Vol 22, No 5 (2018)
- Year: 2018
- Published: 05.11.2018
- Articles: 13
- URL: https://jps-nmp.ru/jour/issue/view/11
ORIGINAL ARTICLES
INTEGRAL INDEX OF ACID-BASE HOMEOSTASIS AND FORECAST OF STATUS OF CHILDREN IN ACUTE PERIOD OF HEAVY MECHANICAL TRAUMA
Abstract
Introduction. The management of children in the acute period of severe mechanical trauma (SMT) requires multi-parameter monitoring, a constant assessment of the severity of the condition and the adequacy of intensive care. The abundance of heterogeneous information about the patient determines the need for the development of integrated indices, enabling the rapid assessment of the status and prognosis of the course of the traumatic disease. The assessment of the acid-base state (ABS) of the blood is one of the day-to-day components of multi-parameter monitoring. The aim of the study was to determine the effectiveness and validity of the integral homeostasis index (IHI) obtained on the basis of the results of the ABS testing, for assessing the clinical state, its dynamics and determination the prognosis of the outcome of an acute period of trauma in children. Material and methods. The study included 345 SMT patients. The determination of ABS indices with the automatic calculation of the IHI was routinely performed 2 or more times a day. The obtained values of IHI were expertly compared with the assessment of the severity of the condition and the dynamics of this evaluation in the acute period of the traumatic illness. Results. The study demonstrated 97% accuracy in the determination of the prognosis of the course of the traumatic disease and 93% coincidence with an expert assessment of the severity of the patient’s condition. The results obtained make it possible to recommend the use of IHI for the practical use in the department of anesthesiology and resuscitation under the conditions of a unified information system combining databases (an electronic medical history, a laboratory information system, and a prognostic status and outcome module integrated in the information system and operating in a continuous mode).
Russian Journal of Pediatric Surgery. 2018;22(5):228-234
228-234
235-240
THE ROLE OF SUPERINFECTION IN THE ETIOLOGICAL STRUCTURE OF ACUTE PURULENT DESTRUCTIVE PNEUMONIA IN CHILDREN
Abstract
In this paper, the importance of superinfection in the development of acute purulent destructive pneumonia (APDP) in children is shown. The study is based on the analysis of a number of clinical, microbiological and immunological indices in 240 patients with severe forms of APDP. A negative effect of superinfection on the course of the disease was found. The presented data may be criteria for the probability of super-contamination, as well as the rationale for timely correction of therapy. These criteria can be used to predict the disease.
Russian Journal of Pediatric Surgery. 2018;22(5):241-245
241-245
MORPHOLOGICAL CRITERIA FOR ESTIMATION OF THE DEGREE OF TESTICULAR HYPOPLASIA IN CHILDREN WITH CRYPTORCHIDISM
Abstract
The possible risk of the development of hypogonadism, infertility, and malignant neoplasm of the testicles in adults dictates the need to develop and implement diagnostic criteria. The identification of such morphological signs as a decrease in the number and diameter of the tubules, the number of germ cells, the development and progression of fibrosis of interstitium may have prognostic significance. The aim of the study is to develop morphological criteria for assessing the severity of testicular hypoplasia in cryptorchidism in children of different age groups. Material and methods. In the study there were identified three groups, taking into account the age of children with cryptorchidism. Group, I included 12 (34.3%) children aged from 1 to 3 years. Group II was presented by 14 (40%) patients aged from 4 to 10 years. Group III included 9 (25.7%) patients aged from 11-14 years. Results and discussion. Morphological changes in the testicle in cryptorchidism children of different age groups vary: in Group I moderate and pronounced structural changes were detected in 53% of cases, in group II - in 50% and in group III - in 72% of cases. Taking into account the morphological criteria of testicular tissue hypoplasia, in our study in cryptorchidism children, hypoplasia of the mild degree was revealed in 17.1% of cases, a moderate degree - in 31.4%, a severe degree - in 31.4% of cases. Conclusion. Morphological criteria for estimating hypoplasia and grading of the severity of hypoplasia of testicular tissue were determined on the basis of a scoring of morphological characters and morphometric indices.
Russian Journal of Pediatric Surgery. 2018;22(5):246-249
246-249
PECULIARITIES OF SURGICAL TREATMENT OF OVARIAN CYSTS IN NEWBORNS
Abstract
The aim of the work is to improve the results of the surgical treatment of congenital ovarian cysts in newborns. Material and methods. From 1982 to 2017, 147 newborns with simple ovarian cysts were treated at the clinic. The main diagnostic method was clinical - ultrasound. Two groups of patients were compared: with access according to Pfannenstiel incision and paraumbilical access. The technology of surgical intervention with paraumbilical access is described in detail. Results. In comparative studies, the benefits of parumbilical access are fully in line with the requirements of modern “open” pediatric surgery for the removal of ovarian cysts (OC) in newborns. There was noted a unique feature of the torsion of simple congenital OK: the emerging ischemia of the cysts leads only to the development of aseptic necrosis without purulent-inflammatory changes in the cyst itself and the adhesive process around. Conclusion. Para-umbilical access during surgical removal of OC may be an alternative to laparoscopic when the latter can not be used. Bearing in mind the torsion of most simple OC to occur in the antenatal period, as well as the asymptomatic course of the disease in the neonatal period, we consider it necessary to operate children with this pathology in the first 2 days after birth.
Russian Journal of Pediatric Surgery. 2018;22(5):250-253
250-253
PECULIARITIES OF SURGICAL TREATMENT OF THYROID GLAND IN CHILDREN
Abstract
The pediatric surgeon in his work has to face a wide variety of diseases related to narrow areas of medicine. Particular difficulties are caused by the diagnosis and treatment of thyroid gland formations (TGF). The number of such patients is steadily growing both in the Russian Federation and in the Altai Territory, due to iodine deficiency, radiological and environmental pollution and other possible causes. In the Children’s Surgery Clinic of the Altai State Medical University, 101 children aged from 5 to 17 years were treated in the period from 2000 to 2017 due to thyroid lesions. The study included operated patients with both benign formations and with follicular and papillary carcinoma:. Depending on the case, a different volume of surgical intervention was used: mainly, hemithyroidectomy with isthmectomy and total thyroidectomy. In the work the analysis of own results of the treatment is carried out, comparison with widely known approaches of the management of patients with TGF is given. We are of the opinion that the desire for radicalism does not always yield the best results. Thus, we consider it quite justified to perform organ-preserving operations in both follicular and papillary thyroid carcinoma. Difficulties in deciding the extent of the intervention are also caused by the inability to differentiate the form of thyroid mass before the operation. In addition, the hormonal status of the child in the postoperative period requires special attention, and the use of hormonal therapy in the absence of hormonal disorders pushes to doubt its necessity. A number of features in the operational process allows achieving good results. Thus, the choice of tactics for treating children with thyroid disorders should be advisedly and carefully considered taking into account the characteristics of the child’s organism and the specific situation.
Russian Journal of Pediatric Surgery. 2018;22(5):254-257
254-257
REVIEWS
MALIGNANT NEOPLASMS OF OVARIES IN CHILDREN AND ADOLESCENTS
Abstract
Tumors of the ovaries in girls represent an actual problem in modern gynecology. First of all, this is due to diagnostic difficulties, due to the absence of characteristic complaints, asymptomatic course and the complexity of the gynecological examination, which leads to the establishment of an erroneous diagnosis, the lack of correct and timely treatment and, as a consequence, the occurrence of complications that often negatively affect the reproductive function of the patient in further. The differential diagnosis of ovarian tumors in girls is still one of the most important problems of modern practical gynecology. The presence of a combined pathology in many patients, which is in 30-40% according to the WHO, puts the problem of the possibility of the simultaneous correction by surgeon and gynecologist. In connection with the difficulty of diagnosing, the diagnosis of such patients must necessarily include an examination by a pediatric surgeon and gynecologist with ultrasound examination of the retroperitoneal space, abdominal cavity organs, and small pelvis. Errors in the differential diagnosis of genital and extragenital diseases occur quite often and are mainly due to the similarity of clinical symptoms. This article presents a clinical case of the diagnosis and management of a 14-year-old patient with an adjacent diagnosis, as well as diagnostic search criteria for the differential diagnosis of gynecological and surgical pathologies.
Russian Journal of Pediatric Surgery. 2018;22(5):258-262
258-262
MODERN REVIEW OF ANATOMO-MORPHOLOGICAL FEATURES AND POSSIBILITIES OF SURGICAL CORRECTION OF VARICOCELE IN CHILDREN
Abstract
Varicocele is a frequent pathology of the testicles, detected during preventive examinations and subsequently often associated with infertility. The most common is the left varicocele. This review presents anatomical features and basic pathophysiological mechanisms promoting the development of varicocele in childhood. For proper treatment of this pathology, a careful approach to the examination and determination of the indications and tactics of the planned surgical intervention is necessary. There is a lot of disagreement about the need, time and technique of the intervention. The practitioner should balance the pros and cons of timing and treatment options.
Russian Journal of Pediatric Surgery. 2018;22(5):263-268
263-268
ANNIVERSARY
Олег Сергеевич Горбачев (к 70-летию со дня рождения)
Russian Journal of Pediatric Surgery. 2018;22(5):280-280
280-280
HISTORY OF PEDIATRIC SURGERY
ПАМЯТИ ПРОФЕССОРА Г.И. ТУРНЕРА (К 160-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ) (1858-1941)
Russian Journal of Pediatric Surgery. 2018;22(5):277-279
277-279
CASE REPORT
DIFFERENTIATED APPROACH TO THE PROBLEM OF REHABILITATION OF BABIES WITH SEPSIS
Abstract
A comparative study in two groups of children received a complex of restorative therapy during the rehabilitation period, with measures for correction of intestinal biocenosis, neurometabolic therapy, and immunotherapy with Viferon and children receiving the immunomodulator T-activin only showed the significant efficacy of the integrated approach in rehabilitation. In addition, a relatively fast positive immunological effect is achieved, a good tolerance of the drug Viferon, a non-invasive route of administration and the absence of adverse responses with the immunorehabilitation method described allow us recommending this drug in the complex of immunoresponsive measures in infants who have had suffered from sepsis.
Russian Journal of Pediatric Surgery. 2018;22(5):269-271
269-271
EXTENSIVE JEJUNAL AND COLONIC INTUSSUSCEPTION IN A CHILD OF 4 MONTHS
Abstract
Extensive jejunal and colonic intussusception is a rare type of intestinal impaction. The aim of the work is to present a therapeutic-diagnostic algorithm for an atypical clinical picture of a rare form of intussusception of intestines (II) in a child of 4 months. A clinical observation of extensive ileocolic intussusception was carried out in a 4-months-old child admitted to the clinic to exclude craniocerebral trauma 34 hours after falling from a height of 1 m. Results. The main reason for seeking medical help was repeated vomiting and lethargy in a child, occurred one day after the fall. The identification of bloody discharge from the anus was a reason for excluding II. The consecutive use of ultrasound, colonoscopy made it possible to confirm the diagnosis, diagnose irreversible circulatory disorders in the invaginate and determine the indications for laparotomy. The absence of peritonitis allowed performing a resection of the necrotic area of the intestine with the application of intestinal anastomosis after desintussusception. Factors provoking the disease were the introduction of a new nutritional formula in the diet and the “lead point” in the form of a Meckel›s diverticulum Conclusion. The symptom of “blood in the stool”, even in the absence of a typical clinical picture, requires the exclusion of II. The diagnostic arsenal (ultrasound, colonoscopy, laparoscopy) in a specialized hospital with rare forms of II allows short-term diagnosing and choosing a rational surgical tactic. The absence of peritonitis during resection of the necrotic area of the intestine makes it possible to perform the anastomosis.
Russian Journal of Pediatric Surgery. 2018;22(5):272-274
272-274
LONG-TERM STAY OF METALLIC FOREIGN BODIES IN THE BRONCHI
Abstract
The article presents two clinical observations of the stay of metallic foreign bodies in the bronchi. In the first child, a needle pushpin with a plastic casing was for 2 years in the lumen of the lower lobe bronchus on the right, while in the other case the screw stayed also in the right lower lobe bronchus for two weeks. Removal of foreign bodies of bronchi is performed urgently after the appropriate preoperative preparation in the operating room. Removal of the foreign body was carried out with pronounced technical difficulties, after repeated attempts for an hour. There were no complications during and after manipulation. Bronchoscopy revealed narrowing of the lumen of the lower lobar bronchus, edema, and hyperemia of the mucous membrane, as well as granulation tissue, partially overlapping the clearance of the bronchus.
Russian Journal of Pediatric Surgery. 2018;22(5):275-276
275-276