卷 22, 编号 4 (2018)

Our aim is to evaluate the possibilities and effectiveness of computed tomography (CT) in a complex of the examination of patients with chronic recurrent hematogenic osteomyelitis of tubular bones. The effectiveness of the CT use in a complex of examination of 60 chronic recurrent hematogenous osteomyelitis of tubular bones in patients aged from 7 to 22 years was analyzed in the work. CT, in contrast to the survey X-ray, made it possible to more accurately determine the true dimensions of the destructive process in the affected bone. In all cases, CT surpassed traditional radiography in the identifying small sequesters promoting chronic inflammation and causing a persistently recurrent course of the disease. With the help of CT, delineated foci of destruction, i.e., intraosseous abscesses, were clearly visualized, whereas with the plain X-ray this substrate was not detected. The obtained data show the high resolution of the CT, to provide with complete information on pathomorphological changes in the bone. This seems extremely important for planning treatment tactics and choosing the amount of surgical intervention.

For the time present, the cochlear implantation is a widely used method of the treatment of deafness and severe hearing impairment. The operation is time-consuming and requires a long stay of the child in the hospital. The placement of the cochlear implant (CI) is executed under general anesthesia through transosseous access. The executive work of the surgical and anesthetic teams is an integral part of the successful implementation of intraoperative CI testing, on the base of results of which, in the postoperative period, there will be carried out the initial adjustment of the speech processor. An anesthesiologist should create conditions that facilitate the use of nerve stimulators in the intraoperative period and in a timely manner prevent such common postoperative complications as nausea, vomiting, and dizziness. This article provides a review of the literature of domestic and foreign authors on the issues arising in anesthesiologists during the implementation of cochlear implantations and the ways of their solutions. It is considered what difficulties can arise during the installation and initial adjustment of CI, as well as what anesthesia complications are most frequent in operations of this type. After studying the results of the work of different authors, the initial adjustment of the CI in the anesthetic management under the control of BIS and TOF monitoring was concluded to be performed at a higher level, and the timely and targeted administration of various drugs, at certain stages of anesthesia, contributed to the decline of the complications rate in the postoperative period.

Funnel-shaped deformation of the chest (pectus excavalus) is a congenital pathology of the anterior thoracic wall, manifested by the retraction of the sternum and sternocostal cartilages in various forms and degrees. There are many options for correcting this deformation, which can be conditionally divided into open and minimally invasive methods. In the leading clinics for this pathology, there is recently used the most minimally invasive method of correction by Nass. Unfortunately, for today there is no the only as an algorithm for preoperative examination of patients with this pathology, as well as the decision on the choice of surgical correction method.

Tumors of the ovaries in girls represent an actual problem in modern gynecology. First of all, this is due to diagnostic difficulties, caused by the absence of characteristic complaints, asymptomatic course and the complexity of the gynecological examination, which leads to making of an erroneous diagnosis, the lack of correct and timely treatment and, as a result, complications that often negatively affect the reproductive function of the female patient in further. The differential diagnosis of ovarian tumors in girls is still one of the most important problems of modern practical gynecology. In many patients, the presence of a combined pathology, which is 30-40% according to WHO data, puts the problem of the possibility of simultaneous correction of such pathology by both surgeons and gynecologists. In connection with the difficulty of diagnosing, the diagnosis of such patients must necessarily include an examination of a pediatric surgeon and a children’s gynecologist with ultrasound examination of the retroperitoneal space, abdominal cavity organs, and small pelvis. Errors in the differential diagnosis of genital and extragenital diseases occur quite often and are mainly due to the similarity of clinical symptoms. This article presents a clinical case of the diagnosis and management of a 14-year-old female patient with an adjacent diagnosis, as well as criteria for the diagnostic search for the differential diagnosis of gynecological and surgical pathologies.

The article presents a clinical case of treating a newborn with the large cystic formation of the spleen. Indications for the operation were volume formation of more than 5 cm, a threat of rupture of the cyst with subsequent bleeding. Laparoscopic fenestration of the spleen cyst with a favorable outcome was performed.