Browsing by Author "Grujić, Blagoje (12772307200)"

Introduction: Congenital diaphragmatic hernia (CDH) with concomitant esophageal atresia (EA) and tracheo-esophageal fistula (TEF) is a very rare condition, with a high mortality rate. Prematurity and congenital heart anomalies additionally increase the mortality rate. This situation is a great challenge for clinicians, requiring multidisciplinary work and adequate treatment strategy. Case report: We presented a premature twin newborn at the gestational age of 33/34 weeks with body mass of 1690 g. The existence of the left CDH was established on prenatal ultrasound exam in the 24th gestational week, and the diagnosis of EA with TEF was made on admittance to our hospital. The cardiac ultrasound exam revealed the total anomalous pulmonary venous connection (TAPVC). The first operation was performed on the day of admittance and consisted of left subcostal laparotomy, diaphragmatic repair, elastic occlusion of the gastroesophageal junction and gastrostomy. The ligation of TEF and esophagoplasty were done 13 days later in the second operation. The lethal outcome during the esophagoplasty was caused by the crisis of pulmonary hypertension and associated congenital heart anomaly (TAPVC). The presence of CDH and EA/TEF in association with TAPVC in a twin newborn has not been reported before in the literature. Conclusion: The treatment of newborns with CDH and EA/TEF requires multidisciplinary well-coordinated team work of pediatric surgeons, anaesthesiologists, neonatologists and pulmologists. The standard protocol for the management does not exist, but well-planned staged operations could enable greater survival rate. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Extraskeletal Ewing sarcoma (ES) is a highly malignant neoplasm occurring most commonly in the thoracic wall and the paravertebral region. ES belongs to the group of small round cell tumors and displays pathognomonic structural abnormalities of the EWS gene. The aim of this article was to present extraskeletal ES in an extremely rare anatomic location, an unusual clinical presentation, and modified treatment strategy. Case outline A 15-year-old boy was admitted to the hospital with acute abdominal pain in the right iliac region. During urgent operation, because of suspected appendicitis with periappendicular infiltrate, partly hemorrhagic tumor tissue was discovered in the preperitoneal space. Histopathological and immunohistochemical analyses revealed a tumor resembling extraskeletal ES. A postoperative CT scan showed the tumor rest, which was completely removed in the second operation. Molecular genetic analysis confirmed extraskeletal ES by finding the EWSR1-FLI1 fusion gene. Chemotherapy and radiotherapy according to the VAC protocol were started, and the patient is free of the disease eight months after the first operation. Conclusion Our case is the fourth case of extraskeletal ES located in the abdominal wall, the second case confirmed by the molecular genetic finding, and the first case described in children at this anatomic site. Due to an extremely rare location, unusual clinical presentation, and needed genetic analysis, the tumor treatment strategy was modified with good short-term results. © 2018, Serbia Medical Society. All rights reserved.

Background/Aim. Diagnosis of acute appendicitis (AA) remains the most common dilemma of pediatric surgical team. Our aim was to determine whether the neutrophil myeloperoxidase index (MPXI), in combination with other laboratory and clinical parameters, can be useful in diagnosis and follow-up of AA in children. Methods. A prospective investigation of MPXI values in 117 consecutive patients, planned for the surgical intervention due to AA, was performed. The patients were stratified into three groups according to the intraoperative finding: the normal/early, uncomplicated and complicated AA. Laboratory analyses were done preoperativly, on the 1st and on the 3rd postoperative days. Results. The statistically significant difference of MPXI values between the uncomplicated and complicated appendicitis before surgery and the positive correlations between the MPXI and C-reactive protein, as well as interleukin-6, before surgery were found. Postoperatively, in the group of uncomplicated, as well as complicated AA, a significant decrease of MPXI was recorded. Conclusion. The MPXI may be used as an informative biomarker in the follow-up of AA in children. A wide reference range for the MPXI and individual differences in the values of MPXI in the healthy children, generate difficulties for its use for the initial diagnosis of acute appendicitis. Usefulness of MPXI determination decreases with a delayed diagnosis. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. Acute appendicitis (AA) is the most frequent emergency and appendectomy is the most frequent abdominal operation in the pediatric surgery. Diagnosis of AA in children is more difficult due to a lack of cooperation and poor clinical history data, leading to significant number of misdiagnostic cases. Our aim was to explore whether neutrophil to lymphocyte ratio (NLR) may be useful in diagnosis and follow-up of AA in children. Methods. Prospective investigation of NLR values in 129 consecutive patients admitted to the Mother and Child Healthcare Institute of Serbia and referred for surgery due to AA was performed. According to the pathohistological findings, patients were divided into 3 groups: normal/early, uncomplicated (phlegmonous) and complicated (gangrenous or/and perforated) AA. Laboratory analysis was done preoperativly and on the 1st and the 3rd postoperative days. Results. Statistically significant differences of NLR values were found in the different time points in total of patients and per groups. Some statistically significant differences of NLR values among histopathological groups were recorded. Investigations of correlation of NLR and other laboratory and clinical parameters showed strong positive correlation between NLR and C-reactive protein postoperatively and between NLR and Pediatric Appendicitis Score (PAS) preoperatively. Strong negative correlation with preoperative symptoms duration (PSD) were also present. Optimal cutoff NLR value between negative and positive appendectomies was 6.14. Conclusion. NLR provides well monitoring of progression of AA in children and, its cutoff values may help in distinguishing the phases of AA. Because of that, NLR should be used in diagnosis of AA in children. © 2018, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Introduction. Annular pancreas is a rare congenital anomaly in which a band of the pancreatic tissue, in continuity with the pancreatic head, completely or incompletely surrounds the descending part of the duodenum. An abnormal pancreatic development can cause complete annular pancreas, partial annular pancreas, and pancreas divisum. Complete annular pancreas is diagnosed in newborns, while the diagnosis of the partial annular pancreas is more frequently established in adults. The most reliable diagnostic methods are computed tomography and magnetic resonance cholangiopancreatography. The anomaly is treated surgically, using bypass procedures. Case report. A 12-year-old girl presented malnourished, with occasional feeding problems, vomiting, heartburn, and pain from infancy. The upper gastrointestinal series showed an extremely dilated stomach, the first and the second part of the duodenum. An endoscopic exam revealed the dilated stomach, pylorus, and the first and the second part of the duodenum with retained contrast, while the entrance of the endoscope into the third part of the duodenum was not possible. Computed tomography showed pancreatic tissue encircling the second part of the duodenum and the characteristic "crocodile jaw" sign. Roux-en-Y duodenojejunostomy was performed as a bypass procedure. Conclusion. The complete annular pancreas is a well-known and easily diagnosed anomaly in newborns. The partial annular pancreas is often poorly recognized, especially in patients who do not present with marked duodenal obstruction. Unrevealed, it causes chronic problems in food intake, with possible serious complications. Although a very rare condition in the pediatric population, partial annular pancreas should be taken into consideration in unclear cases of chronic poor oral food intake and vomiting. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.