Aim To investigate a correlation between resistive index (RI) level changes following extracorporeal shock wave lithotripsy (ESWL) in treated and non-treated kidneys depending on the ESWL treatment intensity. The study was conducted on 60 subjects, which were divided in two groups according to age and treatment protocol. Results In the group of patients younger than 55 years of age there was a significant increase in mean RI values, on the first (p=0.001) and second day after the treatment (p=0.007). In the group older than 55 years of age, the resulting increase in mean RI levels was also significant on the first (p=0.003) and second (p=0.011) day following the treatment. The RI values in the non-treated kidney on the first day after the treatment grew significantly (p=0.033). In the group older than 55, RI values in the non-treated kidney grew significantly on the first day after the treatment (p=0.044). In the group who received 2000 SWs, RI levels grew significantly (p=0.044) as well as in the group who received 4000 SWs during the treatment, where the significance was more pronounced (p=0.007). Conclusion There is a correlation between RI changes and the degree and localization of changes in vascular elements of the kidney. Post-ESWL treatment changes are existent and reversible, over a period of one week after the treatment.

Gastric necrosis with perforation is a rare and potentially life-threatening condition in childhood beyond the neonatal period. We report a case of gastric necrosis and perforation of a portion of the great curvature due to a massive gastric dilatation caused by pathological aerophagia in a 13-years-old, mentally impaired adolescent girl. Despite the successful surgical treatment, the patient's condition rapidly deteriorated post-operatively and she died due to the multisystem organ failure and multiple infections. In addition, we surveyed the literature on this rare condition and assessed the preventive actions to reduce this life-treating condition.

Rationale: Hydrocele of the canal of Nuck is a rare developmental disorder and represents of a homolog of hydrocele of spermatic cord in males. Hydrocele of the canal of Nuck is a very rare cause of inguinal swelling in female infants and children. It results from the failure of obliteration of the distal portion of evaginated parietal peritoneum within the inguinal canal, which forms a sac containing fluid. Patient concerns: We describe a case of hydrocele of the canal of Nuck in an 11-month-old girl with a past medical history of duodenal atresia and Arnold-Chiari malformation. Diagnosis: Physical examination and ultrasound revealed a soft, cystic, noncompressible, and non-fluctuant labial mass measuring approximately 5 cm. Interventions: The patient underwent surgical exploration through a right skin crease incision. The cystic lesion was histologically confirmed to be a non-communicated hydrocele of canal of Nuck. Outcomes: The child is doing well at 1-year follow-up with no swelling or recurrence on the operated side. Lessons: Hydrocele of the canal of Nuck is a rare developmental disorder but should be considered in a differential diagnosis in young girls with an inguino-labial swelling.

Zvizdic Z, Milisic E, Jonuzi A, Terzic S, Zvizdic D. The contribution of morphine sulfate to the development of necrotizing enterocolitis in preterm infants: a matched case-control study. Turk J Pediatr 2019; 61: 513-519. The aim of the study was to determine whether morphine sulfate administration is associated with an increased risk of necrotizing enterocolitis (NEC) in preterm infants supported by mechanical ventilation due to respiratory failure. The matched case-control retrospective study was carried out at the Neonatal Intensive Care Unit (NICU) of the University Clinical Center Sarajevo, on 122 preterm infants classified into total NEC group and control group. The total NEC group was further divided into medical NEC and surgical NEC subgroups. The association between the use and duration of morphine sulfate infusion and the development of NEC was evaluated in both unadjusted and adjusted analysis. Preterm infants who developed NEC were on mechanical ventilation more frequently compared to premature infants without signs of NEC (Mann- Whitney U test; p=0.0031). A positive correlation between the frequency of receiving morphine sulfate and the development of NEC was observed (Chi square test of independence; p=0.0001). The risk of NEC in preterm infants was increased by the use of morphine sulfate. Validation of this observation in other populations is warranted.

Aggressive fibromatosis, also known as desmoid tumor, is a locally invasive soft tissue lesion arising from connective tissues. Reports in children less than 10 years of age is rare. We report a case of a  desmoid tumor located at the middle and lower third of the left rectus abdominis, in a 2-year-old-boy. Partial resection of the muscle segment and simultaneous reconstruction of the abdominal wall by abdominal fascia was done. The patient had an uneventful recovery. At one year of follow-up neither recurrence nor functional or aesthetic complications were seen.

Objective The presence of testicular appendices was prospectively evaluated in 89 boys with 96 undescended testes who underwent orchidopexy over the period of 4 years. Results The patients were divided into two groups. Group A included 42 boys with 49 undescended testes positioned close to the internal inguinal ring, and Group B included 47 boys with 47 undescended testes close to the external inguinal ring. The incidence of appendix testis (AT) in Group A was 57.1% (28 in 49) and 78.7% (37 in 47) in Group B. The results of our study showed significantly decreased incidence of testicular appendices in undescended testes positioned close to the internal inguinal ring compared with undescended testes positioned close to the external inguinal ring (p < 0.05). Conclusion AT may play a role in normal testicular descent and the undescended testis positioned close to the external inguinal ring can be considered as a separate entity of the true congenital undescended testis.

A seven-day old male infant (weight 3.5 kg) presented with abdominal distension and a mass in the abdomen since birth. There was no history of exposure to any drugs or radiation to the mother in the antenatal period. All the laboratory investigations including beta-human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) were normal. X-ray abdomen showed a mass effect in the abdomen with calcifications in the left hypochondrium (Fig.1A).

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.

Gastroschisis is an isolated structural anomaly rarely associated with other life-threatening anomalies. The most common associated gastrointestinal anomalies are intestinal atresia, Meckel's diverticulum and intestinal duplications. Intestinal atresia occurs in 10-15% of gastroschisis cases. [1] We herein report a case of gastroschisis with concomitant type III b jejuno-ileal atresia with perforation of the proximal dilated segment of jejunum with congenital short bowel successfully treated by primary anastomosis and primary abdominal closure.

Background: necrotizing enterocolitis is a serious condition that affects mostly preterm infants, with high mortality rate. Aim: to estimate the influence of potentially contributing factors of this multifactorial disease. Methods: the study group included 51 necrotizing enterocolitis infants who were less than 37 week gestation who were hospitalized in NICU during a five year period. The control group consisted of 71 patients with approximately the same gestational age and birth weight. Average gestational age in the study group was 30.2 weeks (SD 3.7), average birth weight 1502g (SD 781.5). Average postnatal age in the time of the presenting NEC was 18.2 days (SD 12.8). Results: Logistic regression estimates the influence of risk factors, which in our study related to the treatment of preterm infants on the likelihood of NEC development. Our regression model consisted of seven independent variables (nosocomial infections, mechanical ventilation, nasal continuous positive pressure, morphine, inotropes, blood transfusions, and H2 blockers), which were shown to have a statistically significant impact, X2 (7, n=1222) = 49.522, p<0.0001; two independent variables (nosocomial infection and H2 blockers use) were statistically significant. Preterm infants with nosocomial infection had a three times greater chance of developing NEC, and infants who received H2 blockers had a 1.5 higher risk. Conclusions: Underlying pathology of very low birth weight infants and their treatment in NICU contribute to NEC development. Identifying risk factors can be crucial for the early diagnosis and outcome of disease. Awareness of risk factors should influence changes in practice to reduce the risk of NEC.

Introduction: Knowledge of anatomic, physiological, biochemical and physical characteristics of children of all age groups, the existing illness and possible pathological response of the organism to the existing situation, require a pediatric anesthesiologist to participate in the preparation of a child for surgical treatment, to choose the best anesthesia technique and medications, and manipulative techniques to enable the scheduled surgical treatment with minimum anesthesia risks. The aim of this clinical study was to prove reliability and quality of propofol or sevoflurane general anesthesia in children in the age group of 1-14 years from the ASA I group and in the elective surgical treatments in duration of 60 minutes, based on preoperative and postoperative levels of laboratory findings (transaminases, blood sugar, urea and creatinine). Materials and methods: the study included 160 patients randomized in two groups based on different approaches: total intravenous anesthesia was used for the propofol group (n=80) (TIVA) and the inhalation technique was used for the sevoflurane group (n=80). Results: statistical evaluation of the obtained results indicates stability of laboratory findings in the immediate postoperative course (after 24 hours) in respect to the preoperative period. Based on the Mann Whitney test (P), preoperative and postoperative blood sugar levels in the sevoflurane vs. propofol group were P=0.152 vs. 0.021; creatinine levels P=0.113 vs. 0.325; urea levels P= 0.016 vs. 0.900; AST levels P=0,031 vs. 0,268 and ALT levels P=0.021 vs. 0.058. Level of significance was P<0.5. Conclusion: Analysis of the examined laboratory parameters show that propofol and sevoflurane provide full security and quality of general anesthesia in children age group 1-14 years, from the ASA I group. All analyzed laboratory levels in the postoperative course remained in their referential values in both groups of participants.

ABSTRACT Goal: The goal of this study was to determine relationship between the sensitivity and specificity of testicular volume (TV) and testicular atrophy index (TAI) in the indirect assessment of functional ability of cryptorchid testicles. Material and Methods: The study included sixty children with unilateral cryptorchidism who were treated surgically at the Clinic of Pediatric Surgery, Clinical Center University of Sarajevo. We evaluated the correlation of the size of cryptorchid testicles with its locations in various age groups. Results: The results showed a significant decrease in TV and TAI in the all cryptorchid groups after the sixth month of age compared with the same parameters in control group (p<0.001). It is also determined a strong correlation between the TV and TAI of cryptorchid testicles with its locations in various age groups. Conclusion: Our results showed that the average volume of cryptorchid testicles decreased after the sixth month as well as that the reduction of testicular size correlated with increasing distance of cryptorchid testicles from the scrotum.