[Clinical manifestation of acute pancreatitis in children with caustic ingestion injury - the role of oxidative stress].

For a 10 years period (1996-2005) 66 children with severe caustic injuries of the esophagus and stomach were admitted at the Department of Pediatric Surgery. Subject of this article are 17 children with clinical, laboratory and intraoperative proven acute pancreatitis. The patients were admitted at the clinic 12 hours to 12 days after the ingestion of the corrosive agent. Fifteen of them underwent surgery and different surgical procedures were performed - gastric resection, transhiatal esophagectomy, gastrectomy, gastrostomy. In all patients were found elevated levels of alpha-amilase in blood serum and urine as well as elevated CRP in blood serum. Clinically manifested acute pancreatitis was diagnosed on ultrasound studies and laparotomy. The newest theories about the genesis of acute pancreatitis emphasize on the role of oxidative stress. Experimental models suggest that burn trauma (thermal or chemical) cause critical increase of free oxygen radicals and lipid peroxydation products in the tissue of the damaged organ and the bloodstream. The local tissue damage leads to release of inflammatory mediators which enter the bloodstream and cause distant organs damage of - lung, liver, kidneys and pancreas. In this preliminary report the authors discuss the pathogenesis of acute pancreatitis in children with acute corrosive ingestion injury of the esophagus and stomach. We call this phenomenon " caustic " oxidative stress. This is the first scientific report on this topic in the reviewed literature.

[Contemporary treatment of parapneumonic pleural complication in children: the role of Video - Assisted Thoracoscopic Surgery (VATS)].

AIM: To reveal the role of Video Assisted Thoracoscopic Surgery (VATS) in the treatment of different stages of pleural empyema in children. CLINICAL MATERIAL: Between 2004 and 2006, 87 children aged from 11 months to 18 years were treated at the Department of Thoracic pediatric surgery for parapneumonic pleural complications (pleural empyema). The children were admitted in a period from 5 to 30 days (mean 11.9) after the initial pulmonary symptoms. Of them 41 children were treated by means of VATS. The indications for this approach were based on clinical course, radiological features, chest ultrasound image and fluid examination. RESULTS: Primary thoracostomy underwent 22 children (53.6%). VATS was applied in a period of 3 to 12 days after the initial procedure. The indications for VATS includes: a) multiloculated pleural effusion, b) encapsulated empyema and c) failed tube drainage. According to the local finding VATS was performed for evacuation of the flocculated exudate and debridement of fibrinous adhesions in 25 children (61 %). In 16 children (39 %) VATS comprised debridement and decortication. The mean operative time amounts 74.1 min (from 50 to 125). There were 4 conversions to open thoracotomy due to evaluation of necrotic lung parenchyma. Pleural drainage lasts from 2 to 12 days (mean 4.8). The postoperative hospital stay takes from 5 to 24 days (mean 10.2). CONCLUSION: VATS is an appropriate and effective method for treatment of children with complicated parapneumonic effusion in the second (fibrino-purulent) stage as well by some indication in the third (organization) stage.

[Surgical aspects of primary tuberculosis in children: clinical presentation and indications for surgical treatment].

AIM: During the last years a trend of increasing the cases with primary pulmonary tuberculosis (PPT) in our country is observed. The aim of this study is to analyze retrospectively the pediatric cases with PPT and to determinate the specific clinical features as well the indications for surgery. MATERIAL AND METHODS: For a period of six years (2000-2005) thirteen children with PPT were treated at the Department of pediatric surgery. The patients underwent different type surgical procedures. Lobectomy was the most frequent operation. RESULTS: The initial diagnosis at admission was: chronic pneumonia, mediastinal tumor, complicated hydatid cyst, congenital lung cyst and pleural complication of PPT. The radiological features were typical for PPT in only two cases. The remaining showed atypical presentation and the diagnosis were confirmed by histopathological study of the surgery specimens. There were no postoperative complications and no late morbidity. DISCUSSION AND CONCLUSION: We classify the clinical course of children with PPT into three groups: 1) Identified PPT - two children, 2) Suspected PPT according the criteria of Migliori - six children and 3) Non identified PPT - five children. The diagnosis of the childhood pulmonary tuberculosis presents a major challenge. The most common radiological features are similar to those of other pulmonary affections and a thorough examination of symptoms of disease is necessary. Surgery has a complementary role in the complex treatment in children with PPT.

[Surgical tactics and surgical techniques in echinococcal cysts in the lung in children]. / Operativna taktika i khirurgichna tekhnika pri ekhinokokovite kisti na belite drobove v detskata vuzrast.

The differentiated surgical approach to hydatid lung cysts and the operative techniques used in 343 children treated in the Department of Pediatric Surgery over 24 years (1975-1998) are presented. The left lung is involved in 143 children (41.7%), the right--in 155 (45.2%), whereas in 45 cases (13.1%) it is a matter of bilateral location. Infectious complications occur in 198 cases (57.7%). In compliance with the anatomical location, size, extent and accompanying complications two surgical procedures are mainly used: 1) Total removal of the cyst without disrupting its continuity (closed echinococcotomy) in 19 per cent, and 2) Evacuation of the cyst fluid, as well as the germinative membrane, followed by appropriate management of the residual fibrous cavity in 81 per cent of cysts. Echinococcotomy with suture obliteration of the residual cavity in conjunction with sparing lung resection, yielding superior functional results postoperatively, is the method of choice.