Omental infarction (OI) is a rare disease occurring in children. Important risk factors include overweight and obesity. The clinical presentation is often non-specific, and the main symptom is acute abdominal pain. In addition, infarcted omentum may present with fever, anorexia, nausea, vomiting, diarrhea and dysuria. Due to the localisation of the pain, OI should be differentiated from acute appendicitis. The diagnosis of OI is sometimes made intraoperatively, during appendectomy for suspected acute appendicitis. Hence, it is important to state a correct preoperative diagnosis, which is commonly based on abdominal ultrasound and computed tomography. The treatment of OI is still inconclusive. Both conservative and surgical treatments are used. Both methods have their advantages and disadvantages. The decision of which treatment to follow should be multifactorial and include the patient’s clinical condition at the time of admission, the progression or regression of symptoms during hospitalization and laboratory and imaging findings. We present a clinical case of a 9-year-old overweight girl with OI, whose diagnosis was based on imaging diagnostics and enabled conservative treatment with no complications. The case we have described confirms that the conservative treatment is an effective and safe therapy.

Background. Propranolol has become the treatment of choice for infantile hemangiomas (IH). Neither the pathogenesis of IH nor the mechanism of action of propranolol on them are well understood. Possible explanations include the inhibition of angiogenesis by decreasing vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), induction of vascular endothelial cell apoptosis and vasoconstriction.

Background. Propranolol is an effective method of treatment for infantile hemangiomas (IH). A recent concern is a shift of the therapy into outpatient settings.Objectives. The aim of the study was to evaluate the safety of initiating and maintaining propranolol therapy for IH.Material and methods. The study involved 55 consecutive children with IH being treated with propranolol. The patients were assessed in the hospital at the initiation of the therapy and later in outpatient settings during and after the therapy. Each time, the following monitoring methods were used: physical examination, cardiac ultrasound (ECHO), electrocardiography (ECG), blood pressure (BP), heart rate (HR), and biochemical parameters: blood count, blood glucose, aspartate transaminase (AST), alanine transaminase (ALT), and ionogram. The therapeutic dose of propranolol was 2.0 mg/kg/day divided into 2 doses.Results. Four children were excluded during the qualification or the initiation of propranolol; a total of 51 patients were subject to the final analysis. All the children presented clinical improvement. There was a significant reduction in the mean HR values only at the initiation of propranolol. There were no changes in HR during the course of the therapy. Blood pressure values were within normal limits. Both systolic and diastolic values decreased in the first 3 months. Bradycardia and hypotension were observed sporadically, and they were asymptomatic. Electrocardiography did not show significant deviations. The pathological findings of the ECHO scans were not a contraindication to continuing the therapy. There were no changes in biochemical parameters. Apart from 1 symptomatic case of hypoglycemia, other low glucose episodes were asymptomatic and sporadic. The observed adverse effects were mild and the propranolol dose had to be adjusted in only 6 cases. Conclusions.Propranolol is effective, safe and well-tolerated by children with IH. The positive results of the safety assessment support the strategy of initiating propranolol in outpatient settings. Future studies are needed to assess the benefits of the therapy in ambulatory conditions.

Introduction: Pubertal gynecomastia (PG) is a benign enlargement of the breast that affects more than half of boys in puberty. In unclear aetiology there is no explanation for unilateral cases. The most common treatment in persistent cases is surgical removal, but this is associated with certain risks. The aim of the study is to compare oestrogen receptors (ER) and progesterone receptors (PR) status in unilateral and bilateral PG, and to present possible clinical application of the results. Materials and methods: A retrospective review of 30 patients operated on for PG was performed with immunohistochemical analysis of ER and PR in the resected tissue. Unilateral (8) and bilateral (22) cases were compared. Results:Oestrogen and progesterone receptors were present in all of the examined specimens. There was a significantly higher percentage of ER and PR positive nuclei in tissue from bilateral PG than in material from unilateral cases. A positive correlation between the presence of ER and PR was found. Age at the time of surgery was not a significant factor. Conclusions: Oestrogen and progesterone receptors may play a role in the aetiology of PG, especially in bilateral cases. Our results are a good starting point for studies on differences between unilateral and bilateral PG. There is a need for randomized placebo controlled trials on the use of anti-oestrogen drugs to explore pharmacological alternatives to surgical treatment of PG. Keywords: pubertal gynecomastia; unilateral; bilateral; oestrogen receptor; progesterone receptor. ABSTRAKT Wstęp: Ginekomastia pokwitaniowa (GP) jest łagodnym powięk-szeniem gruczołów piersiowych u mężczyzn, które występuje u ponad połowy chłopców w wieku pokwitaniowym. W niejasnej etiologii ginekomastii nie ma również wyjaśnienia przyczyny przypadków jednostronnej GP. Najczęstszą metodą leczenia przetrwałych przypadków jest zabieg operacyjny, obciążony ryzykiem powikłań. Celem badania było porównanie występowania receptorów estrogenowych (ER) i progesteronowych (PR) w jednostronnej i obustronnej GP z oceną możliwego klinicznego zastosowania wyników. Materiały i metody: Przeprowadzono retrospektywną analizę dokumentacji 30 pacjentów operowanych z powodu GP z wtórną oceną immunohistochemiczną występowania ER i PR w wycię-tych preparatach. Porównano przypadki jednostronne (8) z obustronnymi (22). Wyniki:Receptory estrogenowe i progesteronowe były obecne we wszystkich przebadanych preparatach. Stwierdzono statystycznie istotnie wyższy odsetek jąder komórkowych z ER i PR w materiale obustronnych GP niż w przypadkach jednostronnej patologii. Została stwierdzona dodatnia korelacja pomię-dzy występowaniem obu typów receptorów. Wiek pacjentów w chwili operacji nie był istotnym czynnikiem. Wnioski: Receptory estrogenowe i progesteronowe mogą odgrywać istotną rolę w etiologii ginekomastii, szczególnie w przypadkach obustronnych. Uzyskane wyniki stanowią punkt wyjścia do dalszych badań nad różnicami pomiędzy jednostronną a obustronną ginekomastią. Randomizowane badania prospektywne oc...

Introduction: Metal stabilizing implants used in pediatric fractures have to be removed to not inhibit the growth of bones. Bioabsorbable implants can save children from surgical removal of the fixating material. As there have been only a few reports regarding children, we decided to evaluate the clinical advantages of bioabsorbable screws in the treatment of selected bone fractures in pediatric traumatology.Materials and methods: The study group included 35 patients with bone fractures aged 5–17 years (mean 13.2 years) fixed with LactoSorb® bioabsorbable screws made of polymeric lactic acid and polyglycolic acid. The follow-up was compared with a matched control group of 35 children that underwent operative fixation of the same type of fractures with metal screws. Results: Clinical and radiological follow-up showed that bone unions were obtained in all cases, with no signs of osteolysis. The time of immobilization was slightly shorter in the study group (5.5 weeks) than among controls (6.2 weeks; p = 0.038). There were no differences in complications, wound infections, pain management and time of hospitalization between both groups.Conclusions: The use of bioabsorbable material in the treatment of fractures in pediatric traumatology is a safe alternative to metal stabilizing devices, with clinical benefits for young patients including no necessity of a second surgery and anesthesia.