PurposeAssessment of bronchoscopy usefulness for diagnosis and treatment in children suspected of foreign body aspiration.Material and methodThere were 27 boys and 18 girls in the age from 15 month to 14 years (average 5.5 years). Rigid bronchoscopy was performed under general anaesthesia. Assessment of the respiratory tract was done and in cases with foreign body bronchoscopic evacuation was executed. Medical records and video recordings of bronchoscopy procedures were subjected to retrospective analysis.ResultsIn 28 children (62.2%) during bronchoscopy, foreign body aspiration recognized in 17 (37.8%) bronchoscopy cases was negative. In 27 patients, foreign bodies were removed. In one child, foreign body was evacuated during second bronchoscopy after preparing proper instrumentation. There were no complications in post-bronchoscopic period. Operating time was from 5 to 90 min, average time was noted to be 24 min. Average time of hospital stay was 2–3 days.ConclusionsAspiration of foreign body should be suspected in all cases of bronchopulmonary infection with atypical course. Bronchoscopy is the best diagnostic and therapeutic method in all suspicions of foreign body. In children rigid bronchoscopy is still the method of choice.

Esophageal atresia (EA) is a congenital defect of the esophagus involving the interruption of the esophagus with or without connection to the trachea (tracheoesophageal fistula [TEF]). EA/TEF may occur as an isolated anomaly, may be part of a complex of congenital defects (syndromic), or may develop within the context of a known syndrome or association. The molecular mechanisms underlying the development of EA are poorly understood. It is supposed that a combination of multigenic factors and epigenetic modification of genes play a role in its etiology. The aim of our work was to assess the human gene expression microarray study in esophageal tissue samples. Total RNA was extracted from 26 lower pouches of esophageal tissue collected during thoracoscopic EA repair in neonates with the isolated (IEA) and the syndromic form (SEA). We identified 787 downregulated and 841 upregulated transcripts between SEA and controls, and about 817 downregulated and 765 upregulated probes between IEA and controls. Fifty percent of these genes showed differential expression specific for either IEA or SEA. Functional pathway analysis revealed substantial enrichment for Wnt and Sonic hedgehog, as well as cytokine and chemokine signaling pathways. Moreover, we performed reverse transcription polymerase chain reaction study in a group of SHH and Wnt pathways genes with differential expression in microarray profiling to confirm the microarray expression results. We verified the altered expression in SFRP2 gene from the Wnt pathway as well as SHH, GLI1, GLI2, and GLI3 from the Sonic hedgehog pathway. The results suggest an important role of these pathways and genes for EA/TEF etiology.

Introduction: Pneumomediastinum is defined as the presence of free gas in the mediastinal space and occurs with varying frequency depending on age. Aim of the study: The aim of this study is to report a series of spontaneous pneumomediastina in a paediatric population. Material and methods: The study is a retrospective analysis of five clinical cases of pneumomediastina in adolescent patients hospitalised in the Clinical Department of Paediatric Surgery between 2016 and 2018. Two girls and three boys with a mean age of 16.4 years were admitted to the emergency room due to dyspnoea and visible enlargement of neck circumference, which was due to emphysema of soft tissues of the neck. In three patients, chest pain was the predominant symptom. One patient presented with speech difficulties. On admission the general condition of all patients was good. Cardiovascular and respiratory efficiency was reported in all patients. The main symptom suggesting pneumomediastinum was the presence of soft tissue emphysema of the neck. Chest X-ray was performed in all patients as a preliminary examination, confirming the suspicion of pneumomediastinum. Oesophagography was performed in four patients. However, no abnormalities were detected. All patients underwent chest CT. Results: Despite extensive changes in CT, no progression of symptoms was observed. There was no indication for surgical intervention in any patient. Complete spontaneous regression was observed in all cases between day 4 and day 21 of the follow-up. Patients were discharged home after 6-10 days of hospitalisation. No recurrence in long-term follow-up was observed. Spontaneous resolution of free gas in the mediastinum was observed in all patients. Conclusions: Survival rates of patients with pneumomediastinum of unknown cause that do not require surgical treatment are high and reach about 92.5-100%. In the vast majority of patients, spontaneous resolution is observed. The prognosis is therefore favourable, and the risk of recurrence is low.

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