Vol 8, No 2 (2018)

EDITORIAL
PROBLEMS OF LEGISLATIVE REGULATION OF PEDIATRIC SURGERY AND FETAL SURGERY IN THE RUSSIAN FEDERATION
Morozov D.A.
Abstract

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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):6-15
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ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ
CHILD INJURIES AND SPECIALIZED CARE FOR CHILDREN IN A CITY (for Saint Petersburg)
Baindurashvili A.G., Vissarionov S.V., Solovyova K.S., Zaletina A.V.
Abstract

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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):16-23
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MODIFIED SINGLE-SIDED LAPAROSCOPIC EXTRAVESICAL ANTIREFLUX OPERATION
Dubrov V.I., Bondarenko S.G., Kagantsov I.M.
Abstract

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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):24-32
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ESTIMATING THE EFFECTIVENESS OF SURGICAL TREATMENT OF CHILDREN WITH THRYOID NEOPLASMS
Grachev N.S., Vorozhtsov I.N., Babaskina N.V., Iaremenko Е.I.
Abstract

Aim. To estimate the effectiveness of the developed design of perioperative examination of patients and surgery of children and adolescents with thyroid neoplasms.

Materials and methods. The data of surgical treatment and perioperative control of 70 patients’ condition from 2012 to July 2017 were presented. The features of perioperative control included prevention of postoperative hypoparathrosis, use of ACR TI-RADS system to interpret the thyroid ultrasound findings as the first line diagnosis of a malignant neoplasm and intraoperative electrophysiological neuromonitoring of the laryngeal nerves. The follow-up was 1 to 56 months. The quality of life was estimated using a questionnaire.

Results. The basic risk factors of an intraoperative injury to the recurrent laryngeal nerve, postoperative hypocalcemia and hypoparathyrosis were found during the study. The disease duration and aggressive course and a number of surgeries in a patient significantly decrease their life quality (p<0.05).

Conclusions. Comparison of quality of life indicators before and after a surgery and popula tion indicators of healthy adolescents revealed the advantage of using the developed scheme of perioperative control of surgical treatment of thyroid neoplasms in children and adolescents.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):33-47
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PROBLEMS AND WAYS OF SOLVING THE MEDICAL ASPECTS OF CIRCUMCISION
Murtuzaaliev Z.N., Mahachev B.M., Murtuzaaliev N.P.
Abstract

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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):48-55
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STRATEGY OF INFUSION-TRANSFUSION THERAPY IN OPERATIONS WITH MASSIVE BLOODWORK IN CHILDREN WITH TUMOR ABOMALOMAL LOCALIZATION TUMORS
Belousova E.I., Matinyan N.V., Martynov L.А.
Abstract

Surgeries for thoracoabdominal tumors in children predispose to water and electrolyte imbalance, imbalance in the coagulation system, etc. In spite of abundance of recommendations for children, the volume of basic infusion therapy is uncertain.

Study purpose. To estimate the clinical effectiveness of the conducted infusion therapy with isotonic balanced electrolyte solution in children who underwent thoracoabdominal surgeries accompanied with massive blood loss and a complex estimation of the conducted infusion and transfusion therapy.

Materials and methods. The intraoperative and early postoperative (days 1–5) periods were analyzed in 22 patients (ASA II–III) who underwent an operation for thoracoabdominal malignant tumors with massive perioperative blood loss in 2016–2017. Group I included 11 patients who had infusion with balanced crystalloid solutions of 5 to 10 ml/kg/hour under combined anesthesia. Group II includes 11 patients who had infusion with balanced crystalloid solutions of 11 to 20 ml/kg/hour under combined anesthesia.

Results. According to the conducted study, a higher hemodynamic stability was observed in patients from the group of basic infusion therapy with balanced crystalloid solutions of 11–20 ml/kg/hour. It was expressed as the decrease of the mean dose of the used vasopressors and volume of the infusion of colloidal solutions. The patients also had a less intense response to stress.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):56-64
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PROPOFOL-INDUCED METABOLIC DISTRESS SYNDROME
Lazarev V.V., Daryin S.A., Brusov G.P., Tsypin L.E., Popova T.G.
Abstract

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).

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):65-69
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EXCHANGE OF EXPERIENCE
FEATURES OF DIAGNOSIS AND TREATMENT OF GASTRIC HORISTOMА IN CHILDREN
Svarich V.G., Lisitsyn D.А., Kagantsov I.M., Perevozchikov Е.G., Islentiev R.N.
Abstract

For the period from 2014 to 2018 years in surgical Department of the Republican children’s Clinical Hospital in Syktyvkar were treated children with stomach`s horistomа. Endoscopic picture of all patients appeared to be rather specific. In the stomach was determined by education dimensions 0,8–1,0 cm, deepening in the сentre, resembling the excretory duct of the pancreas. Six patients have performed laparoscopic atypical wedge resection of the stomach. One patient was unable to complete the operation laparoscopically, as horistoma was located on the back wall of the stomach. After you perform the conversion operation was completed. One patient in the first 24 hours after laparoscopic surgery emerged partial dehiscence of sutures on the stomach and carry out emergency necessitating additional sealing wounds nodal joints.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):70-74
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CLINICAL OBSERVATIONS
NEW TECHNOLOGIES IN THE TREATMENT OF A CHILD WITH PLEURAL EMPYEMA AFTER SEVERE CATATRAUMA
Bataev S.M., Chogovadze G.A., Molotov R.S., Afaunov M.V., Pilyutik S.F., Zurbaev N.Т., Ignatyev R.O., Fedorov A.K., Firsova M.V.
Abstract

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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):75-83
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THORACOSCOPIC TREATMENT IN NEWBORN WITH EXTENDED TUBULAR ESOPHAGEAL DUPLICATION
Khvorostov I.N., Andreev D.A., Damirov O.N.
Abstract

We present a case of complete extended tubular esophageal duplication in a newborn without concomitant abnormal development. Esophageal duplication is diagnosed based on the clinical picture, direct laryngoscopy, esophagography and contrastenhanced computed tomography. The esophageal duplication was removed by thoracoscopy, isolation from the pharynx was performed via a separate dissection on the neck.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):84-88
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LARGE FOREIGN BODIES OF THE ESOPHAGUS AND STOMACH IN CHILDREN
Gumerov A.A., Alibaev A.K., Kinzikeev R.K., Paramonov V.A., Gumerov R.A., Rakhmangulov R.R., Sharipov N.N.
Abstract

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).

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):89-93
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TWO-STAGE TREATMENT OF NEWBORN WITH GASTRASHISIS
Shidakov I.Н., Kalniyazov B.M.
Abstract

The authors aim to consider a clinical case of treatment of a newborn baby with gastroschisis by staged immersion of intestinal loops and anterior abdominal wall plasty. A defect of the anterior abdominal wall was detected by ultrasound scan at 15 weeks gestation of a baby born at 33 weeks gestation (the Apgar score is 6–7, weight is 2,000 g). The child had a surgery 5 hours after the birth. After revision of the retained organs a pronounced visceral and abdominal disproportion was found. It was decided in favor of two-stage procedure of gastroschisis. A silicon bag with an elastic fixing ring hermetically placed under the abdominal wall was used during silo placement. It is an alternative to original bags for silo placement. At day 9 after the surgery (immersion of intestinal loops) the plasty of the anterior abdominal wall was done. As a result, the patient recovered and was transferred from the neonatal resuscitation department when he was 36 days old. By describing the advantages of the technique, the authors suggest it should replace other types of silo replacement which are widely used in our country.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):94-98
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ХРОНИКА НАУЧНОЙ ЖИЗНИ
RUSSIAN SYMPOSIUM WITH INTERNATIONAL PARTICIPATION "HIRSHPRUNG DISEASE AND NEUROINTESTINAL DISPOSITION IN CHILDREN"
Morozov D.A., Пименова Е.S.
Abstract
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):99
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25th RUSSIAN (58TH ALL-UNION SCIENTIFIC STUDENT CONFERENCE "TOPICAL QUESTIONS OF SURGERY, ANESTHESIOLOGY AND RENAMMATOLOGY OF CHILDHOOD AGE"
Morozov D.A., Pimenova Е.S.
Abstract
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):100
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ENS 5th INTERNATIONAL SYMPOSIUM "DEVELOPMENT OF THE ENTERIC NERVOUS SYSTEM: CELLS, SIGNALS, GENES AND THERAPY" 4/8/2018 – 4/11/2018, BOSTON, MA
Khasanov R.R.
Abstract
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):101-103
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ALL-RUSSIAN CONGRESS WITH INTERNATIONAL PARTICIPATION "TOPICAL ISSUES OF CRITICAL CARE MEDICINE" Final review of the organizers of the Congress
 
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):104-106
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ANNIVERSARIES
К 80-летию Данилу Юлиановичу Кривчене
 
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):107-108
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ANNOUNCEMENT OF SCIENTIFIC EVENTS
 
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):109
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NECROLOGUE
ПАМЯТИ ГАЛИНЫ АЛЕКСАНДРОВНЫ КОСТОМАРОВОЙ
 
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(2):115
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