Vol 7, No 3 (2017)

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):7
pages 7 views

ORIGINAL ARTICLES

THE CAUSES OF THE SHORT BOWEL SYNDROME

Khasanov R.R., Gumerov A.A., Vessel L.M.

Abstract

The short bowel syndrome (SBS) is a severe disorder caused by a significant loss of absorption capacities of the intestine due to its resection manifested as pronounced chronic intestinal insufficiency. We aimed at the investigation of the SBS causes at different intervals. The study was conducted in collaboration with the department of pediatric surgery of the RCCH (Republican Children’s Clinical Hospital) and Mannheim clinics of pediatric surgery at Heidelberg University (Germany). The most frequent causes of SBS in children are necrotizing enterocolitis, gastroschisis, small intestine atresia, twisted bowel, etc. According to our studies, gastroschisis was the most frequently occurred cause whereas necrotizing enterocolitis occupied the 2nd position on the list. Atresia and twisted bowel held the 3rd and 4th positions. However, it should be mentioned that the share of patients with SBS following necrotizing enterocolitis has increased considerably lately.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):8-12
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THORACOSCOPIC TREATMENT OF ESOPHAGEAL ATRESIA

Kozlov Y., Novozhilov V., Rasputin A., Baradieva P., Zvonkov D., Timofeev A., Ochirov C., Rasputina N., Us G., Kuznetsova N.

Abstract

Background. In this study we reported our experience with repair of esophageal atresia using open surgery and thoracoscopy The aim of scientific work was to evaluate the effect of minimally invasive surgery for treatment of this congenital disease.
Methods. We reported the data of 114 neonates who underwent standard thoracotomy (44patients – Group I) and video-assisted thoracoscopic surgery for esophageal atresia repair (70 patients – Group II). The two groups were compared for patients demographics, operative report and postoperative parameters.
Results. The compared groups were similar in terms of demographics and preoperative parameters. There was significant difference in mean operative time between open and thoracoscopic procedure (111,14 min vs 77,00 min; p<0,05). Duration of care in neonatal intensive unit and length of hospital stay were significantly shorter in the Group II (12,39 d vs 8,13 d; p<0,05 and 31,80 d vs 22,81 d; p<0,05). Rates of early complications were diferent between groups (36,36 % – group I vs 11,43 % – group II; p<0,05). Rate of long-term complications was dominated in the thoracotomy group (20,45 % vs 0 %; p<0,05).
Conclusion. Thoracoscopic repair of the esophageal atresia gave results better than open surgery.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):13-23
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SURGICAL CORRECTION OF THE OPEN ARTERIAL DUCCT IN CHILDREN

Razumovsky A.Y., Alkhasov A.B., Mitupov Z.B., Feoktistova E.V., Sitnikova M.I., Kollerov M.Y., Nagornaya Y.V.

Abstract

Introduction. An isolated open arterial duct (OAD) is one of the most common congenital heart disorders. According to literature, every 1 child out of 2,000 children has OAD at birth.
It accounts for 5–10% of all the congenital heart disorders [1].
Material and methods. The article analyzes the results obtained during the minimally invasive surgical treatment of an open arterial duct (OAD) in children. The following two types of surgeries were performed: OAD clipping via an extra pleural mini thoracotomy approach and thoracoscopic clipping. A treatment method is chosen depending on the patient’s severity degree.
Results. Treatment resulted in 100% blood flow termination via the arterial duct in the lack of intraand postoperative lethality and any serious complications in the postoperative period.
Conclusions. It is better to perform OAD clipping in premature children right at the resuscitation unit without transportation of the patients to the operating theater and using the extra pleural minimal thoracic approach.
In elder stable children, thoracoscopic OAD clipping is an effective and reliable treatment method that terminates the pathological blood flow from the open arterial duct irrespective of its form and size.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):24-32
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FEATURES OF OPERATIONAL TREATMENT OF CHILDREN WITH COMPLICATED NEPHROLYTHISIS

Sultonov S.R., Makhmadjonov D.M., Boboev Z.A., Rakhmonov S.D.

Abstract

The purpose of the work was to improve the results of open surgical operations in complicated nephrolythisis in children.
Materials and methods of investigations. 121 patient with complicated nephrolythisis aged 1 to 15 years were observed by the authors. In 87.1% of cases the somatic background was due to concomitant diseases (ARVI, hypertrophy, pneumonia, rickets, etc.).
Results. The calculus deposit was removed using nephrolithotomy in 42.1%, pyelolithotomy in 46.3% and clicolithotomy in 11.6% patients. In obstructive purulent and calculous pyelonephritis, calculus was cured with primary nephrolithotomy and nephrostomy. Corrective surgeries were performed in 37% patients with renal defects. Correct management of the postoperative period and methods of the calices-pelvis system drainage were paid a great attention.
Conclusion. Conservative therapy of concurrent diseases and inflammation in the kidneys was followed by the surgery. Indications for various types of surgeries were developed depending on the type of nephrolithiasis.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):33-38
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PROLONGED CAUDAL EPIDURAL BLOCK IN SURGICAL TREATMENT OF NEWBORNS WITH NECROTIZING ENTEROCOLITIS

Pisklakov A.V., Vysotsky V.V., Dyrul A.K., Kologreev V.A.

Abstract

The purpose of the study was to examine the way the prolonged epidural block influences the post-operative course of necrotizing enterocolitis in newborns.
Materials and methods. We analyzed treatment results of 77 newborns with NEC at the Omsk Regional Center of Newborn Surgery in 2009–2014.
The main group included 47 patients who underwent the prolonged epidural block following the surgery. The control group of 30 patients included newborns without the block.
Results. Comparison of two clinical groups revealed a positive effect produced by the prolonged caudal block on the duration of artificial ventilation and initial functioning of the GIT. This resulted in statistically significant improvement of survival of newborns with necrotizing enterocolitis.
Conclusion. The extended caudal epidural block following the surgeries for NEC in newborns is an affordable, safe and effective method of treatment that optimizes the course of the postoperative period.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):39-45
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MORPHOLOGICAL FEATURES OF INTESTINAL ANASTOMOSIS EXPERIMENTAL FORMATION USING VARIOUS TYPES OF INTESTINAL SUTURE

Semenyuta A.A., Goldberg O.A., Lepekhova S.A., Novozhilov V.A., Stepanova N.M., Milyukova L.P.

Abstract

Purpose of the study: to examine and develop the best variant of formation of the intestinal anastomosis.
Materials and methods: the experimental work analyzes the processes of regeneration in the area of the interintestinal anastomosis formed with a one-row continuous perforated, one-row continuous serous-muscular, two-row precision intestinal suture when performing surgeries on the Wistar white rats (n=45).
Results and discussion: histological investigations of the anastomosis area carried out on the 1, 3, 7, 14, 21 days of the experiment showed a difference in the course of reparative processes in the anastomosis area depending on the method of application of intestinal sutures.
Conclusions: Depending on the conducted morphological studies, the priority of application of two-row precision intestinal suture and feasibility of its application in the clinical practice among newborn children are proven.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):46-53
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INJURE TO THE VAGUS NERVE IN THE PUNCTURE AND CATHETERIZATION OF THE INTERNAL JUGULAR VEIN

Bykov M.V., Lazarev V.V., Madorsky K.S., Bagaev V.G., Bykova L.V.

Abstract

Catheterization of the central veins during intensive therapy is followed by a high risk of mechanical complications. Considering anatomical interrelation in the neurovascular bundle of the neck, it is highly probable that the vagus nerve is damaged in the puncture of the internal jugular vein (IJV).
However, lacking awareness of medical personnel and knowledge of the clinical picture of damage of the valgus nerve don’t allow to prevent and register the complications.
The purpose of the study is to use US when diagnosing location of the vagus nerve to prevent its damage during the puncture and catheterization of the IJV. IJV US examinations were performed in 100 children aged 2 weeks to 17 years with various emergencies in the process of intense therapy to reveal anatomical interrelations between the internal jugular vein, carotid artery and vagus nerve. In 30 children US was performed following catheterization of the IJV (static method) with the following selection of the safest vascular IJV approach.
26 patients underwent a dynamic method of US guiding control when performing catheterization of the IJV. A retrospective analysis of a number of case records is done for the patients at the resuscitation department with suspicion of the vagus nerve damage due to catheterization of the IJV.
Results – preliminary US examinations of the vascular bundle in all children allowed to visualize the valgus nerve. Selection of an optimal and safe approach to the IJV using the data of US statistical method and catheterization under US guidance enabled successful catheterization of the IJV avoiding mechanical complications. Retrospective analysis of case records revealed the complications not registered in the medical records.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):54-62
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КРИТИЧЕСКИЕ СОСТОЯНИЯ В ДЕТСКОЙ ХИРУРГИИ И НЕОНАТОЛОГИИ

INTRA-ABDOMINAL HYPERTENSION AND TRANSPORT OF OXYGEN IN CHILDREN UNDER CRITICAL CONDITION: CLINICAL PARALLELS

Tretyakov D.S.

Abstract

In patients with shock of various genesis intransabdominal hypertension is accompanied by a high lethality. However, the index is rarely measured routinely, especially in pediatric patients. The presented prospective study examines the influence of intraabdominal pressure on oxygen transport in children from the resuscitation department. The changes in the oxygen transport parameters were modelled using statistical methods in various alterations in its consumption and intraabdominal pressure level.
The obtained results show that the stroke volume index and oxygen delivery index were decreased in response to the increased oxygen consumption in the growth of intraabdominal pressure. Patients with hemodynamic disturbances have the most pronounced decrease of oxygen delivery. The data presented show the necessary daily control over the intraabdominal pressure in patients from departments of intensive therapy and resuscitation. This has a peculiar diagnostic value in children with hemodynamic disturbances and shock.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):64-68
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THE POSSIBILITY TO USE THE ULTRASOUND MONITOR OF NONINVASIVE CONTROL OF HEMODYNAMICS IN NEWBORNS

Boronina I.V., Alexandrovich Y.S., Shmakov A.N., Oshanova L.S.

Abstract

Functional Doppler echocardiography and estimation of cardiac output using the ultrasound monitor USCOM (Ultrasound Cardiac Output Monitor) are informative and affordable methods of non-invasive control of hemodynamics in newborns.
The study was aimed to determine the significance level of the results of measuring hemodynamics parameters using the non-invasive ultrasound monitor obtained by a beginning operator who lacks the skills of working with ultrasound devices.
The central hemodynamics parameters were determined using the ultrasound monitor of cardiac output non-invasive control USCOM via the left-sided transaortal approach in newborn children staying at the department of resuscitation and intensive therapy. Data were measured by two operators. One of them wasn’t aware of the results obtained by the other investigator. Stroke output, heart rate and cardiac index were chosen to be compared.
Statistical analysis was done using Wilkinson’s coefficient and Spearman’s rank correlation coefficient. Median values were almost the same. In correlation comparison, a high correlation ratio was found for the cardiac rates obtained by operators 1 and 2 (r=0,827; p=0,000; R²=0,68); the stroke volume values were r=0,837; p=0,000; R²=0,7; the values of cardiac output were r=0,781; p=0,000; R²=0,61.
Acquiring practical skills of dealing with USCOM monitor doesn’t need special costs. On-site training under supervision of an instructor is enough.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):69-73
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PERSONIFICATION OF INTENSIVE THERAPY OF MULTIPLE ORGAN FAILURE IN NEWBORNS

Minochkin P.I.

Abstract

In spite of achievements in modern neonatology, lethality of new-borns at resuscitation departments remains high. The main cause of unfavourable outcomes is multiple organ failure (MOF). A targeted individualized therapy (TIT) was developed to increase the survival. In new-borns, the TIT criterion is represented by the index of oxygen delivery (IDO2) ≤ 583 ml/m2  per minute, whereas the TIT was aimed at the support of IDO2  at the level above the MOF. The prospective, controlled, randomized study included 78 new-borns with MOF. According to the results of the study, survival of the patients accounted to 0.92 in the TIT group within one year after the birth and 0.74 in the other group. Thus, the method was claimed effective.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):75-80
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COMPARISON OF INFORMATION VALUE OF THE SCALE ESTIMATING MULTIPLE ORGAN FAILURE IN NEWBORNS WITH NECROTIZIN ENTEROCOLITIS

Budarova K.V., Shmakov A.N., Sirota S.I.

Abstract

Purpose of the study: to estimate the validity of two scales estimating multiple organ failures among newborns with necrotizing enterocolitis.
Materials and methods. The observational study included 30 newborns with necrotizing enterocolitis at the stage of intestinal perforation. The condition severity was estimated using two sales such as The Sequential Organ Failure Assessment (aSOFA), adjusted for the neonatal period, and The Neonatal Multiple Organ Dysfunction (NEOMOD), with equal intervals of staying at the resuscitation department.
Results. Representativeness of aSOFA and NEOMOD scales was proven using the ROC-analysis.
Conclusion. The compared scales have equal validity for dynamic estimation of the condition.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):81-85
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USING AN EXTERNAL ELECTRIC CARDIAC PACEMAKER IN COMPLEX TREATMENT OF CHILDREN WITH ACUTE POISONING WITH CALCIUM CHANNEL BLOCKERS

Kovalenko L.A., Dolginov D.M., Kovalchuk A.S., Afukov I.I.

Abstract

According to data obtained at the pediatric toxicology department of Moscow during 2015–2016, 48 cases of poisoning with calcium channel blockers and 68 cases of poisoning with beta-adrenergic blockers were registered. The clinical picture of acute poisoning with antihypertensive drugs can have both cardiac (arterial hypotension, impaired conductivity in the heart, disturbances of systemic hemodynamics) and extracardiac symptoms (impairment of consciousness, impairment of vision, hypoglycemia, vomiting and nausea).
In the work, we present a case history of a patient suffering from acute suicidal drug poisoning with verapamil and metaprolol.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):86-90
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CLINICAL OBSERVATIONS

ACUTE INTESTINAL OBSTRUCTION AS A COMPLICATION OF PHYTOTRYHOBEZOAR

Konovalov A.K., Petlakh V.I., Konstantinova I.N., Ganiev S.A., Savel'ev S.B.

Abstract

In urgent pediatric surgery, acute intestinal obstruction due to bezoar obturation is a rare pathological condition. Phytobenzoars are the causes of obstruction in the majority of observations. This is the case where the authors describe the treatment of a child with double localization of a mixed benzoar i.e. in the intestine and stomach.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):91-94
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CHRONIC POST-OPERATIVE ABSCESS OF THE ABDOMINAL CAVITY IN A 12-YEAR-OLD CHILD

Razin M.P., Lapshin V.I., Semakin V.I., Smirnov A.V., Skobelev V.A., Nabieva G.G.

Abstract

The authors present data obtained during the clinical supervision of successful treatment of chronic post-operative abscess of the abdominal cavity in a 12-year-old child developed in 5 years following appendectomy for phlegmonous appendicitis.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):95-97
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REVIEW

SHORT BOWEL SYNDROME IN CHILDREN

Sukhotnik I.G.

Abstract

Short bowel syndrome (SBS) continue to be important clinical problem in pediatric population due to high mortality and morbidity rates, as well as their devastating socioeconomic effects. In this paper, the etiology of SBS, its pathophysiology, the cellular and molecular mechanisms of intestinal adaptation, are reviewed. The most common complications of SBS are outlined with strategies to reduce them. The medical management and nutritional support of a patient with SBS is complex and requires a multidisciplinary. A review of the pharmacologic agents and growth factors that have been studied experimentally and administered clinically for the management of short bowel syndrome is presented.
Surgical procedures to promote intestinal adaptation and intestinal lengthening have largely changed the available options for non-transplant interventions.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):98-115
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ANNIVERSARIES

ANNIVERSARIES

Abstract

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):116-118
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NECROLOGUES

NECROLOGUE

Abstract

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(3):119-120
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