Background: An extensive burn is one of the most serious injuries. The modern treatment of pediatric burns is a logical exercise in resuscitation, infection control, surgical wound care, nutrition and psychologic and physical rehabilitation. The conventional methods of local therapy, especially in extensive and deep burns, cannot prevent infection. The fact is that the necrotic burn tissue always gives rise to infection and must therefore be excised. Tangential excision is a diagnostic procedure as well as a surgical preparation of a recipient bed for skin graft.  Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infenction, laboratory values. Aim of research: The aim of our research was to demonstrate the efficacy of early tangential necrectomy in the treatment of extensive burns in children as well as in preventing the burn diseases. Material and methods: Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infection, laboratory values. Results: The boys comprised 58.3% of the respondents and the girls were 41,7% of the respondents. The most common cause was the hot liquid of 73.3%, open flame 23.3% and the contact with hot metal 3.3%. The body temperature was significantly higher in control group compared to the examined group (p <0.001) significantly lower hematocrit values in the control group compared to the examined group (p = 0.002).      The results show that hospitalization lasted considerably longer in patients in the control group than in the examined group (p = 0.003). The incidence of bacterial infection of the burns is significantly higher in control compared to the examined group of patients (p = 0.007). The most commonly isolated bacteria in the study group was Staphylococcus aureus (15/30 or 50% of all subjects). Acinetobacter spp. was isolated in 9 patients (30% of respondents). Serratia spp. And Enterococcus Foecalis were isolated in 6 patients (20%). Pseudomonas aeruginosa was isolated in 3 patients (10%). Three patients (10%) did not isolate any bacteria during hospitalization Conclusions: The method of early tangential necrectomy of extensively burned children significantly reduce morbidity and mortality (it improves the general condition of the patient, improves clinical and laboratory parameters, reduces the possibility of infection of the wound, reduces the possibility of sepsis, reduces the length of hospitalization).The most optimal time to perform an early tangential necrectomy is the period between the 4th and the 6th day after the injury. In extensively burned children over 30% of the total body surface, an early tangential necrectomy should be performed on an area of about 20% of the total body surface as a prevention of blood loss due to necrectomy and autotransplantation. With extensively burned children over 40% of the total body surface, taking homotransplants from parents or close relatives reduces morbidity and mortality.

The aim of this paper is to report a case of congenital diaphragmatic Bochdalek hernia in eight month old baby with herniation of stomach into thoracic cavity and subsequent postoperative bleeding from right gastroepiploic artery with formation of intraabdominal haemathoma, which was clinically manifested as vomiting and ileus. Multidisciplinary approach (obstetricians, pediatric surgeons and neonatologists) is imperative along with timely diagnosis and treatment.

The pseudocyst wall is covered with inflammatory fibrotic tissue, unlike true cysts whose wall is covered with mesothelium. Treatment of abdominal pseudocysts involves resection of the pseudocyst wall and shunt replacement. The above procedure can be done by open or minimal access to the surgical procedure. A 10-year-old girl to whom the VPS is placed comes from long-term abdominal colic and symptoms similar to an acute abdomen. We treated the girl with minimal access to the procedure, performed a resection from the abdominal pseudocyst, and did a VPS replacement. The patient’s postoperative course was satisfactory.

Pleural effusions in patients with liver disease are common. Bilious pleural effusion can occur following percutaneous biopsy if the pleura is traversed. We reported the case of a 10-year-old girl who had a liver biopsy. After this procedure, the girl had a pleural effusion during the 20-day period we were treated with the chest tube. After this period, the chest tube was removed and the patient continued conservative gastroenterological treatment for liver cirrhosis.

Congenital hypertrophic pilorostenosis is a relatively common illness with an incidence of 2-3.5 on 1000 live-born children. (1,2) Most commonly affects prematuruses, firstborn and male children (male to female ration is 4:1 ) in the period of the 3rd to 6th week of life. (3,4) Etiology is not clear yet, it is assumed to be generated by the interaction of genetic and environmental factors. (5,6) The diagnosis is based on heteroanamnesis, physical finding and ultrasonography. The leading symptom is nonbilious projectile vomiting soon after feeding. There is also opstipation. If vomiting takes a few days, alkalosis, electrolyte disorder, dehydration and malnutrition may be present. The gold standard in diagnosis is ultrasound, which has high sensitivity (97%) and specificity (100%). (7) In certain unclear cases, the contrasting rtg of gastroduodenum is also applied. (8,9,10) The final treatment is surgical incision of the pyloric wall to the mucous membrane with leaving pylorus unstretched. (11,12,13,14) The success of the surgical Abstract

Isolated female epispadias without bladder exstrophy is a rare congenital anomaly affecting 1 in 484,000 females. The presenting features of female epispadias are urinary incontinence and abnormal anatomical features. A 6-year-old girl presented with primary urinary incontinence who on physical examination had a bifid clitoris and labia minora. The vagina and hymen were normal. Voiding cystourethrogram showed no reflux and a funnel shaped proximal urethra. With the diagnosis of isolated female epispadias, one-stage reconstruction of the urethra, bladder neck, labia minora and clitoris was performed.

Aim The aim was to show rare cases of congenital cystic adenomatoid malformation (CCAM) and the manner of its surgical treatment with video-assisted thoracoscopic surgery (VATS). Methods Two male and one female child, 7, 4 and 3 years of age were treated for symptoms of cough and high temperature in district hospitals. In all three children laboratory blood tests and chest radiography were done. Auscultatory findings showed the presence of pneumonia. Children were treated with appropriate doses of antibiotics. After the rehabilitation of inflammation, they were sent to the University Clinical Center Sarajevo, where video-assisted thoracoscopic lobectomy (VATS) was indicated after computerized tomography (CT). Results Chest CT scan pointed to the CCAM and pulmonary sequestration (PS) changes to the lungs. This has required surgery lobectomy of an affected part of the lungs. In two children with PS, the aberrant systemic artery came from the most proximal part of aorta abdominals, the third patient did not have an anomalous artery. Conclusion VATS lobectomy is an alternative to the traditional thoracotomy for the treatment of CCAM and PS, however, it should be investigated in the future for its safety and effectiveness.

The nonparasitic primary splenic cysts are very rare clinical entity. In the past, splenectomy was the treatment of choice but with the recognition of the spleen's important immunological function, spleen-preserving surgery is the preferred treatment modality. We hereby present a case of a large splenic mesothelial cyst and its treatment with preservation of the remaining splenic parenchyma. Our case shows that spleen-preserving surgery in treatment of the large splenic cysts is possible and safe procedure with maintenance of the splenic function.

Hydatide disease is endemic in sheep and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Bosnia and Herzegovina. Retrospective appraisal of the pressentation, approach to surgical treatment and outcome of hydatid disease in children at the Clinic for Pediatric Surgery and Clinic for Thoracic Surgery University of Sarajevo Clinics Centre in period between 2000-2008. We surgically treated 72 patients (57 male, 15 female) with a diagnosis of pulmonary hydatid disease with average age of 10.36 +/- 4.28 (range 4 to 18) years. Chest radiographs, computer tomograms and ultrasonography were the main methods of diagnosis. The basic principle of surgery was to preserve lung parenchyme as much as possible. Clinical assessment of the symptoms, plain and lateral chest X-rays and computed tomograms led to the correct diagnosis in 100% (72/72) of patients. Solitary lung cysts were found in 79.17% (57/72) patients. While the remaining were multiple cysts in one or more lobes of one or both lungs. Intact cysts were found in 48 (52.17%) and rupture cysts in 44 (47.83%) cases. Lung preserving surgical intervention were done in all of the patients. There was no mortality. Recurrent hydatid cysts were observed in 2.78% (2/72) patients. Lung preserving surgical interventions are the treatment of choice for pulmonary hydatid cysts in children. Radical surgical procedures such as segmentectomy, lobectomy and pneumonectomy should be avoided as much as possible in children.

INTRODUCTION: Colonization with Pseudomonas aeruginosa (PA) is common in older kids with cystic fibrosis (CF) and there is increasing evidence that transmissible strains may cross-colonise patients. PA colonization is usually difficult to eradicate with antimicrobial therapy and, in some children and younger patients, infection is associated with rapid decline in pulmonary function and increased hospitalization. Diffuse bronchiectasis is seen in patients with cystic fibrosis. CASE REPORT: A 19-year-old male with CF severe lungs disease and liver insufficiency presented with coughing and breathing difficulties with wheezing progressed to generalized bad situations and Pseudomonas aerigenosa opportunic suprainfection. The effect of combined three antibiotics therapy was very successful as eradication of Pseudomonas aerigenosa. Lung physiological tests were pathologically changed with obstructive and restrictive reductions of vital pulmonal parameters. DISCUSSION: Cystic fibrosis (CF) is the most common potentially lethal genetic disease in the white population. Improvements in life expectancy have led to an increased recognition of lungs and hepatobiliary-pancreatic CF complications. CONCLUSIONS: Cystic fibrosis is a genetic disease usually diagnosed by abnormal sweat testing. Despite the best efforts by CF clinic pediatricians, patients with CF eventually reach the point of respiratory insufficiency, and lungs can no longer sustain, and patients need lungs transplantation.