Vol 27, No 4 (2023)

Introduction. The most common reason for young children to seek medical aid in hospitals is head injuries caused by falls from a small height. Currently, computed tomography (CT) of the head is a preferred method for rapid detection of bone fractures and brain injuries in children.
Purpose. To investigate specific features of CT signs of intracranial hemorrhages in children with TBI under three years of age.
Material and methods. 1334 children aged less than one month to 3 years with isolated TBI were examined at CT scanning. 128-slice scanner "Ingenuity CT" (Philips) was used for the examination. Scanning of the area of interest (head + cervical spine) was performed at the lowest possible values to reduce radiation exposure, including the O-MAR program, with step 0.75 mm at slice thickness 0.75 mm; reconstruction interval was 2 mm. The voltage applied to an X-ray tube during scanning (kV), current strength and time (mAS) were selected depending on patient's weight and age. The effective dose range was from 1.27 mSv to 1.91 mSv.
Results. In 510 out of 1334 injured children (38.2%), there were traumatic injuries of various degree, from uncomplicated cephalohematomas and linear fractures to massive intracranial hematomas and total cerebral edema; the rest 61.8% (n=824) had concussion. The performed CT scanning revealed that 87.84% (448/510) children had skull fractures, of which only 18.3% (82/448) had “isolated skull fractures”; the others (366 = 81.7%) had accompanying intracranial injuries.
Discussion. Pathological changes in children, aged 0 mon-3 years, after TBI are significantly different of those in children of other age groups. CT is the basic primary diagnostic instrument and should be used in all children with TBI no later than the first three hours. Radiation diagnostics play a key role in putting a correct diagnosis, if physicians use the information obtained at CT and know TBI mechanism in infants and little children.
Conclusion. CT is an imaging method of choice for acute TBI in little children to accurately identify and therefore treat intracranial lesions. In addition, CT is an effective diagnostic tool in detecting secondary traumatic injuries.

Introduction. Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are extremely rare vascular tumors characterized by pathologically progressive angiogenesis and lymphangiogenesis. They are also associated with the development of the KazabachMerritt Phenomenon (KMP; Kasabach-Merritt Phenomenon).
Material and methods. 8 patients (5 boys, 3 girls) with kaposiform hemangioendothelioma (two out of them with Kazabakh-Merritt syndrome) and 4 patients (3 boys, 1 girl) with tufted angioma were treated at the Russian Children's Clinical Hospital of Pirogov Russian National Research Medical University (Moscow, Russia) . All patients were prescribed Sirolimus therapy for antiproliferative purpose.
Results. In all children, positive changes were registered: reduction of vascular tumor volume, gradual improvement of clinical picture and control of complications: pain syndrome, KMP, improvement or restoration of functions in affected organs /systems (increase/restoration of movement volume in joints, compensation for length discrepancy in lower legs). Complete resorption of vascular tumors and clinical symptoms were registered in 3 patients.
Conclusion. The obtained encouraging results after Sirolimus therapy prescribed for treating KME and TA allow the authors to recommend this therapy to patients with KME with or without KMP and TA. However, further researches with a large sample of participants is required to confirm the obtained results.

Introduction. The linear type of capillary angiodysplasia (LCA) is represented by pathologically dilated vessels of the capillary flow located between the epidermis and hypodermis. LCA may be both congenital and acquired. By the type of blood supply, LCA are arterial, venous and mixed. Local infections and injuries, excessive solar insolation and hormonal imbalance are noted among LCA causes. LCAs are benign lesions, but they may have complications which may be triggered, for example, by traumatic damage to a pathologically enlarged vessel. There is a large number of non-invasive and invasive curative methods of LCA removal: cryotherapy, electrocoagulation, sclerotherapy, laser photodestruction and others. Among disadvantages, various authors mark: high risk of scarring, hyperpigmentation and high rate of disease relapse.
Purpose. To improve results of treatment of children with LCA by using laser light.
Material and methods. 32 children having LCA were treated with transcutaneous selective photodestruction ( green laser light, wavelength of 520 ± 10.0 nm generated by Russian-made laser device "Malachit") in Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in 2021–2022.
Results. After treatment, 31 child had good results without residual vascular elements and scar deformation in the photodestruction zone. One patient required a repeated laser session because of remained residual elements after which she also had good results.
Conclusion. The presented clinical trial has demonstrated that transcutaneous selective laser photodestruction with consideration of spatial localization of LCA structural elements in the skin, provides a precise treatment of pathological dilated vascular structures, practically without skin damage, and allows to achieve radical good clinical and aesthetic outcomes.

 Dear colleagues, in this issue we continue the discussion started in the 3^rd issue of 2023 with the publication of the article "Closed injuries of the median nerve in children: tactics, operation options" and the opinion of experts on the data and conclusions of this work. 

Introduction. Foreign bodies in the gastrointestinal tract (GIT) is a serious problem in pediatric surgery. In recent years, the incidence of cases when children swallow magnets has increased significantly. Foreign bodies in the stomach, small and large intestines can cause their perforation.
Purpose. To demonstrate a successful endoscopic removal of multiple magnetic foreign bodies which were in the stomach of a 2–yearold child for a long time.
Description of clinical observation. Boy, 2 y.o., was admitted by the ambulance to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in Moscow with suspected presence of multiple magnetic foreign bodies in the stomach and complaints of melena during the last 2 months, about which his parents repeatedly consulted their pediatrician. Two days before the admission, the parents found several magnetic balls in child's faeces and decided to visit the pediatrician for the second time. This time the child had X-ray examination and was transferred to the hospital. At the survey radiography and ultrasound examination of the abdominal cavity, the diagnosis of multiple foreign bodies in the stomach was confirmed. Esophagogastroduodenoscopy revealed a conglomerate of multiple magnetic foreign bodies that filled ½ of the stomach lumen. Under general anesthesia, 209 pieces of magnetic beans were endoscopically removed. Postoperative course was uneventful.
Conclusion. If there is the slightest suspicion of a foreign body in the gastrointestinal tract and if there is a clinical picture of gastrointestinal bleeding, the child must be sent to surgical hospital for further examination and, if possible, for endoscopic management.

Introduction. Among congenital and acquired malformations in the urinary system organs, one of the topical issues is the choice of management modalities in bladder diverticulum. Modern equipment and development of minimally invasive techniques have expanded the variability of curative approaches, which is especially important for children with comorbidities.
Purpose. To optimize surgical treatment of children with bladder diverticulum using minimally invasive surgical interventions, to reduce the rate of intraoperative and postoperative complications as well as to improve endovideosurgical access for the successful implementation of reconstructive interventions based on the authors' analysis of their own material on treating children with bladder diverticula.
Material and methods. Five patients of different age having a bladder diverticulum with various anatomical features and with comorbidities were treated at the surgical department of St. Luka Clinical Research Specialized Center for Children (Moscow, Russia) in 2021–2022. The researchers could find the principle for selecting a proper surgical modality after they had assessed positive and negative aspects of each type of surgical access.
Results. While choosing the type of surgical access in the discussed patients, the authors took into account anatomical features, concomitant pathologies, findings of instrumental diagnostics. As a result, all patients had good outcomes. The authors demonstrated a successful application of endovideosurgical techniques in the management of patients with congenital bladder diverticula after they had analyzed their own clinical material. They also described effective techniques for reconstructing ureterovesical anastomosis area with consideration of its place in relation to the diverticulum.
Conclusion. The pneumovesicoscopic access for congenital bladder diverticulum removal is the most rational one, as it allows to accurately restore the relationship of anatomical structures.