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The purpose of this experimental study is to investigate whether acute fluid accumulation within the peripancreatic space would increase retro-peritoneal pressure, affecting thus pancreatic perfusion. Six adult male swine ventilated through tracheostomy and having catheters inserted into the right carotid and femoral arteries were used. After baseline systemic hemodynamics and intraabdominal and retroperitoneal pressures assessment, a suspension of color-labeled microspheres was injected into the left cardiac ventricle for pancreatic blood flow evaluation. It is concluded that retroperitoneal fluid collection increases retroperitoneal compartment pressure, leading to pancreatic tissue hypoperfusion.

Objectives: To investigate whether the increase of the retroperitoneal compartment pressure, as in the case of peripancreatic fluid accumulation in severe acute pancreatitis, simulated by infusing a colloid fluid into the retroperitoneum, has any effect on pancreatic tissue blood flow., Methods: Six male anesthetized swine were subjected to a transcutaneous placement of catheters into the retroperitoneal space. Through these catheters, a colloid solution was infused, under continuous retroperitoneal pressure monitoring, to achieve a pressure up to 20 mm Hg. Pancreatic tissue blood flow was assessed by colored microsphere injection technique, and pancreatic interstitial pressure was measured by means of a commercially available pressure monitor system before and after the distension of the retroperitoneal space, allowing the appropriate time for the animals to be stabilized from any intervention., Results: The increase in the retroperitoneal compartment pressure was found to significantly increase pancreatic interstitial pressure (from 8 +/- 1 to 20 +/- 2.4 mm Hg, P = 0.001) as well as reduce pancreatic tissue blood flow (from 1.75 +/- 0.4 to 0.56 +/- 0.12 mL . min . g, P = 0.002)., Conclusions: The increase of retroperitoneal pressure leads to an impairment of pancreatic tissue blood flow in the healthy pancreas. Although these findings support the hypothesis that peripancreatic fluid collection during the course of acute pancreatitis could contribute or augment pancreatic tissue ischemia, further assessment is necessary.

Between 1985 and 2002 we treated 38 children with 39 fractures of the proximal tibia. Fractures affecting the proximal tibial physis were excluded from this study. Mean age at the time of injury was 7.1 years (range: 2.5 to 14). Conservative treatment was followed in 34 cases and four patients underwent surgery. We examined 31 children with 32 fractures followed up for an average of 4.8 years (range: 16 months to 15 years). Twenty eight (90.3%) patients developed post-traumatic tibia valga. Deformities were observed at an average 5.3 months after injury. All the cases with fractures of the medial cortex developed valgus angulation. The mean valgus angular deformity was 5.5 degrees. There was also an average of 5.31 mm limb lengthening in 27 patients. Eleven patients with an angulation >5 degrees were reevaluated at an average of 7.4 years from the initial injury. Partial remodelling was observed in 6 patients (54.5%) and total remodelling in 3 (25%). We recommend that children with proximal metaphyseal tibial fractures should be initially treated conservatively and followed up during skeletal development, because valgus deformity tends to remodel with age.

Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology. Its pathogenesis is related to the embryology of the clavicle. We present a 6-year-old girl with congenital pseudarthrosis of the right clavicle. A prominence was noticed at birth between the middle and distal ends of the clavicle that increased in size when the right shoulder was actively mobilised. Radiographic examination revealed a hypertrophic pseudarthrosis of the clavicle. The pseudarthrosis was resected and the clavicular segments were fixed with an external fixator for 2 months until union. Clinical results were excellent at the 7-year follow-up: the right shoulder was pain-free and the appearance satisfactory. Surgical treatment of congenital pseudarthrosis of the clavicle in children using an external fixator provides a better cosmetic outcome with smaller postoperative scars and avoids a second surgical procedure to remove the implants.

We present a 12-year-old boy with a displaced fracture of the distal radial epiphysis type I according to the Salter-Harris classification. The distal radial epiphysis was completely dorsally displaced, while the distal ulna remained intact. The injury was result of a fall on the patient's outstretched hand. Closed reduction was applied and the forearm was immobilized with a long arm cast. In the radiological re-examination a week later, a complete re-displacement of the fracture was detected. Open reduction followed and interposed flexor tendons (flexor pollicis longus and flexor carpi radialis) were found in the anatomical position of the distal radial epiphysis. The displaced epiphysis was reduced and fixed with two Kirschner wires and a long arm cast for a period of 6 weeks. The follow-up examination 2 years later showed that the movement range of the wrist joint was not limited and skeletal growth of the radius was not disturbed. The failure of closed reduction in these fractures is due to anatomical obstacles such as periosteum, flexor tendons and pronator quadratus interposition. Repeated forceful manipulations to achieve closed reduction must be avoided because of the potential for a number of complications, such as growth arrest, compartment syndrome, and avascular necrosis of the epiphysis.