Results of surgical treatment of myelomeningocele.

UNLABELLED: The aim of this study was to analyse the long-term outcome of children and adolescents born with myelomeningocele. MATERIAL AND METHODS: Sixty-six children aged from 3 to 21 years old, all patients of the Paediatric Surgery Clinic of the Medical Academy in Bialystok, were evaluated. The hospital records were reviewed and data was obtained from parents, using a questionnaire designed by authors. The material was classified with respect to the degree of disability using Lagergren's scale. RESULTS: 15 (23 %) patients had no physical or mental handicap, 18 (27 %) were moderately handicapped, 20 (30 %) were severely handicapped, 13 (20 %) were very severely handicapped. CONCLUSIONS: A higher spinal cord lesion, hydrocephalus and complications due to its surgical management had a negative influence on development of children born with myelomeningocele.

Educational and nursing problems of parents of children with stoma.

In children, it is usually one of the stages of treatment of lower alimentary congenital defects. Such patients require long-term professional medical and nursing attention as well as solicitous care of the parents at home. The aim of the study was the analysis of educational and nursing problems that are faced by parents of children with stoma, the influence of a nurse on the quality of their care, and determination of nurse educational assignment in preparing the parents for the care at home. The study was performed in the group of 30 parents of children, 0-2 years old, with lower alimentary congenital defects who had intestinal stoma inserted in 2003. The questionnaire revealed that the main causes of the stoma were Hirschsprung disease (40%), anal atresia (37%), perianal fistula, intestinal perforation and necrosis (10% each). All responders stated that the knowledge acquired in the ward was of great help while nursing a child at home. The results showed that above 80% of parents had the opportunity to change the stomal sacks by themselves, once or more times, in the presence of medical staff. Skin changes (33%) were the most common complications in case of stoma, which could encounter for inappropriate care. Other complications included hemorrhage (20%), prolapse (13%), and stoma narrowing (10%).

Quality of life and psychomotor development after surgical treatment of hydrocephalus.

The purpose of this report is to analyse the long-term outcome in hydrocephalic children treated by shunt insertion, in particular their psycho-intellectual development and quality of life. We studied 46 patients aged 3 - 21, who had been operated on in the Department of Paediatric Surgery of the Medical University of Bialystok between 1982 - 2000 and had had ventriculo-peritoneal shunts inserted during their first year of life. Data from anamnesis and medical documentation were analysed. Age-appropriate psychomotor development and IQ tests were carried out: Wechsler Intelligence Scale for Children, Revised (WISC-R) (for children between the ages of 6 and 16), Wechsler Adult Intelligence Scale, Revised (WAIS-R PL) (for adults), Brunet-Lezine psychometric scale (early childhood), and Terman-Merril intelligence scale (children younger than 3). The final IQs were above 90 in 30 % of children, between 70 and 90 in 24 %, between 50 and 70 in 26 %, and lower than 50 in 20 %. 69 % of patients presented with neurological deficits and visual or auditory deficits were found in 22 %. Integration into normal schools was possible for 58.7 % of the children, one of whom is now a second year medical student. A relationship between shunt malfunction and the children's development was observed. An essential aspect of caring for hydrocephalic children is their rehabilitation and integration into society. Early physical rehabilitation, stimulation of psychological development, and continued monitoring by a paediatric surgeon to ensure proper functioning of the shunts will improve the independence of such children in their families and among their peers.

[Advances in treatment of congenital gastroschisis based on personal examinations]. / Postepy w leczeniu wrodzonego wytrzewienia na podstawie badan wlasnych.

The aim of the study was the definition of standard approach to a newborn with gastroschisis. The rules of treatment introduced in 1992 enabled the closure of the abdominal wall primarily in all newborns and made it possible to decrease the mortality considerably. This was achieved despite the fact that we usually did not have influence on time and method of delivery or quality of transportation to our department. In the Department of Pediatric Surgery of Institute Mother and Child, in the years 1992-1997, twenty three newborns with gastroschisis were admitted. The standard approach in all patients was the following: insertion of the catheters to the small bowel through the appenddicocaecostomy and to the large bowel through the rectum, intraoperative irrigation of the meconium (mucosolvan), forceful stretching of the abdominal wall, returning of extraabdominal viscera under control of central venous pressure or middle airway pressure (anesthesiologic control). In the postoperative period all patients routinely had controlled ventilation, administration of analgesic drugs, catecholamines, antibiotics and total parenteral nutrition. Intestinal catheters were gradually removed every day for irrigations of all levels. Oral nutrition was started after the return of effective peristalsis. From 23 treated newborns 16 are alive. 7 children died, 4 of them were resuscitated before operation because of severe general condition. Two patients died because of sepsis in the second month of life, one because of SIDS (sudden infant death syndrome) in the third week of life. Sixteen children are followed up. The development of all children is normal.

Back closure with a latissimus dorsi myocutaneous flap.

A method of back closure with the use of latissimus dorsi myocutaneous flap in cases of myelomeningocele is reported. A three-layer cover consisting of the skin, subcutaneous fat, and the muscle with proper innervation and blood supply of the flap permits successful closure of large defects. Well-vascularized coverage prevents common complications such as partial necrosis of the flap or wound breakdown and consequent infection of the central nervous system. This report is based on 30 cases of newborns with large thoracolumbar myelomeningocele.

[Results of the surgical treatment of children with residual developmental anomalies of the 1st and 2d branchial clefts and thyroglossal duct]. / Ocena wyników leczenia operacyjnego dzieci z pozostalosciami rozwojowymi I i II szczeliny skrzelowej oraz przewodu jezykowo-tarczowego.

The purpose of this study was assessment of the results of surgical treatment of children with developmental anomalies derived from the first and second branchial clefts and thyroglossal duct. Normal and abnormal development of branchial arches and clefts, pharyngeal pouches and thyroglossal duct, as well as the anatomy nd topography of the resulting developmental anomalies are discussed. The observed developmental anomalies are classified into: cysts, cysts with sinuses developing as a result of inflammatory processes, puncture, incision, operation, dermal sinuses draining externally, dermal sinuses with external and internal orifices, the latter in the groove of the palatine tonsil or foramen caecum of the tongue, dermal sinus with external orifice and dermal fistula. Methods of diagnostic investigations and surgical treatment are described. The cysts derived from the first and second branchial arches were treated surgically by a transverse incision running across the peak of the bulging cyst. Removal of the cyst was started by dissection of the anterior and lateral surfaces of the wall, and then the posterior wall was dissected free from the deep structures in the neck. In cases of cysts with fistulae or dermal sinuses the operation was preceded by injection of 1% methylene blue into its external orifice. In this way it was possible to stain the walls of the cyst or sinus and to mark its end. The operation was started with elliptical excision of the external orifice of the lesion. In cases of dermal sinuses derived from the first branchial clefts an additional incision was made along the posteroinferior border of attachment of the auricule to the skull. In operations of dermal sinuses derived from the second branchial cleft after dissection of the wall at a distance of several centimeters a second incision was made transversely for easier dissection of the sinus wall lying in deeper parts of the neck. Removal of the cysts and sinuses derived from the thyroglossal duct required always resection of the middle part of the body of the hyoid bone. Upward elevation of the cut hyoid bone body visualized the upper part of the thyroglossal duct up to its end in the lingual foramen caecum, and made possible removal of this part. The cut hyoid bone body was left divided. In the years 1953-1976 56 children were treated surgically for these developmental anomalies. The material comprised 33 girls and 23 boys. Three groups of patients were isolated. Most children were operated upon between the 5th and the 9th year of life at the age of 12 years.(ABSTRACT TRUNCATED AT 400 WORDS)