卷 22, 编号 2 (2018)

67 purulent peritonitis children (excluding newborns) aged of from 1.5 months to 15 years treated in the hospital from 2007 to 2016 for gastric or intestinal perforation at different levels were examined. These children were divided in 2 groups of patients with purulent peritonitis, matched for the gender, age and severity of the disease. The control group of the examined patients comprised 36 children, who were treated in the period of 2007-2012 for a purulent peritonitis of non-appendiceal genesis. The main group of cases included 31purulent peritonitis patients with perforation of the stomach or intestines, who was treated during the period of 2012--2016. In all 67 patients in both groups, the causes of perforation of the hollow organs - the stomach, small intestine or large intestine - with the development of purulent peritonitis were detected and remained the same for years. The severity of the course of purulent peritonitis of non-appendiceal genesis and the difficulty of treating such patients mostly depended on the patient’s age, disease nosology and background diseases. The basis for successful implementation of the treatment is the difference in the etiology of the disease and the degree of danger of the pathogen of the purulent process, depending on the level of perforation of the intestinal tube. Virulence of the pathogen and antibiotic susceptibility of purulent mono- or mixt-infection significantly influenced the severity of purulent peritonitis and the outcome of the treatment. The authors developed and proposed a complex of the differentiated etiopathogenetic treatment of patients with purulent peritonitis of non-appendiceal genesis with a decrease in the mortality rate. The basis for the successful implementation of the treatment is the difference in the etiology of the disease and the degree of danger of the pathogen of the purulent process, depending on the level of perforation of the intestinal tube.

The aim of the study was to study the changes in tissues after interstitial administration of aethoxysclerol (5 and 10 mg/ml) in comparison with 70% ethanol in the experimental model of hemangioma (chicken caruncle). After the introduction of 70% ethyl alcohol into the chicken, disintegration of fibers and amorphous substancecaruncle from the 1st day, thrombosis of large and small vessels, perivascular edema of connective tissue were detected. By the 14th day, there was observed necrosis of the caruncle tooth, into which ethanol was injected. By the 21st day, under the area of necrosis, in the part of the scallop, a coarse keloid scar was formed with deformation of the tissues. Introduction of aethoxiclerol in dose of 5 mg/ml into the caruncle led to the compaction of the structure of the caruncle due to the proliferation of fibrous tissue. Partial thrombosis of small and large vessels of both superficial and deep layers of the caruncle was observed with a small number of inflammatory cells. By the 21st day, the compaction of the tissues was combined with the large-lamellar desquamation of the caruncle on the site of infiltration of the drug without necrosis. In the fibrous-fat layer, there was a substitution of fat tissue by fibrous, which was distributed evenly. In the dynamics, there was an increase in the compaction of all the layers of the caruncle without formation of the coarse scar tissue. An increase in the dose of aethoxysclerol to 10 mg/ml was accompanied by necrosis and gross morphological changes, similar to the administration of 70% ethanol.

Our goal was to develop objective criteria for early diagnosis of acute hematogenous osteomyelitis (AHO) of bones of the hip joint (BHJ)) in children. For the differential diagnosis between AHO and the reactive coxitis (RC) we examined a total of 93 children (61 AHO BHJ and 32 RC cases). AHO BHJ patients are characterized by a higher degree of endogenous intoxication when compared with RC patients. CT allows diagnose AHO BHJ before the appearance of radiological signs (starting from 3 days from the onset of the disease) in the bone tissue and can be used to differentiate AHO BHJ from RC. These features allow using these parameters as objective criteria for the differential diagnosis in children with acutely developed pain in hip joint area

The aim is a demonstration of a rare clinical observation of cystic ileal duplication with a complex diagnostic search of the common source of recurrent bleedings. The boy of 7 years was on the treatment at the Research Institute of Emergency Pediatric Surgery and Traumatology due to frequent recurrent gastrointestinal bleeding. There was performed a comprehensive examination, including laboratory and instrumental methods: common blood and urine test, biochemical blood tests, x-rays of the abdomen, scintigraphy, ultrasound of the abdominal organs, esophagogastroduodenoscopy, colonoscopy, video capsule endoscopic study. Results. The complex diagnostic search was performed. On the basis of the video capsule endoscopic examination and radiography of the abdominal cavity there was suspected the cystic duplication of the ileum with ulcerative defects as the source of bleeding. Upon completion of the examination and relief of post-hemorrhagic anemia there was executed the surgical treatment with resection of the changed area of the intestine and anastomosis “end to end”. The postoperative period was uneventful. Conclusion. Recurrent intestinal bleedings and bowel obstruction can be a complication of such rare malformation of the intestinal tube as the intestinal duplication. The use of modern diagnostic and surgical technology provides timely and minimally invasive treatment that leads to the rapid patient recovery, decline in overall costs and the cost of treatment.

The authors present an observation of the 3-year-old child with the perforating wound of the posterior pharyngeal wall caused by a drumstick, happened in the mouth during the fall. Starting mediastinitis was managed to stop with a massive antibiotic therapy and parenteral nutrition of the child, and then nutrition via a nasogastric tube.