Vol 22, No 6 (2018)

The article presents our clinical observation of a left-sided traumatic diaphragmatic hernia with the damage to the diaphragmatic nerve in a patient Sh., 2 years old. After a comprehensive examination and confirmation of the diagnosis, he underwent thoracoscopic plastic surgery of the left aperture dome. In satisfactory condition, the patient was discharged from the hospital.

Ureteral duplication is an abnormality of the urogenital tract, which may be presented in about 0,8% of the population. However, in some cases, a complete doubling of the collective system is combined with such defects as megaureter, ureterocele, vesicoureteral reflux, urinary incontinence, and others. Currently, there are several treatment options for children with urological pathology in the doubling of the kidneys. Depending on the type of pathology and the functional state of the affected segment, this can be both organ-bearing operations (heminephrouretherectomy), and reconstructive plastic interventions - ureterocystoneoimplantation of the one ureter or both ureters by a “single unit”, as well as the formation of inter-uterine anastomoses. In recent years, there was appeared the possibility to use endovideosurgical technologies for the reconstruction of the urinary tract. The article presents the experience of using laparoscopic reimplantation of the ureter in the correction of various variants of defects in doubling the upper urinary tract in children. But on the other hand, complete ureteral duplication can be detected in the association with ureter hydronephrosis, ureterocele, and ectopic ureters. Another common disease, which can coexist with duplication is vesicoureteral reflux (VUR).

The article deals with the features of integumentary tissues in the Achilles tendon region, which must be taken into account in the planning of reconstructive surgeries, the clinical features of this scar localization, as well as the advantages and disadvantages of existing methods of normal skin repair in the Achilles tendon area.

Aim of the study. The incidence of hypospadias increased by 2-3 times within the last 50 years. Changes in the frequency occurred mostly due to the gain of the distal isolated forms. The etiology of the majority of cases of the isolated hypospadias isn’t clear. The study of the origin hypospadias is at a stage of the search and assessment of the value of risk factors. The multifactorial pathology is supposed to be caused by changes in an organism of the mother, a placenta and environment factors. Our research is devoted to the assessment of placental factors in the formation of hypospadias. Material and Methods. We have performed a retrospective questionnaire among parents of 99 children with the isolated forms of hypospadias. The special attention was paid to the collecting of the family anamnesis, including data on diseases of reproductive organs, both at parents and at the immediate family in the male line and also data on a occupation, addictions (smoking) of parents. Information was also collected about the peculiarities of the course of the prenatal period and the outcome of childbirth. On the basis of the obtained data, an assessment of the influence of various “parental” factors on the formation of the isolated hypospadias forms in their sons is given. Results. In 4 out of 99 cases, the origin of isolated hypospadias has been caused by genetic deviations. Primary diseases of reproductive organs in parents have been noted as follow: in fathers in 18 of 95 cases, and in mothers in 12 cases. Most often the placenta pathology in the first trimester of pregnancy was shown by the threat of a spontaneous miscarriage (in 35 cases from 95). Placental disturbances during all pregnancy were accompanied by premature births in 25 cases. In 22 cases placental disorders were shown by a fetus arrest of development. Conclusions. In our research placental disturbances were the most frequent risk factors in the formation of the isolated hypospadias.

Aim of the study to improve the results of treatment of children with intracranial hypertension in the acute period of severe mechanical trauma by virtue of the use of the “Protocol of step-by-step therapy” Material and methods. The article is devoted to the problem of intracranial hypertension in children with severe mechanical trauma. An analysis of 148 case histories of children with severe mechanical trauma, including brain trauma hospitalized in an intensive care unit. 27 patients out of 148 were excluded from the inclusion criteria: 6 patients (22.2%) due to the “late” admission (more than 72 hours from the time of injury); 21 patients - (77,8%) due to the persistent condition of atonic coma from the moment of trauma. 121 patients, according to indications, monitored intracranial pressure and intensive therapy of intracranial hypertension. All patients were divided into two groups: one group (the main one - 84 patients), in which the treatment was carried out according to the “Protocol of step-by-step therapy of intracranial hypertension” and approved in the Scientific Research Institute of Emergency Children’s Surgery and Traumatology, characterized by a strict sequence of treatment measures (“steps”), with clear indications for prescribing each subsequent “step” and the time frame for the duration of the “steps” taken; 2 group (control group - 37 patients), in which the treatment was carried out according to existing international guidelines for the management of patients with severe head injury. Conclusion. Comparative evaluation of treatment results showed outcomes of trauma in the main group to be better, including a statistically significantly less mortality rate (p = 0.0002, p < 0.05).