卷 24, 编号 1 (2020)

Introduction. Malformations of the anterior abdominal wall in newborns is one of the actual problems in neonatal surgery. Antenatal diagnostics of such defects as omphalocele and gastroschisis allows to diagnose and perform necessary surgical interventions in time. Often, outcomes of treatment of newborns with embryonic hernia depend not only on the form of the defect, but also on the accompanying abnomalies. Purpose. To present outcomes of surgical treatment of newborns with anterior abdominal wall malformations. Material and methods. From December 2017 till May 2019, 34 pregnant women with fetal anterior abdominal wall malformations were consulted; 17 out of them with omphalocele and gastroschisis were treated. Results. In December 2017, the surgical department for newborns and infants at the National Medical Research Center for Children’s Health successfully helped children with malformations of the anterior abdominal wall. 16 children were discharged home in a satisfactory condition; there was one unsatisfactory outcome. 11 patients were treated for gastroschisis; 6 patients were treated for omphalocele. 3 patients had repeated surgeries for concomitant pathologies. There were no any adhesive processes and commissural intestinal obstruction. Conclusions. In Russia, there are two groups of newborns with anterior abdominal wall defects: children with isolated defects and children with concomitant pathologies who have an increased risk of unsatisfactory outcomes. The technique developed by us for treating newborns with anterior abdominal wall malformations and concomitant pathologies has very good cosmetic and functional results and reduces the number of postoperative complications and unsatisfactory outcomes.

Purpose. To improve the quality of treatment of patients with liver echinococcosis by optimizing postoperative chemotherapy. Material and methods. 226 patients with liver echinococcosis were admitted to the surgical department of the 2nd Clinic of the Samarkand State Medical Institute in 2009-2017. Patients were divided into two groups. In 2009-2012, 112 (49.5%) patients were operated on and were included into a control group. In 2013-2017, 114 (50.5%) patients were followed -up and were included into a study group. In the control group, postoperative chemotherapy was made by the standard protocol. In the studied group, Albendazole dosage was corrected according to the initial functional state of the liver. Due to positive findings in the experimental group, Albendazole was used at the dosage 5 mg / kg / day in patients with verified chronic liver disease and if liver enzymes were elevated before surgery. Results. Adverse reactions of Albendazole chemotherapy, by clinical and laboratory parameters, could develop in 52.7% - due to the preparation toxic effect and concomitant chronic diffuse liver pathology- while under dose correction, this figure is reduced to 18.3%. Conclusion. The proposed dose correction in patients with signs of liver insufficiency normalizes biochemical parameters and reduces toxic manifestations during chemotherapy. Of these 144 patients, long-term observations revealed echinococcosis relapse in 6 (4.2%) patients.

Relevance. Children with acute and chronic paraproctitis constitute 1-3% of hospitalized subjects with purulent surgical infection. Purpose. To study specific features of paraproctitis in children and to analyze outcomes of treatment. Material and methods. Case-histories of 218 children with acute and chronic paraproctitis were analyzed. Microbiological culture for pathogen identification was taken from paraproctitis focus, breast milk, from feces for conditionally pathogenic flora. The researchers also studied anamnesis, type of feeding, results of ultrasound examination of the perianal area and histological test of the material taken during surgery. Results. Patients with subcutaneous and subcutaneous-submucous paraproctitis constituted 95.5% [1]. The majority of patients with subcutaneous and subcutaneous-submucous paraproctitis - up to 62,5% - were children of the first 6 months of their life. The researchers defined age and etiopathogenic aspects of paraproctitis in children; the impact of provoking factors at acute paraproctitis as well as the specificity of chronic paraprocitis course and its treatment. 76 patients with acute paraproctitis had bottle and mixed feeding for the first 6 months of their life with further developed intestinal dysbiosis. In 112 children, conditionally pathogenic microorganisms were identified in 91 (81,2%) at the first year of their life. Ultrasound examination was sensitive for acute and chronic paraproctitis in about 90% [2, 3]. With the developed intestinal dysbiosis and immunological features of children at their first year of life , the process of acute paraproctitis was caused by the causal anal crypt and abnormal ducts of anal glands. It is considered to be the first step in fistula formation (fistulous abscess) [4-6]. The Gabriel surgery performed in acute paraproctitis was pathogenically verified because due to it one of the pathogenic steps was erradicated- pararectal fistula formation [7-11]. Disease relapse (pararectal fistula) was met in 7 patients. In average, hospitalization lasted for 7.1 days in acute paraproctitis and 8.4 in chronic paraproctitis. Conclusion. On analyzing etiopahogenic features of acute subcutaneous and subcutaneous-submucous paraproctitis, the authors recommend to perform a one-step surgical intervention.

This article includes studies which meet the requirements of evidence-based medicine and is written for resuscitation and intensive care unit staff. Articles from PubMed database were used in it. The review of the relevant literature is aimed at practitioners and nurses. These recommendations reflect the current scientific and clinical knowledge base. In everyday practice, the differences and limitations of thermal monitoring and the application of thermoregulatory effects in each individual patient should be taken into account. These recommendations should not be construed as a mandatory protocol of action, and the use of these recommendations does not guarantee a specific clinical outcome. There is no conflict of interest.

Chronic liver diseases in children are characterized by a progressive course and lead to fibrotic changes in the organ up to cirrhotic transformation. Therapy effectiveness and patient’s quality of life depend on timely verified diagnosis and stage of the process. Morphological examination of hepatobiopsies remains a key issue in the diagnostics of histopathological changes in the liver; however, biopsy sampling is associated with a risk of complications and does not exclude insufficiently informative biopsies. This article discusses three clinical cases of patients in whom a personalized choice of the way of biopsy sampling allowed to avoid life-threatening complications and to obtain the most informative biopsy material.

The article describes a clinical case of mesenteric lymphangioma in the small intestine in a 5-year-old child who had an acute abdominal syndrome. The lymphangioma was removed. The postoperative period was uneventful. Patient’s condition was satisfactory within the next 6-months of follow-up; there were no any complaints either.