Bronchoscopic treatment of pediatric atelectasis: A modified segmental insufflation-surfactant instillation technique.

BACKGROUND: Atelectasis is a condition characterized by the collapse and nonaeration of lung regions and is considered a manifestation of an underlying disease process. The goal of atelectasis treatment is the restoration of volume loss. In the range of different treatment options, chest physiotherapy is often used as a first-line approach, and some cases require bronchoscopic interventions. METHODS: In this case series, we describe a modified bronchoscopic treatment procedure using pressure-controlled bronchoscopic segmental insufflation with surfactant application. RESULTS: The proposed approach resulted in significant improvement of lung volume across a range of patients including massive lobar, atypical rounded atelectasis in previously healthy patients, and in a particularly challenging case involving an infant suffering from spinal muscular atrophy type I. CONCLUSION: The modified segmental insufflation-surfactant instillation technique offers a safe and promising easily implementable treatment of persistent atelectasis caused by different underlying disease processes with positive long-term outcomes.

Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?-A retrospective multicenter study.

INTRODUCTION: Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature. OBJECTIVE: The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period. STUDY DESIGN: A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation. RESULTS: During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007). CONCLUSION: During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required.

Early Childhood Fat Tissue Changes-Adipocyte Morphometry, Collagen Deposition, and Expression of CD163+ Cells in Subcutaneous and Visceral Adipose Tissue of Male Children.

Childhood obesity is a complex health problem, and not many studies have been done on adipose tissue remodeling in early childhood. The aim of this study was to examine extracellular matrix remodeling in the adipose tissue of healthy male children depending on their weight status. Subcutaneous and visceral adipose tissue was obtained from 45 otherwise healthy male children who underwent elective surgery for hernia repairs or orchidopexy. The children were divided into overweight/obese (n = 17) or normal weight groups (n = 28) depending on their body mass index (BMI) z-score. Serum was obtained for glucose, testosterone, triglyceride, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) measurements. Sections of adipose tissue were stained with hematoxylin and eosin to determine the adipocytes' surface area, and Masson's trichrome stain was used to detect the adipocytes' collagen content. Immunohistochemistry for CD163+ cells was also performed. The results showed that male children in the overweight group had higher serum triglyceride levels, greater adipocyte surface area and collagen content in their subcutaneous adipose tissue, more crown-like structures in fat tissues, and more CD163+ cells in their visceral adipose tissue than males in the normal weight group. In conclusion, in male children, obesity can lead to the hypertrophy of adipocytes, increased collagen deposition in subcutaneous adipose tissues, and changes in the polarization and accumulation of macrophages.

Aggressive progression of Takayasu's arteritis in infancy: a case report.

Takayasu's arteritis (TA) affects the aorta and its branches. Immunosuppressants are the usual course of therapy, while surgery has been used in acute cases. There is only scant information on TA in infancy, and the nonspecific symptoms in the initial stage of the disease make the diagnosis difficult and delayed, thus increasing the mortality rate. We describe a case of aggressive progression of TA in an infant. This child was the youngest to be affected with the disease as reported in the literature. A 3.5-month-old boy presented with cyanosis of both legs, tachycardia and antithrombin III deficiency. Computed tomography angiography (CTA) revealed thrombosis of distal aorta and both iliac arteries. Thrombectomy was performed at the level of both common femoral arteries. In addition, thigh amputation of the left leg had to be performed. TA was diagnosed postmortem with thrombosis of the distal aorta, its branches and upper mesenteric artery which was not occluded on previous CTA, glomerulonephritis and pulmonary parenchymal granulomatous infiltrations.

Effect of Pre-Emptive Paracetamol Infusion on Postoperative Analgesic Consumption in Children Undergoing Elective Herniorrhaphy.

OBJECTIVE: Studies have suggested that pre-emptive analgesia may decrease postoperative pain and opioid consumption. This study was undertaken to determine whether pre-emptive analgesia reduces postoperative pain and total paracetamol and opioid consumption in children undergoing herniorrhaphy. METHODS: In this retrospective study, medical records were analysed before and after the pre-emptive analgesia regimen was introduced. Demographic data, perioperative drug consumption and discharge time were recorded. In the first group, no pre-emptive analgesia (NA; year, 2011; n=60) was given and in the second group, the pre-emptive analgesia (PA) paracetamol 10-15 mg kg-1 was given intravenously in the surgical ward at least 1 h before the surgical procedure (year 2013; n=60). Postoperative pain determining supplemental pain medications was scored using a Faces Pain Scale or visual analogue scale. Total paracetamol and opioid consumption during 24 perioperative hours was registered for all patients. The statistical analysis was performed using t test and Chi-square test. RESULTS: The mean age of children was 69.6±49.9 and 58.7±32.4 months (p=0.157), and the mean body mass index (BMI) was 18.3±8.8 kg m-2 and 16.4±3.7 kg m-2 (p=0.125) in the NA and PA groups, respectively. Total paracetamol consumption was 1157.8±908.8 mg vs. 983.0±536.4 mg (p=0.202), and the total opioid consumption was 5.8±4.7 in the NA group and 7.0±4.6 morphine equivalents in the PA group (p=0.160). No differences in the discharge time between the groups were observed (2.1±0.3 vs. 2.0±0.3 days, p=0.13). CONCLUSION: PA was proven to be efficient in the terms of postoperative pain control but did not reduce the overall analgesic drug consumption in the children undergoing elective herniorrhaphy. Multimodal pain treatment may decrease the consumption of analgesic drugs.

A successful early gore-tex reconstruction of an abdominal wall defect in a neonate with Cantrell pentalogy: a case report and literature review.

A surgical technique, materials used for abdominal wall reconstruction, and postoperative care are important for patient outcomes. We report the first case of neonate with Cantrell's pentalogy surviving early reconstruction of abdominal, diaphragmal and pericardial defects. Several recent investigations suggest that intraabdominal pressure monitoring may improve outcomes in this patient category.

Overweight - early stage of "adipokines related cardiovascular diseases": leptin and adiponectin relation to anthropometric parametars.

AIM: Adipose tissue possess endocrine functions that include synthesis of various adipocytokines, which affect the metabolism of lipids and glucoses, development of atherosclerotic processes, and are involved in the development of hypertension and cardiovascular diseases. Body fat distribution is a significant risk factor for the development of obesity related diseases. Leptin and adiponectin are adipokines whose concentrations vary with the level of obesity. The aim of this research is to determine the relation of the changes in leptin and adiponectin concentrations in overweight persons with anthropometric parameters of the subjects. METHODS: The study included 40 adult, hypertensive subjects - divided into two groups according to sex, with the body mass index 25-30 kg/m², with regular glycemia and renal function. All subjects underwent biochemical (serum lipid, glucose and creatinine level) and anthropometric measurements. Leptin concentration was determined by radioimmunoassay, while adiponectin concentration was determined by enzyme immunoassay. RESULTS: Both leptin and adiponectin concentrations significantly correlated with the waist circumference in both groups of subjects. In male subjects, leptin concentration correlated positively with the body mass index and the hip circumference, while adiponectin concentration correlated negatively with the hip circumference. CONCLUSION: Being overweight is a condition marked by pathologically altered values of leptin concentration (increased level) and adiponectin (decreased level), that are changing as the obesity level and the waist circumference increase. It can be concluded that abdominal obesity and higher body mass index increase the risk for the development of overweight-obesity-related diseases.

Conservative surgical management of necrotic tissues following meningococcal sepsis: case report of a child treated with hyperbaric oxygen.

This article presents the case of a 5-month-old infant, who survived a fulminant meningococcal sepsis with purpura fulminans, septic shock and severe DIC with gastrointestinal bleeding. Amputation and reconstructive surgery were considered to treat the multiple skin and limb necroses at high risk of superinfection, but the surgical intervention was delayed due to the extremely doubtful outcome. On Day 10 after the onset of the disease, a hemodynamic improvement was achieved. The baby overcame early critical period, but was still in poor general condition. The hyperbaric oxygenation (HBO2) as adjuvant therapy was started in the monoplace chamber using the following protocol: from first through fifth day 45 minutes twice a day on 1.5 atmosphere absolute (ATA); after a two-day break, once a day on 1.8 ATA for 60 minutes. During 52 HBO2 treatments multiple areas of necrotic skin and subcutaneous tissue, together with fingertips and toes, detached spontaneously. All wounds healed without reinfections. An increased oxygen concentration during HBO2 therapy promoted spontaneous wound healing. Bacterial superinfection was not observed in numerous low-perfused lesions. Since repeated anesthesia and surgical interventions were not needed, a final invalidity was minimized. To the best of our knowledge, this is the first report on the successful conservative surgical treatment of this mutilating disease without aggressive reconstructive surgery in an infant with the help of HBO2.