卷 22, 编号 5 (2018)

The possible risk of the development of hypogonadism, infertility, and malignant neoplasm of the testicles in adults dictates the need to develop and implement diagnostic criteria. The identification of such morphological signs as a decrease in the number and diameter of the tubules, the number of germ cells, the development and progression of fibrosis of interstitium may have prognostic significance. The aim of the study is to develop morphological criteria for assessing the severity of testicular hypoplasia in cryptorchidism in children of different age groups. Material and methods. In the study there were identified three groups, taking into account the age of children with cryptorchidism. Group, I included 12 (34.3%) children aged from 1 to 3 years. Group II was presented by 14 (40%) patients aged from 4 to 10 years. Group III included 9 (25.7%) patients aged from 11-14 years. Results and discussion. Morphological changes in the testicle in cryptorchidism children of different age groups vary: in Group I moderate and pronounced structural changes were detected in 53% of cases, in group II - in 50% and in group III - in 72% of cases. Taking into account the morphological criteria of testicular tissue hypoplasia, in our study in cryptorchidism children, hypoplasia of the mild degree was revealed in 17.1% of cases, a moderate degree - in 31.4%, a severe degree - in 31.4% of cases. Conclusion. Morphological criteria for estimating hypoplasia and grading of the severity of hypoplasia of testicular tissue were determined on the basis of a scoring of morphological characters and morphometric indices.

The pediatric surgeon in his work has to face a wide variety of diseases related to narrow areas of medicine. Particular difficulties are caused by the diagnosis and treatment of thyroid gland formations (TGF). The number of such patients is steadily growing both in the Russian Federation and in the Altai Territory, due to iodine deficiency, radiological and environmental pollution and other possible causes. In the Children’s Surgery Clinic of the Altai State Medical University, 101 children aged from 5 to 17 years were treated in the period from 2000 to 2017 due to thyroid lesions. The study included operated patients with both benign formations and with follicular and papillary carcinoma:. Depending on the case, a different volume of surgical intervention was used: mainly, hemithyroidectomy with isthmectomy and total thyroidectomy. In the work the analysis of own results of the treatment is carried out, comparison with widely known approaches of the management of patients with TGF is given. We are of the opinion that the desire for radicalism does not always yield the best results. Thus, we consider it quite justified to perform organ-preserving operations in both follicular and papillary thyroid carcinoma. Difficulties in deciding the extent of the intervention are also caused by the inability to differentiate the form of thyroid mass before the operation. In addition, the hormonal status of the child in the postoperative period requires special attention, and the use of hormonal therapy in the absence of hormonal disorders pushes to doubt its necessity. A number of features in the operational process allows achieving good results. Thus, the choice of tactics for treating children with thyroid disorders should be advisedly and carefully considered taking into account the characteristics of the child’s organism and the specific situation.

Varicocele is a frequent pathology of the testicles, detected during preventive examinations and subsequently often associated with infertility. The most common is the left varicocele. This review presents anatomical features and basic pathophysiological mechanisms promoting the development of varicocele in childhood. For proper treatment of this pathology, a careful approach to the examination and determination of the indications and tactics of the planned surgical intervention is necessary. There is a lot of disagreement about the need, time and technique of the intervention. The practitioner should balance the pros and cons of timing and treatment options.

Extensive jejunal and colonic intussusception is a rare type of intestinal impaction. The aim of the work is to present a therapeutic-diagnostic algorithm for an atypical clinical picture of a rare form of intussusception of intestines (II) in a child of 4 months. A clinical observation of extensive ileocolic intussusception was carried out in a 4-months-old child admitted to the clinic to exclude craniocerebral trauma 34 hours after falling from a height of 1 m. Results. The main reason for seeking medical help was repeated vomiting and lethargy in a child, occurred one day after the fall. The identification of bloody discharge from the anus was a reason for excluding II. The consecutive use of ultrasound, colonoscopy made it possible to confirm the diagnosis, diagnose irreversible circulatory disorders in the invaginate and determine the indications for laparotomy. The absence of peritonitis allowed performing a resection of the necrotic area of the intestine with the application of intestinal anastomosis after desintussusception. Factors provoking the disease were the introduction of a new nutritional formula in the diet and the “lead point” in the form of a Meckel›s diverticulum Conclusion. The symptom of “blood in the stool”, even in the absence of a typical clinical picture, requires the exclusion of II. The diagnostic arsenal (ultrasound, colonoscopy, laparoscopy) in a specialized hospital with rare forms of II allows short-term diagnosing and choosing a rational surgical tactic. The absence of peritonitis during resection of the necrotic area of the intestine makes it possible to perform the anastomosis.