Child abuse experience, training, knowledge, and attitude of healthcare professionals in sixty hospitals in Greece.

OBJECTIVE: This study aims to record the overall perception of healthcare professionals on child abuse and identify potential affecting factors in a nationwide scale in Greece as well as to provide information that might be useful for future educational actions. MATERIALS AND METHODS: A total of 1,185 healthcare professionals in 60 hospitals with pediatric departments across Greece participated in this cross-sectional study. Participants included pediatricians, pediatric surgeons, residents, nurses, psychiatrists, psychologists, and social workers. Sections under investigation involved experience and training in child abuse, knowledge of formal and judicial issues, clinical knowledge, and self-assessment. RESULTS: Although more than half of the participants had confronted child abuse (n=712, 60.08%), only 273 (38.34% of them) submitted reports. One third of participants reported that they had received some training (n=440, 37.13%), mainly of postgraduate nature and based on personal initiative. Of those who reported child abuse, 175 (64.10%) had been trained. Each professional category was aware of topics regarding its own interest, without adequate knowledge of other disciplines. One third of psychiatrists, psychologists, and social workers felt confident in discussing with children and parents. Relevant scores were lower in the other categories. The lower scores were recorded among nurses and residents. The training deficit and reluctance to engage with judicial issues were the main causes of avoidance to deal with child abuse. CONCLUSIONS: Focused and organized training in child abuse is crucial to create reliable professionals in the field. The internet is a considerably helpful tool. Professionalism must characterize knowledge and practice in child abuse at the same level as in other medical topics. Motivation to engage should be early inspired and developed during the graduate years.

Stress response to ovariohysterectomy in rabbits: role of anaesthesia and surgery.

The aim of this study was to evaluate the neuroendocrine and inflammation response to laparoscopic total ovariohysterectomy (TOH) in rabbits, by comparing surgical stress markers of laparoscopic group with those of conventional open ovariohysterectomy and open ovariohysterectomy with pre-incisional local anaesthesia groups. Blood was sampled from 18 rabbits, of which six underwent laparoscopic TOH, six conventional open TOH and six conventional open TOH with pre-incisional local anaesthesia, 30 min before induction of anaesthesia (T0), immediately after skin incision (T1), 90 min postoperatively (T2), and 24 h postoperatively (T3). Cortisol and C-reactive protein serum, and adrenocorticothrophic hormone, tumour necrosis factor-a (TNF-a), adrenaline, noradrenaline and IL-6 plasma concentrations were evaluated. Laparoscopic TOH in rabbits has advantages over the open surgical technique because it causes less surgical stress response in terms of serum cortisol concentrations immediately after skin incision (p = .04), as well as plasma adrenaline (p = .035) and TNF-a (p = .047) concentrations 24 h postoperatively. Impact statement What is already known on this subject? Hysterectomy is the second most common surgery performed on women after caesarean section. Research has focussed on methods to modify the stress response associated with surgery. Various studies both in humans and animals, have demonstrated the less systemic, immunological and neurohormonal response of the laparoscopic technique, which is expressed by less elevated serum enzymes' and proteins' concentrations. However, other studies have documented that the systemic stress response after open hysterectomy is similar to that following laparoscopic surgery. What do the results of this study add? Laparoscopic total ovariohysterectomy in rabbits has advantages over the open surgical technique because it causes less surgical stress response in terms of serum cortisol concentrations, as well as plasma adrenaline and TNF-a concentrations during the first 24 h postoperatively. What are the implications are of these findings for clinical practice and/or further research? There were no significant differences between the groups in number of surgical stress markers (p > .05) perioperatively. We cannot exclude the possibility that a later increase of surgical stress response might take place after the first 24 h postoperatively.

Double-blind ureteral duplication: a rare urologic anomaly.

We present an extremely infrequent urologic entity of asymptomatic double-blind ureteral duplication in an 8-year-old girl. Contemporary imaging modalities provided major assistance in the diagnosis. Surgical management is advocated because of the potential for future complications, such as lithiasis, obstruction of the collecting system, and renal failure.

Fetal ovarian cysts: report of two cases and literature review.

In the present study we report two cases of fetal ovarian cysts. In the first case the cyst was initially discovered during prenatal ultrasound examination, while in the second case the cyst was identified during autopsy examination of a stillborn fetus. Pathologic examination of both specimens revealed similar histology, which was mainly characterized by the presence of an ovarian cortex comprising several maturing and primordial follicles which were occasionally biovular, and a focal lining of luteinized theca cells. Another prominent feature was the presence of multiple deposits of dystrophic calcifications within the cyst wall. Both cysts were diagnosed as follicular in origin.

Successful bronchotracheal reconstruction in esophageal bronchus: two case reports.

Esophageal bronchus is the most common congenital bronchopulmonary foregut malformation. Current surgical treatment is resection of anomalous pulmonary tissue, which is often hypoplastic and destroyed by infection. The authors report two cases of bronchotracheal reconstruction. The diagnosis was early, before 15 days of age. The anomalous pulmonary tissue had a pulmonary arterial supply and venous drainage as assessed by angiography and a good functional capacity on selective ventilation. Bronchotracheal anastomosis was successful in both cases: a right main bronchus at 25 days of age and a left main bronchus at 13 days of age. One child underwent reoperation 1 year later for bronchomalacia of the reimplanted bronchus. Both children are well with normal growth 3 and 7 years after surgery. Chest roentgenograms showed normal and symmetrical lung aeration. Tracheal reimplantation may be preferred to pulmonary resection when the anomalous pulmonary tissue is not destroyed. The pulmonary functional capacity is increased and the complications of pneumonectomy avoided.

Congenital pyloric stenosis: a modified umbilical incision for pyloromyotomy

Thirty-two patients underwent a pyloromyotomy via an umbilical incision; in 11 a modified umbilical approach was used to facilitate delivery of the pyloric mass. Incisions are made in the skin fold of the upper half of the umbilicus and at the midline, joining the two at the top. The skin incision is closed by upper umbilical translocation with a very good cosmetic result. This incision allows easy access to the pylorus and provides more convenient exposure. The absence of traction on the retractors avoids tissue ischemia, which leads to wound abscess development.

Congenital pyloric stenosis: a modified umbilical incision for pyloromyotomy.

Thirty-two patients underwent a pyloromyotomy via an umbilical incision; in 11 a modified umbilical approach was used to facilitate delivery of the pyloric mass. Incisions are made in the skin fold of the upper half of the umbilicus and at the midline, joining the two at the top. The skin incision is closed by upper umbilical translocation with a very good cosmetic result. This incision allows easy access to the pylorus and provides more convenient exposure. The absence of traction on the retractors avoids tissue ischemia, which leads to wound abscess development.

Tubular musculopleural pedicle grafting of esophageal long gaps in dogs.

Direct anastomosis of the esophagus is the treatment of choice in patients with esophageal atresia. If, however, a long esophageal gap exists, the anastomosis is performed under tension or a staged procedure is anticipated. The aim of this study was to prove that a pedicle musculopleural graft can be used to bridge the two esophageal ends. In 14 dogs through a right thoracotomy, the periosteum of the fifth rib was mobilized and the rib was excised. An intercostal musculopleural flap was created leaving the muscle attached to its vascular pedicle posteriorly with the intercostal vessels and nerve carefully preserved. A tube-like portion including pleural and intercostal muscles was formed from the free part of the graft. A 5 cm segment of the esophagus was excised and the tubular graft was interimposed. Animals were studied 1 month postoperatively with a barium meal that showed free passage through the esophageal neolumen. Peristaltic activity was studied with strain gauges above, below, and at the grafted area. Histologic examination revealed good healing at both anastomotic sites, while esophageal squamous epithelium covered the lumen all over the graft. Survival of the musculopleural pedicle graft seems to be feasible providing that its vascular supply is preserved. It is, thus, suggested that this technique might offer an alternative method in bridging long gaps in esophageal surgery.