Vol 29, No 3 (2025)

Background: Currently, restoration of bone tissue damaged in injuries and surgical interventions remains an urgent problem in medicine. Combination of titanium nickelide with added silver seems a promising one in terms of decreasing the inflammatory process, speedy regeneration and restoration of damaged bone tissue function.

Aim: To find out levels of possible acute systemic and subacute toxicity of the innovative titanium nickelide alloy with silver in an experiment on laboratory animals.

Methods: The study of acute systemic toxicity was carried out in white outbred mice (17–23 g). Acute systemic toxicity was studied in white outbred mice (17–23 g). Supernatant liquid of titanium nickelide alloy powder with water-based 0.5% silver was injected into the tail vein (n=10), non water-based ― intraperitoneally (n=10), in volume of 50 ml/kg. In the control group (n=10), the same substance was used , but without silver. To identify the subacute toxicity, studied samples were sewn into the thigh muscles of Wistar rats (250–320 g): three experimental groups (n=10) ― titanium nickelide with 0.3% silver, 0.5% silver and 0% silver. The fourth group (n=10) ― controls (wound modeling without powder injection). After 28 days, the animals were removed from the experiment, and hematological and biochemical blood tests were performed.

Results: No animal deaths or adverse clinical signs were recorded following the acute systemic toxicity test. The number of erythrocytes in the blood of experimental animals after intramuscular administration of titanium nickelide with 0.5% silver was significantly higher than in the control rats, but remaining within the normal limits for this indicator. A moderate decrease in platelet levels in the animals treated with titanium nickelide and 0.3% silver may be explained by anti-inflammatory activity of the sample. Urea concentration in the blood of animals after sewn-in titanium nickelide with 0.5% silver was significantly lower than in control animals (p=0.019), which may be due to increased silver concentration in the alloy; however, it requires further research.

Conclusion: New materials based on titanium nickelide with added silver do not have acute systemic or subacute toxicity.

Meckel's diverticulum is a common pathology in urgent pediatric surgery. Despite a high frequency, its diagnostics is still not easy. It applies to its visualization both as an intact anatomical formation without clinical manifestations and with complications.

The mentioned above indicates the necessity to improve diagnostic tools for such patients and is of interest to practicing surgeons. In this literature review, the authors analyzed publications on Meckel's diverticulum diagnostics in source engines like PubMed, GoogleScholar, Cochrane and Scientific Electronic Library eLIBRARY.ru, using keywords "Meckel's diverticulum", "diagnostics", "complications", "diverticulitis", "bleeding", "ultrasound", "scintigraphy", "computed tomography". 195 publications related to the review topic were identified. 44 works corresponding to the review purpose were selected for citation. Large series of observations and rare cases of Meckel's diverticulum in young children are included too.

The authors have analyzed potentials of various diagnostic methods, such as radiography, ultrasound, computed tomography, scintigraphy, and less commo ― endoscopic examination, angiography. They also have analyzed their effectiveness depending on the form of pathological changes and patient’s age. Direct and indirect symptoms detected with the discussed methods are described as well. Ultrasound has low sensitivity, no more than 50%; however, the diagnostic efficiency increases after the detection of not only an inflamed infiltrate with expanded intestinal loop, but also with the detection of an unchanged vermiform appendix under inflammatory changes in the abdominal cavity. Due to this, physicians, using the method of exclusion and rejecting appendicitis as the most probable source, look for other causes of the acute process in the abdominal cavity. Computed tomography, despite its high resolution, does not significantly add to the efficiency of diagnostics.

Technetium scintigraphy increases diagnostic capabilities and is the gold standard in diagnosing Meckel's diverticulum, but has a high selectivity depending on the clinical course and the presence of ectopic tissue in the diverticulum wall, which limits its diagnostic effectiveness. In addition, this method is not available everywhere in Russia; the lack of technical capabilities in some regions lowers its diagnostic potentials. Other diagnostic options are either at the experimental stage or have been poorly tested in pediatric population what does not allow to speak convincingly about their effectiveness and recommendations for application. All the above leaves the problem open and requires searching for new solutions or improving the effectiveness of existing diagnostic tools.

The first edition of the clinical guidelines on anterior abdominal wall hernias, developed by specialists from the Russian Association of Pediatric Surgeons, includes information on the diagnosis and treatment of this disease. The authors used data of domestic and international clinical trials, including systematic reviews and meta-analyses.

The clinical guidelines underline the role of ultrasound examination of the scrotum organs in diagnosing the inguinal hernia, if findings of clinical examination of a child are doubtful. Criteria and indications for emergency and conservative treatment of a strangulated inguinal hernia are described. In case of oblique hernias, the treatment is directed to disconnecting the communication of the vaginal process of the peritoneum (which is in fact a hernial sac) with the abdominal cavity, so as to prevent protrusion of the abdominal organs through the inguinal canal. The authors underline that despite the fact that the only effective method of treating inguinal hernias is a surgical one, still the choice of a surgical technique depends on the surgical team and resources of their medical setting.

In addition to inguinal hernia, the presented clinical guidelines describe basic modalities for diagnosis and treatment of umbilical hernia and hernia of the white line of the abdomen.

Adnexal torsion in preschool girls is rare, and diagnosis is difficult due to the lack of pronounced clinical manifestations. The pathology is more common on the right side, which is due to the anatomy of the pelvis, and the clinical picture can be mistaken for acute appendicitis. Adnexal torsion is characterized by impaired blood supply and rapid development of necrosis in the affected organ, which requires emergency surgical intervention.

The article presents a case of late diagnosis and treatment of a 3-year-old girl who was admitted to the Children's Republican Clinical Hospital in Saransk by an ambulance team with complaints of intermittent, sharp abdominal pain and a preliminary diagnosis of acute appendicitis. During a diagnostic ultrasound examination using color Doppler mapping, signs of a structurally altered right ovary without a vascular pattern were detected. Intraoperatively, a diagnosis of torsion, necrosis of the right uterine appendages, and secondary appendicitis was made.

This case of a long diagnostic journey, complicated by the vague clinical picture of torsion combined with inflammation of the appendix, highlights the importance of both clinical and instrumental findings in young children with suspected urgent conditions. Despite the fact that the patient was discharged with improvement under the supervision of a district pediatrician, the girl's reproductive health was affected due to the long diagnostic process caused by the subclinical form of the disease.

Thus, when abdominal pain occurs, given the importance of reproductive health for girls, doctors need to be particularly vigilant in order to detect and treat the disease promptly using organ-preserving methods.

Inflammatory bowel disease occurs in approximately 4–5 children per 100,000, and its course is more severe than in adults. Inflammatory bowel disease is predominantly diagnosed in boys aged 11–17 years, but data on the incidence of very early onset (before 6 years of age) remain contradictory. The gold standard for diagnosing inflammatory bowel disease is endoscopic examination with colon biopsy, but invasive methods are avoided in young children due to technical difficulties and risks, and often due to parental refusal. One possible explanation for the delay in diagnosing inflammatory bowel disease is the nonspecific nature of its symptoms (abdominal pain, blood in the stool, diarrhea, perirectal abscesses), which can easily be confused with more common conditions such as irritable bowel syndrome or polyps. Nonspecific symptoms, complicating the diagnostic search, lead to late diagnosis and delayed proper treatment. The most serious complication of the long-lasting untreated disease is intestinal strictures, which over time lead to a violation of the passage of intestinal contents and require surgical intervention, which negatively affects the functions of the intestine (absorption and motor) and leads to the worsened quality of life.

The article describes a clinical case of inflammatory bowel disease in a child aged 2 years 10 months, admitted to Filatov City Clinical Hospital in Moscw with complaints of blood in the stool. Only 3 months after the initial visit to doctors, colonoscopy was made which showed endoscopic and morphological signs of inflammatory bowel disease. After a number of conservative measures, the stool became semi-formed, without signs of bleeding. The child was discharged in a satisfactory condition with recommendations to continue symptomatic therapy under the supervision of a district gastroenterologist and pediatrician.

Thus, underestimation of inflammatory bowel disease as a possible diagnosis at an early age threatens the transition of an acute condition to a chronic one with its subsequent deterioration. Increasing the alertness of outpatient doctors, if a child has non-specific complaints, will allow timely diagnostics and selection of the adequate treatment.