Ruxandra Caragata

Osteogenesis imperfecta (OI) is the most common heritable bone-fragility disorder, with type I (non-deforming OI) representing its mildest classical phenotype (historically referred to as Lobstein disease). Intramedullary (IM) rodding is essential for managing recurrent long-bone fractures and progressive deformities, with the Fassier–Duval (FD) telescopic rod now being the standard choice. This narrative review, based on a structured search from the seminal 1959 description of IM rodding to 2026, synthesizes the design principles, the minimally invasive technique and the comparative outcomes of FD rodding of the lower limb, with explicit attention to type I disease. Across cohort studies, comparative series and a recent systematic review, telescopic rods consistently achieve lower revision rates and longer implant survival than static or non-telescopic devices, reducing reoperation odds by roughly three-quarters. Overall complication rates nonetheless remain high (commonly 33–55%) and are dominated by implant migration and failure of telescoping. Younger age and eccentric epiphyseal positioning after incomplete deformity correction increase migration risk. Type-I-specific evidence remains limited. A report published under the “Lobstein” designation involved a Sillence type IV patient and therefore does not constitute type-I-specific evidence. Retrospective data nevertheless suggest favorable implant survival with telescopic fixation, but definitive conclusions cannot yet be drawn. Proper technique, adjunctive bisphosphonate therapy and multidisciplinary care remain decisive. Phenotype-stratified prospective data are the principal unmet need.

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. When severe, functional voiding disorders may closely mimic obstructive or reflux pathology, leading to diagnostic errors, unnecessary invasive procedures, and potential risk to the upper urinary tract. Case presentation: We present three pediatric cases (aged 3–10 years) referred for recurrent febrile urinary tract infections, incontinence, or acute urinary retention in the absence of neurological or structural abnormalities. Urodynamic evaluation identified three distinct severe functional phenotypes: detrusor overactivity with reduced bladder capacity, poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome), and detrusor underactivity with significant post-void residual volumes. All patients demonstrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid mucosal changes. Case discussion: Despite similar clinical severity, the cases illustrated substantial functional heterogeneity and differing risks of upper urinary tract involvement. Urodynamic phenotyping proved central to diagnosis, differentiation from structural disease, and treatment planning. Multimodal conservative management—including urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, clean intermittent catheterization or antibiotic prophylaxis—led to resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD in otherwise healthy children. Early functional recognition based on urodynamic assessment is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment. The findings are discussed in the context of the existing literature on severe non-neurogenic LUTD and Hinman syndrome.

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. Its clinical presentation may closely mimic obstructive or reflux pathology, creating a significant diagnostic pitfall and exposing patients to unnecessary invasive procedures or surgery, with potential risk to the upper urinary tract. Methods: We conducted a descriptive case series of three pediatric patients evaluated at a tertiary pediatric urology center, complemented by a focused narrative review of the literature on severe non-neurogenic LUTD and Hinman syndrome. Clinical data included imaging, cystoscopy, urodynamic evaluation, management strategies, and medium-term follow-up. Results: The three patients (aged 3–10 years) presented with recurrent febrile urinary tract infections, incontinence, or acute urinary retention. Distinct severe functional urodynamic phenotypes were identified: detrusor overactivity with reduced bladder capacity; poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome); and detrusor underactivity with significant post-void residuals. Despite normal neuroanatomy, all patients illustrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid changes. Multimodal conservative management—combining urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, continuous antibiotic prophylaxis or clean intermittent catheterization—resulted in resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD within the non-neurogenic voiding disorder spectrum. Early functional recognition based on urodynamic phenotyping is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment in this population.

Background: Recurrent urinary tract infections (rUTIs) in children are increasingly complicated by antimicrobial resistance, leading to limited treatment options and challenging prophylactic management. Continuous local monitoring of resistance trends is essential for evidence-based stewardship. Methods: This retrospective study analysed recurrent paediatric UTI recorded between 2020 and 2024 at a tertiary hospital in Romania. Data were extracted using the ICD-10 code N39.0 and included demographic, clinical, and microbiological variables. Antimicrobial susceptibility testing followed CLSI standards. Associations between multidrug resistance (MDR) and clinical factors were assessed with χ² tests and Cramer’s V, and predictors of MDR were evaluated by multivariable logistic regression. Temporal trends in resistance were examined using logistic regression with year as a continuous variable, and results were validated with the non-parametric Cochran–Armitage linear-by-linear χ² trend test to strengthen analytical rigour. Proportions are presented with Wilson 95% confidence intervals (CIs). Results: A total of 134 children met inclusion criteria for rUTI, of whom 130 had complete demographic and microbiological data and were included in analyses. Each episode represented a distinct culture-confirmed infection occurring ≥30 days apart. MDR occurred in 48.5% of isolates (95% CI, 40.2–56.9) and ESBL in 20.9% (95% CI, 14.9–28.5). MDR was significantly associated with urinary tract malformations (χ² = 5.78, p = 0.016) and continuous antibiotic prophylaxis (χ² = 4.23, p = 0.040). Neither logistic nor Cochran–Armitage trend analyses demonstrated a significant temporal increase in MDR (OR per year = 0.94; 95% CI 0.75–1.17; p = 0.566; χ² = 0.89; p = 0.346). Conclusions: MDR and ESBL rates among children with recurrent UTIs remain high but stable. The combined use of parametric and non-parametric trend analyses confirmed the absence of a significant upward trajectory, underscoring the need for ongoing surveillance and stewardship to maintain antibiotic effectiveness in paediatric care.

Background: Recurrent urinary tract infections (rUTIs) in children are increasingly complicated by antimicrobial resistance, leading to limited treatment options and chal-lenging prophylactic management. Continuous local monitoring of resistance trends is essential for evidence-based stewardship. Methods: This retrospective study analysed 130 episodes of recurrent paediatric UTI recorded between 2020 and 2024 at a tertiary hospital in Romania. Data were extracted using the ICD-10 code N39.0 and included demographic, clinical, and microbiological variables. Antimicrobial susceptibility testing followed CLSI standards. Associations between multidrug resistance (MDR) and clinical factors were assessed with χ² tests and Cramer’s V, and predictors of MDR were evaluated by multivariable logistic regression. Temporal trends in resistance were examined using logistic regression with year as a continuous variable, and results were validated with the non-parametric Cochran–Armitage linear-by-linear χ² trend test to strengthen analytical rigor. Proportions are presented with Wilson 95% confidence intervals (CIs). Results: MDR occurred in 48.5% of isolates (95% CI, 40.2–56.9) and ESBL in 20.9% (95% CI, 14.9–28.5). MDR was significantly associated with urinary tract malformations (χ² = 5.78, p = 0.016) and continuous antibiotic prophylaxis (χ² = 4.23, p = 0.040). Neither logistic nor Cochran–Armitage trend analyses demonstrated a significant temporal increase in MDR (OR per year = 0.94; 95% CI 0.75–1.17; p = 0.566; χ² = 0.89; p = 0.346). Conclusions: MDR and ESBL rates among children with recurrent UTIs remain high but stable. The combined use of parametric and non-parametric trend analyses confirmed the absence of a significant upward trajectory, underscoring the need for ongoing surveillance and stewardship to maintain antibiotic effectiveness in paediatric care.

Background: Pediatric cholelithiasis has become increasingly diagnosed, partly due to enhanced imaging accessibility and rising obesity rates. Despite laparoscopic cholecystectomy being the standard treatment, the optimal timing for surgery remains debated, especially in complicated cases. The aim of our study is to analyze the demographic, clinical, and surgical characteristics of pediatric patients undergoing cholecystectomy and to identify the most favorable timing for surgery in terms of outcomes and complications. Material and methods: A retrospective study was conducted on 101 pediatric patients who underwent cholecystectomy between 2015 and 2024 at a tertiary children’s hospital. Patients were categorized based on surgical timing: elective, early (day 1–4), intermediate (day 5–14), and delayed (after day 14). Demographic data, clinical presentation, laboratory values, imaging, operative time, intraoperative findings, and postoperative complications were analyzed. Results: The median age was 15 years, with 64.35% female. Obesity was highly prevalent and significantly associated with choledocholithiasis and pancreatitis. Elective and delayed surgeries (after 14 days) had the shortest operative times (median: 2 h) and the lowest complication rates. Early surgeries (within 4 days) showed longer operative times and a higher incidence of intraoperative difficulties and complications. Histopathological findings did not influence clinical management, suggesting potential for selective examination. Conclusions: Elective or delayed cholecystectomy after a “cool-down” period of 5–14 days provides the most favorable outcomes in pediatric patients with complicated cholelithiasis. Conservative management remains appropriate for asymptomatic cases. A standardized approach to surgical timing may reduce complications and hospital costs

Background and Objectives: Duodenal atresia and stenosis are common causes of intestinal obstruction. Associated anomalies significantly influence early postoperative mortality, while postoperative complications impact long-term survival. Materials and Methods: Over a 13-year period from January 2010 to August 2023, a total of 74 infants and children with congenital duodenal obstruction were treated at “Grigore Alexandrescu” Children’s Emergency Hospital and met the inclusion criteria. All patients diagnosed with duodenal obstruction (both instrinsic and extrinsic causes) were included. Analysed data included congenital anomalies, Apgar scores, birth weights, surgical techniques, and complications. Results: The associated anomalies included cardiac (n = 33), Down syndrome (n = 13), neurological (n = 11), pulmonary (n = 7), renal (n = 4), skeletal (n = 1), and gastrointestinal and hepatobiliopancreatic anomalies (n = 25). In total, 12 patients experienced perioperative ventilation problems. Early postoperative complications (within 30 days) occurred in 21 patients, while 6 had late postoperative complications (after 30 days). Among non-surgical complications, we noted ventilation problems, sepsis (n = 7), and pneumothorax (n = 1). Surgical complications included adhesive bowel obstruction (n = 7), incisional hernia (n = 3), peritonitis (n = 3), dysfunctional duodenoduodenostomy or duodenojejunostomy (n = 3), pneumoperitoneum (n = 5), enteric fistula (n = 3), and volvulus (n = 4). Conclusions: Surprisingly, this retrospective study revealed that an Apgar score below 8, along with neurological and pulmonary abnormalities, is associated with postoperative complications. Conversely, other congenital anomalies, low birth weight, and age at admission do not serve as prognostic factors.