Chronic abdominal pain is the most commonly seen condition in the pediatric population. Many causes can be successfully managed by conservative treatment; nevertheless, surgical intervention is sometimes inevitable. Among many surgical conditions, such as appendicitis as the most frequent cause, one is also to think about congenital abdominal bands. We report a case of a 10-year-old boy with chronic abdominal pain, who suddenly developed clinical and radiologic signs of intestinal obstruction. The cause of chronic abdominal pain as well as the intestinal obstruction was revealed during the operation: 2 congenital abdominal bands, trapping the gut convolutes. To our knowledge, this is the first report of 2 bands in a single patient.
Unexpected rapid maternal death after delivery due to HELLP syndrome is rarely encountered and may become the subject of forensic expertise. Unexpectedness, suddenness, and fulminant course of this syndrome as well as absence of classical signs of pre-eclampsia can confuse physicians and lead to diagnostic delay. A definitive post-mortem diagnosis of HELLP syndrome in questionable cases of maternal death should be based on accepted laboratory criteria and characteristic histopathological alterations. We present a case of acute postpartum HELLP syndrome complicated by disseminated intravascular coagulation and acute renal failure which caused rapid maternal death only 20 hours after a caesarean section following an uncomplicated pregnancy.
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Humeral supracondylar fractures are the second most common fractures seen in children and young teenagers (16.6%). They represent 60-70% of all the elbow fractures. The maximum incidence is found between the fifth and seventh year of age, slightly more often in boys and on non-dominant hand.We performed a retrospective study in our clinic which included 105 patients admitted to our facility during the period from January, 2008 to April, 2012. The included patients had humeral supracondylar fracture either type 2 or type 3 (Gartland classification). At the moment of admission the median age was 7.26 years. All the patients were treated during the first 12 hours, with no more than two attempts of closed reposition. Sixteen patients with type 2 fracture were treated by analgosedation, closed reduction followed by cast immobilization. All other patients were treated after induction of general anesthesia. Sixteen patients were treated by percutaneous fixation of the fragments after closed reduction and 73 were treated with open reduction and pinning with different number and positions of "К" wires.None of the patients had deep tissue infection; four patients had pin site infection. Three patients had cubitus varus deformity, two patients had elbow contracture, five patients had temporary limitation in extension, and one patient had iatrogenic lesion of the ulnar nerve. This makes 14.2% complication rate in our series. All the fractures healed in the expected period (3-4 weeks). Bauman's angle, carrying angle and functional factor were measured postoperatively.Closed reposition with pinning, using radiographic control, for the dislocated supracondylar humeral fractures is the safest, as well as the least time consuming and cost-effective method. We also suggest treating these fractures within 12 hours and conversion of closed into open reposition in case of lacking crepitations (possibility of interposition of soft tissues between fragments).
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