Vol 6, No 4 (2016)

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. 

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. 

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.

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. 

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. 

Results of II Congress of children surgeons of Russia.

Symposium April–2017.

Necrologue.

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. 

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. 

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. 

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. 

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.