卷 28, 编号 2 (2024)

BACKGROUND: The diagnostics of necrotizing enterocolitis is a complex and often ineffective issue. Biomarkers reflecting key links in the pathogenesis of the disease may serve as early predictors of development, progression, and severe course of necrotizing enterocolitis.

AIM: To assess potentials of platelet monoamine oxidase activity and erythrocyte ATPase to predict the development of necrotizing enterocolitis in premature newborns.

METHODS: The present study had two stages and included 28 children who were treated at the Chelyabinsk Regional Children’s Clinical Hospital from November 2021 to December 2022. At the first stage, premature newborns were examined; among them a group of newborns with necrotizing enterocolitis IIB–IIIA-B was identified. Venous blood was used for testings. At the second stage, specimens obtained from the intestine during surgical interventions in newborns with surgical pathology were examined additionally as well.

RESULTS: Children with necrotizing enterocolitis showed a significant decrease in the specific activity of platelet monoamine oxidase which correlated with the activity of monoamine oxidase in gut specimens. The following changes were registered: decrease in the activity of magnesium adenosine triphosphatasein erythrocytes by 50–100% of the maximum enzyme activity in the control group; decrease of sodium-potassium adenosine triphosphatase activity y 4 times from the maximum values in the control group. There was also a significant increase in the activity of calcium adenosine triphosphatase activity in erythrocytes.

CONCLUSION: The obtained data allow to suggest that platelet monoamine oxidase in preterm newborns may potentially serve as an indicator of tissue and organ immaturity, rather than a marker of inflammation and oxidative damage. Changes in erythrocyte adenosine triphosphatase activity in preterm infants with surgical stages of necrotizing enterocolitis indicate a hypoxic hypoenergetic state, accompanied by high concentrations of intracellular calcium.

The obtained data are promising for developing new methods for diagnosis/prognosis of necrotizing enterocolitis in newborns.

BACKGROUND: Currently, more and more laser surgeries are performed in pediatric ophthalmology. Expansion of indications for laser vision correction in children entails the increase in the number of patients and poses new specific tasks for pediatric anesthesiology. Solution of these problems is currently at the stage of active clinical search.

AIM: To propose a safe, reproducible and controllable method of anesthesiological support at pediatric ophthalmic surgeries which would ensure complete immobility of the eyeball during the intervention and patient’s rapid awakening after the surgery.

METHODS: A retrospective trial has been conducted. From October 2016 to May 2022, in the hospital of Joint Stock Company "Medicine" (clinic of Academician Roitberg) specialists from Yasny Vzor Children's Eye Clinics of Professor Igor Aznauryan operated on 429 children with ophthalmosurgical pathology. Laser vision correction was performed in children with refractive errors (astigmatism, hyperopia, congenital stable high myopia) complicated by anisometropia and/or amblyopia. The composite endpoint was surgeon's satisfaction with eye position during the main intervention and at the time of patient's awakening at the end of surgical stage. The surgeon's satisfaction was assessed with a 10-point scale, where 1 means no centration achieved and 10 means complete immobility during the correction. Awakening was the time from the end of surgical procedure until the removal of laryngeal mask after restoration of spontaneous breathing and signs of consciousness.

RESULTS: All 429 patients included in the trial completed it. Awakening came quickly and lasted, on average, 13.3 min (95% confidence interval, 12.1–14.6 min). At the early postoperative period, pain syndrome was in significant and amounted to 1–3 points by the Face, Legs, Activity, Cry, Consolability Scale and to 1–2 points by the Visual Analogue Scale. Additional anesthesia (Ibuprofen) was required in less than 10% of patients. Nausea, vomiting, and muscle pain were not observed in the postoperative period.

CONCLUSION: The proposed technique is adequate for ensuring the eyeball immobility and for acceptable wake-up time up to 9–10 points by the Aldreth scale.

BACKGROUND: for several decades, the remote shock wave lithotripsy was a leading technique for surgical management of concretions in the upper urinary tract. The key reason for its wide spread was minimal invasion combined with high efficiency. However, it has been proven that after each lithotripsy session the acute kidney injury develops. Currently, there is no any curative strategy aimed to protect the renal parenchyma from pathological impacts of shock wave energy.

AIM: to evaluate Prednisolone nephroprotective efficacy after analysing dynamic levels of biomarkers of kidney damage during the remote shock wave lithotripsy in children.

METHODS: 108 children with urolithiasis after a session of remote shock wave lithotripsy were enrolled in the study. All patients were divided into two groups of 54 participants in each. Participants from the control group were treated according to the standard protocol. Participants from the studied group, in addition to the traditional therapy, were prescribed Prednisolone orally at dosage 0.5 mg/kg once a day for 2 days before the session of external shock wave lithotripsy and 2 hours before the surgery. Urine and blood samples were taken from all patients: before surgery, 45 minutes and 24 hours after it. Biomarker concentration was assessed in all samples.

RESULTS: The biomarker concentration in the urine differed statistically significantly in patients of the studied group and of the control one. The most pronounced changes were noted 45 minutes after the surgery. A statistically significant concentration increase of all studied biomarkers was revealed in patients from the control group. In children from the studied group, concentration of kidney damage molecule 1 did not change, and lipocalin concentration associated with neutrophil gelatinase, tissue inhibitor of metalloproteinase 2 and hepatic forms of fatty acid binding protein increased statistically significantly less than in patients of the control group. Interleukin 18 concentration in the blood serum of patients from the control group increased statistically significantly, while in patients from the studied group - statistically insignificantly.

CONCLUSION: A statistically significant decrease in the concentration of studied biomarkers, and, consequently, less degree of renal damage in the studied group, can promote implementation of the glucocorticoid therapy as a medical support during the external shock wave lithotripsy in children.

One of the acute problems of emergency neurosurgery is craniocerebral injury in children. Acuteness of the problem is determined by the disease frequency, high percentage of disability and mortality. Issues of medical and social research, diagnostics and treatment of craniocerebral trauma have not lost their relevance. Preventive measures, such as improved parental control and increased safety in the home surrounding, are being developed. Domestic and foreign literature sources on craniocerebral trauma in infants and young children for the last 15 years have been analysed . The search was done using keywords: “craniocerebral trauma”, “skull fractures” in such search engines as Google Scholar, eLibrary, PubMed and Medline. 243 sources were analysed, from which 45 articles were selected (21 domestic publications). These papers focused on specific aspects of traumatic brain injury in patients of different age categories. Infants and young children represent a specific group of traumatic brain injury victims due to specific anatomic and physiologic features. Better understanding of injury nature in infants and young children is necessary in order to improve traumatic brain injury prevention, diagnostics and treatment.

The article discusses features of allogeneic blood component transfusion in newborns and infants. This work is primarily addressed to specialists of "non–transfusiological" profile, such as neonatologists, anesthesiologists, intensive care specialists, pediatricians, hematologists and pediatric surgeons. Specific anatomical and physiological structure of child's organism, especially at its neonatologic period, specifies different approaches to the clinical application of donor blood components. However, description of transfusion therapy in children is found only in a small proportion of clinical recommendations, and its legislative level is regulated with an order of the Ministry of Health and the Government decree. Last documents are of administrative nature, and do not help much clinicians in specific decision-making situation. At the same time, transfusion with allogeneic blood is associated with significant complications. The overall prevalence of posttransfusion reactions in children is higher than in adults, and is associated with higher mortality rates. This is especially true for pediatric cardiac surgery. Application of donated blood after cardiopulmonary bypass surgery is associated with postoperative complications such as thrombosis, stroke, acute kidney injury, prolonged mechanical ventilation and death. The authors emphasize the necessity of scientific substantiation of each transfusion with evidence-based medicine. Indications for hemotransfusion have to rely not only on the concentration of hemoglobin and hematocrit, but also on additional physiological triggers. In order to minimize undesirable transfusion reactions and complications, modern technologies should be used to improve the quality of blood components. Attention is focused on modern components of donated blood. The review is aimed to summarize and structure current data on transfusion therapy in pediatric patients. The authors analyse domestic and foreign clinical recommendations and publications. Restrictive and liberal strategies of transfusion therapy are compared. Specific criteria for indications, algorithms for prescription, speed and volume of donor blood component infusion in pediatric units were revealed.

BACKGROUND: Esophageal achalasia in children is a rare disease. Heller myotomy combined with Dor fundoplication remains the treatment of choice for this disease. Surgical interventions include open, laparoscopic and robotic approaches. This article describes the first experience of Heller robot-assisted myotome in a child. It also presents a literature review on this topic.

CLINICAL CASE DESCRIPTION: The authors present retrospective data of a 10-year-old adolescent boy who was operated on for esophageal achalasia with the robot-assisted approach. The patient was admitted to the surgical department of Irkutsk State Regional Children's Clinical Hospital in satisfactory condition with complaints of dysphagia, frequent regurgitation after meals, and delayed weight gain. The diagnosis of cardia achalasia was put after contrast examination of the esophagus and after endoscopic examination of the upper gastrointestinal tract and after esophageal manometry. Heller robot-assisted myotomy was performed with surgical robot Versius (manufactured by CMR, UK). Patient's weight was 30 kg. His age was 10 years. This disease lasted for 3 years. Robot-assisted Heller myotomy was done in a minimally invasive manner without conversion to an open surgery. Total myotomy length was 7 cm; duration of surgical intervention — 125 minutes; duration of patient's stay in the hospital — 4 days; duration of follow-up — 4 months. In the late follow-up, no significant complications, like symptom recurrence or reflux, were seen.

CONCLUSION: Robotic-assisted Heller myotomy for esophageal achalasia in children is safe and effective technique. It is also good alternative to open and laparoscopic surgeries.

BACKGROUND: Jadassohn's nevus (seborrheic nevus, nevus of the sebaceous glands) is a hamartoma which is mainly localized on the scalp and face skin. At birth, it looks like a barely noticeable light yellow plaque which significantly increases at the puberty period under androgenic stimulation. The histological picture of Jadasson's nevus is characterized by changes in the epidermis in the form of acanthosis, papillomatosis, hyperkeratosis, and a large number of hyperplastic sebaceous glands. Pluripotent epithelial cells, which are part of the hamartoma, may provoke the growth of secondary benign and malignant tumors. This nevus may be manifested by Schimmelpenning–Feuerstein–Mims syndrome which can damage the nervous system and eyes. Currently, there are no uniform recommendations for the management of patients with Jadassohn's nevus.

CLINICAL CASE DESCRIPTION: In this article, we present our own experience of treating two children discussed pathology. The first boy had a radical surgery at the age of 16 days of life because of large dimensions of the nevus and a significant cosmetic defect. Removal of the formation at the neonatal period has prevented the development of rough postoperative scars and promoted good cosmetic outcome due to high elastic and regenerative properties of baby's skin. In the second child, Jadasson's nevus looked like a barely noticeable light yellow plaque; therefore, conservative tactics was chosen for this patient. Both children were consulted by a neurologist and an ophthalmologist who found no pathology in the nervous system and in the vision organs.

CONCLUSION: The described two clinical examples demonstrate the need for individual and multidisciplinary approaches in the management of patients with Jadasson's nevus. Active surgical tactics should be applied because of a significant cosmetic defect rather than for the prevention of malignant transformation which is met in less than 1% of cases.

BACKGROUND: A benign teratodermoid tumor of thoracoabdominal localization is a rare condition in which one half of the formation is located in the pleural cavity, and covered with the visceral pleura of the right lung lower lobe and the other half is located in the right liver lobe The incidence of teratodermoid tumors of the thoracic-abdominal location is unknown; no such publications are found in the literature .

CLINICAL CASE DESCRIPTION: This article describes a clinical case of a child with a benign teratodermoid tumor of thoraco-abdominal localization, which was detected during X-ray examination of the chest organs because of respiratory disease. It is believed that surgical intervention is the only effective treatment for this pathology. During surgery, it was found out that the tumor had a dumbbell shape; its upper part was located in the chest cavity, and the symmetrical lower part-via a congenital hole in the diaphragm — was located in the right liver lobe. Despite of such unusual location, all tumor was enucleated.

CONCLUSION: This clinical case demonstrates the only described complete surgical removal of the tumor with rare thoracoabdominal location.