AN UNCOMMON CLINICAL PRESENTATION OF DIROFILARIASIS IN A CHILD – A CASE REPORT

Dirofilariasis is a zoonotic infection caused by filarial nematodes of the genus Dirofilaria, with D. repens as the most common one. Definitive hosts are usually dogs and other carnivores, while humans are accidentally included into the epizootic chain. It usually manifests as subcutaneous or ocular localization and here we present an unusual case of scrotal dirofilariasis

Rascjep prsne kosti – prikaz troje bolesnika [Sternal cleft – report of three cases]

During the last 25 years we surgically treated three patients with sternal cleft anomaly, aged from 6 weeks to 2 years. The aim of this case series is to present this extremely rare congenital anomaly and differences in the operative treatment of sternal cleft (SC) depending on patients age due to flexibility of the chest wall. Patients presented to us with signs of sternal cleft; displaced sternoclavicular articulations and paradoxical motion of the skin over the defect. Preoperatively we performed X-ray and computed tomography of the chest which revealed displaced sternoclavicular articulations with superior incomplete sternal cleft and echocardiography which showed orthotopic heart without malformations of the great vessels. Surgical treatment included primary closure in two infants and Sabiston’s technique in a two-year-old girl. All three patients were successfully operated without complications

STERNAL CLEFT – REPORT OF THREE CASES

U posljednjih 25 godina operirali smo troje bolesnika s rascjepom prsne kosti, u dobi od 6 tjedana do dvije godine. Cilj je serije prikazati ovu izrazito rijetku kongenitalnu anomaliju te razlike u operativnom pristupu rascjepu prsne kosti ovisno o dobi bolesnika zbog fleksibilnosti prsnog koša. Bolesnici su se prezentirali znakovima rascjepa prsne kosti, dispozicioniranim sternoklavikularnim zglobovima te paradoksalnim gibanjem kože iznad samog defekta. Preoperativno su učinjeni rendgenogram i kompjutorizirana tomografija prsnog koša koji su pokazali dispozicionirane sternoklavikularne zglobove uz nepotpun rascjep u gornjem dijelu prsne kosti, te ehokardiografija kojom je nađeno ortotropično srce bez ­malformacija velikih krvnih žila. Kirurško liječenje sastojalo se od primarnog zatvaranja u dojenačkoj dobi, odnosno ­Sabistonove tehnike primijenjene u dvogodišnje djevojčice. Sve troje bolesnika uspješno je operirano bez komplikacija.During the last 25 years we surgically treated three patients with sternal cleft anomaly, aged from 6 weeks to 2 years. The aim of this case series is to present this extremely rare congenital anomaly and differences in the operative treatment of sternal cleft (SC) depending on patients age due to flexibility of the chest wall. Patients presented to us with signs of sternal cleft; displaced sternoclavicular articulations and paradoxical motion of the skin over the defect. Preoperatively we performed X-ray and computed tomography of the chest which revealed displaced sternoclavicular articulations with superior incomplete sternal cleft and echocardiography which showed orthotopic heart without malformations of the great vessels. Surgical treatment included primary closure in two infants and Sabiston’s technique in a two-year-old girl. All three patients were successfully operated without complications

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

Duodenal duplication cyst: a rare differential diagnosis in a neonate with bilious vomiting

Bilious vomiting is a relevant sign in neonates that requires immediate evaluation and diagnosis. A duplication of the intestinal tract is a possible cause of obstruction if located distally to the major duodenal papilla of Vater and most of them involve the jejunum, stomach, or colon. Duodenal duplications are very rare and can have an endoscopic or surgical treatment after diagnosis. We present a case of a 16-day-old term newborn that consulted because of bilious vomiting and after evaluation with imaging and upper endoscopy, a duodenal duplication cyst was found at the level of the third portion causing compression of the intestinal lumen that required surgical resolution with duodenocystostomy

Rare Abdominal Wall Malformation: Case Report of Umbilical Cord Hernia

The umbilical cord hernia is the rarest form of abdominal wall malformations, anatomically completely different from gastroschisis and omphalocele. It occurs due to the permanent physiological evisceration of abdominal organs into umbilical celom and persistence of a patent umbilical ring. The umbilical cord hernia is often mistaken for omphalocele and called “small omphalocele”. Here we present a case of a female newborn with umbilical cord hernia treated in our Hospital. After preoperative examinations surgery was done on the second day of life. The abdominal wall was closed without tension. The aim of this article is to present the importance of the proper diagnose of these three entities and to stimulate academic community for the answer, is this umbilical cord hernia or small omphalocele