Surgery, Traumatology and Orthopaedics

Pediatric Cardiac Surgery
Main Tasks
- Congenital heart diseases
- Acquired heart diseases
- Infective endocarditis
- Injury to heart and great vessels
- Cardiomyopathy
- Heart transplantation
- Stenosis of trachea and bronchi
Examinations; Most Common Congenital Heart Diseases; Critical CHD - Hypoxaemia, Heart failure; Surgical Treatment of CHD; Surgeries without Cardiopulmonary Bypass ...
 

Chest wall deformities:
• Pectus excavatum - (funnel chest), most common chest wall deformity, Surgical repair - without metallic strut - modif. Welch, with metallic strut - modif. Holcomb, complications, Minimally invasive Repair of Pectus Excavatum - Nuss technique
• Pectus carinatum - (pigeon brest) - protrusion deformity
• Poland´s syndrom - Absence of the pectoralis major and minor muscles and syndactyly
• Sternal defects
Esophageal Atresia; CCAM; Oncological pulmonary diseases; Mediastinal Masses; Anterior and superior mediastinum.

Perioperative analgesia in children; Postoperative pain management is a crucial task for all doctors treating children in a postoperative setting; Aims:
- to eliminate postoperative pain
- to minimize perioperative stress
- to prevent forming of negative memory imprints
Patophysiology of paediatric perioperative pain;
Drug absorption is decreased in neonates because of
Drug distribution in influenced by
Drug elimination is influenced by
Analgetics overview; Opioids I.; Opioids II.; Non-opioids I.

Onconsurgery in children:
• Embryonal tumors
• Neuroblastoma
• Nephroblastoma
• Hepatoblastoma
• Pulmoblastoma, pankreatoblastoma, lipoblastoma
• Sarcoma

Intrabdominal Mass
• Hepatomegaly, Hydrops, Liver cyst, Liver tumor, Choledochal cyst
• Infiltration– appendix, Crohn; Abscess – appendix, Crohn
• Splenomegaly, Bezoar, Splenic cyst
• Gas, Stoool, Intestinal tumor, Abscess

Neonatal surgery Congenital diseases
•Atresia GIT, biliary atresia, Malrotation, Diaphragmatic hernias, Abdominal wall defects, Lung anomaly

Acquired diseases
•Perinatal trauma, Hernias, Testicular torsion, Ileus, Perforation and inflammation of GIT, NEC, Tumors

Surgery of congenital malformations - complex treatment; Survival in isolated malformation in Motol Hospital; Congenital diaphragmatic hernia – posterolateral, Bochdalek - Czech pathologist Professor Bochdalek in1848.

Hepatobiliary surgery; Liver tumors in children; Benign liver tumors; Hemangiomas: 1. Cavernous hemangiomas 2. Hemangioendotheliomas
Hemangiomas
•Cardiac failure - digoxin, diuretics
•Corticosteroids or alpha2A-interferon induce regresion in some cases
•Localized - resection
•Bilobar - hepatic artery ligation or embolization
•Rare - transplantation
Focal nodular hyperplasia - FNH; Adenoma; Non-Parasitic Cysts; Congenital liver cyst – located partially extrahepatic in porta hepatis; Malignant liver tumors; Hepatoblastoma; Staging by SIOP of malignant liver tumors; Hepatoblastoma - Histopathology

Anorectal malformations; Anorectal malformations; Congenital defects of anus and rectum;
Failure of cloaca´s development; Classification Anorectal malformations - Male, Female; ARM - embryology, genetics, Incidence, diagnosis, Magnetic Resonance Imaging, Treatment; Standard surgical technique of definitive ARM repair; PSARP - minimal, classical - perineal, perineal + abdominal; Postoperative complications in 156 patients.

Inflammatory; Bowel obstruction; Trauma; Peritoneal and thoracic cavity with foetal circulation; Gastrointestinal; Genitourinary; Gynaecolologic; Neurogenic; Vascular; Systemic disease; Mimicking intraabdominal pathology; Bowel obstruction - Mechanic, Neurogenic, Vascular; Ladd syndrome – malrotation of the midgut with Ladd´s bands; The difference between hernia in a child and an adult.
 

Abdominal trauma
Blunt trauma 85% mortality 9%
Penetrating trauma 15% mortality 6%
Shock = Inadequate tissue perfusion
Shock - clinical features
Management of abdominal trauma
Treatment of shock:
•oxygen support - 100% O2
•cannulation of peripheral vein 2x
•fluid replacement - crystalloid solution
•transport to ICU
ICU management
ICU monitoring
Fluid resuscitation - hemodynamic stability
Laparotomy

NICU clinical cases
Case no. 1: Patient after omphalocele repair - contrast study for CVC placement
Case no. 2: Patient after AOE repair – primary anastomosis – X-ray control on 2nd postoperative day for ventilatory deterioration following extubation
Case no. 3: Boy 2-mo. old, meconium plug syndrome with spontaneous resolution, discharged home, healthy until…
Case no. 4: Dyspnea after delivery. Transferred to NICU, where X-rayed.
Case no. 5: 3-d. old infant, treated for suspected infection from day 2, bloody stools, spinal tap performed, on day 3 for abdominal distention X-ray study