Vol 26, No 4 (2022)

Introduction. The modern stage of medical science is marked by the search for and improvement of methods for the treatment of malformations and surgical diseases of the colon in childhood. Variants of surgical interventions for Hirschsprung's disease have undergone an obvious evolution. The development of medical technologies has led to the widespread introduction of minimally invasive endoscopic surgical interventions, often performed without the formation of stomas in various parts of the intestinal tube. The accumulated experience of clinics, the obtained long-term results of treatment are subject to reflection and the development of common approaches in choosing an operative strategy for correcting this malformation. The purpose of this study was to conduct a comparative analysis of various minimally invasive approaches in the treatment of Hirschsprung's disease used in the Ivano-Matreninskaya City Children's Clinical Hospital in Irkutsk.

Material and method. We used a retrospective analysis of 96 records of an inpatient with a histologically verified diagnosis of congenital colon agangliosis. The exclusion group consisted of cases of total colon agangliosis.

Results. In 86.7% of cases, the disease was presented as a short aganglionic segment localized in the rectosigmoid junction, which was an indication for transanal endorectal reduction in 100% (10) and laparoscopically assisted intervention in 80% (16) of cases. An extended aganglionic segment was an indication for video-assisted reduction in 20% of cases. The mean operation time was 118 min in the LAEPT group versus 140 min in the TAEPT group. Intraoperative complications and lethality were not observed. 83.33% were examined in follow-up, the follow-up period was over 2 years. Persistent constipation requiring the use of laxatives, cleansing enemas, course physiotherapy was noted in 3.3% of the LAEPT group and 6.7% of the TAEPT group. The incidence of Hirschsprung-associated colitis in the late postoperative period in the LAEPT and TAEPT groups was 3.3% (1) and 10% (3), respectively.

Conclusion. Minimally invasive methods of surgical treatment of Hirschsprung's disease have excellent results, both cosmetically and functionally, and can claim to be the “gold standard” for the correction of this defect. Both methods have their obvious advantages and disadvantages, dictating a personalized approach to the choice of technological method in each specific case.

Introduction. Pyogenic granuloma is a benign vascular tumor-like formation on the skin having inflammatory etiology. It is often seen in childhood; its complications in the form of ulcerations and bleedings are met in about 7.5% of cases.

Material and methods. Over the past two years, 164 patients were operated on for pyogenic granulomas at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) in Moscow. 120 of them had bleedings in the anamnesis. Before surgery, all patients had ultrasound examination with color Doppler mapping (CDM) of their vascular formation. 137 children had planned surgeries under local anesthesia in an outpatient unit. 27 patients had bleeding from their pyogenic granulomas on the admission. On reaching hemostasis after conservative treatment, 21 of them had delayed surgeries; 6 children with severe bleeding, in who conservative treatment was ineffective, were operated urgently. All delayed surgeries were made under local anesthesia in an outpatient surgical room; urgent surgeries were performed under general anesthesia in a hospital surgical room.

A technique of combined laser photodestruction was applied in all 164 patients with pyogenic granulomas (invention priority dated May 11, 2022). Laser surgical device “IRE-Polyus” (Russia) with a wavelength of 0.97 urn, was used for this.

Results. Postoperative period in all patients was uneventful; complete healing of wound defect was seen on day 10±2. No recurrence or residual elements of the vascular formation were observed. After surgical treatment, good clinical and esthetic results were obtained in all 164 patients.

Conclusion. To prevent complications of pyogenic granulomas in children, surgical treatment with a technique of combined laser photodestruction is recommended. Moreover, the discussed technique has been developed with considerations of structural features of pyogenic granulomas. A technique of combined laser photodestruction allows to radically remove pathological tissues of pyogenic granuloma both in inpatient and outpatient settings and guarantees reliable hemostasis, thus providing good clinical and esthetic outcomes in pediatric patients.

Background. Capillary angiodysplasia is a common vascular malformation represented by an increase in the number of dilated capillaries of the skin. Being located in the face area, this defect contributes to the development of an inferiority complex in a child. Various methods are used for treatment, but all of them are not effective enough. Currently, the most effective and promising method is laser photodestruction.

Aim. To study the efficacy and safety of laser treatment of skin сapillary angiodysplasia in children with various laser devices (PDL 585 nm, Nd:YAG 1064 nm, Nd:YAG/KTP 532 nm), based on a systematic review of modern literature for the period from 2000 to 2020.

Materials and methods. A systematic review was conducted in foreign and Russian databases for the period from 2000 to 2020. Keywords were used for the search: capillary angiodysplasia, capillary malformation, wine stain, vascular malformation, laser treatment. Out of 1543 literature sources, 9 full-text articles are included in the review.

Results. Comparing the results of treatment using different types of lasers, it was noted that a very good result was achieved in 33.8% of cases, good in 33.7%, average in 20.4%, no effect in 1.2%. The total number of complications was 62 cases (9.5%): hyperpigmentation in 32 patients, scars in 15 cases, hypopigmentation in 12, skin atrophy in three.

Discussion. The conducted systematic review indicates the effectiveness and disadvantages of using various laser radiation for the treatment of capillary angiodysplasia of the skin. The articles lack information on the relationship between the effectiveness of treatment from morphological and hemodynamic features of vascular formations and the selectivity of laser radiation to skin chromophores.

Conclusion. It is necessary to conduct research to select the optimal laser radiation, taking into account the morphological and hemodynamic features of capillary angiodysplasia, which will ensure minimal skin damage and improve treatment results.

Congenital esophageal stenosis is a rare developmental anomaly. It occurs with a frequency of about 1 case per 20-50 thousand newborns and accounts for about 3-5% of the total number of congenital malformations. In the initial diagnosis, it is difficult to differentiate it from other stenoses caused by inflammatory changes in the mucous membrane of the esophagus, the final diagnosis becomes clear only after treatment and dilation.

Treatment of congenital esophageal stenosis can be carried out in various ways. Endoscopic dilation is an effective and safe method of treatment, while surgical intervention is intended only for stenoses that do not respond to dilation.

Introduction. The most life-threatening bacterial complication of chickenpox in children is necrotizing epifascial phlegmon. The incidence of this disease is 0.01-0.2%. Unsatisfactory results of treatment can be associated with late and erroneous diagnosis, as well as insufficient intensive therapy.

The aim is to study the features of the course and treatment of necrotizing epifascial phlegmon with chickenpox in children.

Material and methods. An analysis of the treatment of 20 children with necrotizing epifascial phlegmon with chickenpox was carried out. Microbiological and histological studies were performed from the lesion focus, the immune status and the state of hemostasis were studied, and a clinical assessment of the wound process was given on the basis of visual observation.

Results. In the study, there were 12 boys and 8 girls among all patients. The most frequent localization of necrotizing epifascial phlegmon in chickenpox was the lower and upper extremities. Of the observed 20 patients with necrotizing epifascial phlegmon at the age from 1 to 7 years, there were 16 children. The development of this disease usually occurred on the 3-5th day of the course of chickenpox. The disease proceeded with a clearly pronounced staging, thrombosis in the vessels of the skin and subcutaneous tissue, followed by necrosis. The severity of the patient's condition depended on the area of skin and subcutaneous tissue lesions. Streptococcus pyogenes was the main causative agent in the inoculation of the lesion separatedfrom the focus. Changes in the immune status for the most part corresponded to those in acute purulent inflammation. Complex treatment with systemic antibacterial and intensive syndromic therapy, active intervention in the lesion focus and the use of modern technologies in the management of wounds and wound defects contributed to the healing of patients and a decrease in mortality.

Conclusion. The likelihood of developing necrotic epifascial phlegmon in children with chickenpox is quite high when infected with Streptococcus pyogenes. The course of necrotic epifascial phlegmon with chickenpox in children has a certain sequence: a period of progressive course, a period of necrosis and wound defects, a period of repair. Active early complex treatment with targeted antibacterial and intensive post-syndrome therapy, the use of anticoagulants and antiplatelet agents, antibiotic-novocaine blockade and incisions in the lesion focus, the use of modern technologies in the management of wounds and wound defects contributed to the healing of patients and the prevention of deaths.

Anna A. Rusanova (March 8, 1907 - May 5, 1991) - surgeon, teacher, professor (1961), Doctor of Medical Sciences (1961), memoirist.

Graduated from the Medical Faculty of Voronezh State University (1929). During the Great Patriotic War, he was a military doctor. Dean (1944-1974), Head of the Department of Pediatric Surgery at the Pediatric Faculty of Voronezh State Medical University (1961-1972). Author of more than 100 scientific papers, including the book "Clinic and treatment of closed craniocerebral trauma" (1974). Author of posthumously published poems, documentary stories, memoirs.

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15 июня 2022 года перестало биться сердце выдающегося детского хирурга Российской Федерации, Отличника здравоохранения СССР, Заслуженного деятель науки РБ, Лауреата премии имени С.Д. Терновского, доктора медицинских наук, профессора Мунавары Габдракиповны Мавлютовой.