Dragoljub Zivanovic | University in Nis (original) (raw)

Papers by Dragoljub Zivanovic

Physiological Research, Oct 15, 2011

Pneumatic tourniquets are widely used in pediatric extremity surgery to provide a bloodless field... more Pneumatic tourniquets are widely used in pediatric extremity surgery to provide a bloodless field and facilitate dissection. This prospective study was carried out to examine possible effect of different anesthesia techniques on oxidative stress and endothelial dysfunction connected with ischemia-reperfusion injury during extremity operations at children's age. Patients were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples for determination of the malondialdehyde in plasma and erythrocytes, protein carbonyl groups concentration as well as plasma nitrites and nitrates level and xanthine oxidase activity were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release, 5 and 20 min after tourniquet release. This study demonstrates that total intravenous anesthesia with propofol and regional anesthesia techniques provide better antioxidant defense and reduce endothelial dysfunction than general inhalational anesthesia with sevoflurane during tourniquet application in pediatric extremity surgery.

Open Medicine, Jun 1, 2010

Bezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel s... more Bezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel syndrome is a rare complication of a gastric trichobezoar in which the mass of hair extends through the pylorus into the small bowel and can even reach the colon. A 12-year-old girl with severe pain and a feeling of "fullness" in the upper abdomen was admitted to Pediatric Surgery. Two days before admission, the patient presented with vague abdominal pain, vomiting with a little blood, and black stool. On physical examination she was pale and listless with patchy alopecia. Abdominal examination showed a mobile, palpable mass in the epigastrium. The initial hematocrit was 7,1%, and the erythrocyte count was 1,12x10 12 cells per liter. Abdominal ultrasound and computed tomographic (CT) examinations confirmed the presence of a tumor-like formation in stomach. A giant bezoar with ulceration on the back wall of the stomach was verified by upper gastrointestinal endoscopy. Endoscopic extraction was not possible because of the size of the bezoar. Gastrotomy was performed to remove the bezoar that occupied most of the stomach, with a long tail that extended deeply into the duodenum (Rapunzel syndrome). The bezoar, 35 by 10 cm in diameter, was black and consisted of hair and synthetic fibers. Prompt diagnosis and treatment of trichobezoars are important to avoid a possible fatal outcome.

West Indian Medical Journal, Mar 9, 2015

Objective: Despite great prevention efforts, blunt abdominal trauma still remains a leading cause... more Objective: Despite great prevention efforts, blunt abdominal trauma still remains a leading cause of injury, especially in the paediatric population. Abdominal trauma is the main culprit of serious children's injury and the most common area of initially missed diagnosis with a fatal outcome. Aim: The purpose of this study was to determine the incidence, aetiology, grades of abdominal organ injuries, diagnosis, management and outcome of blunt abdominal trauma in a paediatric population. Method: This is a retrospective study of 31 patients with isolated parenchymatous abdominal organs, treated in a single centre. Stable patients with no signs of peritonitis and insignificant changes in laboratory findings were managed conservatively. Unstable patients received surgery. Results: The leading cause of injuries were traffic accidents (64.5%), followed by fall from a height (22.5%), bicycle handlebar injuries (6.45%), contact sport and child abuse (3.22% each). The majority of injured children (90.32%) were managed conservatively. Only three patients (9.68%) were operated on due to complete avulsion and organ smash, or devascularization of the injured organs. Diagnostic computed tomography (CT) scan examination was performed on 93.5% of patients. Few patients had grade I and grade V injuries, while the largest proportion of patients had grade III and IV injuries. The most frequently injured organs were the spleen and kidney. There was no mortality. Conclusion: The results emphasize that conservative treatment was appropriate for all stable patients with blunt abdominal trauma regardless of organ injury grade. The success of non-operative management depends upon proper patient selection. The choice of non-operative treatment should be based predominantly on physiological response, rather than grade injury on CT scan.

Acta Facultatis Medicae Naissensis

Gastric teratoma is a extremely infrequent tumor and accounts for less than 1% of all teratomas a... more Gastric teratoma is a extremely infrequent tumor and accounts for less than 1% of all teratomas among children population with male predominance. Case history: Herewith is described a case of mature gastric teratoma in a three months-old female infant associated with malrotation, hypotonia, torticollis and fusion of labia minoria. Due to the abdominal distension, the child was admitted to the Paediatric Surgery Department. On physical examination, a large lump was palpable, and laboratory findings were normal. Computed tomography (CT) showed a major heterogeneous solid formation within the right hemi-abdomen, extending to pelvis and crossing the midline. The infant underwent surgery and complete excision of tumor originating from lesser curvature of the stomach was made. Tumor was weighing 600 gr and was 10 x 14 x 8 cm large. The histopathological examination finding pointed to mature gastric teratoma. The post-operative course and further follow-up were eventless. Conclusion: As so...

The West Indian medical journal, 2015

Neonatal epididymo-orchitis is a rare condition, causing testicular pain in neonatal boys. It rep... more Neonatal epididymo-orchitis is a rare condition, causing testicular pain in neonatal boys. It represents epididymo-testicular inflammation which commonly coexists with urinary tract infections and malformations. The idiopathic type is extremely rare. We present a case of a seven-day old male neonate with advanced septic form of idiopathic orchiepididymitis and no associated urinary tract anomalies. The boy was hospitalized with signs of sepsis, anterior abdominal wall phlegmona and bilateral acute scrotum. Colour Doppler echosonography indicated epididymo-testicular inflammation with increased vascular flow. The patient underwent surgical exploration of both scrota in order to evacuate purulent content and fibrin. Cultures of Enterobacter spp were detected in hemiscrotal pus. Prompt administration of antibiotics was done. The postoperative course was uneventful. We suggest that every male baby must be very meticulously examined by a neonatologist in the early postnatal period, in or...

Knowledge International Journal, May 22, 2017

Children

Treating complicated wounds in the pediatric population using traditional wet to moist wound dres... more Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patien...

Facta Universitatis, Nov 24, 2022

Ewing's sarcoma (ES) is the second most common malignant bone tumor accounting for 5-10% of malig... more Ewing's sarcoma (ES) is the second most common malignant bone tumor accounting for 5-10% of malignancies in childhood. The scapula is rarely affected and only several reports have been published. Early symptoms of Ewing's sarcoma of the scapula may be ignored by patients or misinterpreted by physicians, leading to a delay in diagnosis. In the retrospective analysis, we identified 3 patients (2 males) with Ewing's sarcoma of scapula, aged 11-14½ years in a 15-year period. The introduction of combined treatment with multimodal chemotherapy, surgical resection and/or radiation therapy has improved the survival of patients with Ewing's sarcoma significantly. Several options for resection of ES of scapula were described with generally unfavorable functional results. Two patients were treated with chemotherapy and resection of the scapula. The third patient is on chemotherapy. Two patients died after 2½ and 4 years. In children and adolescents presenting with shoulder pain, Ewing's sarcoma must be ruled out.

Acta orthopaedica Belgica, 2016

Aneurysmal bone cysts (ABC) are rare and they represent 1- 1.4 % of all primary bone tumors. ABC ... more Aneurysmal bone cysts (ABC) are rare and they represent 1- 1.4 % of all primary bone tumors. ABC of cuboid bone are extremely rare, especially in children. Very few cases have been reported in the literature since 1967. We present a case of pathological fracture of cuboid bone due to an aneurysmal cyst in a 10-year-old girl. Surgery was performed, which included open biopsy with aspiration and intralesional curettage . Bone defect was then filled in by fully synthetic cancellous bone graft substitute consisting of pure β-tricalcium phosphate. Aneurysmal cyst of cuboid bone with pathological fracture could be successfully treated with pure β-tricalcium phosphate as a bone graft substitute. This procedure is safe with excellent outcome.Follow up to nearly four years did not show any recurrence.

Children

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Nagoya Journal of Medical Science, 2019

Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological sub... more Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the di...

Facta Universitatis, Series: Medicine and Biology, 2020

Rectum is the least common site of gastrointestinal duplication. Up to now fewer than 100 cases h... more Rectum is the least common site of gastrointestinal duplication. Up to now fewer than 100 cases have been reported in the literature. We present two infants with cystic rectal duplications manifested with chronic constipation as a main clinical symptom. The first patient was a 4-year-old boy who was admitted to emergency department because of chronic constipation unresponsive to fiber supplements and laxatives. Digital rectal exam revealed mass adjacent to posterior rectal wall. Abdominal ultrasound and magnetic resonance imaging confirmed oval, homogenous and hypoechogenic cystic mass (87x65x60 mm in size) behind the rectum. The size and location of the cystic mass was confirmed by magnetic resonance imaging. The second patient was an 11-month-old boy who was hospitalized due to rectal bleeding. He was suffering from chronic constipation over the last five months. Digital rectal exam revealed a mass behind the rectum. Abdominal ultrasound and computed tomography showed unilocular c...

Acta facultatis medicae …, 2004

Femur fractures are the most common major skeletal injury in pediatric population. These fracture... more Femur fractures are the most common major skeletal injury in pediatric population. These fractures typically occur either in early childhood or during adolescence. The majority of these fractures in children heal satisfactorily regardless of treatment method. Spica casting ...

Acute abdominal pain is a reason for hospital admission of about 20% of children. Typical clinica... more Acute abdominal pain is a reason for hospital admission of about 20% of children. Typical clinical presentation of appendicitis may be significantly different in children. Diagnosis is based on the combination of symptoms, clinical signs, and results of laboratory and radiology examinations. The objective of the present study was to analyze symptoms, signs, laboratory and histopathology findings in children who underwent surgery for acute appendicitis. Sixty-seven patients (37 males and 30 females) with mean age of 9.77 years, operated on for clinical diagnosis of acute appendicitis were enrolled in the study. Abdominal pain was present in all patients, followed by vomitus and fever. Laboratory markers of inflammation varied significantly with severity of inflammation, but were normal in chronic appendicitis. Clinical and histopathology assessments of inflammation were concordant in 22-43% depending of the degree of appendicitis. Perforation occurred in 26.86% and negative appendect...

The CIAO Study (“Complicated Intra-Abdominal infection Observational ” Study) is a multicenter in... more The CIAO Study (“Complicated Intra-Abdominal infection Observational ” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012). Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3 % of the patients were women and 53.7 % were men. Intraperitoneal specimens were collected from 62.2 % of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5 % (163/2.152). According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular pe...

Medicina, 2021

Background and objectives: For the last three decades, non-operative management (NOM) has been th... more Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had...

Humerus fractures are infrequent in children, except for supracondylar humerus fractures. Histori... more Humerus fractures are infrequent in children, except for supracondylar humerus fractures. Historically, most of the humerus fractures in children and adolescents have been treated non-operatively based on the tremendous remodeling potential of the proximal humeral physis and the great arc of shoulder motion. However, in older patients, less-than-anatomic reduction may lead to prolonged pain and restricted shoulder mobility and expose the gleno-humeral joint and rotator cuff to higher stress with unknown long-term effects. Elastic stable intramedullary nailing (ESIN) had encountered slower acceptance as a standard of treatment for humeral fractures than for any other long bone in pediatric patients. A retrospective analysis of 32 patients aged 5.5-17.8 years who were treated with ESIN for humeral fractures was performed. The most common cause of injury was fall, followed by traffic accidents. There were 16 proximal, 12 shaft and 4 distal humeral fractures. Twenty-five patients had is...

Duplicational anomalies of gastrointestinal tract have the reported incidence of 1 in 4500. Among... more Duplicational anomalies of gastrointestinal tract have the reported incidence of 1 in 4500. Among them, rectal duplications seem the be the least common type of these anomalies with very few cases reported. We present two cases over the period od five years. Both children were presented with prolonged constipation, and one child had rectal bleeding. Both children were successfully treated by surgical excision.

Srpski arhiv za celokupno lekarstvo

Introduction/Objective. The objective of the study was to determinate which groups in the populat... more Introduction/Objective. The objective of the study was to determinate which groups in the population of children are most prone to hand injuries and to identify the causes of the injuries with the aim of further developing better means of severe injuries prevention that can lead to invalidity. Methods. A retrospective epidemiological study was carried out, and included all children with hand injuries admitted to our hospital between January 1, 2010 and December 31, 2017; The data were collected and analyzed statistically using SPSSR. Significance was defined as p < 0.05. Results. The total number of patients was 254, 202 boys and 52 girls, with a mean age for both sexes 10.13 years (range1?17). The majority of patients were from an urban population 56.7% and 43.3% were from a rural area. Regarding the month in the year when the injury occurred, there were two peaks, in January and in May. The right hand was more affected, 53.2%, than the left, 45.6%, and both hands were affected ...

Physiological Research, Oct 15, 2011

Pneumatic tourniquets are widely used in pediatric extremity surgery to provide a bloodless field... more Pneumatic tourniquets are widely used in pediatric extremity surgery to provide a bloodless field and facilitate dissection. This prospective study was carried out to examine possible effect of different anesthesia techniques on oxidative stress and endothelial dysfunction connected with ischemia-reperfusion injury during extremity operations at children's age. Patients were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples for determination of the malondialdehyde in plasma and erythrocytes, protein carbonyl groups concentration as well as plasma nitrites and nitrates level and xanthine oxidase activity were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release, 5 and 20 min after tourniquet release. This study demonstrates that total intravenous anesthesia with propofol and regional anesthesia techniques provide better antioxidant defense and reduce endothelial dysfunction than general inhalational anesthesia with sevoflurane during tourniquet application in pediatric extremity surgery.

Open Medicine, Jun 1, 2010

Bezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel s... more Bezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel syndrome is a rare complication of a gastric trichobezoar in which the mass of hair extends through the pylorus into the small bowel and can even reach the colon. A 12-year-old girl with severe pain and a feeling of "fullness" in the upper abdomen was admitted to Pediatric Surgery. Two days before admission, the patient presented with vague abdominal pain, vomiting with a little blood, and black stool. On physical examination she was pale and listless with patchy alopecia. Abdominal examination showed a mobile, palpable mass in the epigastrium. The initial hematocrit was 7,1%, and the erythrocyte count was 1,12x10 12 cells per liter. Abdominal ultrasound and computed tomographic (CT) examinations confirmed the presence of a tumor-like formation in stomach. A giant bezoar with ulceration on the back wall of the stomach was verified by upper gastrointestinal endoscopy. Endoscopic extraction was not possible because of the size of the bezoar. Gastrotomy was performed to remove the bezoar that occupied most of the stomach, with a long tail that extended deeply into the duodenum (Rapunzel syndrome). The bezoar, 35 by 10 cm in diameter, was black and consisted of hair and synthetic fibers. Prompt diagnosis and treatment of trichobezoars are important to avoid a possible fatal outcome.

West Indian Medical Journal, Mar 9, 2015

Objective: Despite great prevention efforts, blunt abdominal trauma still remains a leading cause... more Objective: Despite great prevention efforts, blunt abdominal trauma still remains a leading cause of injury, especially in the paediatric population. Abdominal trauma is the main culprit of serious children's injury and the most common area of initially missed diagnosis with a fatal outcome. Aim: The purpose of this study was to determine the incidence, aetiology, grades of abdominal organ injuries, diagnosis, management and outcome of blunt abdominal trauma in a paediatric population. Method: This is a retrospective study of 31 patients with isolated parenchymatous abdominal organs, treated in a single centre. Stable patients with no signs of peritonitis and insignificant changes in laboratory findings were managed conservatively. Unstable patients received surgery. Results: The leading cause of injuries were traffic accidents (64.5%), followed by fall from a height (22.5%), bicycle handlebar injuries (6.45%), contact sport and child abuse (3.22% each). The majority of injured children (90.32%) were managed conservatively. Only three patients (9.68%) were operated on due to complete avulsion and organ smash, or devascularization of the injured organs. Diagnostic computed tomography (CT) scan examination was performed on 93.5% of patients. Few patients had grade I and grade V injuries, while the largest proportion of patients had grade III and IV injuries. The most frequently injured organs were the spleen and kidney. There was no mortality. Conclusion: The results emphasize that conservative treatment was appropriate for all stable patients with blunt abdominal trauma regardless of organ injury grade. The success of non-operative management depends upon proper patient selection. The choice of non-operative treatment should be based predominantly on physiological response, rather than grade injury on CT scan.

Acta Facultatis Medicae Naissensis

Gastric teratoma is a extremely infrequent tumor and accounts for less than 1% of all teratomas a... more Gastric teratoma is a extremely infrequent tumor and accounts for less than 1% of all teratomas among children population with male predominance. Case history: Herewith is described a case of mature gastric teratoma in a three months-old female infant associated with malrotation, hypotonia, torticollis and fusion of labia minoria. Due to the abdominal distension, the child was admitted to the Paediatric Surgery Department. On physical examination, a large lump was palpable, and laboratory findings were normal. Computed tomography (CT) showed a major heterogeneous solid formation within the right hemi-abdomen, extending to pelvis and crossing the midline. The infant underwent surgery and complete excision of tumor originating from lesser curvature of the stomach was made. Tumor was weighing 600 gr and was 10 x 14 x 8 cm large. The histopathological examination finding pointed to mature gastric teratoma. The post-operative course and further follow-up were eventless. Conclusion: As so...

The West Indian medical journal, 2015

Neonatal epididymo-orchitis is a rare condition, causing testicular pain in neonatal boys. It rep... more Neonatal epididymo-orchitis is a rare condition, causing testicular pain in neonatal boys. It represents epididymo-testicular inflammation which commonly coexists with urinary tract infections and malformations. The idiopathic type is extremely rare. We present a case of a seven-day old male neonate with advanced septic form of idiopathic orchiepididymitis and no associated urinary tract anomalies. The boy was hospitalized with signs of sepsis, anterior abdominal wall phlegmona and bilateral acute scrotum. Colour Doppler echosonography indicated epididymo-testicular inflammation with increased vascular flow. The patient underwent surgical exploration of both scrota in order to evacuate purulent content and fibrin. Cultures of Enterobacter spp were detected in hemiscrotal pus. Prompt administration of antibiotics was done. The postoperative course was uneventful. We suggest that every male baby must be very meticulously examined by a neonatologist in the early postnatal period, in or...

Knowledge International Journal, May 22, 2017

Children

Treating complicated wounds in the pediatric population using traditional wet to moist wound dres... more Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patien...

Facta Universitatis, Nov 24, 2022

Ewing's sarcoma (ES) is the second most common malignant bone tumor accounting for 5-10% of malig... more Ewing's sarcoma (ES) is the second most common malignant bone tumor accounting for 5-10% of malignancies in childhood. The scapula is rarely affected and only several reports have been published. Early symptoms of Ewing's sarcoma of the scapula may be ignored by patients or misinterpreted by physicians, leading to a delay in diagnosis. In the retrospective analysis, we identified 3 patients (2 males) with Ewing's sarcoma of scapula, aged 11-14½ years in a 15-year period. The introduction of combined treatment with multimodal chemotherapy, surgical resection and/or radiation therapy has improved the survival of patients with Ewing's sarcoma significantly. Several options for resection of ES of scapula were described with generally unfavorable functional results. Two patients were treated with chemotherapy and resection of the scapula. The third patient is on chemotherapy. Two patients died after 2½ and 4 years. In children and adolescents presenting with shoulder pain, Ewing's sarcoma must be ruled out.

Acta orthopaedica Belgica, 2016

Aneurysmal bone cysts (ABC) are rare and they represent 1- 1.4 % of all primary bone tumors. ABC ... more Aneurysmal bone cysts (ABC) are rare and they represent 1- 1.4 % of all primary bone tumors. ABC of cuboid bone are extremely rare, especially in children. Very few cases have been reported in the literature since 1967. We present a case of pathological fracture of cuboid bone due to an aneurysmal cyst in a 10-year-old girl. Surgery was performed, which included open biopsy with aspiration and intralesional curettage . Bone defect was then filled in by fully synthetic cancellous bone graft substitute consisting of pure β-tricalcium phosphate. Aneurysmal cyst of cuboid bone with pathological fracture could be successfully treated with pure β-tricalcium phosphate as a bone graft substitute. This procedure is safe with excellent outcome.Follow up to nearly four years did not show any recurrence.

Children

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Nagoya Journal of Medical Science, 2019

Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological sub... more Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the di...

Facta Universitatis, Series: Medicine and Biology, 2020

Rectum is the least common site of gastrointestinal duplication. Up to now fewer than 100 cases h... more Rectum is the least common site of gastrointestinal duplication. Up to now fewer than 100 cases have been reported in the literature. We present two infants with cystic rectal duplications manifested with chronic constipation as a main clinical symptom. The first patient was a 4-year-old boy who was admitted to emergency department because of chronic constipation unresponsive to fiber supplements and laxatives. Digital rectal exam revealed mass adjacent to posterior rectal wall. Abdominal ultrasound and magnetic resonance imaging confirmed oval, homogenous and hypoechogenic cystic mass (87x65x60 mm in size) behind the rectum. The size and location of the cystic mass was confirmed by magnetic resonance imaging. The second patient was an 11-month-old boy who was hospitalized due to rectal bleeding. He was suffering from chronic constipation over the last five months. Digital rectal exam revealed a mass behind the rectum. Abdominal ultrasound and computed tomography showed unilocular c...

Acta facultatis medicae …, 2004

Femur fractures are the most common major skeletal injury in pediatric population. These fracture... more Femur fractures are the most common major skeletal injury in pediatric population. These fractures typically occur either in early childhood or during adolescence. The majority of these fractures in children heal satisfactorily regardless of treatment method. Spica casting ...

Acute abdominal pain is a reason for hospital admission of about 20% of children. Typical clinica... more Acute abdominal pain is a reason for hospital admission of about 20% of children. Typical clinical presentation of appendicitis may be significantly different in children. Diagnosis is based on the combination of symptoms, clinical signs, and results of laboratory and radiology examinations. The objective of the present study was to analyze symptoms, signs, laboratory and histopathology findings in children who underwent surgery for acute appendicitis. Sixty-seven patients (37 males and 30 females) with mean age of 9.77 years, operated on for clinical diagnosis of acute appendicitis were enrolled in the study. Abdominal pain was present in all patients, followed by vomitus and fever. Laboratory markers of inflammation varied significantly with severity of inflammation, but were normal in chronic appendicitis. Clinical and histopathology assessments of inflammation were concordant in 22-43% depending of the degree of appendicitis. Perforation occurred in 26.86% and negative appendect...

The CIAO Study (“Complicated Intra-Abdominal infection Observational ” Study) is a multicenter in... more The CIAO Study (“Complicated Intra-Abdominal infection Observational ” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012). Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3 % of the patients were women and 53.7 % were men. Intraperitoneal specimens were collected from 62.2 % of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5 % (163/2.152). According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular pe...

Medicina, 2021

Background and objectives: For the last three decades, non-operative management (NOM) has been th... more Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had...

Humerus fractures are infrequent in children, except for supracondylar humerus fractures. Histori... more Humerus fractures are infrequent in children, except for supracondylar humerus fractures. Historically, most of the humerus fractures in children and adolescents have been treated non-operatively based on the tremendous remodeling potential of the proximal humeral physis and the great arc of shoulder motion. However, in older patients, less-than-anatomic reduction may lead to prolonged pain and restricted shoulder mobility and expose the gleno-humeral joint and rotator cuff to higher stress with unknown long-term effects. Elastic stable intramedullary nailing (ESIN) had encountered slower acceptance as a standard of treatment for humeral fractures than for any other long bone in pediatric patients. A retrospective analysis of 32 patients aged 5.5-17.8 years who were treated with ESIN for humeral fractures was performed. The most common cause of injury was fall, followed by traffic accidents. There were 16 proximal, 12 shaft and 4 distal humeral fractures. Twenty-five patients had is...

Duplicational anomalies of gastrointestinal tract have the reported incidence of 1 in 4500. Among... more Duplicational anomalies of gastrointestinal tract have the reported incidence of 1 in 4500. Among them, rectal duplications seem the be the least common type of these anomalies with very few cases reported. We present two cases over the period od five years. Both children were presented with prolonged constipation, and one child had rectal bleeding. Both children were successfully treated by surgical excision.

Srpski arhiv za celokupno lekarstvo

Introduction/Objective. The objective of the study was to determinate which groups in the populat... more Introduction/Objective. The objective of the study was to determinate which groups in the population of children are most prone to hand injuries and to identify the causes of the injuries with the aim of further developing better means of severe injuries prevention that can lead to invalidity. Methods. A retrospective epidemiological study was carried out, and included all children with hand injuries admitted to our hospital between January 1, 2010 and December 31, 2017; The data were collected and analyzed statistically using SPSSR. Significance was defined as p < 0.05. Results. The total number of patients was 254, 202 boys and 52 girls, with a mean age for both sexes 10.13 years (range1?17). The majority of patients were from an urban population 56.7% and 43.3% were from a rural area. Regarding the month in the year when the injury occurred, there were two peaks, in January and in May. The right hand was more affected, 53.2%, than the left, 45.6%, and both hands were affected ...