卷 22, 编号 3 (2018)

Introduction. In the structure of the general morbidity rate, trauma and diseases of the musculoskeletal system take the third place after diseases of the respiratory system and pathology of the gastrointestinal tract. In recent years, an intensive indices characterizing the trauma prevalence rate has increased by 1.9 times. Aim. to improve the results of the management of juxta- and intraarticular fractures in children by means of the use of biodegradable implants. Material and methods. Over the period from 2014 to 2016 in the Department of Traumatology of the Research Institute of Emergency Pediatric Surgery and Traumatology there were examined and treated 108 children with juxta- and intra-articular fractures of the upper and lower extremities aged from 5 to 17 years, with an average age of 13.3 ± 1.8, including 38 (34.96 %) girls and 70 (65.04%) boys. All patients underwent complex examination including laboratory and instrumental methods: complete blood count (CBC), Common Urine Examination (CUE), X-Ray, spiral computed tomography, MRI. Results. To describe injuries and determine the tactics of the treatment of juxta- and intra-articular fractures in children, there was used the fracture classification system delivered by Robert B. Salter and W. Robert Harris. All children with metaphyseal fractures of the second, third, and fourth types underwent surgical treatment with the use of biodegradable implants. The postoperative period proceeded without complications. Conclusion. The use of biodegradable screws in juxta- and intra-articular fractures in children is a safe and effective method of treatment, reducing its timing by eliminating repeated surgical intervention.

Intraoperative infusion in newborns and premature infants is a very important part of anesthesia, which affects the course and long-term results of the surgical treatment. The purpose of the infusion therapy in these children is to maintain normovolemia, adequate oxygen supply to tissues, normalization of the acid-base state, electrolyte balance and normoglycemia. In most cases, the maintenance of hemodynamics in newborns and premature infants requires the use of large amounts of crystalloid preparations, which in turn, due to their physical and chemical properties, lead to additional changes in the neurohumoral status of the child. Therefore, at the present stage of anesthesiology more and more works are devoted to the experience of using balanced solutions containing carriers of reserve alkalinity. The influence of such solutions on the electrolyte balance and acid-base state is evaluated. A separate issue is concerned with the intraoperative need for glucose in newborn infants, the dosing of glucose in anesthesia, and the percentage of glucose in the solutions used. Correction of all pathophysiological disorders inevitably occurring in the immature body of a newborn, especially a premature baby, is the most important factor for achieving the optimal therapeutic effect.

Background. The severity of patients with concomitant injuries under time constraints determines the need for a rapid adequate assessment of life-threatening syndromes and their sequential alleviation. Most common mistakes are made in the diagnosis of ongoing bleeding and shock. Objective. The improvement results of the treatment of children with concomitant injuries. Material and methods. Post-hoc analysis of the treatment of 239 children with abdominal injuries within concomitant injuries. Results. The development of the algorithm for a surgeon to diagnose and to treat concomitant injuries. Conclusions. The high-priority problem in patients with concomitant injuries is life- saving by revealing and alleviation of life-threatening syndromes (acute respiratory failure, ongoing bleeding and brain herniation with vital disorders). The diagnosis and treatment of injuries should be realized with the elimination of all possible prerequisites for the revealed syndrome, taking into account the degree of the urgency of administration of the emergency measures. Non-life-threatening injuries should be treated only after the stabilization of the hemodynamic state.

The open arterial duct (OAD) means the maintenance of the OAD patency in the postnatal period within 48-72 hours after birth. OAD in preterm infants is of particular importance and often determines their survival. The presence of OAD significantly reduces chances of premature babies to recover, as it contributes to the emergence and aggravation of diseases such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), renal dysfunction, intraventricular hemorrhage (IVH), cerebral palsy and, often, the death of a newborn. From this point of view, there is appeared the importance of diagnosis and treatment of OAD in premature newborns to improve the prognosis of life in this category of patients. Until today, there is no generally accepted strategy for treating OAD in premature infants. As a result, in various neonatal centers, even within the same country, doctors adhere to different tactics in the treatment of OAD in premature infants. Surgical correction of the hemodynamically significant OAP is indicated for premature infants dependent on artificial ventilation of the lungs, with lack of the effect of the drug therapy or inability to introduce medication. In this scientific review, 3 technologies of surgical treatment of OAD are discussed: open surgery, thoracoscopy, and endovascular treatment. Special attention is paid to postoperative management of patients and prevention of complications.

Lymphangiomas are non-specific formations developing from the lymphatic vessels, occupying an intermediate position between the tumor and the developmental malformation. The most frequent localization of the pathology is the face and neck area (75%) and the axillary region (20%), less than 1% of cases are located in the mediastinum. According to the literature data, the only radical treatment is surgical, but there is a high prevalence rate of relapses (25%). This article is devoted to the analysis of the clinical case of the treatment of lymphangioma of the complex anatomical localization, reflecting the complexity of the diagnosis and radical relapse-free treatment of this pathology.

Tumors of the ovaries in girls represent an actual problem in modern gynecology. First of all, this is due to diagnostic difficulties, caused by the absence of characteristic complaints, asymptomatic course and the complexity of the gynecological examination, which leads to making of an erroneous diagnosis, the lack of correct and timely treatment and, as a result, complications that often negatively affect the reproductive function of the female patient in further. The differential diagnosis of ovarian tumors in girls is still one of the most important problems of modern practical gynecology. In many patients, the presence of a combined pathology, which is 30-40% according to WHO data, puts the problem of the possibility of simultaneous correction of such pathology by both surgeons and gynecologists. In connection with the difficulty of diagnosing, the diagnosis of such patients must necessarily include an examination of a pediatric surgeon and a children’s gynecologist with ultrasound examination of the retroperitoneal space, abdominal cavity organs, and small pelvis. Errors in the differential diagnosis of genital and extragenital diseases occur quite often and are mainly due to the similarity of clinical symptoms. This article presents a clinical case of the diagnosis and management of a 14-year-old female patient with an adjacent diagnosis, as well as criteria for the diagnostic search for the differential diagnosis of gynecological and surgical pathologies.