Vol 9, No 1 (2019)

Cover Page

Full Issue

Case reports

SUCCESSFUL SURGICAL TREATMENT OF A NEWBORN WITH CHYLOPERITONEUM

Kucherov Y.I., Kholodnova N.V., Adleiba S.R., Belaya A.L., Makarova L.M., Ovsiannikova M.A., Zhirkova Y.V.

Abstract

The article describes clinical observation of treatment of a premature infant with chyloperitoneum. Accumulation of fluid in the abdominal cavity was diagnosed prenatally at 31–32 weeks of gestation. Premature surgical delivery was performed at 34– 35 weeks due to the high risk of antenatal fetal death. Paracentesis with fluid analysis was done; chylous exudate was confirmed. Total parenteral nutrition, octreotide and drainage of the abdominal cavity were used during conservative treatment. It was decided to perform a surgery as the therapy was ineffective. At the age of 2 months and 7 days laparotomy was conducted, abdominal organs were revised, lymph ducts were ligated, and abdominal cavity was drained producing a positive effect. The fluid outflow was terminated and the child was discharged in a satisfactory condition.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):96-103
pages 96-103 views

DIFFICULTIES IN DIAGNOSING A FOREIGN BODY IN THE GASTROINTESTINAL TRACT (HYDROGEL) OF A 10-MONTH-OLD CHILD

Shangareeva R.K., Mirasov A.A., Zaynullin R.R., Soldatov P.Y., Valeeva G.R.

Abstract

Abstract. Purpose: informing the doctors who provide aid to children of the peculiarity of the pathology. Methods: a 10-month-old boy who developed recurrent vomiting, cough, nasal discharge and fatigue was admitted to the hospital in his place of residence and diagnosed ARVI with abdominal pain syndrome. In spite of the treatment, the patient’s condition worsened, cerebral edema aggravated, and he received artificial pulmonary ventilation with a diagnosis of acute meningoencephalitis of unclear etiology, cerebral edema, and stage 3 coma. The patient was transferred to the republican hospital where his condition was stabilized using intensive care and correction of water-electrolyte and metabolic disorders. At day 9 after the disease onset, a mobile tumor-like lesion was found on palpation in the right mesogastric region. An abdominal ultrasound showed a round anechogenic lesion with distinct regular outlines (40x40 mm). A surgery was performed to eliminate jejunal obstruction with hydrogel balls. Relaparotomy was done in 6 days. Discussion: this clinical observation shows there are diagnostic difficulties that are unavoidable when a history of peroral intake of hydrogel is lacking. Being in the intestine, hydrogel granules absorbed fluid and their size increased leading to obturation intestinal obstruction. Recurrent vomiting resulted in extrarenal loss of fluid and electrolytes. The patient developed cytotoxic cerebral edema due to hypotonic dehydration. A tumour-like lesion was found on palpation at day 9 after the disease onset. Conclusions: hydrogel balls result in obturation intestinal obstruction with severe water-electrolytic disorders. This pathology requires a surgery with full revision and complete evacuation of foreign bodies from the intestine.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):104-109
pages 104-109 views

LAPAROSCOPIC TREATMENT OF GASTRIC TRICHOBEZOAR

Shidakov I.H., Kalniyazov B.M., Voytkovsky A.E.

Abstract

Purpose: to report a case of a giant stomach trichobezoar successfully treated with a laparoscopic technique. Methods. A 14-year-old girl with signs of partial upper gastrointestinal obstruction was admitted to the hospital. Stomach trichobezoar was found during an endoscopic examination. The child was discharged following conservative therapy, as her parents gave no consent to surgery. In 2 months, she was admitted to the hospital again for planned surgery. Result. Gastrotomy was performed laparoscopically. Giant bezoar was removed from the stomach, placed in an endosac and then removed from the abdominal cavity through a Pfannenstiel incision. No postoperative general or wound complications were found. The patient recovered and was discharged. Conclusion. Treatment of stomach trichobezoars should be surgical. The method depends on a certain case. We believe that laparoscopy is more useful as compared to open surgeries and recommend it in uncomplicated forms of stomach trichobezoars.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):110-114
pages 110-114 views

CLINICAL CASE OF WHITE SPIRIT TOXIC ACTION IN A 2-YEAR-OLD CHILD

Bocharov R.V., Varlamov K.G., Semchenko E.A., Gayfullin R.R., Mun’kin A.V., Shchegolev V.E.

Abstract

Purpose. To describe the clinical observation of white spirit toxic effect resulting from an accidental fracture in a 2-year-old child. Materials and methods. Medical card retrospective analysis. Clinical and laboratory data were examined to estimate the functional state of a patient’s basic systems. Results and discussion. The cerebral and respiratory systems were rapidly affected in the acute period. Somatogenic stage of poisoning was complicated by the course of acute respiratory distress syndrome, toxic encephalopathy with a convulsive disorder, intestinal failure, and systemic inflammatory response syndrome. Conclusion. White spirit toxic effect in a child was manifested through long-term cerebral, respiratory and intestinal failure.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):115-121
pages 115-121 views

Original Study Articles

INTERREGIONAL CENTERS FOR SPECIALIZED PEDIATRIC SURGICAL AID IN RUSSIA – PROFILE AND DISLOCATION

Rozinov V.M., Morozov D.A., Rumyantsev S.A., Vaganov N.N., Fedorov A.K., Gorbachev O.S.

Abstract

Introduction. Russia needs to reform the stepwise model for delivering medical aid to children with surgical diseases and traumas mobilizing patients and those injured at specialized Interregional Centers (IRC). Purpose. To substantiate profiles and dislocation of IRC providing surgical aid to children in Russia. Material and methods. 103 specialists from 85 territorial entities of the Russian Federation presented their expert reviews concerning profiles and dislocation of IRC that provide surgical aid to children in accordance with the nomenclature of professions and administrative structure of the country. The expert reviews were analyzed using the methods of descriptive statistics to rate IRC profiles, their territorial dislocation, and focus on interaction of those surveyed with certain medical organizations. Consistency of expert opinions was estimated using Kendall’s coefficient of concordance. Results. Experts indicated 14 activity profiles of IRC providing surgical aid to children. According to rating results, more than a half of positive estimates belonged to five priority profiles including surgery of neonates, neurosurgery, oncology, thoracic surgery and combustiolgy. As far as IRC dislocation is concerned, experts mainly considered medical organizations within a federal district of territorial entities of the Russian Federation. Total number (287) of references (by priority profiles) to hospitals within territorial entities of Russia was 4 times more than the respective estimate (66) for federally governed healthcare providers. Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology that served as a base for potential IRC (oncology) was the most in-demand (19 requests) federal structure. Conclusion. Community of professionals has come to a consolidated opinion according to which buildup of IRC providing care in neonatal surgery, neurosurgery, oncology, thoracic surgery, and combustiology at children’s hospitals in territorial entities of the Russian Federation and 13 federally governed clinical research centers is a significant factor of providing affordable and qualitative medical aid.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):8-16
pages 8-16 views

POTENTIAL OF RADIODIAGNOSTIC METHODS FOR SMALL INTESTINE EXAMINATION IN THE CONTEXT OF SHORT BOWEL SYNDROME IN CHILDREN

Khasanov R.R., Weis M., Gumerov R.A., Gumerov A.A., Wessel L.M.

Abstract

Objective. For many years such diagnostic techniques as ultrasonography (U/S), contrast radiography (CR) and magnetic resonance imaging (MRI) have been successfully applied for the diagnosis of gastrointestinal diseases in children. Despite the long experience with U/S, CR and MRI for small intestine examinations, their diagnostic yield is yet not defined in the context of the short bowel syndrome considering the evaluation of advantages and disadvantages of these methods. In this regard, the purpose of our research was to define the role of each of these methods as a matter of assessing and monitoring patients’ condition as well as diagnosis of complications in patients with short bowel syndrome. Methods. To determine the opportunities of U/S, CR and MRI diagnostics for detection of malconditions in cases of short bowel syndrome we examined patients who had undergone ultrasound, CR and MRI of the intestinal tract as part of preoperative preparation for elongation of small intestine. In order to assess the diagnostic efficacy of aforementioned methods in the context of short bowel syndrome research results were compared with data obtained during surgery. Results. Ultrasonography (U/S) is considered to be the best screening technique for patients with SBS. Contrast radiography (CR) provides an opportunity to research the morphology of small intestine and its transport function quite thoroughly. Magnetic resonance imaging (MRI) is a method which allows one to give the best possible estimate of morphology of small intestine. Conclusion. U/S, CR and MRI of abdominal cavity organs are effective methods when it comes to the examination of small intestine in short bowel syndrome; each of these screening techniques has its own strengths and weaknesses. However, a proper combination of these methods should be applied, as it allows one to perform a comprehensive diagnosis of changes in short bowel syndrome and to take appropriate and timely actions regarding further patients’ treatment.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):17-36
pages 17-36 views

TREATMENT OF PATIENTS LOW WEIGHT WITH ESOPHAGUS ATRESIA

Razumovskiy A.Y., Mokrushina O.G., Afukov I.I., Shumikhin V.S., Koshko O.V., Emirbekova S.K.

Abstract

Introduction. Surgical treatment of intestinal atresia with distal tracheoesophageal fistula involves resection of fistula and intestinal primary anastomosis. However, premature children often have complications associated with delayed anastomosis. Thus, an optimal surgical approach is not determined. Purpose. Analyzing treatment results in newborns with intestinal atresia and very low weight. Materials and methods. Treatments outcomes in infants with intestinal atresia and very low weight (less than 1500 g) from 2008 to 2017 were assessed retrospectively. The patients were divided into 2 groups: (1) fistula dressing and crossing with subsequent delayed anastomosis reconstruction and (2) primary anastomosis. Demographic, surgical and postoperative complications were compared. Results. 23 preterm children with IA/TEF were operated. Twelve patients (52%) underwent primary anastomosis, whereas 11 (48%) of them had a stepwise surgery. Anastomotic leak confirmed by esophagram was similar in both groups (17% and 18%). Stenosis was more common in step-wise surgery (83%) as compared to the group of primary anastomosis (27%) (р<0.05). The esophagus was preserved in two patients who underwent step-wise surgery. 4 patients had coloesophagoplasty. The postoperative period was similar in both groups. 6 patients (50%) from the step-wise group and 5 patients (45%) from the group of primary anastomosis died. Conclusion. Staging plasty of IA/TEF in newborns does not improve the quality of life. In this group, gastro- and esophagostomy exteriorization is a preferable surgical approach.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):37-46
pages 37-46 views

SURGICAL TREATMENT OF NEONATES WITH GASTRIC PERFORATION

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

Introduction. Gastric perforation in neonates is a rare disease with high post-operative lethality. The purpose of our study was to analyze risk factors of gastric peroration in neonates and present the surgical treatment outcomes. Materials and methods. We examined the outcomes of surgical treatment of 18 neonates with gastric perforation. At the time of surgery, they have been staying at Ivan and Matryona Children’s Clinical Hospital since January 2000. Demographic measures such as gestational age, after-birth age, gender, and weight at birth are discussed. Risk factors for gastric perforation, gastric lesion localization and disease-related lethality were estimated. Results. We observed 18 premature children with gastric perforation amounting to 13.6% of the total number of children with gastrointestinal perforations. The patients were 1 to 30 days old (mean age of 6.3 days). Mean gestational age was 34 weeks. The weight ranged from 950 to 2.600 g (mean body mass was 2,151.8 g). 10 (55.5%) children had a gastric defect on the greater curvature, 2 (11.1%) children had it on the lesser curvature and 6 (33.3%) patients had the defect on the posterior wall of the stomach. In newborns with gastric perforation, post-operative lethality was 33.3% (n = 6). Conclusion. Preliminary abdominal paracentesis and drainage of the abdominal cavity with multiple organ failure correction until the basic surgery stage will probably improve treatment outcomes and decrease lethality due to decreased pressure in the abdominal cavity.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):47-56
pages 47-56 views

EXPERIENCE WITH TREATMENT OF DENTIGEROUS CYSTS OF THE JAWS IN CHILDREN

Slesareva O.A., Karpova I.Y.

Abstract

Introduction A tendency to the increasing rate of follicular jaw cysts in children has been observed in Nizhny Novgorod region lately. Material and methods. 240 children (131 (54.6%) boys and 109 (45.4%) girls) with follicular jaw cysts aged 4 to 17 inclusive were treated at the maxillofacial department of Nizhny Novgorod Regional Children’s Clinical Hospital between 2003 and 2018. The follicular jaw cyst was diagnosed based on complaints, past medical history, and X‑ray examination (orthopantomography, computed tomography) done on the outpatient basis. All patients were operated using standard methods such as cystectomy, cystotomy, cystectomy with maxillary sinusotomy (when a cyst penetrates the maxillary sinus). Results. Within the last years, duration of hospitalization was reduced from 17.0±0.6 to 4.0±0.3 calendar days (2017) and to 4.8±0.4 calendar days (2018). The amount of immature permanent teeth increased as well. Conclusions. Thus, in spite of a greater number of children with follicular jaw cysts in Nizhny Novgorod region, it was possible to reduce duration of hospitalization and increase the number of preserved immature permanent teeth due to better diagnostics, earlier cyst detection and use of cystectomy.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):57-61
pages 57-61 views

MANAGEMENT OF LATERAL HUMERAL CONDYLAR FRACTURE IN CHILDREN

Dorokhin A.I., Bagomedov H.G.

Abstract

Analysis of literature related to treatment of children with humeral condyle fracture (HCF) showed that in 15–51% of cases the outcomes were unsatisfactory. Material and methods. Treatment experience of 486 children with acute HCF fractures aged 1 to 16 years is presented. The diagnostic uses additional oblique projections and computed tomography to detect the degree of dislocation and fragment mobility alongside with standard ultrasound examinations. Patients were distributed as follows considering the degree of HCF bone fragment dislocation: 170 (35%) patients with 1 degree of dislocation and 117 (24%) patients with 2 degree of dislocation, whereas 199 (41%) patients had 3 degree dislocation. Results. The patients were operated using the developed tactical scheme based on the suggested classification. It took into account both the degree of dislocation and fragment mobility in 1 degree fractures. Remote results were examined in 321 (66%) patients within 1–15 years after the trauma: the results were excellent in 278 (87%) cases, good in 29 (%) cases and satisfactory in 13 (4%) cases. Conclusions. Treatment of children with humeral condyle fractures was based on the differentiated approach to selection of treatment method depending on dislocation degree and mobility of a distal bone fragment.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):62-69
pages 62-69 views

MULTIPLE TRAUMA STRUCTURING IN CHILDREN WITH ESTIMATION ACCORDING TO ISS SYSTEM AND CONCENTRATIONS OF S100B PROTEIN MARKERS AND CYSTATIN C

Bakowski V.B., Gibadyllin D.G., Shabaldin N.A., Golovkin S.I., Utkin V.A.

Abstract

Introduction: to analyze pathological processes in a patient with multiple trauma. Classification and structuring are not taken into account, as they require estimation of condition severity and dynamics of pathological process. It is frequently impossible to do so. In every specific case, it is necessary to structure multiple trauma. The Injury Severity Score (ISS) system is useful in this case, as it consists of a combination, certain quantitative and qualitative estimate which makes it possible to estimate a patient’s condition at early pre-hospital stage and adjust treatment. Purpose: to make a structural analysis of a multiple trauma in children in the state of shock using ISS and concentrations of S100B protein and cystatin C to change the examination tactics and improve treatment outcomes. Materials and methods. 44 patients in shock with multiple trauma were structured and examined. The patients came for treatment from cities of the northern region and the city of Kemerovo. Patients mainly had a predominant severe cranial cerebral injury (SCCI). There were 36 patients including two patients with diffuse axonal injuries and 8 patients with predominant skeletal trauma (ST) and damage of internal organs with the syndrome of intraperitoneal bleeding (SPB). Results: treatment protocols were taken into account alongside with objectively obtained data on multiple trauma structure based on the ISS severity scale. We obtained reliable data on the type of changes in S100B and cystatin C concentrations during the acute period of multiple trauma. Conclusions: multiple trauma structuring in children using the ISS system and S100B protein and cystatin C concentrations enables objective detection of signs characterizing the severity of an acute period among those injured and optimization of the examination scheme along with a treatment program.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):70-77
pages 70-77 views

XENON ANESTHESIA IN PEDIATRIC DENTAL INTERVENTIONS

Lazarev V.V., Khaliullin D.M., Gabdrafikov R.R., Koshcheev D.V., Gracheva E.S.

Abstract

Introduction. Therapeutic dental manipulations in smaller children are usually done under general anesthesia and sedation using inhalation anesthetics due to their high psychoemotional lability. Xenon (inert gas) is of particular interest among inhalation anesthetic agents due to its unique pharmacological properties such as hypnotic and analgesic effect, lack of toxicity, organ protective properties, etc. Purpose is to estimate adequacy, safety and comfort with anesthesia in pediatric dentistry. Materials and methods. 30 children (18 boys and 12 girls) were involved in an open, prospective, randomized study. They obtained dental treatment for caries and pulpitis. Sevoflurane 8% and concentration of 60–70% xenon with О2 was given to induce anesthesia. Anesthesia adequacy, safety and comfort were estimated based on hemodynamics data, BIS index, concentrations of sevoflurane and xenon in the anesthetic gas, recovery time, rate of agitation, nausea and vomiting. Results. The study demonstrated safety of xenon gas anesthesia in pediatric dentistry. The estimated values were within the reference range. Following anesthesia, recovery occurred after 30 minutes, no single case of postanesthesia agitation, nausea and vomiting was noted. Conclusion. Xenon provides for high effectiveness and safety of anesthesia in pediatric dentistry. The results show that further studies are reasonable.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):78-84
pages 78-84 views

LOCAL CONSERVATIVE THERAPY IN CHILDREN WITH BURNS AT THE STAGE OF SPECIALIZED MEDICAL CARE

Budkevich L.I., Soshkina V.V., Astamirova T.S., Mirsoyan G.V., Avanesyan A.A.

Abstract

Purpose: to evaluate effectiveness and safety of wound dressings featuring Safetac ® technology in local conservative treatment of children with skin burns. Materials and methods: retrospective analysis of the results obtained when using a line of wound dressings with Safetac® technology in children aged 1 months old to 3 years old with superficial I– II‑degree skin burns and borderline III degree skin burns who have been staying at the burn center of G. N. Speransky Children’s Hospital No. 9 during the last 5 years. The area of burn wounds ranged from 1% of body surface area (BSA) to 25% of BSA. In the observed patients, hot fluid was the basic damaging agent. Routine examination methods were used to confirm effectiveness and safety of the following medical procedures: monitoring of the course of the wound process, estimation of temperature and possible allergic reactions against the background of dressing application, microbiological follow-up control of burn wounds determining sensitivity to antimicrobials, and epithelization duration of damaged skin areas. Some dressings that belong to this batch (Mepilex® Lite, Mepilex® Transfer and Mepilex® Border) are reviewed here. Results and conclusions: effectiveness and safety of therapeutic dressings in patients with thermal injuries are verified using clinical experience. It is proved that a combined line of dressings provides for a good therapeutic effect depending on the wound process phase and depth of tissue affected with hot fluid. Possible complications in the form of allergic reactions (and contact dermatitis, is particular) are found. Methods of their prevention are recommended. In case of their development, adequate local therapy is provided. According to the study, wound dressings with Safetac ® technology are effective and safe in children with local superficial I–II‑degree skin burns and borderline III degree skin burns (ICD‑10).

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):86-95
pages 86-95 views

News

POSTRELEASE. III EDUCATIONAL FORUM "ERRORS, HAZARDS AND COMPLICATIONS IN ANESTHESIOLOGY AND RESUSCITATION"

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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(1):138-140
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