bolesne i zdrave noge bilo je 131 (67,5%) konzervativno liječeno dijete i 29-ero (72,5%) operacijski liječene djece. Ove razlike nisu statistički značajne. Rezultati liječenja ovih prijeloma u naše djece i autora sa sličnim serijama potvrđuju da nema statistički značajne razlike kasnih učinaka ovisno o načinu liječenja.Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length beetwen treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods

Liječenje prijeloma bedrene kosti kod djece u Gradu Zagrebu

Femur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children’s Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Nonoperative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010- 2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods.Prijelomi bedrene kosti u djece mogu se liječiti operativno ili konzervativno. Više čimbenika utječe na izbor najbolje metode liječenja ovisno o vrsti prijeloma. Cilj ovoga istraživanja bio je utvrditi učestalost prijeloma bedrene kosti u djece na području Grada Zagreba i Zagrebačke županije i raspodjelu učestalosti prema mjestu nastanka, dobi djeteta te vrsti, načinu nastanka i načinu liječenja prijeloma. Istraživanje je uključilo 103 djece u dobi do 18 godina liječene zbog prijeloma bedrene kosti u Kliničkom bolničkom centru Zagreb i Klinici za dječje bolesti Zagreb. Podaci za ovu retrospektivnu analizu su prikupljeni iz navedenih ustanova za razdoblje od 2010. do 2015. godine. Uzroci nastanka prijeloma su šifrirani prema Međunarodnoj klasifikaciji bolesti. Kirurško liječenje je bilo potrebno u 55% bolesnika, što nije u skladu s podacima iz prethodnih analiza. Najveća učestalost prijeloma bedrene kosti bila je u dobnoj skupini od 0 do 4 godine, koja čini 49,1% svih bolesnika. U toj skupini su prijelomi najčešće nastali prilikom pada i većinom su liječeni konzervativno. U svim ostalim dobnim skupinama prevladavalo je operativno liječenje. Najčešće primijenjeni konzervativni način liječenja je bila kokso-femoralna imobilizacija, a najčešći operativni način stabilna elastična osteosinteza titanskim čavlima. Način liječenja je ovisio o dobi, vrsti i složenosti prijeloma, pomaku ulomaka i udruženim ozljedama. Uzrok nastanka prijeloma je također bio važan čimbenik u odabiru načina liječenja. Konzervativno liječenje je većinom primijenjeno kod prijeloma koji su nastali padom (u 64,7% prijeloma nastalih padom), a operativno liječenje većinom kod prijeloma nastalih u prometnim nezgodama (79,4% tako nastalih prijeloma je liječeno operativno). Opće prihvaćeno je stajalište da je konzervativno liječenje najbolje za dijete. Ipak, u novijim radovima je povećana učestalost operativnog liječenja prijeloma bedrene kosti u djece. U našoj skupini bolesnika liječenih u razdoblju od 2010. do 2015. godine operativno liječenje također je bilo češće nego konzervativno. Primijenjena su dva načina konzervativnog liječenja i osam načina operativnog liječenja. Tako velik broj različitih načina liječenja pokazuje da ne postoji jedinstvena metoda za liječenje svih prijeloma. S druge strane, porast učestalosti operativnog liječenja je očito posljedica trajnih socio-demografskih i socio-ekonomkih promjena u urbanim područjima poput Zagreba. Promjena načina života izravno utječe na učestalost prijeloma bedrene kosti, kao i na način njihovog liječenja. Mišljenje većine je da se prijelomi nastali u ranoj dobi uglavnom mogu liječiti konzervativno. Naše istraživanje to potvrđuje: 75% bolesnika u najmlađoj dobnoj skupini, koji su činili većinu ozljeđenika (49,1%), liječeni su konzervativno. Operativno liječenje je prevladavalo u drugim dobnim skupinama, a drugi autori su objavili slične rezultate. Zaključno, najmlađi bolesnici (u dobi od 0 do 4 godine) čine gotovo polovicu (49,1%) svih bolesnika s prijelomom bedrene kosti. Najčešće mjesto prijeloma je bila dijafiza. Većina prijeloma u razdoblju od 2010. do 2015. godine liječena je operativno, većinom u djece u dobi od 5 do 9 godina. Od osam različitih operativnih načina liječenja, stabilna elastična osteosinteza bila je najčešća (60%). Kokso-femoralna imobilizacija ili trakcija bile su najčešći konzervativni načini liječenja

TESTICULAR CAPILLARY HEMANGIOMA, REPORT A TWELVE YEAR PATIENT

Kapilarni hemangiom testisa iznimno je rijedak tumor. Prikazujemo slučaj testikularnog hemangioma u namjeri da skrenemo pozornost na rijetke benigne neoplazme i poštednu kirurgiju testisa zahvaćenog tumorom. Bolesnik je dvanaestogodišnji dječak, koji se prezentirao vodenom kilom i palpabilnim tumorom lijevog testisa. Ultrazvuk skrotuma i testisa pokazuje varikokelu II. stupnja, manji izljev u lijevom skrotumu te hipoehogenu zonu lijevog testisa veličine 5 mm u promjeru. Razina tumorskih markera u serumu (alfa-fetoproteina i beta-korionskoga gonadotropina) bila je u granicama referentnih vrijednosti. Intraoperativno je načinjena biopsija, a brza histološka analiza (na smrznutom preparatu) pokazuje kapilarni hemangiom. Potom je tumor potpuno odstranjen, a testis sačuvan. Klinički, ultrazvučnim nalazom i nalazom magnetske rezonancije hemangiomi se ne razlikuju od malignih solidnih tumora testisa. Intraoperacijska brza patohistološka dijagnoza određuje opsežnost kirurškog zahvata. Enukleacija hemangioma u zdravo tkivo testisa siguran je i opravdan kirurški zahvat.Capillary hemangiomas of the testis are extremly rare tumors. We reported a case of intratesticular hemangioma, unusually localisation of this vascular benign neoplasm. The patient was 12 year old boy, with hydrocele and a palpabile testicular mass. Scrotal sonography revealed varicocele and hydrocele in the left scrotal sac. There was a solid hypoechogenic zone 5 mm in diameter in the left testis. Tumor markers like serum level of b human chorionic gonadotropin and a fetoprotein were normal. The patient underwent surgery, and intraoperativ frozen section showed a capillary hemangioma. The lesion was completly removed, but testis was preserved. Accordingly tu the literature, tumors of vascular origin are extremly rare. Capillary hemangiomas of the testis are similarity to malignant testicular solid tumors during physical examination, ultrasound examination and MR imaging. Before operation, it’s hardly differentiate tumors of testis, but intraoperativ frozen section cuold be helpfull to differentiate a hemangioma from other testicular mass. Hemangioma is benign, but lesion must be complete removed to avoid recurence. In cases capillarx hemangimas, tumor enucleation with preservation tissue of the testis is possible if intraoperative frozen section examination can be performed

Undescended testes in children

Kriptorhizam (nespušten testis), izostanak jednog ili obaju testisa u normalnom skrotalnom položaju, može biti kongenitalan ili stečen. Kongenitalni, primjetljiv već pri rođenju, nastao je zastojem (intraabdominalno, ingvinalno ili visoko skrotalno) testisa na njegovom normalnom putu spuštanja. Kongenitalni kriptorhizam jedna je od najčešćih kongenitalnih anomalija (4% zdrave terminske novorođenčadi i oko 45% nedonoščadi). Kriptorhični testisi, ako dugo ostanu u abnormalnom položaju, prolaze kroz određene histološke promjene, a koje dovode do smanjene plodnosti i povećanog rizika za razvoj malignih tumora testisa. Stoga je preporuka kirurško liječenje završiti do navršenih 12, najkasnije 18 mjeseci života. Cilj ovog rada bio je utvrditi pratimo li mi te smjernice. Proučavali smo razdoblje od 2011. do 2020. godine. U istraživanje je uključeno 598 djece, a koja su u vrijeme operacije bila u dobi od 0 do 18 godina života. Jednostrano nespušteni testis imalo je 413 (69,1%) djece, od čega 245 desno, a 168 lijevo. Bilateralni kriptorhizam je imalo 158 (26,4%) djece koja su operirana u istom aktu i još 27 (4,5%) djece, kod kojih je prvo operirana jedna strana, a naknadno i druga. U prvih 16 mjeseci života operirano je 110 (18,4 %) sve djece koja su analizirana u ovom radu. U prve tri godine života operirano je 279 (46,7%), a do polaska u školu 431 (72%) djece. Prosječna dob djece pri obavljanju orhidopeksije bila je 57,8 mjeseci. Nema značajne razlike bilo da se radilo o jednostranom ili obostranom kriptorhizmu. Kroz čitavo razdoblje praćenja (deset godina) nema razlike prosječne starosti djece, niti se zamjećuje tendencija pada. Valja zaključiti kako se tek mali broj djece operira unutar prvih 18 mjeseci života, a zabrinjava izostanak tendencije smanjenja životne dobi u vrijeme zahvata u promatranom razdoblju.Cryptorchidism (undescended testicle), the absence of one or both testicles in the normal scrotal position, can be congenital or acquired. Congenital, noticeable already at birth, is caused by the stagnation (intraabdominal, inguinal or high scrotal) of the testis on its normal path of descent. Congenital cryptorchidism is one of the most common congenital anomalies, occurring in 4% of healthy term newborns and about 45% of premature babies. Cryptorchid testicles, if they remain in an abnormal position for a long time, go through certain histological changes, which lead to reduced fertility and an increased risk for the development of malignant testicular tumors. Therefore, it is recommended to complete the surgical treatment by 12, at the latest 18 months of age. The aim of this paper was to determine whether we follow these guidelines. We studied the period from 2011 to 2020. A total of 598 children were included in this study, who were between 0 and 18 years old at the time of the operation. Out of the total number of children, 413 (69.1%) had unilateral undescended testicles, of which 245 were on the right and 168 on the left side. Bilateral cryptorchidism was present in 158 (26.4%) children who were operated on in the same act and another 27 (4.5%) children who were operated on one side first and then on the other., One hundred and ten(18.4%) children analyzed in this paper were operated in the first 16 months of life. In the first three years of life, 279 (46.7 %) children were operated , and by the time they started school, 431 (72 %) children. The average age of the children when orchidopexy was performed was 57.8 months. There is no significant difference considering whether it was unilateral or bilateral cryptorchidism. Throughout the entire monitoring period (ten years), there was no difference in the average age of the children, nor was there a tendency of decline. It can be concluded that only a small number of children are operated on within the first 18 months of life, and the absence of a tendency to decrease the age at the time of surgery in the observed period is worrying

TREATMENT OF EMPYEMA THORACIS IN CHILDREN

Empijem prsišta nakupljanje je infektivne tekućine u pleuralnom prostoru, a najčešće nastane kao komplikacija bakterijske pneumonije u djece. Bolest ima ubrzan tijek i često već nakon nekoliko dana unatoč antibiotskom liječenju ulazi u stadij kada je nužno kirurško liječenje. Nema općeprihvaćenog stajališta kada i koju od kirurških metoda treba primijeniti. Te razlike u liječenju empijema prsišta osobito su izražene u djece. Unatoč razlikama u procjeni faze bolesti i optimalne metode liječenja krajnji su ishodi uglavnom dobri. U radu se analiziraju literaturna zapažanja o učinkovitosti različitih metoda te se opisuju postupci liječenja djece s empijemom prsišta. Opisan je postupak torakoskopske i otvorene operacije prsišta u djece. Iznesena su vlastita zapažanja i iskustva u liječenju empijema prsišta.Empyema, an accumulation of infected fluid in the thoracic cavity, is commonly secondary to bacterial pneumonia in children. Despite the high prevalence and availability of many medical treatment options, there is no general consensus on the optimal management approach, which would lead to full and rapid recovery. Especially, there are the big differences in treatment options for the child with empyema. Regardless of the differences in the procedures, the ultimate outcomes are good. This article reviews the current literature and discusses the important considerations in managing these patients. This paper describes thoracoscopic and open thoracic surgery procedures in children. The authors present their own observations based on years of experience in the treatment of thoracic empyema