Vol 6, No 4 (2016)

Cover Page

Full Issue

ORIGINAL ARTICLES

PROVISION OF EMERGENCY CARE TO CHILDREN

Rosinov V.M., Petlakh V.I.

Abstract

There is limited representation of pediatric aspects of the activity produced by the national services of emergency medicine in specialized literature. The article reveals the amount of children among the affected ones under various emergency conditions, pediatric anatomy and physiology, a rational way to render medical care to children in the system of medical and evacuation support, necessity and effectiveness of organizational forms of doctors’ involvement at different stages of medical evacuation. The data are prepared using the terms of modern directives. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):6-12
pages 6-12 views

STRUCTURAL CHANGES IN THE INTESTINAL WALL IN IMPLEMENTATION OF THE SYNDROME OF INTESTINAL DYSMOTILITY IN CHILDREN WITH GASTROSCHISIS

Babuch S., Tika K., Petrovich V., Sinitsina L., Zhalbe A., Negru I.

Abstract

The authors presented the results of histopathological and immunohistochemical studies using autopsy material (22 newborns who died of gastroschisis). According to the results, in all the cases inflammation of the parietal and visceral peritoneum were of productive, proliferative and fibroplastic origin. In the majority of cases, an acute purulent inflammation with formation of abscesses at the level of the eviscerated intestinal loops was revealed.

In some cases the acute inflammation process was manifested through leukocytic erosive and abscessed inflammatory exudative fibrinous lesions at the level of the parietal and visceral peritoneum involving the entire intestinal wall in the process. The presence of only one mainly circular muscular layer was a peculiar feature found in the eviscerated intestinal loops with the external muscular layer undergoing regional hypoplasia or aplasia.

Results of the conducted study helped the authors to determine the combination of neuromuscular structural changes of the eviscerated intestinal loops and find the relation of the implementation of the intestinal motility stable disturbances in newborns with gastroschisis. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):13-19
pages 13-19 views

THE FIRST EXPERIENCE OF ANORECTAL MANOMETRY IN CHILDREN

Pimenova E.S., Fomenko O.Y., Morozov D.A., Starostina I.E.

Abstract

The article presents the first results of using a modern method of functional examination of the large intestine and pelvic floor muscles in children or high-resolution anorectal manometry. 60 children aged 7 months to 17 years were examined in total (34 children had underwent different surgeries on the intestine and anorectal area due to Hirschsprung disease and anorectal malformations, 26 of them had not undergone any surgery). Apart from high-resolution anorectal manometry the children had routine anorectal profilometry and sphincterometry; no sedation was applied.

The authors noted that high-resolution anorectal manometry has wider possibilities in diagnostics of defecation disturbances in children as compared with routine methods. Usage of functional methods of the examination in children alongside with clinical and instrumental examination enables to reveal the condition requiring surgical correction. The method was proved effective in dynamic examination of children undergoing rehabilitation following intestinal surgery as the conducted procedures and manipulations could be conducted effectively.

High-resolution anorectal manometry was used for the first time to reveal the symptoms of obstructive (dyssynergic) defecation in many children both after the surgeries and in those not operated explaining the reasons for chronic constipation in the children and requiring a fundamentally new approach to their treatment.

The new method is a perspective trend in complex treatment of children with defecation disturbances. Use of high-resolution anorectal manometry in pediatric colopractology will enable to optimize the therapeutic and diagnostic schemes and rehabilitation programs for patients in future.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):20-27
pages 20-27 views

EFFICACY OF LAPAROSCOPIC TECHNIQUES IN CHILDREN WITH DIVERTICULUM OF MECKEL

Korovin S.A., Dzyadchik A.V., Allakhverdiev I.S., Zykin A.P., Sokolov Y.Y.

Abstract

The article sums up the experience of laparo￾scopic interventions in 94 patients with diverticulum of Meckel (DM) aged 6 months to 18 years and observed from 2005 to 2015 at the clinic of pediatric surgery of the Russian Medical Academy of Postgraduate Education. Information value of clinical, ultrasound and X-ray methods of preoperative diagnostics in diverticulum of Meckel is shown. The surgery volume and type were determined during laparoscopy. In the inflammation of DM, bleeding DM and DM torsion (57) laparoscopic diverticulectomy was performed in 48 patients, in intestinal obstruction (26) laparoscopic techniques was successful in 17 patients. During planned and urgent surgeries simultaneous diverticulectomy was performed in 9 observations. Limitations for laparoscopic techniques (19) were noted in diffuse peritonitis (4), advanced forms of bowel obstruction (9), intense bleeding (1), equipment of the operation room and competence of specialists (5) when developing the techniques. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):28-36
pages 28-36 views

PERSISTING CLOACA IN GIRLS. THE ISSUES OF DIAGNOSTICS AND SURGICAL CORRECTION

Otamuradov F.A., Ergashev N.S.

Abstract

The article presents the summary of literature data on the persistent cloaca, results of diagnostics and treatment of 16 girls with the mentioned pathology at our clinic. The PC is a multivariant fusion of anatomical structures forming the common canal or urogenital sinus. This explains occurrence of different complications requiring surgeries. The number of concurrent abnormalities with pronounced anatomical and functional disturbances is increased alongside with the length of the common canal. In 4 observations surgeries were performed without colostomy and in 12 cases these were done applying colostomy. Posterior and sagittal anorecto-ureterovaginoplasty procedure was the method of choice for surgical correction. The abdominoperineal approach was used in 3 observations as an addition. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):37-42
pages 37-42 views

RISK FACTORS OF CHRONIC RENAL DISEASE PROGRESSION IN CHILDREN WITH CONGENITAL DEFECTS OF THE URINARY TRACT IN THE POSTOPERATIVE PERIOD

Akhmetshin R.Z., Mironov P.I.

Abstract

The purpose of the study was to find independent and attributive predictors of progression of chronic renal disease (CRD) in children who underwent a surgery for congenital defects of the urinary tracts.

Methods. It was a retrospective, observational and cohort study. The inclusion criteria were congenital abnormality of the kidneys and urinary tracts, glomerular filtration rate (GFR) <90 ml/min/1.73 m2, patients less than 18 years old. 297 patients were included in the study. The data were statistically processed using «Statistica 6.0» and MedCalc (MedCalcSoftware, Belgium).

Results. We found out that the glomerular filtration rate at the stage of primary hospitalization (RR = 9.40) and arterial hypertension (OR = 4.40) were the only independent predictors of the CRD progression. The combination of the two types were shown using the area under ROC-curve (0.756) which was significantly (р<0.005) higher than the isolated value of the symptoms.

Conclusions. The attributive risk factor of CRD progression in children who had a surgery for congenital defects of the urinary tracts is arterial hypertension (AH). The independent risk factor are GFR and AH. Their combination significantly increases the risk (р<0.005) of chronic renal disease progression.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):43-49
pages 43-49 views

MODERN VIEW ON THE DEVELOPMENT AND TREATMENT OF HYPOSPADIA

Severgina L.O., Menovschikova L.B., Korovin I.A.

Abstract

Hypospadia is a malformation of the penis when incomplete fusion of ureteral folds and the ectopy of the ureteral outlet are observed; depending on its position according to Barcat there are anterior, medium and posterior forms of hypospadias. The main reasons for hypospadias development are genetic disturbances and hormonal shifts such as a low level of testosterone. Peculiarities of the prepuce skin blood supply in hypospadias are irregular and diffuse type of vascular branching and insufficient prepuce skin vascularization pointing at the conjugation of penis malformation disturbances and dysangiogenesis. The degree of vascularization of prepuce skin derma various in three forms of hypospadia also produces a significant effect on the favourable course of the postoperative period. Both its excessive and weak blood supply can complicate the course of the postoperative period forming ureteral fistulas. An inflammatory component stimulating the pathological angiogenesis is considered as the aggravating factor. Sufficient blood supply of the prepuce skin in the lack of a pronounced inflammatory reaction is an important criterion of favourable outcome of the postoperative period. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):50-56
pages 50-56 views

INTRAOPERATIVE GLYCEMIC PROFILE AND DEMAND IN GLUCOSE IN NEWBORNS

Nasser M.M., Kucherov Y.I., Zhirkova Y.V.

Abstract

The article sums up the data of the study examining the intraoperative glycemic status in 30 newborns with congenital abnormalities. Median age at the operation amounted to 72 [48; 168] years of life, duration of surgery was 72.5 [60; 90] minutes. All children used general anesthesia (Sevofluran+ Phentanyl), intraoperative infusion therapy consisted of saline solutions. The level of glucose in blood was estimated before the surgery, every 30 minutes during the surgery and at the end of the surgery; correction was performed when needed. High frequency of non-euglycemic conditions was revealed especially at the stages of tracheal intubation and skin incision. In the majority of cases the children had hypoglycemia (66.7%) requiring correction. During the surgery, the blood glucose level was normalized and remained within the reference range. Thus, intraoperative glycemia in newborns is an unstable indicator; it requires monitoring for adequate infusion of glucose-containing solutions to avoid hypo- and hyperglycemia. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):57-62
pages 57-62 views

EXCHANGE OF EXPERIENCE

REMOTE RESULTS OF TREATMENT OF THE NEWBORNS WITH SACROCOCCYGEAL TERATOMAS

Savvina V.A., Tarasov A.Y., Nikolayev V.N., Varfolomeev A.R., Petrova N.E., Sleptsov A.A.

Abstract

The article presents the results of treatment of sacrococcygeal teratomas in newborns from 2001 to 2015. 10 newborns were operated in total; 8 of them had antenatal pathology. Complications in the early postoperative period were observed in 2 cases. Only 1 patient had an immature teratoma found during a histological examination of the removed tumor. In 2 cases the malignization was found in the remote period, the patients had high AFP values at control. Thus, during our study the malignant course of sacrococcygeal teratoma was revealed in 30% of cases. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):63-66
pages 63-66 views

THE FIRST EXPERIENCE OF XENON ANESTHESIA IN PATIENTS WITH INFANTILE CEREBRAL PALSY

Аdkina E.A., Lazarev V.V., Batysheva T.T., Diordiev A.V., Yakovleva E.S., Shagurin R.V.

Abstract

Introduction. The article analyzes the experience of using xenon anesthesia combined with epidural block in children with cerebral palsy and spastic dysplegia when performing the lower extremity surgeries.

Materials and methods. The study included 15 children for whom the central hemodynamics parameters, peculiarities of anesthesia and the course of early postoperative period were determined. The obtained data were compared with the results of retrospective studies in the group of children obtaining anesthesia using propofol and neuroaxial blockade.

Results. Our study showed that xenon anesthesia was accompanied by a considerable increase of stroke volume and cardiac index compensating for the depressive influence of neuroaxial blockade on hemodynamics. After xenon is failed to be delivered to the breathing circuit, fast restoration of spontaneous respiration and consciousness occurred.

Conclusion. Xenon anesthesia is characterized by a stable hemodynamic profile and fast comfort awakening which makes it possible to use it in children with cerebral palsy. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):67-77
pages 67-77 views

OBSERVATIONS FROM PRACTICE

ENDOVASCULAR TRANSJUGULAR CLOSURE OF ARANTSIEVA FLOW VIA VASCULAR OCCLUDER

Razumovsky A.Y., Galibin I.E., Feoktistova E.V., Smolyankin A.A., Tsygankov V.N., Gurevich A.I., Alkhasov A.B., Zadvernyuk A.S., Simakov M.V., Ushakov A.N.

Abstract

In the description of a clinical case the authors cite the example of a successful endovascular occlusion of open ductus venosus in a child with signs of portosystemic encephalopathy. It shows one of the methods of diagnosis and treatment of vascular defect of the liver with the help of Interventional Radiology. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):78-81
pages 78-81 views

LAPAROSCOPIC SPLENOSCOPY IN CHILDREN WITH TORSION OF THE FLOATING SPLEEN

Sokolov Y.Y., Korovin S.A., Olkhova E.B., Akopyan M.N., Shuvalov M.E., Stonogin S.V., Sidneva E.N.

Abstract

Two extremely rare clinical cases of the floating spleen torsion in children aged 7 and 14 are presented. Concern of the pathology, use of US examination, SCT and laparoscopy enabled to perform minimally invasive organ preserving interventions in both cases. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):82-87
pages 82-87 views

CHYLOTHORAX AND CHYLOPERITONEUM IN NEWBORNS: 4 CASE REPORT

Kireeva N.B., Pivikov V.E., Novopoltsev E.A., Tumakova N.B., Plokharsky N.A., Biryukov Y.P., Privalova L.P., Yaskovetz A.A., Novopoltseva E.G.

Abstract

Chylothorax (CT) and chyloperitoneum (CP) are pathological conditions associated with the accumulation of lymphatic fluid in the pleural or abdominal abdomen caused by malformations of the lymphatic ducts and a trauma in surgical interventions. The report describes 3 cases of CT and 1 case of CP. The treatment included drainage of the pleural or abdominal abdomen, complete parenteral nutrition, and use of octreotide as a synthetic analog of somatostatin. 2 children were doing well, 2 others died. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):88-90
pages 88-90 views

SURGICAL CORRECTION OF NONHORMONAL CLITOROMEGALY IN NEUROFIBROMATOSIS TYPE 1

Morozov D.A., Raigorodskaya N.Y., Pimenova E.S., Bolotova N.V., Airyan E.K.

Abstract

Neurofibromatosis 1 type (NF1, Recklinghausen disease) is caused by mutations in the NF1 gene (localized to chromosome 17q) and is an autosomal dominant genetic syndrome. The disease occurs in 1 of every 2500–3000 births. In neurobibromatosis the urogenital tract is affected rarely. The article presents the clinical case of examination, diagnosis verification and surgery of a 12‑year-old girl complaining of an increased clitoris with the aggravated genealogical anamnesis (her uncle suffers from neurofibromatosis type 1). The child examined by an endocrinologist, removed diagnosis violation forming the floor. Spend plastic feminized external genitalia with the removal of nodules neurofibromatosis imitating virilization of the external genitalia, resection of the corpora cavernosa, labiaplasty of mucocutaneous grafts. Cosmetic outcome immediately after the operation is regarded as satisfactory. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):92-96
pages 92-96 views

SURGICAL TREATMENT OF A PATIENT WITH INHERITED EPIDERMOLYSIS BULLOSA COMPLICATED WITH DEFORMITY OF HANDS AND FEET

Shurova L.V., Starostin O.I., Korsunsky A.A., Plotnikov N.A.

Abstract

The purpose of the message is to demonstrate the results of surgical treatment of a patient with a rare genetic disorder i.e. inherited epidermolysis bullosa complicated with deformity of hands and feet. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):98-101
pages 98-101 views

SCIENTIFIC REVIEWS

SPONTANEOUS PERFORATION OF THE INTESTINE IN PREMATURELY BORN CHILDREN

Kozlov Y.A., Novozhilov V.A., Timofeev A.D.

Abstract

Intestinal perforation is the most frequent ca-Perforation of the intestine is the most frequent reason for abdominal troubles in premature infants. Etiology of neonatal perforation of the intestinal tube is usually associated with the necrotic enterocolitis (NEC). However, the other reason for pneumoperitoneum in premature and mature newborns is an isolated perforation of the intestine (IPI) which is also known as the spontaneous perforation of the intestine (SPI). The study presents new modern data which confirm the results from many research papers and demonstrate the changes that occurred recently and affected various aspects of the SPI concerning its epidemiology, prevention, treatment and outcome prediction. In the present study we strived to present new knowledge of spontaneous perforation of the intestine, familiarize readers with novel surgical techniques and raise issues of treatment of the disease that remained unclear till now. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):102-110
pages 102-110 views

MODERN IDEAS OF PERIOPERATION INFUSION THERAPY STRATEGIES

Matinyan N.V., Martynov L.A.

Abstract

The outcome of surgery, risk of postoperative complications largely depend on the adequate strategy of perioperative infusion therapy. Opposing the role and position of colloid and crystalloid solutions in infusion therapy and low awareness of the composition and properties of various solutions among doctors including intensivists have been causing significant problems in the administration of infusion therapy originating from inadequate interpretation of the concepts of volume and liquid substitution for decades. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):111-117
pages 111-117 views

HISTORY OF SPECIALTY

HISTORICAL CRONICLES OF INFUSION THERAPY OF BURN DAMAGES

Azovsky D.A., Lekmanov A.U., Pilyutik S.F.

Abstract

The literature review presents the evolution of the issue of infusion therapy in patients with burn damages from the middle of the 19th century to the middle of the 20th century. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):118-123
pages 118-123 views

RESULTS OF II CONGRESS OF CHILDREN SURGEONS OF RUSSIA

Abstract

Results of II Congress of children surgeons of Russia.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):124-125
pages 124-125 views

ANNIVERSARIES

Abstract

Anniversaries.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):126
pages 126 views

SYMPOSIUM APRIL–2017

Abstract

Symposium April–2017.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):127-128
pages 127-128 views

MEMORY MAHMUDJON AKHMEDOVICH AKHMEDOV

Abstract

Memory Mahmudjon Akhmedovich Akhmedov.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):129-131
pages 129-131 views

NECROLOGUE

Abstract

Necrologue.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(4):132
pages 132 views

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