Vol 27, No 3 (2023)

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Introduction. In the structure of acute pathology in the abdominal cavity of children associated with appendicular peritonitis, local limited forms occur in 10–16.8% of cases, mainly in older patients.

Purpose. To make a comparative assessment of Amikacin and Ceftriaxone efficacy in the empiric antibacterial therapy of appendicular infiltrate and periappendicular abscess in children of different age groups under the dynamics of inflammatory process and results of bacteriological tests.

Material and methods. The article provides a retrospective analysis of 43 medical records of children of various ages with appendicular infiltrate and periappendicular abscess. All patients had a quantitative assessment of inflammatory markers and bacteriological findings in their gastric content. Amikacin and Ceftriaxone were prescribed as a starting antibacterial therapy.

Results. The present trail revealed a rather high incidence of appendicular infiltrate and periappendicular abscess in children. The maximum increase in leukocytes number, C-reactive protein were registered before surgery and one day after it, mostly in little children. The acid α1-glycoprotein level was increasing during the first day after surgery in little patients, while in adolescents and teenagers it didn’t change significantly.

Bacteriological examination of the gastric content revealed that the most common pathogens were Escherichia coli (34.9%) and Pseudomonas aeruginosa (14%). Many pathogenic bacteria were highly sensitive to Amikacin and little sensitive to Ceftriaxone. In two children, lack of sensitivity of microorganisms to antibacterial drugs caused the development of abdominal abscesses in the postoperative period.

Conclusion. The empiric antibiotic therapy is of great importance in the management of appendicular infiltrate and periappendicular abscess. While prescribing the starting antibiotic therapy, a physician has to use his/her experience and to know or to anticipate possible microflora nature and its sensitivity to antimicrobial preparations.

Introduction. The open Ladd surgery is a standard treatment of intestinal malrotation. After implementing laparoscopic techniques into clinical practice, the number of reports on successful treatment of this defect with minimally invasive laparoscopic techniques is growing. However, publications on such correction of the defect in newborns are rather scarce.

Purpose. To improve management of newborns with intestinal malrotation.

Material and methods. Retrospective and prospective analyses of 77 newborns with intestinal malrotation, treated in 2002–2020, have been made. The studied group included 35 newborns; the control group – 42. StatTech program was used for statistical data processing.

Results. Groups were comparable in anthropometric indicators, gender composition, gestational age. The following differences were revealed during the study: laparoscopic surgery lasts longer than the open surgery. The intensive care period was uneventful in the studied group. Passage through the intestine was restored faster, enteral feeding started earlier in the laparoscopic group too. The number of bed days in patients operated with minimally invasive techniques was less , if to compare to the control group with open surgery. After the open surgery, children often required intestinal stimulation in order to restore passage through the gastrointestinal tract. The incidence of complications does not depend on the applied surgical technique. Relapses in both groups are comparable; the leading factor in developing relapses is violations of surgical techniques.

Introduction. The choice of tactics for surgical correction of virilized genitalia in girls with the classic form of congenital adrenal hyperplasia (CAH) remains a topical issue in pediatric surgery. The early one-stage feminization in severe forms of genital virilization, in case of urogenital sinus, is recommended by the international guidelines on CAH clinical practice (2018). One of the arguments for the early one-stage feminizing plasty is to prevent urinary tract infection. However, in experts’ opinion, it has a low level of evidence.

Purpose. To find out a statistically significance risk of developing chronic inflammation in the bladder (CIB) in patients with persistent urogenital sinus due to CAH.

Material and methods. The lower urinary tract was examined in two groups of girls with CAH having non-persistent urogenital sinus (UGS) (n=15) and persistent UGS (n=32). In both groups, cystoscopy was made which is highly specific and sensitive to diagnosing chronic inflammation in the bladder (CIB) which develops as a consequence of long-term disorders in urodynamics and long-term urinary tract infection. Statistical analysis was carried out by comparing 95% confidence interval (95% CI) for the relative frequency of CIB in groups with a population value and for testing the hypotheses on the coincidence of observed and population frequencies of binary trait values using the Chi square criterion (χ²).

Results. The relative CIB frequency in the group with persistent UGS was 75%. As far as the point estimate of population value of the relative CIB frequency (0.1) was located outside the calculated 95% CI (0.581; 0.918) and the value of calculated χ² criterion (148.7813) corresponded to r<0.05 (0.000000), the difference between the obtained data and population values can be considered statistically significant.

Conclusion. The conducted study confirms a high risk of developing CIB in patients with persistent UGS compared to population values what is backgrounded by the obtained statistical significance.

Introduction. Pyogenic granuloma (PG) is an acquired benign vascular tumor of the skin or mucosa, often solitary, 1.0±0.5 cm in size. Despite various methods for PG care, there is a large number of unsatisfactory outcomes. In this regard, the problem of PG treatment is still actual and requires optimization of curative options to improve clinical and aesthetic outcomes.

Purpose. To study current problems and to define prospects for PG management in children after reviewing current literature for the period 2005–2022.

Material and methods. A literature search was made in domestic and foreign databases – FEML (Federal Electronic Medical Library), eLIBRARY, PubMed for the period 2005–2022. Key words used for the search: pyogenic granuloma; lobular capillary hemangioma, laser radiation. 1224 sources of literature were studied, 59 works were included in the review.

Results. Though various techniques of PG removal are used, unsatisfactory outcomes are seen in 40% of patients; out of them up to 16% are recurrences; hypertrophic cicatricial deformities of the skin at incision areas are met in 34%.

Conclusion. Future researches are expected to develop optimal ways for removing PG in children using modern laser medical techniques adapted for this pathology so as to achieve a significant improvement in clinical and aesthetic outcomes in treating this vascular pathology in children.

Purpose. To demonstrate intraoperative variants of closed injuries of the median nerve, possible types of surgical correction, their correlation with preoperative clinical, electromyographic and ultrasound findings.

Material and methods. 10 children with closed injuries of the median nerve were examined with a score scale, electroneuromyography and ultrasound. The obtained findings were compared with intraoperative findings.

Results. Complete and deep impairments of median nerve conduction were revealed after supra-, trans-condylar fractures of the humerus and dislocation in the elbow joint many weeks and months later after the date of injury. 6 out of 10 children were operated on because of the lack dynamics in neurological symptoms. At the same time, in two cases ultrasound examination showed that the nerve trunk was completely involved in the callus and strangled; this finding corrected surgical tactics. Intraoperatively , three variants of median nerve injury were described: (1) the nerve has an angular deformation, is surrounded by bone or scar tissues, compressed and fixed to the underlying bone or soft tissues without nerve bundles damage; (2) in addition to the abovementioned, the nerve has damaged bundles with various degrees of damage; (3) the nerve is located in scars in its usual position with intact bundles and without a distinct neuroma formation.

Conclusion. Comparison of clinical, edectroneuromyographic and ultrasound findings plus intraoperatively identified variants of nerve damage allows to choose a proper surgical tactics - decompression and neurolysis with restoration of the nerve natural position in tissues, microsurgical partial autoplasty or microsurgical suture of the nerve trunk. Ultrasound examination helps to clarify indications for surgery.

Introduction. Abernethy malformation (CEPS) is a rare condition in which portomesenteric blood bypasses the liver through a partial or complete shunt into the inferior vena cava. This pathology is extremely rare in children. Clinically, it can occur almost asymptomatically or under the guise of other diseases. It is manifested by signs of hepatic encephalopathy, pulmonary hypertension or hepatopulmonary syndrome. Mesoportal bypass surgery is an option for correcting portocaval shunts with the restoration of physiological blood flow in the liver.

Since 2016, a center for treating developmental anomalies in the hepato-pancreato-biliary system in children has been operating in Filatov Municipal Children's Hospital (Moscow). To date, the center has performed more than 1,500 surgical interventions on the organs of biliopancreato-duodenal zone. For the period from 2016 to 2022, an endovascular occluder was used in 13 children with congenital portocaval shunts; surgical dressing – in 6 children.

Description of clinical observation. This article describes a clinical case of a child with a congenital portocaval shunt. A comprehensive instrumental examination revealed a complete absence of portal blood flow in the liver of a newborn baby . The spleen vein and superior mesenteric vein flowed into the inferior vena cava as a single trunk. It is believed that liver transplantation is the only effective treatment for this type of pathology. Despite the ambiguous anatomy of liver vessels, the child was operated on for the mesoportal bypass. The architectonics of child's liver was restored, and he returned to an absolutely normal life without any life-threatening factors.

Conclusion. This clinical case demonstrates the only described case of complete surgical cure of a complex liver vascular defect.

In the observation, a clinical case "fetus in fetus" in a newborn boy is described. The pathology was revealed before surgery. During the surgery, the second fetus was found in the same place, in retroperitoneal space. The multiplicity of "fetuses in fetus" has not yet been described by anyone yet, though some researchers express their opinion that such pathology is a possible option.

Over the past fifty years, a specialized pediatric surgical care in the Volgograd region has become an integral part of the life of its inhabitants. It has contributed a lot to reducing mortality and improving the quality of life of pediatric population. Graduates of the Volgograd State Medical University work as pediatric surgeons in all regions of the country and in many countries of the world. The staff of the Department of Pediatric Surgery has also contributed a lot to treating patients, to teaching future physicians using a solid foundation of scientific knowledge, their own multi-year experience and experience of their teachers.