The first well-documented case of the duodenal diverticulum (DD) was presented by Morgagni in 1762. In 1913 Case presented four cases of radiologically diagnosed DD. The first surgical resection of the duodenal diverticulum took place in 1915 and was performed by Key. The aetiology of the duodenal diverticula is not clear and remains controversial. The existence of the locus minoris resistentiae in the duodenal wall may be the place of mucosal or submucosal tissue layer herniation through the muscular defect. Duodenum is the second most common location of diverticula in the gastrointestinal tract. They appear in about 23% of the population and are rarely found in children. Surgical treatment is applied only if complications occur. We present a case of a 17-year-old female treated surgically with the use of a minimally invasive laparoscopic method combined with endoscopic control of the surgical field.

Aim of the study: Tissue damage resulting from thermal injury is associated with systemic disturbances of the water-electrolyte balance. This process consists of exudation and increased evaporation within the burnt area. Therefore, appropriate fluid therapy plays a key role in stabilisation of the general condition and treatment of burns. It is even more important in children with burns. It should be verified whether the existing fluid therapy rules require modification. This is the purpose of the study. Material and methods: An analysis was performed on hospitalisation of 310 children with isolated burn injury. Hydration rate, followed by electrolyte balance and acid-base balance, were evaluated. Fluid balance and everyday body weight were recorded. The obtained data were analysed using the descriptive statistical methods and tools. Results: In the group of patients treated according to the Parkland formula, a significant overhydration rate was observed. Overhydration at admission to hospital was recorded in 42.6% of patients, and after 24 hours of hospitalisation in 59.8% of children. Children with burn injuries covering up to 20% of total body surface area (TBSA) required no additional fluid supplementation exceeding the daily fluid intake in order to maintain normal hydration as well as electrolyte and acid-base balances. The sodium bicarbonate solution was not necessary to achieve correction of acid-base balance at the first stage of burn disease management. Conclusions: Application of technologically advanced dressings results in reduced local fluid escape, which is associated with increased risk of patient overhydration and necessary modification of the commonly applied principles of fluid therapy. Children with burn injuries covering up to 20% of TBSA do not require supplementation of any other fluids than crystalloids, in particular supplementation with sodium hydrogen carbonate solution in order to maintain the correct value of the water-electrolyte and acid-base balance.

Introduction Nutrition therapy is medical treatment that includes assessment of patients’ nutritional status, their nutrient requirements, supply of nutritional products in appropriate quantities, and monitoring all of these processes. The nutrition support team is responsible for the organization of the nutrition therapy. Aim To evaluate the activity of nutrition support teams in hospitals in the Greater Poland voivodeship. Material and methods An evaluation of nutrition support teams’ activity and the types of nutrition therapy used in hospitals in the Greater Poland voivodeship was made. In order to collect all the necessary data, a questionnaire with closed-ended questions was sent to all hospitals registered in the voivodeship. Results Out of 25 hospitals that returned the completed questionnaire, 15 (60.0%) confirmed the presence of a nutrition support team in their structures. In previous reports it was 17 centres (68.0%) that had such team, but sometimes the team was not working to its full extent. 73.0% of hospitals were satisfied with both the presence of the team and its activity concerning proper fulfilment of entrusted tasks. The activity of nutrition support teams in the Greater Poland voivodeship correlated closely with the size of the hospital. Conclusions Nutrition support teams function in the majority of hospitals in the Greater Poland voivodeship. Nutrition teams are more common in larger hospitals. In order to provide proper medical nutrition therapy, the legal obligation to appoint nutrition support teams in the hospitals should be restored.

Background: Each year, nearly 1% of population suffers from burn injuries. The main cause of complications and death after thermal injury is infections. Excessive use of antibiotics affects however the children treated for burns and can have negative effects. Therefore, specifying the recommendations for antibiotic therapy in patients after thermal injury seems to be of importance. Materials and methods: An evaluation of 310 paediatric patients hospitalised for burn injuries was performed. In the first part of evaluation, a retrospective analysis of treatment with particular focus on infection complications and administered antibiotics was performed. This was followed by a prospective evaluation of effectiveness of the principles of antibiotic therapy specified at the earlier stage. Results: In 2010-2016, an antibiotic was systemically administered to 53.4% of children treated for thermal injury, provided that in 87.1% of cases it was introduced as a prophylactic measure. Infection of a burn wound was recorded in 4.7% of cases. The most frequently isolated bacterium (57.1%) was Staphylococcus aureus MSSA. Supply of antibiotics failed to reduce the number of infection complications or burn wound infections. The studies formed the basis for specification of the internal antibiotic therapy criteria, effectiveness of which was then evaluated. In 2017, an antibiotic was administered to 37.1% of patients. Reducing antibiotic therapy did not increase the risk of infection complications or frequency of wound infections. Conclusion: Routine antibiotic prophylaxis in burn injuries has no effect on the risk of infection complications and does not reduce the treatment time. It should be limited to perioperative prophylaxis in the case of skin grafts and to the patients with progressing symptoms of burn disease or with concomitant infections.

Ventriculoperitoneal shunt implantation is one of the most common procedures in paediatric neurosurgery. Although the procedure is used often in general neurosurgical practice and regarded as a safe intervention, it has several usual and unusual complications. About a half of these complications involve the peritoneal catheter. Spontaneous transanal protrusion of ventriculoperitoneal shunt is very rare. A 4-month-old baby was admitted to hospital due to spontaneous, asymptomatic transanal protrusion of ventriculoperitoneal catheter. The boy was put on intravenous antibiotics and taken to surgery. Treatment consisted of extrusion of the peritoneal catheter through the anus and temporary externalisation of the proximal part of the shunt. The previously implanted valve was preserved. Laparotomy was not necessary. Postoperative parenteral nutrition was used. No gastrointestinal complications were found on postoperative observation. Finally, a new peritoneal catheter was implanted.

Aim of the study: Burn injuries occur mainly in children, primarily between two and four years of age. The most common cause of burns is contact with hot liquid. Apart from local treatment of damaged tissues, an important role in burn injury management is played by immediate implementation of burn disease management. This procedure, aimed at mitigation of systemic effects of thermal injury, consists of an adequate nutritional procedure, including supply of high-protein diet. The purpose of this study is to evaluate the nutritional procedure in children with burns. Material and methods: An evaluation was performed on nutritional interventions implemented in children hospitalised for burn injuries in 2010-2017. The effectiveness of the use of oral nutritional supplements was researched in detail. Results: In the studied period, 310 children were hospitalised for burns. Implementation of temporary parenteral nutrition was necessary in 1.94% of patients. In the subsequent years of the study, a significant increase in the supply of oral nutritional supplements (ONS) within the nutritional intervention was observed (2.6% vs. 45.7%). The applied nutritional interventions enabled maintenance of a proper nutritional status during treatment at the surgery department. The values of total protein and albumins as of the last day of hospitalisation displayed no significant differences compared to the values determined at admission to hospital. Paediatric patients administered with ONS had significantly higher total protein values at discharge from hospital (6.87 ±0.12 g/dl for ONS vs. 6.26 ±0.24 g/dl for N-ONS) and displayed a higher rate of burn wound healing (p = 0.030). Conclusions: Implementation of adequate nutritional intervention affects both the course of burn disease management and the wound healing rate. Oral nutritional supplements play an increasing role in the treatment of paediatric patients with burn injuries. Administration of ONS has a significant impact on the nutritional status of burnt children and accelerates the wound healing process.

Introduction: Each year, nearly 1% of the world population suffers from burn injuries. However, thermal injuries most often occur in children. Aim of the study: Burn treatment should consider both local treatment and prevention of existing systemic disturbances. Frequency and importance of the problem requires a revision and optimisation of the existing therapeutic schemes applied for paediatric burns, which constitutes the purpose of this study. Material and methods: A retrospective analysis was performed on treatment of 310 paediatric patients hospitalised for burns in the years 2010-2017. Results: In the studied period, 310 patients were hospitalised for burns; the majority of them (66.8%, 207 patients) were boys. In most cases, hospitalisation was required by children between the first and third year of life (71.9%, 223 patients). The main cause of burn injuries was contact with hot liquid (98.1%, 304 patients), primarily in the upper body part. The majority of the patients required only conservative treatment, while split-thickness skin graft (STSG) was performed in 9% of patients. Early introduction of surgical treatment accelerated wound healing and normalisation of systemic disturbances and correlated with reduced length of stay (p = 0.0019). No prevalence of any of the applied professional dressings on the wound healing rate was observed. Substantially, all children required multidrug pain therapy. A low rate of analgesic administration at the pre-hospitalisation stage was recorded. Conclusions: The vast majority of the patients required only conservative treatment, although the need for introducing surgery should be considered as early as at the first treatment stage. The current condition of burn wound with particular focus on exudation rate and presence of eschar should be the key criterion for the selection of dressing.

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