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The authors present a case of a pneumatocele associated with blunt trauma in a child. An 11-year-old boy was admitted to the emergency department after he was knocked over and his chest was trapped under a soccer goal. Chest computed tomography (CT) revealed several cavities in the lobes of both lungs. The CT of the abdomen revealed traumatic laceration of the liver. The patient was treated conservatively. His condition was stable and subsequently improved. He was discharged 19 days later. After nine months, a chest radiograph showed complete resolution of the pneumatocele, and abdominal ultrasound demonstrated complete resolution of the liver hematoma. A traumatic pneumatocele is a benign lesion resulting from blunt chest trauma, usually in children and young adults, which typically requires only conservative treatment. The CT scanning is the most sensitive method for the detection of traumatic pneumatoceles. All emergency physicians should be familiar with the diagnosis and management of this condition, to avoid unnecessary invasive procedures.

Infantile haemangiomas (IH) are neoplastic proliferations of endothelial cells which occur with an incidence of 10-12%. IH rapidly growing and found in cosmetically sensitive areas or complicated with ulcerations are of special concern of parents.A review of medical charts was performed for newborns treated with propranolol because of IH between 2012 and 2013. There were two boys and two girls, referred to our department at the age of 2-3 weeks. Children were commenced on propranolol 0.5 mg/kg daily and closely monitored. The dosage was increased up to a maximum of 2 mg/kg/d and was maintained until the lesion had involuted or showed good result.The minimal dosage required to achieve involution was 1.5-2.0 mg/kg/d. No rebound growth or complications were observed. Three patients showed excellent response with resolution of the lesion. Fourth patient showed good result with50% reduction of IH.Propranolol at 1.5-2.0 mg/kg/d is effective and safe for treating IH in our series of newborn patients. Treatment should be maintained until the lesion is involuted or shows good cosmetic result. Still there is need for larger scale studies confirming the safety and efficacy of propranolol in treatment of haemangiomas in newborns.

Aim of the study: Assessment of risk factors for cholelithiasis in pediatric population. Methods: A retrospective analysis of 143 patients with cholelithiasis treated during the period 2002–2012. Results: There was a significant female predilection for gallstones (73.4%). 70 (48.9%) children showed one or more risk factors for gallstones. 73 (51.1%) patients had no risk factors. Four groups of patients could be distinguished: 106 (74.3%) patients with colicky pain without jaundice, 10 patients with colicky pain with jaundice (7%), 16 (11.2%) children with pancreatitis, 8 (5.5%) with acute cholecystitis, and 3 patients with atypical symptoms (2%). According to therapy, patients could be divided in 3 groups: 130 children treated with laparoscopic cholecystectomy, 4 children treated with laparotomic cholecystectomy and 9 children treated with ursodeoxycholic acid. Conclusions: Laparoscopic cholecystectomy remains the golden standard in treatment for symptomatic cholelithiasis. Complications connected with laparoscopic cholecystectomy were noted in only 2% of patients in our series. Presence of relatives with cholelithiasis, obesity and hemolytic disorders were the predominant risk factors.

This case report demonstrates efficacy of topical timolol for the treatment for residual IH in the facial area in a child, previously treated with propranolol. The treatment was well tolerated. Local or systemic side effects were not seen. Conclusion Timolol gel is an effective therapy option for residual hemangiomas, and should be considered as a complementary treatment for residual hemangiomas after terminating propranolol treatment.

BACKGROUND The aim of this study was to assess the expression of estrogen receptors alpha and beta in paratesticular tissues in a group of boys with and without cryptorchidism, and evaluation of karyotypes, localization, morphology and the major length of the undescended testes. MATERIAL/METHODS Fifty boys (1-4 years old) with unilateral cryptorchidism were evaluated. Fifty healthy boys within the same age range, with inguinal hernia, served as a control group. Measurements concerning expression of ERalpha ERbeta receptors were preformed using monoclonal mouse antibodies against human receptor alpha and beta. RESULTS In the mesothelial layer, the expression of ERalpha was higher in the patients group with undescended testes and it was statistically significant (p=0.04). There was no difference in the expression of ERbeta in this layer between groups. In the stromal cell layer there was statistically significant higher expression of ERbeta (p

Streszczenie Cel Celem pracy bylo określenie wieku rozpoczecia siadania, raczkowania i chodzenia oraz analiza stopnia uszkodzenia funkcji motorycznych u dzieci urodzonych z przepukliną oponowo-rdzeniową. Material i metody Analizie klinicznej poddano trzydzieścioro dzieci z przepukliną oponowo-rdzeniową, ktore są podopiecznymi poradni klinicznych Uniwersyteckiego Dzieciecego Szpitala Klinicznego im. L. Zamenhofa w Bialymstoku. Wyniki Wszystkie dzieci z przepukliną ulokowaną w odcinku Th-L kregoslupa mialy opoźniony wiek siadania, raczkowania i chodzenia. Nieco lepiej sytuacja przedstawiala sie w grupie pacjentow dotknietych rozszczepem w odcinku L i L-S. W grupie pacjentow z poziomem S przepukliny oponowo-rdzeniowej wiekszośc badanych miala prawidlowy rozwoj motoryczny. Az 77% badanych nie uzyskalo samodzielności w poruszaniu sie i korzystalo z pomocy wozka inwalidzkiego. Pozostale 23% ankietowanych bylo zdolnych do samodzielnego poruszania sie. Wnioski Im wyzej ulokowana jest przepuklina oponowo-rdzeniowa, tym poźniejszy jest wiek rozpoczecia siadania, raczkowania i chodzenia. Przepuklina ulokowana w odcinku Th-L i L kregoslupa byla przyczyną trwalego kalectwa, wszystkie dzieci z rozszczepem kregoslupa w odcinku piersiowo-ledźwiowym oraz ledźwiowym poruszaly sie na wozku inwalidzkim. Jedno dziecko z przepukliną odcinka L-S poruszalo sie samodzielnie. W grupie z poziomem krzyzowym przepukliny oponowo-rdzeniowej wszystkie dzieci poruszaly sie samodzielnie.

Streszczenie Wstep Oparzenia nalezą do najbardziej dramatycznych, a jednocześnie najczestszych urazow wieku dzieciecego. Cel Celem pracy jest analiza etiologii, rozleglości i stopnia oraz wynikow leczenia oparzen u dzieci. Material Material do badan stanowila dokumentacja 357 pacjentow leczonych z powodu oparzen w Dzieciecym Szpitalu Klinicznym w Bialymstoku, w Klinice Chirurgii Dzieciecej i w Poradni Chirurgicznej, w latach 2004–2009. Wyniki Dzieci najcześciej ulegaly oparzeniu gorącymi plynami – w ponad 90% przypadkow. Najwiecej dzieci bylo leczonych zachowawczo. Pietnaścioro dzieci wymagalo leczenia operacyjnego. Czas leczenia – zarowno zachowawczego, jak i operacyjnego byl uzalezniony od procentu poparzonej powierzchni ciala. Im wieksza byla powierzchnia oparzenia – tym dluzej trwalo leczenie zachowawcze i operacyjne. Oparzenia I° i II° goily sie bez pozostawienia blizn. Oparzenia III° i IV° pozostawialy po sobie blizny pooparzeniowe. Wnioski Wyniki leczenia oparzen u dzieci zalezą przede wszystkim od glebokości urazu i powierzchni oparzonej. Wlaściwe postepowanie jest bardzo wazne w celu osiągniecia dobrego efektu kosmetycznego oraz zapobiegania wtornym deformacjom w obrebie stawow.

We estimated a number of cell populations of peritoneal fluid in rats with experimentally developed peritoneal adhesions.The fluid was taken in standarized conditions at the first operation and during reoperation. Animals were divided into four groups. The first group was the control group (n = 20) on which the abdomen was opened and closed without any manipulations (group 1a), and the reoperation was done after 72 hr (group 1b). The other groups (2, 3, 4; n = 20 for each group) were operated, and scarification of the parietal peritoneum and serosa of the bowel was performed. The rats were reoperated after 24, 72, and 168 hr, respectively, after the first surgery. The peritoneal cavity was washed with the 0.9% saline solution. The number of the peritoneal adhesions and populations of the cells were counted.The highest number of peritoneal adhesions was observed in the group of animals reoperated after 72 hr. After 72 and 168 hr, the higher number of mast cells (MC) and neutrophils was observed. The difference was statistically significant. The percentage of mast cells (MC) increased during the experiment. It was different from other cell populations which decreased after 168 hr. The highest change in number was observed for MC. The highest number of MC was observed on the seventh day after the laparotomy.MC influence peritoneal adhesion formation and probably take part in adhesion remodeling. MC and neutrophils changed significantly after manipulations in the peritoneal cavity. Probably, they play an important role in peritoneal adhesion formation.

Mast cells (MC) produce, store and release many biologically active substances, especially inflammatory factors, chemotactic substances for neutrophiles, cytokines and prostaglandins. They play very important role in fibrinosis and they are an important factor in peritoneal adhesions formation and lysis. In this study we tried to evaluate role of mast cells in peritoneal adhesions formation. We estimated number of mast cells in peritoneal fluid in rats with experimentally developed peritoneal adhesions. The number of mast cells per ml was counted in flow cytometry in specimens of peritoneal fluid taken from operated rats. The fluid was taken in standardized conditions the same for each group at the first operation and during reoperation. Peritoneal cavity was washed with 0.9% Saline solution. MC were visualized using indirect immunohistochemical method LSAB with mouse antibody. The animals were divided into 4 groups. 1 st group was control group (n=20) on which the abdomen was opened and closed without any manipulations, and the reoperation was done after 72 hours. The other groups (2, 3, 4; n=20 for each group) were operated and scarification of the partial peritoneum and serosa was performed. The rats were brought back to conscious and then were reoperated respectively after 24, 72 and 168 hours after first surgery. After the laparotomy and damage of the peritoneum we observed formation of the peritoneal adhesions between intestine loops and between intestines and damaged parietal peritoneum. Also the higher number of mast cells was observed in the groups of animals with damaged peritoneum. The highest number of peritoneal adhesions was observed in the group of animals reoperated after 72 hours. After 72 and 168 hours the higher number of MC and neutrophils was observed. The difference was statistically significant. The percentage of mast cells was increasing during the experiment duration. It was different from other cells populations which decreased after 168 hours. The MC and neutrophils were cell population which changed significantly after manipulations in peritoneal cavity. It is very probable that they play an important role in peritoneal adhesions formation.

Streszczenie Cel Celem pracy jest ocena rozwoju psychomotorycznego dzieci, ktore byly leczone z powodu martwiczego zapalenia jelit i ktore pozostawaly w opiece ambulatoryjnej w Klinice Chirurgii Dzieciecej w czasie 3-letniej obserwacji. Material W Klinice Chirurgii Dzieciecej Uniwersytetu Medycznego w Bialymstoku w latach 2003–2006 leczono 19 noworodkow z martwiczym zapaleniem jelit. Wyniki Sześcioro dzieci zmarlo. Znacznego stopnia uszkodzenie funkcji psychomotorycznych stwierdzono u 5 pacjentow po leczeniu NEC. Rozwoj 5 pacjentow oceniono jako prawidlowy. Gorszy wynik odlegly stwierdzono u pacjentow po chirurgicznym leczeniu NEC. Wnioski Na gorszy rozwoj psychomotoryczny dzieci po martwiczym zapaleniu jelit wplywa wiele czynnikow – czynniki dzialające jeszcze w okresie prenatalnym, bedące przyczyną przedwczesnego porodu, ciezkośc przebiegu NEC, deficyty odzywcze, interwencje chirurgiczne i ich powiklania. Najczestszym odleglym powiklaniem martwiczego zapalenia jelit w naszym materiale byla niedroznośc na tle zwezenia jelit.

Wady wrodzone ukladu nerwowego, w tym przepukliny oponowo-rdzeniowe stwierdza sie u 1–2 dzieci na 1000 zywo urodzonych. Są one obok urazow i nowotworow najczestszą przyczyną zgonow, kalectwa i obnizenia jakości zycia dzieci. Celem opracowania jest przedstawienie zasad postepowania z noworodkiem i dzieckiem urodzonym z przepukliną oponowo-rdzeniową stosowanych w Klinice Chirurgii Dzieciecej AMB.

Cel pracy Określenie czestości wystepowania zmian nowotworowych i nienowotworowych u dziewczynek ze zmianami torbielowatymi i guzami jajnikow. Material i metody W Klinice Chirurgii Dzieciecej AMB w latach 2001–2006 leczono 36 dziewczynek z powodu rozpoznanych badaniem USG zmian torbielowatych jajnikow. Autorzy omawiają badania diagnostyczne, leczenie zachowawcze oraz wskazania do leczenia operacyjnego. Przedstawiają odlegle wyniki leczenia zachowawczego. Wyniki W grupie 36 dziewczynek u 24 (66%) stwierdzono proste torbiele jajnika, u 12 (34%) stwierdzono zmiany nowotworowe jajnika, u 10 (84%) byly to zmiany lagodne. 11 (48%) dziewczynek z torbielami jajnika wymagalo leczenia chirurgicznego. Wnioski W naszym materiale wiekszośc zmian w jajnikach u dziewczynek stanowily proste torbiele. Wśrod zmian nowotworowych przewazaly zmiany o charakterze lagodnym. Rokowanie u dziewczynek jest zwykle dobre, nawet w przypadkach zaawansowanych zmian nowotworowych. Postepowanie terapeutyczne powinno byc dobrane indywidualnie i uwzglednic zachowanie plodności. Resekcja macicy i totalna omentektomia w kazdym przypadku zlośliwego guza jajnika nie są konieczne u dzieci.

We describe the successful treatment of an infant with life-threatening Kasabach–Merritt syndrome (KMS) who received propranolol therapy. A full-term, 6-week-old female infant, in poor general condition, was admitted with a large vascular tumor of right buttock, perineal region, extending to a lumbar region and the right thigh. There was a gray-blue, tense, shiny, warm swelling over the site of vascular tumor. The child had platelet count of 20,000 cells/mm. d -dimer was positive and suggestive of consumptive coagulopathy. A diagnosis of KMS was made. Computer tomography (CT) imaging was suggestive of a vascular tumor – Kaposiform hemangioendothelioma. The baby was initially treated with platelet, fresh frozen plasma and blood transfusions. There was temporary rise in platelets to 118,000 cells/mm but after transfusions the platelets dropped to 20,000 cells/mm and the baby developed purpuric swelling over right thigh and right buttock. Platelet transfusions were discontinued and propranolol treatment was started. From the 4th day, the swelling started regressing and the platelet count rose to 73,000 cells/mm. At the age of 2 years, the tumor has nearly completely involuted. In our case propranolol proved to be effective first-line treatment for Kasabach–Merritt syndrome associated with a vascular tumor – Kaposiform hemangioendothelioma. Minor side effect was poor weight gain after prolonged treatment.

UNLABELLED Infantile hemangiomas (IH) are neoplastic proliferations of endothelial cells which occur with an incidence of 10 to 12% within the first year of life. IH grow after birth and usually regress spontaneously, but still can lead to deformities when they are located in the facial areas of the lip, eyelid, nasal tip or the ear. We wanted to share our experience in the treatment of problematic IH with propranolol. A retrospective review of medical charts was performed for 40 consecutive children treated with propranolol because of problematic IH between 2009 and 2012. 40 patients (33 girls, 7 boys) with a median age of 4.2 months (aged 1 to 11 months) were treated because of problematic IH. Rapid improvement was reported in the first days of treatment in 38 patients. In one case we had to terminate the treatment because serious tachycardia developed within the first 48 hours after propranolol was started. In this case the patient benefited from alternative treatment with timolol maleate gel. 35 patients (87%) showed an excellent response with complete resolution of the lesion. 4 patients (10%) showed a good result with >50% reduction in the size of the hemangioma. Also a patient with residual IH after terminating oral propranolol benefited from topical treatment with timolol maleate gel. A minor side effect was poor weight gain during prolonged treatment in one patient and tachycardia in another patient in which case we had to terminate the treatment. CONCLUSIONS Our observations show that gradually increasing the dosage of propranolol up to 3 mg/kg and gradually weaning the dosage is safe and effective in treatment of problematic IH. Timolol maleate gel should be considered as a complementary treatment for residual hemangiomas after terminating propranolol treatment or as an alternative treatment in patients who do not tolerate oral propranolol well.

The aim of this study was to determine the serum anti-Mullerian hormone (AMH levels) in a group of boys with cryptorchidism before and 1 year after surgery. Additionally, the effect of orchiopexy, based on the testicular position and morphology, was evaluated. Fifty boys who were 1-4 years old (median, 2.4 years) with unilateral cryptorchidism were evaluated before and 1 year after they underwent orchiopexy. Prior to the procedure, all of the patients had undergone karyotyping to exclude chromosomal abnormalities. Blood samples were collected while obtaining blood for standard laboratory tests routinely performed just before and 12 months after surgery. Twelve months after the orchiopexy, in most cases surgically treated testes were in the middle or lower pole of the scrotum. The descended glands were of comparable size and density in comparison with the testes on the opposite side. In the treated children, serum AMH levels measured at 12 months after orchiopexy were similar to preoperative basal levels. The authors found that AMH levels in children with unilateral undescended testes do not change significantly 1 year after surgical procedure. We still do not have trustworthy factors to predict fertility in children affected with cryptorchidism. We observed an upward trend in AMH concentration 1 year after orchiopexy, but it was statistically insignificant. Therefore, we plan further measurements of AMH in boys after orchiopexy to assess the influence of this procedure on gonadal function.