Biliary atresia - a new derivative method?

BACKGROUND: Biliary atresia is a progressive cholangiopathy in neonates of unknown origin. Surgical intervention - Kasai portoenterostomy - is the only treatment possible. However, only liver transplantation can be considered a definitive solution even in cases of favourable post-operative course, i.e., after bile passage has been recreated. OBJECTIVES: The authors set out to identify ways to optimize the operative treatment in biliary atresia patients. In particular, their objective was to identify a suitable bile derivation area outside porta hepatis, thereby simplifying the surgical procedure of the following liver transplantation. METHODS: The research was conducted from 2006 to 2010 on a set of 30 corrosive casts prepared by the Institute of Anatomy, Medical Faculty, Comenius University Bratislava. The research consisted of an analysis of individual tubular structures of the liver parenchyma, particularly the bile vessels. The authors explored the latter's position and branching out, as well as their relationships in different segments, and their availability in surgical exploration. RESULTS: The analysis of the corrosive casts resulted in selecting an area in liver segments II and III suitable for creating a new type of hepatoenterostomy. The area is sufficiently distant from porta hepatis, conveniently accessible to the surgeon, and has a broad bile duct branch. This type of anastomosis would preserve the anatomic situation in the porta hepatis area intact for the following transplantation. CONCLUSION: While the results of the experiment warrant some optimism, authors will have to wait until this type of derivation operation is applicable in practice. The authors continue their research by performing anastomosis in an animal model (Fig. 5, Ref. 18)

[Long-term results of the treatment of diaphyseal femur fractures in children]. / Dlhodobé výsledky liecby zlomenín diafýzy femuru u detí

PURPOSE OF THE STUDY: Bone overgrowth of the femur after fracture in childhood treated either conservatively or surgically is well documented. The aim of this study was to investigate the frequency of bone overgrowth in childhood fractures treated by elastic stable intramedullary nailing (ESIN), to evaluate it in relation to conservative treatment and to compare its presence in the youngest age categories. MATERIAL AND METHODS: A total of 49 patients, age range 4 to 17 years, with femoral shaft fracture treated in our department by ESIN osteosynthesis between 2001 and 2005 were asked to appear for a follow-up not earlier than one year after the fracture had healed to be examined for the presence of bone overgrowth. The results were statistically analysed and compared with a group of 99 patients treated conservatively (CONS) between 1987 and 1997. RESULTS: In the ESIN group, femoral overgrowth ranging from 5 to 22 mm was found in 15 out of 49 patients. It was most frequent in children up to 6 years of age; with an increasing age overgrowth frequency decreased. In the CONS group, overgrowth was recorded in 30 out of 99 patients and ranged from 4 to 20 mm. Similarly to the ESIN group, it was most frequent in the youngest age category (up to 6 years). In relation to age categories, there were no significant differences in overgrowth values between surgical and conservative treatment. DISCUSSION: ESIN osteosynthesis is currently the most universal method of surgical treatment for long-bone fracture. Although it has undisputable benefits, it may also be associated with longitudinal femoral overgrowth. Children in youngest age categories are often not indicated for ESIN for the fear of bone overgrowth. CONCLUSIONS: The use of ESIN for treatment of femoral fractures in childhood is not associated with a higher risk of long-bone over- growth, as compared with conservative therapy. Moreover, the authors' experience shows that the method of retrograde insertion of osteosynthetic material is safe even in distal diaphyseal fractures and does not increase risk of bone over- growth.

[Acute scrotum is a condition requiring surgical intervention]. / Akútne skrótum je stav vyzadujúci chirurgickú intervenciu.

UNLABELLED: Acute scrotum (AS) is a clinical syndrome, in which authors indicate a surgical exploration of the scrotum. We retrospectively analyzed the group of 354 patients in 10 years (1997-2006) to compare the preoperative findings with the diagnosis of surgical exploration. The aim was to actualize diagnostics and therapeutic management. PATIENTS AND METHODS: We focused on the age of patients, incidence of nosological units of AS and preoperative and surgical diagnosis. RESULTS: 334 boys were operated on from the whole group - 354 patients. Most frequent incidence of AS was in the age group 8-12 (55%). Torsion of testicular appendix or epididymis is the most frequent cause of AS in our group - 204, 59%. In this group of patients ultrasound confirmed the diagnosis only in 120 patients, 65%. Testicular torsion was managed in 74 boys (30 neonates), in 40 of them we decided, mostly at the second look operation after 48-72 hours, for testicle ablation caused by the organ avitality. In all patients with testicular torsion ultrasound confirmed the diagnosis, 100%. In 10 boys we found testicular tumor. In the group of 334 patients operated on, there were no serious complications. DISCUSSION: Testicular torsion and tumor are the units in which the surgical exploration is performed without discussion. Beside that, torsion of the testicular or epididymic appendix is the most frequent occurring diagnosis. There is a group of surgeons, who performed in this unit conservative management. CONCLUSIONS: after the analysis of the group of our patients we actualized the guidelines used in the management of AS in children. Urgent surgical exploration in boys with AS still seems to be the method of choice.

[Use of allogenous material in the management of spina bifida aperta]. / Pouzitie alogénneho materiálu pri riesení spina bifida aperta.

AIM: "Conditio sine qua non" in the management of open neural tube defects includes closure of all layers with as minimum as possible tension left within the suture region, in order to prevent early, as well as long-term postoperative complications. In extensive fascial defects, the authors used the Gore-Tex patch as an alternative to myofascial or fasciocutaneous flaps. PATIENTS AND METHODS: From January 2004 to January 2008, 23 patients suffering from open spina bifida underwent surgery in the Bratislava Pediatric Surgery Centre. In 17 subjects, the fascia was sutured following a myofascial release, in 2 subjects the suture was secured with tissue adhesive. In 4 subjects, the Gore-Tex patch was implanted to secure the "tension free" plasty; the Gore-Tex Dual Mesh was used in 2 subjects as well as the Gore-Tex Spinal. RESULTS: Two subjects, who had the Gore-Tex Dual Mesh implanted, developed sequestration of the implant during the late postopertive period. Upon reoperation, the authors removed the Gore-Tex Dual Mesh in the both subjects. However, they found a firm fibrous membrane, which was considered sufficient to protect the dural sac. On the contrary, the both subjects who had the Gore-Tex Spinal implanted, healed with no complications recorded. CONCLUSION: Based on the experience, the Gore-Tex Dual Mesh, although implanted lege artis, does not appear a suitable material for fascia replacements in open spina bifida plastic procedures. Further experience will give more evidence, whether Gore-Tex Spinal would be a suitable alternative, however, the courses in the 2 subjects have hitherto been encouraging.

Dysphagia in acute stroke: correlation with stroke subtype, vascular territory and in-hospital respiratory morbidity and mortality.

AIMS: The study aimed at correlation of post-stroke dysphagia with area and volume of infarct/ bleed, and with subsequent in-hospital respiratory morbidity and mortality. MATERIALS AND METHODS: 50 patients of acute stroke were serially recruited. Standard Staff swallowing assessment was performed within 24 hours of admission along with pulse oximetry. Ischemic strokes were classified as per OCPS registry. In-hospital respiratory morbidity and mortality, mode of nutrition and disability status at discharge were noted. RESULTS: 21/50 (42%) patients had post-stroke dysphagia during their hospital course. Among infarcts, Total Anterior Circulation Infarcts (TACI) had 100% incidence of dysphagia, followed by Partial Anterior Circulation Infarcts (PACI-36%), Posterior Circulation infarcts (POCI-33%), and Lacunar infarcts (LACI-18%). 67% of hemorrhages had post-stroke dysphagia. Staff swallowing assessment had a sensitivity and specificity of 75% and 73% respy., for predicting respiratory morbidity. The corresponding figures for Pulse oximetry were 79% and 91%.