Vol 8, No 2 (2018)

The article deals with the recommendations accepted during the round table discussion of the Health Protection Committee of the State Duma of Russia (Pediatric surgery and surgery of the fetus in Russia: legislation regulation of practice, science and training of personnel). The general characteristics of the issue related to the provision of surgical aid to children, legal status of the pediatric surgeon, law enforcement when providing surgical aid to children, training of specialists and scientific personnel are reviewed. The recommendations for the Government of the country, Ministry of health, associations of pediatric surgeons and other executive agencies are presented in detail.

Observation of successful treatment of a 12‑yearold child with severe catatrauma obtained at falls from over 50 m is presented. It was required to perform a number of surgeries including splenectomy during treatment. A pneumococcal empyema of the left lung that determined the patient’s severity developed against the background of a traumatic disease. The child underwent two procedures of thoracoscopic pleural cavity sanation. VersaJet hydrosurgical system was used to debride and decorticate the lungs. Plasma Jet surgical system of argon plasma coagulation was used to arrest the bleeding caused by rib fractures and air stasis. It was found out for the first time that the techniques could be combined. This enabled to achieve a favorable treatment result for a child with a severe injury to the brain, multiple injuries to the skeletal bones and soft tissues complicated with destructive pleuropneumonia and sepsis.

The article presents clinical observations of two patients with large metallic foreign bodies (carbine closure in the esophagus and a table spoon in the stomach of a 1.5‑year-old child). The closure was removed from the esophagus endoscopically, but a big size and configuration of a table spoon made a surgery necessary (laparotomy, gastrotomy).

Introduction. Based on the state statistics and in-house research the rates of child injury in SaintPetersburg in 2015–2017 were examined. As compared with the previous years, the rates of injury prevalence in children of 0–14 years (145.2%) and adolescents of 15–17 years (247.5%) don’t tend to the decrease and exceed the overall rates for Russia.

Materials and methods. The structure of child injury by gender, age, type of injury, injury localization, and number of bone fractures in various locations as per chapter XIX of ICD-10 were presented.

Results and discussion. External causes include road accidents, physical assault (chapter XX of ICD-10). Low disability index associated with musculoskeletal disorders in children is an advantage (0.7 per 10 thousand). The activity of outpatient and inpatient medical facilities providing specialized aid to children with musculoskeletal diseases in Saint-Petersburg was analyzed. The unique research centers for treatment of severe injuries of the musculoskeletal system and their consequences in children located in the municipal and federal institutions of Saint-Petersburg were presented.

Introduction. Laparoscopic techniques have been applied to ensure surgical treatment of the vesicoureteral reflux (VUR) in children during the last decades. We present the experience of using the laparoscopic extravesical antireflux standard and ureter-fixed modified surgery.

Materials and methods. A multi-center prospective experimental clinical historical cohort two-group study of patients with III–V stage primary VUR. The basic group consisted of 48 children who had a unilateral laparoscopic extravesical surgery when the ureter was fixed according to the developed technique. 44 children who had a surgery according to the standard technique were included into the control group.

Results. Complete VUR removal was noted in 100% of patients from the basic group and 81.2% of patients from the control group (р <0.01). Preservation of the megaureter with complete reflux resolution was seen in 1 child only (2.1%) from the basic group who had V stage VUR (p=0.2).

Conclusions. Laparoscopic extravesical antireflux is a safe and effective surgery. Distal ureter fixation reduces the rate of VUR recurrences.

Purpose: the study was aimed at analyzing the complications that occur during circumcision and estimate the effectiveness of the developed original method of this surgery.

Materials and methods. Over 6,000 observed results of circumcision performed in boys from 3 regions of the country using both conventional, and original author techniques were analyzed. They included saving resection of the prepuce preserving the inner leaf of the prepuce without sutures.

Results. The first group included 3,223 boys who had a surgery following the technique made at the clinic when 0.3% of unsatisfied results were obtained. The second group consisted of 3,115 children who had a conventional surgery at medical institutions and at home with unsatisfactory results diagnosed in 7.6% of patients.

Conclusions. The main reasons for complications in circumcision are the lack of a proper preoperative preparation of the surgical field, deviation from the conventional surgery technique and inad equate postoperative care. The sutureless circumcision technique developed by the author enabled to achieve minimum of complications.

Introduction. The obtained experience of using propofol under clinical conditions and in experimental studies discover the mechanism of a negative drug effect at the level of mitochondrial enzymes which is currently treated as the propofol infusion syndrome.

Purpose. To demonstrate the cases of creatine phosphokinase level variation during the intraoperative pediatric use of propofol in anesthesia.

Materials and methods. Three cases of intraoperative use of propofol in 2–17‑years-old patients with different dosages and dose schedules.

Results. The level of creatine phosphokinase was increased 9–44 times within 2–5 days of postoperative period without any significant disturbances or with insignificant changes in the levels of transaminase and lactic dehydrogenase (LDG).

Conclusion. Propofol-based variation in the cellular metabolism proven today rather corresponds to the term ‘propofol-induced metabolic distress syndrome’. It can be manifested both at the level of clinical symptoms and subclinically, without any evident clinical signs with short-term transient variations of laboratory parameters only (acid-base balance (ABB), transaminase, LDG and CPK).