Vol 11, No 3 (2021)

BACKGROUND: The pentalogy of Cantrell is a rare congenital malformation characterized by five component defects in the anterior abdominal wall, lower sternum, anterior diaphragm, and diaphragmatic pericardium and congenital heart disease. The occurrence of the five features is quite rare. The pentalogy of Cantrell is classified as complete, partial, and incomplete. Few studies have described the successful treatment of neonates with the pentalogy of Cantrell, with even fewer publications about an incomplete defect.

CASE REPORT: We report the successful surgical treatment of a newborn boy with an incomplete pentalogy of Cantrell. In this patient, the diaphragmatic hernia was eliminated at the first stage, and a temporary container for umbilical cord hernia was made by suturing the silastic sac to the edges of the defect in the anterior abdominal wall for subsequent gradual immersion of the hernia contents into the abdominal cavity. These steps made it possible to reduce intra-abdominal and, accordingly, intrathoracic pressures, provide favorable conditions for the healing of the diaphragm, and thus stabilize the child’s respiratory and cardiovascular systems. Subsequently, the cardiovascular system was examined under more favorable conditions and intracardiac defects were excluded. Moreover, the proposed technique made it possible to safely perform the second stage of surgical correction, i.e., radical plasty of the anterior abdominal wall on day 14 of life with full restoration of the normal anatomical and physiological relationships, by which time the diaphragm and mediastinum had taken their correct topographic position. The literature review provides data from 32 sources.

CONCLUSION: The pentalogy of Cantrell is a severe congenital malformation with a high risk of poor outcomes. Reporting of all possible variants of the pentalogy of Cantrell (complete, partial, or incomplete), regardless of the outcome, is important for the accumulation of experience in treating such patients, which by focusing on the clinical situation and the combination of various defects in the pentalogy of Cantrell will improve the strategy and prognosis for this defect.

BACKGROUND: In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults.

CASE REPORT: This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m², Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acid–base balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation.

CONCLUSION: Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.

In the letter, the author relies on data from the foreign and domestic literature and his own experience and confirms the relevant creation of clinical guidelines, “Sepsis in children.” The letter summarizes the main advantages of domestic recommendations and notes the provisions requiring critical assessment. In general, the author of the letter highly appreciated the work done by the authors of the recommendation.

In the letter, the author relies on data from the foreign and domestic literature and his own experience and confirms the urgent problem of myelodysplasia syndrome in children. The letter summarizes the main advantages of the given abstract review and notes the provisions requiring addition. In general, the author of the letter highly appreciated the work done by the authors of the review.

A brief overview of the content of the Russian Congress of Pediatric Anesthesiologists and Reanimatologists that occurred in April 2021 and discussed topical problems of the specialty. The Congress was held in an online format and convened over two thousand participants from all regions of Russia and 20 countries. A significant event of the Congress was the adoption of the draft federal clinical guidelines, “Sepsis in children.” Also, the round table, “Legal aspects in anesthesiology and resuscitation. For what the anesthesiologists are being tried,” was held. Video recordings of all speeches are posted on the Internet, which allows a wide range of specialists to familiarize themselves with the reports and speeches.

This paper describes the professional activities and merits of the pediatric surgeon Anatoly F. Dronov in celebration of his 85th anniversary.

AIM: This study aimed to investigate the possible effect of intravenous anesthesia (sedation) with propofol on the levels of several cytokines (interleukin [IL]-6, IL-8, IL-10, and tumor necrosis factors-α) and S100B protein in the blood plasma of children aged <1 year with craniostenosis.

MATERIALS AND METHODS: Twenty patients aged 1–12 months diagnosed with non-syndromic forms of craniosynostosis, who underwent magnetic resonance imaging (MRI) of the brain under propofol sedation, were classified according to ASA I-II class. Peripheral blood sampling was performed before and after the drug administration, followed by laboratory analysis.

RESULTS: A significant increase was found in the serum level of IL-6 (p = 0.004) when intravenous sedation with propofol was used for 29 ± 4.93 min.

CONCLUSION: Short exposure of children aged <1 year with craniostenosis to hypnotic propofol during brain MRI significantly increased the level of the pro-inflammatory cytokine IL-6 in the blood plasma.

BACKGROUND: Endoscopic rhinosinus surgery in children is associated with a high anesthetic risk because of intraoperative stress. This study aimed to, considering the dynamic picture of the biochemical markers of surgical stress, to assess the effectiveness of regional methods of combined anesthesia in rhinosinus surgery in children.

MATERIALS AND METHODS: A comparative study was conducted in parallel groups composed of 100 patients aged 6–17 years who had undergone an assessment of their physical condition using the ASA I-II scales and planned endoscopic endonasal surgery lasting up to 2 h under combined anesthesia. In all groups, the introductory anesthesia was combined, i.e., inhalation of sevoflurane in an oxygen–air mixture in combination with intravenous administration of propofol. To ensure the patency of the respiratory tract, endotracheal anesthesia was administered. Patients were divided into two groups of 50 people each, depending on the method of maintaining anesthesia. Group 1 received inhalation of sevoflurane in an air–oxygen mixture with a target value of the minimum alveolar concentration of (MAC) 0.7–0.9, and regional blockage was performed bilaterally, i.e., pterygopalatine anesthesia with palatine access (palatinal) and infra-orbital intraoral access with ropivacaine solution. Group 2 received inhalation of sevoflurane in an air–oxygen mixture with a target value of 1.5 МАС, and 5% tramadol solution was used intravenously for analgesia.

RESULTS: Data on the dynamics of glucose, lactate, and cortisol levels in both groups proved the effectiveness and stability of the anesthesia methods used. However, the concentration of the inhaled anesthetic agent in the tramadol group was used was twice as high as the concentration in the regional anesthetic group.

DISCUSSION: The dynamics and deviations of biochemical markers of surgical stress were not significantly different in the intergroup and intragroup interstage parameters beyond the reference values.

CONCLUSIONS: The proposed anesthesia methods did not induce stress reactions to surgical intervention, and the anesthesia methods in both groups were adequate and effective.

BACKGROUND: With the spread of endoscopic procedures, thoracoscopy has become an ideal method for the surgical treatment of pleural complications. Ultrasound examination of the pleural cavity made it possible to differentiate the nature of the pleural contents and timely use of thoracoscopic sanitation of the pleural cavity.

AIM: This study aimed to conduct ultrasound monitoring of the complete restoration of the pleural cavity after video-assisted thoracoscopic debridement in children with fibrinothorax.

MATERIALS AND METHODS: The study was conducted in the children’s surgical department of the Republican Children’s Clinical Hospital of Health Ministry of the Chuvash Republic. From 2011 to 2019, 31 children aged 1 month to 18 years were diagnosed with community-acquired pneumonia complicated by fibrinothorax, and thoracoscopic debridement and drainage of the pleural cavity were performed. During hospitalization, before thoracoscopy, 1–3 ultrasound examinations of the pleural cavities and lungs were performed in all children, which made it possible to determine methods of management. After thoracoscopic debridement, ultrasound examination of the pleural cavities was performed 3–7 times during hospitalization and 1–2 times monthly for 3–6 months after discharge from the hospital until the pleural cavity was completely restored.

RESULTS: Ultrasound monitoring of the pleural cavities and lungs after thoracoscopic debridement at the outpatient stage showed that changes in the pleural cavity and lung parenchyma can last up to 6 months, while children’s health status was satisfactory.

CONCLUSIONS: Preoperative and postoperative ultrasound monitoring can adequately assess the overall state of the pleural cavities and lungs. Changes in the pleural cavity after thoracoscopic debridement under ultrasound guidance are observed later than by X-ray. In this regard, after discharge from the hospital, children with complicated purulent and destructive pneumonia who underwent thoracoscopic debridement need ultrasound monitoring of the pleural cavity until it is completely restored.

BACKGROUND: After the surgical treatment of children for anorectal malformations, spinal pathology, and Hirschsprung’s disease, their quality of life is significantly reduced due to fecal incontinence. For patients with persistent defecation disorders, the “Bowel Management” program is offered.

AIM: This study analyzes the “Bowel Management” program implemented in the clinic.

MATERIALS AND METHODS: A prospective analysis of the program used in children after surgical correction of malformations was conducted. The program comprised the following components: lectures for patients/parents, hospitalization, irrigography with water-soluble contrast, teaching patients/parents about cleansing enemas, keeping a bowel movement diary, plain abdominal X-ray, changing the recipe for enema solution, monitoring the effectiveness, and correcting recommendations.

RESULTS: A total of 66 children from 1.5 to 17 years old were treated. Three groups were identified: (I) anorectal malformations (n = 26), (II) spinal pathology (n = 30), and (III) Hirschsprung’s disease (n = 10). The results were considered satisfactory if the bowel cleansing procedure was painless for the child and did not cause stress reactions; the parents were satisfied with the result of the prescribed program if after the enema a sufficient amount of stool was removed within 45 minutes, there were no episodes of defecation during the day. With the help of the Rome IV revision criteria, fecal incontinence was noted in all cases against the background of stool retention. In 11 (16.7%), there was no fecal incontinence even in cases of prolonged stool retention. A correlation was found between “high” lesions (in the lumbar spine) in spinal hernias with the absence of fecal incontinence with prolonged stool retention compared with the “low” sacral localization of the hernia. In group I, 91.7% had spinal cord fixation. In group II, 86.7% had it, and none were present in group III. The effectiveness of the program was 83.3%.

CONCLUSION: The Bowel Management is easy to use and effective in 83% of patients. It can be recommended for the rehabilitation of children with defecation disorders, fecal incontinence after surgical correction of congenital malformations (anorectal malformations, spinal pathology and Hirschsprung's disease).