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• Arterial constriction during neurogenic tumors surgery is a significant, yet unexplored, therapeutic problem. • Local arterial constriction constitutes a relatively common (10% of cases) and severe complication of neuroblastic tumors resection. • Efficacy of local application of papaverine based on our experience remains unproven hence further research is warranted. Neuroblastic tumors are the most common pediatric extracranial solid tumors in infants and very young children. Although, especially in newborns, there is an increasing number of situations in which observation alone is used, surgery remains an important step in the treatment of neuroblastoma but can be complicated by arterial vasospasm in the surgical field. The aim of this two-center retrospective study was to analyze the occurrence of arterial constriction as a complication of neuroblastic tumors resection. Medical records of patients who were treated surgically for neuroblastic tumors in the years 2012–2019 were reviewed. For 8 years, 113 children were treated for neuroblastic tumors. The treatment included both primary and delayed surgery after initial chemotherapy carried out according to SIOPEN protocols. In 11 out of 113 cases (9.7%) local arterial constriction was observed. In 6 out of 11 cases an attempt was made to save the organ, however, two patients suffered from kidney atrophy, two other partial kidney infarctions, one child suffered from partial limb paresis, and another from brain ischemia and death. Local arterial constriction constitutes a relatively common (10% of cases) and severe complication of neuroblastic tumors resection. Efficacy of local application of papaverine based on our experience remains unproven hence further research is warranted. [ABSTRACT FROM AUTHOR]

Laparoscopy for the resection of liver tumors in children has remained undeveloped in comparison to adults. Most of the indications for pediatric laparoscopic hepatic surgery have been limited to diagnostic laparoscopy (biopsy). Over the past ten years, however, laparoscopic liver resections for pediatric hepatic diseases have been performed successfully, and many case reports have been published. The authors report 6 cases of laparoscopic hepatic resection of benign tumors in children. The most important aspects of surgical technique are presented. There were 3 boys and 3 girls, with age between 4 months and 16 years. The lesions were located in the following segments: II and III (4 patients), I (1), V (1). The maximum tumor size was 7 cm. One anatomical (left bisegmentectomy) and 5 nonanatomical resections were performed. Conversion to laparotomy was necessary in 1 patient owing to bleeding from the posterior branch of the right hepatic artery. There were no postoperative complications and patients were discharged on postoperative day 4, 5, 5, 5, 7 and 3 accordingly. The postoperative pathology of the specimens confirmed their benign nature: infantile hemangioendothelioma (1), nested stromal epithelial tumor (1), focal nodular hyperplasia (3), mixed benign tumor (hamartoma + vascular malformation) (1). This report demonstrates the feasibility of a laparoscopic hepatic resection in children. On the other hand, laparoscopic liver resection is challenging and teamwork and specific training are necessary. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a multicenter experience of 159 laparoscopic splenectomies. Methods: Records of 159 children, who underwent LS in 3 pediatric surgery centers between 1996 and 2006, were reviewed retrospectively with a special questionnaire. The indication for splenectomy were hematologic disorders (147), esophageal varices (6), splenic cyst (5), and tumor of the tail of the pancreas (1). The LS was performed using standard laparoscopic technique and instrumentation. Results: There were 75 boys and 84 girls. Median age was 12.5 years (range, 2-19.4 years). Laparoscopic splenectomy alone was performed in 118 cases and LS with cholecystectomy or cholecystotomy in 36. In 5 cases, LS was performed together with fundoplication. Eight LS required conversion to an open procedure for following reasons: severe bleeding (3), massive splenomegaly (1), anatomical (2), and technical aspects (2). Accessory spleens were identified in 20 cases (12.6%). There was no mortality. Complications consisted of 8 conversions and postoperatively of mild generalized infection in 3 children and abdominal bleeding that resulted in re-laparoscopy in 1 case. Conclusions: Laparoscopic splenectomy can be safely and effectively performed in children. [Copyright &y& Elsevier]

Abstract: The case of a child with advanced hepatocellular carcinoma that did not respond to systemic chemotherapy is presented. Three courses of chemoembolization (hepatic arterial chemoembolization) were given, with partial tumor response. The hepatic artery was cannulated via the femoral artery using the Seldinger technique. Arteriography was performed, and chemoembolization suspension (cisplatin + doxorubicin + mitomycin mixed with Lipiodol) was injected. After the third hepatic arterial chemoembolization, the patient developed fatal pulmonary oil embolism. Hepatic arterial chemoembolization seems to be a useful method for treatment of high-risk hepatocellular carcinoma cases, which can induce responses, even in metastatic patients refractory to standard systemic chemotherapy. However, it may result in pulmonary embolism, which is a potentially fatal complication. In children, Lipiodol should be used as an embolizing material and cytostatic carrier with extreme care. Consideration should be given to replacing it with other materials, including albumin or collagen. [Copyright &y& Elsevier]

Abstract: Background: Hepatoblastoma arising from and limited to the caudate lobe is an extremely rare clinical entity. The object of this case report is to present a case of isolated caudate lobe resection due to hepatoblastoma originating in the caudate lobe. Methods: The patient was an 18-month-old male who was admitted with a huge tumor located in the left hepatic lobe. The histological diagnosis was fetal type of hepatoblastoma. The patient received 4cycles of preoperative and 2cycles of postoperative chemotherapy. Results: During surgical exploration, a well-defined, exophytic tumor originating in the caudate lobe was found. Isolated caudate lobe (Spiegel lobe) resection was performed. The intra- and postoperative course was uneventful. Surgical margins were negative for tumor. The patient remains alive with no signs of recurrence 15months after surgery. Conclusions: Isolated caudate lobe resection is one of the most challenging procedures in liver surgery. Despite the technical difficulties and high complications risk, isolated caudate lobectomy can be performed successfully in children. It needs to be noted that in the reported case, preoperative chemotherapy shrunk the tumor and largely facilitated its resection. [Copyright &y& Elsevier]

Abstract: Blunt abdominal trauma with isolated rupture of the normal renal pelvis is an extremely rare clinical entity. The correct preoperative diagnosis may be difficult and challenging because of the insidious onset, lack of blood loss, and frequently, lack of urinary symptoms. Intraoperative inspection of the collecting system is the most accurate method to fully define an extent of injury. The object of the case report is to present the case of a 15-year-old male with isolated pelvic rupture of a normal kidney because of strong punch in the abdomen during the handball match. [Copyright &y& Elsevier]

Extragonadal germ cell tumors are rare. The association with Klinefelter syndrome has become observed recently. A case of an 11-month-old infant with Klinefelter syndrome and a retroperitoneal mature teratoma is presented. In the tumor and lymphocytes, a 47,XXY karyotype was found. The association of Klinefelter syndrome with germ cell tumors and its possible explanations are discussed.