Vol 8, No 3 (2018)

Cover Page

Full Issue

EDITORIAL

INTERREGIONAL CENTERS OF HIGH-TECH CHILDREN’S SURGERY – MORTGAGE OF ACCESSIBILITY AND QUALITY OF MEDICAL CARE FOR RUSSIAN CHILDREN

Rozinov V.M., Morozov D.A., Rumyantsev S.A., Vaganov N.N., Azovskiy D.R., Afaunov N.V.

Abstract

The article starts with a summary of the international experience in making medical care both accessible and high quality for children with surgical conditions and trauma by concentrating patients in specialized trans-regional centers. The authors give results of the retrospective analysis of the reasons for failure when implementing the concept of trans-regional specialized medical care in the Russian healthcare system. The paper lists problems with legislative control over these aspects: supplying the centers with resources, medical evacuation processes, distribution of responsibility by areas, and the information exchange with local medical institutions (hospitals, clinics, etc). The article also illustrates similarities and differences on how the trans-regional centers for pediatric surgical care function inRussiaand in other countries. The authors outline high priority measures for creating trans-regional centers for specialized medical assistance for children inRussia. The systematic review includes 16 domestic and 28 foreign literature sources, 8 references to Russian laws and regulations. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):6-17
pages 6-17 views

ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ

MORPHOLOGICAL TRANSFORMATION OF THE INTESTINAL WALL IN NEWBORNS WITH NECROTISING ENTEROCOLITIS

Karpova I.Y., Parshikov V.V., Shirokova N.Y., Pyatova Е.D., Molchanova D.V., Bebenina A.A.

Abstract

The purpose is to present morphological and morphometric changes in the histoarchitecture of the intestinal wall in newborns with necrotizing enterocolitis considering the outcomes of the disease. Materials and methods. The PRMU clinics carried out a morphological study of histological intestinal sections of 99 operated patients with NEC from 2003 to 2017. The patients were divided into the following groups: 72 survived newborns from group I (favourable outcome) and 27 dead newborns from group II (unfavourable outcome). The object under study was surgical specimen of the ileum and large intestine. Result. The disease outcome can be predicted using morphological changes in the intestinal wall in NEC. The leading role of the drainage function of the lymphatic apparatus is established in the article. It is completely restructured in the operational specimen of patients with the unfavourable course. Changes in the cellular composition in the form of insufficient number of fibroblast cells and isolated epithelial and stromal cells enabled subsequent destruction of the bowel wall with progression of the exudative processes.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):18-27
pages 18-27 views

MORPHOLOGICAL CHANGES OF THE SMALL INTESTINE IN ACUTE STRANGULATIVE INTESTINAL OBSTRUCTION IN THE STAGE OF DECOMPOSITION IN CHILDREN

Solovev A.E., Vasin I.V., Kul’chitskij O.А.

Abstract

Purpose. The purpose was to determine the depth and prevalence of pathomorphological changes in the small intestine of children at the distance from the visible border of necrosis with decompensated acute strangulated intestinal obstruction (ASIO) to determine the minimum possible length of intestinal resection.

Material and methods. Morphological studies of a resected fragment of the small intestine were performed in 24 children aged 3 days to 18 years who had undergone a surgery for ASIO with intestinal necrosis. Strangulated adhesive obstruction was found in 17 children, five children had congenital intestine torsion and two children faced small intestinal strangulation in the congenital mesenteric defect. The postsurgical material was studied morphologically using histological stains with the distance of 3 cm between the section.

Results. The depth, prevalence of the morphological changes in the small intestinal wall, intensity and length of morphological changes in children with decompensated ASIO were determined.

Conclusion. A differentiated approach to the selection of resection scope in the proximal and distal directions from the visible border of ASIO-related necrosis is necessary. The distances are twice shorter in children as compared to adults. Refusal from extensive resections will enable to reduce the rate of short bowel syndrome in children.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):28-33
pages 28-33 views

CLINICAL EFFICIENCY OF BIOPLASTIC COLLAGEN MATERIAL «COLLOST» IN CHILDREN WITH THERMAL INJURY (MULTICENTER STUDY)

Budkevich L.I., Kovalchuk V.I., Glutkin A.V., Brazol M.A., Mirzoyan G.V., Gnipov P.A., Salisty P.V., Chekinev Y.V., Shmyrin A.A., Gabitov R.B.

Abstract

The results of an international prospective multicenter observational study are presented. Its purpose was to compare the dynamics of a wound process when using various forms of Collost medical device (gel 7%, membranes, powder) and traditional local conservative treatment with hydrocolloid dressings in children with burns of II–III degrees (ICD-10). 94 patients aged 1 to 12 years old with a mosaic thermal injury were included. The patients were divided into 3 groups depending on the type of collagen material. The fourth group (comparison group) was composed of patients with traditional local conservative management of wounds. The obtained results were compared. It was proven that the dynamics of wound area reduction and rate of its epithelization were the best when Collost collagen material was used. Collost as gel and as powder produces a special favorable effect on the course of the wound process in the presence of secondand third-degree burns.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):34-44
pages 34-44 views

KEEL-SHAPED DEFORMITY OF THE CHEST

Akselrov M.A., Razin М.P., Satyvaldayev M.N., Vol’skiy G.B., Skobelev V.A., Baturov M.A.

Abstract

Purpose. To analyze the results of treatment of children with keel-shaped deformity of the chest using various methods.

Materials and methods. The work is based on the retrospective analysis of treatment outcomes for 28 children who obtained treatment for KSDC at pediatric surgical departments of Regional Clinical Hospital No. 2 in Tyumen and Children’s Regional Clinical Hospital in Kirov. These are clinical bases of pediatric surgery departments of Tyumen and Kirov State Medical Universities. Various treatment methods were applied including chest constant pressure devices and thoracoplasties.

Results and discussion. The Ravich procedure was done in 14 children. The patients stayed at the hospital for 18±3 days and required prolonged anesthesia and long-term antibacterial therapy; discharge was followed by long-term immobilization with a plaster or polymer corset. 6 children had surgeries using smallinvasive thoracoplasty based on the method offered by H. Abramson. The hospital treatment stage was 7 to 11 days. 8 children had therapy using orthosis.

Conclusion. The authors believe that mental traumas caused by a keel-shaped deformity require minimally invasive techniques for correction that eliminate the deformity considering esthetic requirements of a patient.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):45-52
pages 45-52 views

LAPAROSCOPIC NEPHRECTOMY IN FATAL CHILDREN WITH WILMS TUMOR

Kagantsov I.M., Karmanov A.L., Svarich V.G., Sannikov I.A.

Abstract

Over the past decades, minimally invasive surgical procedures have been widely applied in the field of pediatric urology. However, very few cases of possible laparoscopic removal of a nephroblastoma (Wilms’ tumor) in children have been reported, especially during the 1st year of life. In this study, we estimated our experience of laparoscopic nephrectomy for Wilms’ tumor in young children. 5 children with unilateral Wilms’ tumor who were less than 1 year of age and underwent radical nephrectomy via laparoscopic approach were observed from 2010 to 2017. During the intervention, the average age of the patients was 7.4 months. All children who underwent the laparoscopic surgery had a favourable early perioperative period. No continuous tumor growth, tumor implantation in the perioperative wound and trocar-related injury were noted. No delayed complications were found during the 12 to 60 month control period. The observed patients had no phenomena of renal insufficiency. The survival rate was 92.9%. Laparoscopic tumor nephrectomy is feasible in infants. It can be performed when the Wilms’ tumor reaches a volume of no more than 70 cm3 at specialized pediatric hospitals that provide oncological and urological services. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):53-59
pages 53-59 views

КРИТИЧЕСКИЕ СОСТОЯНИЯ В ДЕТСКОЙ ХИРУРГИИ И НЕОНАТОЛОГИИ

GLUTAMINE SOLUTION IN PARENTERAL NUTRITION IN PATIENTS WITH SURGICAL PATHOLOGY

Erpuleva Y.W., Kucherov Y.I., Adleiba S.R.

Abstract

The article presents literature review on the usage of glutamine solution in the parenteral nutrition of patients with surgical pathology (burns, trauma, cancer). It considers modern approaches to parenteral nutrition using the glutamine solution; the clinical effect is displayed. Experience of using the glutamine solution within the last thirty years in patients with different surgical diseases is shown in the article.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):60-66
pages 60-66 views

STRESS-RESPONSE EXPRESSION IN DIFFERENT ANESTHESIA TECHNIQUES DURING OPHTHALMOSURGICAL INTERVENTIONS IN CHILDREN

Korobova L.S., Lazarev V.V., Balashova L.M., Kantarzhi E.P.

Abstract

Just like any surgery, a surgical operation pertaining to the eye and its appendages is a common cause of stress that changes the functions of all organs and systems. Numerous previous studies have shown this. The task of anesthesia is to protect a body from stress.

The purpose of the study was to estimate the severity of a stress reaction when using different methods of anesthesia during eye surgeries in children.

Material and methods. Plasma concentrations of glucose, lactate and cortisol were measured in children aged 4 to 18 years old at three surgical stages. Various methods of anesthesia were used in 5 groups. The patients were distributed at random with 20 children in every group. Results. All estimated values were within the age-specific reference range. Glucose and cortisol levels tended to increase, whereas lactate level was decreasing.

Conclusion. The suggested anesthesia types can sufficiently protect patients during eye surgeries and be applied in the practice. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):67-75
pages 67-75 views

EXCHANGE OF EXPERIENCE

BEZOARS OF THE GASTROINTESTINAL TRACT IN CHILDREN

Grigovich I.N., Savchuk O.B., Savchuk M.O., Derbenev V.V.

Abstract

The purpose of the study: evaluation of the results of surgical treatment of children with bezoars of the gastrointestinal tract.

Materials and methods. Over the past 18 years, we have observed 6 children with bezoaris (girls-4, boys-2). Of these, 5 children with trichobezoirs of the stomach and intestines and one child with polybezoar – rags, bandages. Age fluctuated from 8 to 13 years. Only one girl was at the age of 3 years. With careful collection of anamnesis, it was found that everyone had a bad habit of chewing the ends of the hair. Only one child suffering from a severe CNS lesion had a polybekoar. It is difficult to determine the exact period of existence of trihobezoars. Children were registered with pediatricians for gastritis 2–3 years; perhaps these were the first signs of the formation of trichobezoara in the stomach.

Results. Of the six children operated 5 (3 girls and 2 boys). At one girl of 12 years the tri-chaser in the size of 4 sm was in a stomach, and its tail descended in duodenum. This bezoar removes endoscopically. The remaining 5 children were operated. All the children recovered.

Conclusions. With trihobezoare stomach possible endoscopic removal. However, the main method of treating children with bezoars of the gastrointestinal tract is surgical. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):76-80
pages 76-80 views

CLINICAL OBSERVATIONS

SURGICAL TREATMENT OF A CHILD WITH DEEP BURN OF THE FACE

Rybchenok V.V., Starostin O.I., Trusov A.V., Shcherbakova M.A., Stepanovich V.V., Fomina M.G.

Abstract

Total deep facial burns represent one of the most complex clinical tasks for a surgeon. A child’s quality of life and complexity of subsequent treatment stages depends on effective surgical tactics used during the acute period of a burn trauma. The article describes the use of full-thickness graft preliminarily stretched with an endoexpander when treating deep facial burns in a child with the total burns involving 60% of body surface and thermoinhalation lesion. The surgery was done on the 36th day of staying at the hospital in spite of the patient’s severe condition. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):81-87
pages 81-87 views

LUNG LOBE GANGRENE IN ITS CYSTIC ADENOMATOID MALFORMATION

Stalmakhovich V.N., Dyukov A.A., Telezhkin A.L.

Abstract

The article describes a case of successful treatment of a child not elder than 1 year old with a gangrene in the right upper lobe of the lung against the background of its cystic adenomatoid malformation. The disease manifested as pneumonia. The diagnosis was confirmed following multispiral computed tomography. The first stage of surgery was drainage of the pleural cavity. Thoracotomy and upper lobe lobectomy were done after a child’s condition had stabilized. Gangrene in the cystic and adenomatoid piece of the lobe was confirmed macroscopically and histologically. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):88-92
pages 88-92 views

FOCAL NODULAR HYPERPLASIA OF THE LIVER IN A CHILD OF 13 YEARS

Bataev S.M., Musaev G.H., Zurbaev N.T., Molotov R.S., Grushickaya E.V.

Abstract

The article describes a clinical case of a child with hepatic focal nodular hyperplasia. The obtained good result is confirmed with clinical data and instrumental studies. This allows us to assume safely that radical surgery is possible in these patients. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):93-99
pages 93-99 views

REVIEW OF LITERATURE

MODERN APPROACHES TO THE SURGICAL TREATMENT OF BILIARY ATRESIA

Razumovskiy A.Y., Ratnikov S.A.

Abstract

The review of literature deals with the current classification of the biliary atresia, presents the authors’ opinion considering a technique of theKasaiprocedure, and displays modern modifications of portoenteroanastomosis estimating their effectiveness. PubMed database and Google Scholar search system were used to search for primary terms. Survival of children with this pathology was analyzed depending on theKasaitechnique, anatomical form, terms of portoenteroanastomosis and importance of early diagnosis of this pathology. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):100-111
pages 100-111 views

CONGENITAL NON-PARASITIC LIVER CYSTS IN CHILDREN

Kozlov Y.A., Rasputin A.A., Baradieva P.J., Ochirov C.B., Rasputina N.V., Us G.P., Kuznetsova N.N., Kononenko M.I.

Abstract

The study presents a discussion of the literature on congenital non-parasitic cysts of the liver known to date. Congenital non-parasitic cysts of the liver in children are rare. In children, the cysts are believed to be the unique reason for abdominal tumors. Although the majority of liver cysts in children are asymptomatic, some infants can have the symptoms in the prime of life frequently requiring urgent surgery. All the patients need a surgery to prevent complications and malignization of the cyst. The purpose of the surgery is to enucleate the cyst preventing a cancer recurrence. Minimally invasive surgery is used to treat hepatic cysts in children with ever-increasing frequency. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):112-118
pages 112-118 views

HISTORY OF PEDIATRIC SURGERY

THE HISTORY OF PEDIATRIC SURGERY IN THE SECHENOV UNIVERSITY

Morozov D.A., Pimenova E.S., Ayrapetyan M.I.

Abstract

The article is devoted to the history of establishing the Department of Pediatric Surgery and UrologyAndrology of theSechenovUniversity. The role of the first PD of the EmperorMoscowUniversity and founder of pediatric surgery as a science Leonty P. Aleksandrov was described. He organized a course devoted to pediatric surgical diseases in 1893 and was the head physician of Saint Olga’sPediatricHospital. He also founded the Society of Pediatric Surgeons inMoscow, and was an initiator of the meeting of Russian surgeons conducting serious work on the organization of meetings of Russian surgeons in memory of N. I. Pirogov. In 2008, he founded a Department of Pediatric Surgery and Urology-Andrology of theFirstMoscowStateUniversitynamed after I. M. Sechenov. The article describes therapeutic, research, organizational and pedagogical work of the department since its establishment till now. 

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):119-136
pages 119-136 views

ANNIVERSARIES

ANNIVERSARIES

Abstract

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):137-138
pages 137-138 views

ХРОНИКА НАУЧНОЙ ЖИЗНИ

INTERNATIONAL PEDIATRIC SURGICAL CONGRESSANNUAL MEETING

Ignatyev R.O., Bataev S.M.

Abstract

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):139-140
pages 139-140 views

25 INTERNATIONAL MEETING OF THE PEDIATRIC COLORECTAL CLUB

Abstract

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):141
pages 141 views

NEGROLOGUES

Abstract

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(3):142-146
pages 142-146 views

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