Vol 22, No 6 (2018)
- Year: 2018
- Published: 25.12.2018
- Articles: 15
- URL: https://jps-nmp.ru/jour/issue/view/12
ORIGINAL ARTICLES
EXPERIENCE IN THE IMPLEMENTATION OF EXTENSIVE LIVER RESECTIONS IN CHILDREN
Abstract
Aim of the study. The massive liver resection in children is executed very seldom. The article analyzes the clinical cases of six patients aged from 3 to 14 years with benign and malignant volume neoplasm of the liver. Material and methods. Diagnosis is laborious enough and requires both, the application of routine methods and highly specialized equipment. All children underwent a typical or atypical liver resection through open access, using modern surgical techniques. Results. The length of hospitalization averaged 39 days. Postoperative complications, like bile duct damage, occurred in two cases. One child had a hematoma at the site of the operation. Conclusion. Extensive liver resections in children refer to comprehensive high-tech surgical interventions, in which the main complication is damaging of the bile duct. The early detection of complications contributes to the favorable course of the postoperative period.
Russian Journal of Pediatric Surgery. 2018;22(6):284-287
284-287
THE ROLE OF PLACENTAL DISORDERS AMONG RISK FACTORS IN THE FORMATION OF ISOLATED HYPOSPADIAS
Abstract
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.
Russian Journal of Pediatric Surgery. 2018;22(6):288-291
288-291
MULTISPIRAL COMPUTER TOMOGRAPHY IN DIAGNOSTICS OF ACUTE SKELETAL INJURIES IN CHILDREN
Abstract
Multi-sliced computed tomography (MSCT) is widely used to study patients with polytrauma, especially when assessing skeletal and spinal injuries as it has provided possible volume visualization. MSCT has long been used to diagnose injuries of pelvic bones and the spine. For the examination of limb injuries, it is used rarely until now. Although traditionally used radiography often underestimates degree and severity of damages, especially in the complex body parts such as shoulder, elbow, wrist, knee and ankle joints. The role of MSCT is extremely important to identify complex and small fractures, their nature and evaluation, planning of treatment. Multiplanar reconstruction clearly visualizes structural features, and three-dimensional images help to understand spatial relationships, which is important for pre-operative planning and classification of fractures. In addition, modern technologies for suppressing metal artifacts in MSCT allow monitoring postoperative results even in the presence of metal implants.
Russian Journal of Pediatric Surgery. 2018;22(6):292-295
292-295
STEP-BY-STEP THERAPY OF INTRACRANIAL HYPERTENSION IN THE ACUTE PERIOD OF SEVERE MECHANICAL TRAUMA IN CHILDREN
Abstract
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).
Russian Journal of Pediatric Surgery. 2018;22(6):296-300
296-300
REVIEWS
SURGICAL TREATMENT OF OPEN DUCTUS ARTERIOSUS IN PREMATURE INFANTS
Abstract
The choice of tactics for the treatment of open arterial duct (OAD) in newborns is one of the most controversial and debatable topics in neonatal medicine. There are several approaches in the treatment of OAD in small infants: 1) the prophylactic use of cyclooxygenase inhibitors; 2) treatment on the background of maintenance therapy without the medical and surgical intervention; 3) drug stimulation of the closure of the AOA; 4) surgical intervention. Surgical treatment, which can be done with the aid of the open surgery and thoracoscopy, still plays a leading role. Complications associated directly with the operation are minimal. In this study, we present a review of the literature, including current information on the most frequent complications arising from the surgical treatment of OAD in newborns - damage to the lungs with the development of pneumothorax, damage to the great vessels with circulatory disorders, wound to the left phrenic nerve followed by paresis of the left diaphragm dome, damage to the recurrent nerve with impaired function of the left vocal cords, damage to the thoracic lymphatic duct with the development of chylothorax, damage to the muscles with development of functional scoliosis. Special attention is paid to the prognosis of the course of the disease and the survival rate of low birth weight infants.
Russian Journal of Pediatric Surgery. 2018;22(6):301-305
301-305
LAPAROSCOPIC REIMPLANTATION FOR THE MANAGEMENT OF URETERAL DUPLICATIONS WITH PRIMARY MEGAURETERS IN CHILDREN
Abstract
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).
Russian Journal of Pediatric Surgery. 2018;22(6):306-308
306-308
309-316
CLINICO-ANATOMICAL FEATURES OF INTEGUMENTARY TISSUES IN THE ACHILLES TENDON FROM THE POINT OF VIEW OF PLASTIC SURGERY. THE ANALYSIS OF WAYS OF ELIMINATION OF CICATRICIAL DEFORMATIONS IN THE ACHILLES TENDON AREA: THEIR ADVANTAGES, DISADVANTAGES
Abstract
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.
Russian Journal of Pediatric Surgery. 2018;22(6):317-320
317-320
OBITUARY
СЕРГЕЙ ИВАНОВИЧ ВОЗДВИЖЕНСКИЙ
Russian Journal of Pediatric Surgery. 2018;22(6):335-335
335-335
МИХАИЛ РАФАИЛОВИЧ РОКИТСКИЙ
Russian Journal of Pediatric Surgery. 2018;22(6):336-336
336-336
DISCUSSION
TO THE QUESTION OF THE TERATOGENESIS OF GASTROSCHISIS
Abstract
Gastroschisis is a severe congenital malformation of the development, characterized by celosoma (defect in the anterior abdominal wall and intrauterine intestinal eventration). The origin of the malformation is currently not fully investigated. Most authors consider the cause of gastroschisis to be a violation of the formation of the anterior abdominal wall, in contrast to omphalocele, which is unanimously considered a malrotation of the first period of rotation of the midgut. The authors compare known facts about gastroschisis and new literary (including experimental) data. The analysis allows us to conclude gastroschisis to be an associated defect of intestinal malrotation and development of the anterior abdominal wall.
Russian Journal of Pediatric Surgery. 2018;22(6):321-322
321-322
ANNIVERSARY
АЗАМ ТАИРОВИЧ ПУЛАТОВ (К 90-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ)
Russian Journal of Pediatric Surgery. 2018;22(6):334-334
334-334
HISTORY OF PEDIATRIC SURGERY
ЛЕОНИД РОШАЛЬ СТАЛ КАВАЛЕРОМ «ОРДЕНА ЛАДОШКИ»
Russian Journal of Pediatric Surgery. 2018;22(6):333-333
333-333
CASE REPORT
CLINICAL OBSERVATION OF A FAVORABLE OUTCOME AFTER SEVERE INJURY DUE TO THE FALL FROM THE SIXTEENTH STOREY
Abstract
Introduction. Catatrauma is one of the main causes of childhood injuries and deaths in Russia. The severity of the condition of catatrauma is caused by combined injuries, high disability and lethality depend on them. Most often, children fall from the balconies of houses, windows, trees, and playgrounds. The purpose of the study was to show, on a clinical example, the case of a fall of a child from the height of the 16th storey of a dwelling house and the survival with a favorable outcome. Material and methods. The clinical example demonstrates the provision of medical care to a 5 years old child with catatrauma in a metropolis. After falling from a critical height (48 m) at the prehospital stage, he was assisted by ambulance brigades, and transportation was carried out by a helicopter. At the hospital stage, the victim was treated at the Research Institute of Emergency Surgery and Traumatology, where all departments of the clinic were involved. Results. This clinical case is unique in that the child, having fallen from the 16th sorey, from a height of more than 48 m, having received multiple combined injuries with an ISS score of 34 points, survived. An outcome was favorable due to the fact that the child was dressed in winter clothes with a jacket hooded over his head and fell into the snow, as well as coordinated actions of the services and units providing medical care at the prehospital and hospital stages in the metropolis. Conclusion. A favorable outcome after the child had fallen from a critical height, was affected by facts that both the child was dressed in winter clothes with a hood and a hat, put on the head, falling into the snow, and the coordinated activity of the structures and units participating in the prehospital and hospital stages of medical care.
Russian Journal of Pediatric Surgery. 2018;22(6):323-329
323-329
LEFT-SIDED TRAUMATIC DIAPHRAGMATIC HERNIA WITH THE INVOLVEMENT OF THE DIAPHRAGMATIC NERVE IN A CHILD
Abstract
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.
Russian Journal of Pediatric Surgery. 2018;22(6):330-332
330-332