卷 24, 编号 3 (2020)

Introduction. Infantile hemangioma (IH) is the most common benign vascular tumor of childhood. Currently, the first line of IH therapy are beta-blockers (Propranolol, Atenolol). However, their application may cause some complications, like cardiac, pulmonary and others. Practitioners who are engaged in HI therapy should be well aware of criteria for prescribing such treatment. Up to now, there are no uniform criteria anywhere in the world when to start and to finish the systemic therapy with beta-blockers. Material and methods. We have developed a rating scale for determining indications for IH systemic treatment with beta-blockers which includes the following parameters: IH volumetric component (thickness), child’s age, IH location, IH dimensions, number of IH on the skin and complications. A physician examines a patient, analyzes the abovementioned criteria and summarizes scores. During the period from October 1, 2018 to May 31, 2019, the Center for Vascular Pathology conducted 923 initial consultations for children using an assessment scale (main group). During an 8-month period from February 1, 2018 to September 30, 2018, 879 children consulted without using an assessment scale were included in the comparison group. Results. After analyzing results in two compared groups , one can see a clear decrease in prescription of the medicamentous therapy by 1.5 times: from 43.3% to 27.3%. Conclusions. The discussed rating scale, developed for determining indications of IH systemic treatment with beta-blockers, objectively and reliably evaluates prescription of medicamentous therapy not only due to physician’s experience but also due to summarized indicators. Such an approach can produce a positive effect at the disease course. However, it is worth reminding that the proposed scale is more a proposed direction in choosing a technique for IH treatment.

The aim of the study was to study the formation of urination in young children, taking into account perinatal factors. Material and methods. the pattern of urination was studied in 42 patients at the stages of antenatal observation, after birth during the first year of life and at the age of three. Clinical evaluation of urination was performed in young children using a developed qualimetric table that takes into account the volume of the bladder and frequency of urination, the nature of urination, the presence of urge to urinate and behavioral reactions. At the age of three, a qualimetric table was used to evaluate E. L. Vishnevsky’s urination (2001). The observation group consisted of 42 patients whose urination pattern was studied at the stages of antenatal observation, during the first year of life and at the age of three. The features of the course of the antenatal and postnatal period of children’s development were taken into account: pregnancy complications, fetal pathological conditions, features of the morpho-functional state of infants, and neurological comorbidities. Results. According to the results of clinical evaluation of urination in children at 3 years of age, 3 groups of children were identified: with “Mature”,”delayed formation of “Mature” type of urination”, as well as “dysfunctional type of urination”. Conclusions. the manifestations of “maturity of urination” in infants at the age of 1 year are the compliance of hydrodynamic indicators with age standards, the formation of continuous urination, signs of controlling behavior: behavioral reaction to the urge, the absence of” missing urine “during the day, during daytime and nighttime sleep, “urination on request”. The “delay in the formation of mature urination type”, the formation of “dysfunctional urination type “ revealed the determining influence of the pathological course of the antenatal period of child development, the implementation of signs of pathological fetal urination, the presence of neurological symptoms and signs of morpho-functional immaturity of the postnatal period. “Dysfunctional urination” was manifested by: a decrease in the capacity of the bladder and the discrepancy between the hydrodynamic characteristics of the age parameters; monotony of the volume characteristics of the bladder during the day; imperative contractions of the bladder, that is, the presence of “wet gaps” between urination; urination during sleep; as well as a delay or lack of urge to urinate, behavioral responses and neatness skills.

Purpose. to analyze the effectiveness of soft tissue surgical correction of equine-flat-valgus-feet deformity in children with cerebral palsy. Material and methods. A retrospective analysis of clinical and X-ray findings of 47 patients (86 feet) with equino-flat-valgus deformity was performed. All patients were treated surgically. They were divided into two groups by age: Group I - 23 children (4-7 y.o.); Group II - 24 children (8-11 y.o.). The neurological status was examined in patients with the motor development of level I - III (by GMFCS classification) who had hemiparesis, diplegia and tetroparesis. A comparative analysis was made with a reference group which consisted of 30 children (56 feet), aged 4-11, who had exostotic chondrodysplasia or trauma of the ligamentous apparatus in one foot without neurological pathology and feet deformities. Results. One year after surgery, a significant improvement in clinical and radiological parameters comparing to preoperative findings was registered in patients of both studied groups. Most parameters were close to the established reference intervals. In Group I, three years later at the follow-up examination no significant difference was revealed in similar parameters obtained three years later and one year later after the surgery. However, in Group II three years later a negative dynamics was seen in most of studied parameters when compared with reference values and with results of the first postoperative year. Such outcomes demonstrate high efficiency of soft foot tissue surgery in children under 8. A significant decrease in clinical and radiological parameters after similar amount of surgical correction in children of primary school age (8-11 y.o.), which were under the long-term observation, may indicate the ineffectiveness of such techniques at this age. Evaluation of the functional status by the Gillette functional assessment scale three years after the surgery revealed the increased functional status in 78.26% of patients from Group I and in 41.66% from Group II. In some children from Group II (primary school age), there was a negative dynamics in their functional status. Conclusion. In generally, the obtained data indicate good prospects for improving the functional status in the postoperative period in children of both groups. However, the existing negative dynamics in children from Group II (8-11 y.o.) indicates a weak prospective for a long-term surgical deformity correction of the foot ligamentous apparatus because the coming period is a period of rapid growth and increased loading on the musculoskeletal system of a child with cerebral palsy.

New approaches to the treatment of meniscus lesions is currently a hot topic in traumatology and orthopedics. Meniscus resection and suture issues are widely discussed and studied in modern literature. Current trends in the care of meniscus pathologies are aimed to restore the structure of the damaged segment by stitching it using various techniques. A classification scale plays an important role in the treatment of any disease because it allows to uniformly describe the main criteria of pathology and to define a treatment tactics. The given review describes modern classifications of meniscus lesions with their advantages and disadvantages.

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.