Vol 12, No 2 (2022)

BACKGROUND: Predicting sepsis in ventilated neonates remains a challenge in neonatology.

AIM: To increase the efficiency of predicting sepsis diagnosis in newborns by developing a decision rule for its development based on decision trees.

MATERIALS AND METHODS: This clinical study retrospectively reviewed 200 full-term newborns with respiratory pathology that are admitted to the intensive care unit and are on mechanical ventilation without clinical signs of bacterial infection.

Upon admission to the department on days 1, 3–5, and 20, an enzyme-linked immunosorbent assay determined the plasma concentration of interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α, granulocyte colony-stimulating factor, soluble Fas ligand, fibroblast growth factors, and nitric oxide (NO), and immunophenotyping method determined CD3⁺CD19^–, CD3^–CD19⁺, CD3⁺CD4⁺, CD3⁺CD8⁺, CD69⁺, CD71⁺, CD95⁺, HLA^–DR⁺, CD34⁺, CD14⁺, CD3^–CD56⁺; lymphocytes expressing AnnexinV-FITC⁺PI^–, and AnnexinV-FITC⁺PI⁺. The possibility of diagnosing sepsis upon intensive care unit admission was assessed by statistical cluster analysis of the total studied immunological criteria. The method of decision trees in the statistical environment R formed a diagnostic rule for predicting sepsis.

RESULTS: Visualization of the cluster analysis results of admitted patients did not exclude the presence of two clusters among them (with and without sepsis, which explain the 60.81% of the point variability).

Sepsis prediction rule are as follows: disease progression occurs if on day 1 CD95 is ≥16.8% and NO is ≤9.6 mkmol/l or CD95 is ≤16.8%, CD34 is ≤0.2%, CD69 is ≥4.12% or CD95 is ≤16.8%, CD34 is ≤0.2%, CD69 is ≤4.12%, and lymphocytes expressing AnnexinV-FITC+PI– is ≥12.3%. The diagnostic accuracy was 96.00%; sensitivity was 97.00%; specificity was 94.90%; the false-positive proportion of diagnoses was 5.10%; the false-negative proportion of diagnoses was 2.94%; the positive result accuracy was 95.19%; and the negative result was 96.88%. The disease was complicated by bacterial sepsis development on 4–5 days of observation in 45 newborns.

CONCLUSIONS: Significant importance in sepsis development belongs to the prevalence of altered immunocompetent cells over proliferation and endogenous synthesis of nitric oxide. The cumulative determination of CD95⁺, CD69⁺, AnnexinV-FITC⁺PI^–, CD34⁺, and plasma nitric oxide concentration helped diagnose sepsis development at the preclinical stage. The obtained results indirectly confirm the relevance of studies on sepsis prevention and treatment by drug correction of apoptosis and inhaled NO.

BACKGROUND: The use of lidocaine in the scheme of multimodal anesthesia in order to reduce doses of opioids in comparison with traditional anesthesia and the possibility of influencing various links in the pathogenesis of pain is a promising direction in modern cardioanesthesiology.

AIM: This study evaluates the effectiveness of intravenous infusion of lidocaine as a component of multimodal analgesia and its effect on the postoperative period in children under one year of age after surgical correction of congenital heart defects.

MATERIALS AND METHODS: The prospective comparative study included 81 cardiac surgery patients aged 0 to 1 year. All patients underwent open cardiac surgery by a cardiopulmonary bypass from January 2019 to April 2021. The patients were divided into two groups: the first (n = 40) included patients receiving intravenous lidocaine as a component of multimodal analgesia in the postoperative period, and the second, control (n = 41) patients who were not prescribed lidocaine.

RESULTS: : In patients receiving lidocaine infusion, the need for opioids was significantly lower (p < 0.001), which is also associated with a shorter mechanical ventilation time (p = 0.03). The cortisol levels and most laboratory parameters (the concentration of glucose, lactate, albumin, C-reactive protein, and the level of leukocytes and lymphocytes) in the two patient groups did not differ. Clinical indicators reflecting intestinal paresis development (the appearance of peristalsis, the onset of enteral nutrition, the rate of its increase, and the time when the patient receives the total amount of food only enterally) also did not differ between the groups. No side effects of lidocaine infusion were reported. There were no deceased patients in any of the study groups.

CONCLUSIONS: Intravenous infusion of lidocaine as a component of multimodal analgesia after heart surgery in children has an additional opioid-saving effect and shortens the mechanical ventilation time. It is not accompanied by the development of side effects and does not affect the restoration of gastrointestinal functions.

BACKGROUND: The risk of vital homeostasis disorders and the likelihood of death in patients with spleen injury is determined by organ damage, acute intra-abdominal bleeding, and often hemorrhagic shock.

AIM: This study determines the validity of the clinical criteria for the syndrome of intra-abdominal bleeding, shock, and the argumentation of indications for surgical treatment in the first six hours from the moment of hospital admission in children with an isolated injury, rupture of the spleen.

MATERIALS AND METHODS: The study included 89 patients aged 6 to 12 years with spleen injuries treated at the Republican Children’s Clinical Hospital of the Donetsk People’s Republic from 2014 to 2021. The first subgroup included 61 (68.5%) patients treated conservatively, and the second subgroup comprised 28 (31.5%) operated patients (splenectomy) who initially underwent conservative therapy. Blood pressure and heart rate were controlled, and hemoglobin, hematocrit, erythrocyte, and leukocyte counts were determined. Abdominal echography was performed every three hours.

RESULTS: In assessing the severity of the condition, there were changes in peripheral hemodynamic parameters, such as arterial hypotension and hemoperitoneum with hemorheological disorders (posthemorrhagic anemia of I–II degree, a tendency to thrombocytopenia). In the first six hours from hospital admission, the most objective clinical and laboratory indicators of bleeding and the choice of treatment method were the value of the hemoperitoneum, the level of arterial pressure system, hematocrit, and hemoglobin. No decrease in blood pressure in patients below 100.0 mm Hg, blood hemoglobin of 95.0 g/l with a hemoperitoneum volume of less than 275.0 ml dictated the expediency of continuing conservative therapeutic measures. In cases of deterioration in the condition of patients due to ongoing bleeding with the ineffectiveness of intensive therapy, surgical intervention (laparotomy, splenectomy) is recommended to stop the bleeding.

CONCLUSIONS: In the first hours after injury, the most accurate predictor of the choice of treatment method is the volume of the hemoperitoneum (according to echography), associated with the impaired hemodynamic status of the patient, namely arterial hypotension, which affects choosing a conservative or surgical treatment option.

BACKGROUND: : Fecal incontinence significantly affects the quality of life of children with anorectal malformations, Hirschsprung’s disease, and spinal pathologies.

AIM: This work uses the PedsQL 4.0 questionnaire to assess the quality of life of children with defecation disorders after surgical treatment of congenital malformations and evaluate its effectiveness.

MATERIALS AND METHODS: Interviews were conducted with 20 families in which children aged from 17 months to 18 years were operated on for spinal hernia (50%), anorectal defects (35%), and Hirschsprung disease (15%). Parents and patients were interviewed according to four blocks of the questionnaire: “The impact of pathology on the family”, “Assessment of the quality of medical care”, “Assessment of the quality of life of a child (for parents)”, “Assessment of the quality of life of a child (for children)”. The maximum score for each questionnaire was 100 points. The reliability assessment was performed using the α-survey of the Cronbach coefficient.

RESULTS: When evaluating the PedsQL 4.0 questionnaire, α-Cronbach’s coefficient for the “Impact of pathology on the family” block was 0.963, “Assessment of the quality of medical care” — 0.924, “Assessment of the quality of life of a child” from 0.740 to 0.877. A reliability result of >0.7 is considered satisfactory. Thus, the PedsQL 4.0 questionnaire was considered reliable for this study. When analyzing the block, “Influence of pathology on the family”, data from 23.6 to 67.4 points were obtained. A relationship was noted between the growing up of the child and an increase in the level of quality of life (p < 0.05). According to the block, “Assessment of the quality of medical care”, the dissatisfaction of most parents was established. The average score was 75 points. When analyzing the block, “Assessment of the quality of life of children (questionnaire for parents)”, values were obtained from 66.4 to 74.2 points. With the increase in the age of the child, parents estimated his standard of living to be lower. An inverse correlation was found between the child’s age and his standard of living from the parent’s point of view (p < 0.05). When analyzing the block, “Assessment of the quality of life of children” (questionnaire for children), the opposite situation was observed: with age, children rated the standard of living higher. The result ranged from 59.5 to 90 points.

CONCLUSIONS: In children with anorectal defects, Hirschsprung’s disease, and spinal pathologies, a significant decrease in the standard of living was revealed, including a significant negative impact of the disease on the standard of living of the entire child’s family. Further research is needed to determine the leading causes that reduce the quality of life of children to develop an integrated approach to their rehabilitation and social adaptation.

Dissecting osteochondritis of the knee joint, Koenig’s disease is a disease of the knee joint that result in articular surface and osteoarthritis congruence. The disease incidence reaches 15% in the pathological knee joint structure in children. The comparative effectiveness of various treatment methods for children with Koenig’s disease, from conservative therapy to orthobiological technologies, is a topical subject of discussion among specialists.

The effectiveness of modern treatment methods for children with Koenig’s disease has been evaluated and is the leading trend in the use of biotechnology for further experimental and clinical studies.

The literature search was conducted in the electronic databases of PubMed, Web of Science, Scopus, MEDLINE, eLibrary, RSCI, and Cyberleninka, whereas 2300 references were analyzed, 283 articles were viewed, and 90 publications on orthopedics and biotechnology were selected for the review.

Indications for conservative treatment in children with Koenig’s disease are currently limited to stages I–II of the process. Surgical methods occupy a dominant position when pain relief and pathological focus regeneration stimulation are necessary. However, the long-term results of therapy indicate the replacement of the necrosis zone with coarse fibrous connective tissue, which is significantly inferior to hyaline cartilage in terms of biomechanical characteristics, which determines a high risk of developing osteoarthritis. The actively developing direction of orthobiology allows the use of a patient’s tissues to activate the processes of reparative regeneration with the relief of clinical manifestations and favorable immediate results.

The focus of attention of researchers has shifted to the plane of orthobiological technologies following the established trends in regenerative medicine development, which provide a high proportion of favorable immediate interventional results. However, the limited number of publications and the lack of long-term results of therapy do not meet the criteria for demonstrative effectiveness of technologies.

Presentation of clinical observation of a patient with an atypically extended stricture of the bulbar urethra.

A 15-year-old boy came to the clinic with complaints of difficult and prolonged urination after an injury to the perineum and scrotum. The patient underwent a 3-fold surgical treatment for an extended stricture of the bulbous urethra. Complete recovery of the patient was achieved after repeated surgical interventions. At follow-up for 2.5 years, he urinates freely and painlessly. The average urination rate is 18 ml/s, urine tests are without deviations according to echography, and adequate emptying of the bladder is noted.

In children, a post-traumatic urethral stricture is a rare condition, and patient management has not been finalized. In most cases, the methods of operations adopted in adult patients are used. Reconstructive surgery in this patient was performed in the “cold” postoperative period. With extended strictures, preference should be given to open urethroplasty, namely, augmentation techniques using a free buccal mucosal graft.

The presented clinical case demonstrates the complexity of determining the therapeutic strategies and the surgical treatment in cases of an extended bulbous urethra stricture.

Presentation of a rare clinical case of hydronephrosis of the lower half of the kidney due to vasoureteral conflict against the background of the complete doubling of the upper urinary tract. The rarity of this anomaly is demonstrated by only a single mention of a similar case in an adult patient in the literature.

The patient, three years old, had dilatation of the upper urinary tract that was detected antenatally. According to the postnatal ultrasound results at three months, the anterior-posterior size of the pelvis of the lower half of the left kidney was 13 mm, and the parenchyma of the left kidney was 11 mm. The child was followed up on an outpatient basis. There were no laboratory or clinical manifestations of urinary tract infection. Ultrasound monitoring revealed progression of dilatation of the pelvis of the lower half max up to 40 mm and thinning of the kidney parenchyma in the projection of the lower pole up to 7 mm, in connection with which the child successfully underwent antevasal ureteropyeloanastomosis of the lower half of a completely doubled kidney. The anterior-posterior size of the pelvis of the lower half after removal of the pyelostomy was 16 mm. The child did not have any clinical and laboratory disease manifestations in the postoperative period.

The described clinical case expands our understanding of the anatomy of obstruction of the pyeloureteral segment and hydronephrosis of the lower half of the duplex kidney. It enables us to plan surgical tactics, considering the possible intraoperative detection of the described anatomical configuration.

The article discusses the content of the first Russian manual on pediatric traumatology and the key points of the biography and work of its author, Nikolai G. Dam’e. The article introduction briefly outlines the creation history of the first Russian manual on traumatology for adult patients, which noted that pediatric traumatology developed within the framework of pediatric surgery. The first part of the work focused on its greatest interest to readers. It presents previously unpublished reviews of famous orthopedic traumatologists for the first (1950) and second (1960) editions, which perfectly reveal the book’s content. The second part of the article included the published autobiography written by N.G. Dam’e. Additionally, the work of N.G. Dam’e based on archival documents as a military field surgeon during the Great Patriotic War was presented in the same section. The final part included the role of N.G. Dam’e in creating an original school of pediatric trauma surgeons.

The merit of N. G. Dam’e is the creation of a manual that outlines the basics of diagnosing and treating injuries in children of all types and localizations. He believed that a traumatologist should have the necessary knowledge and skills in emergency general surgery, neurotraumatology, and other surgical specialties. Thus, he anticipated the creation of injury surgery, of which the basic provisions were transferred from the practice of military field surgery.

The paper provides the text of the draft decision of the Russian Symposium of Pediatric Surgeons on “Esophageal Atresia.” Recommendations on antenatal and postnatal esophageal atresia diagnosis, surgical treatment methods, and postoperative complications are presented based on modern study data. Discussion with a wide range of specialists proposed the addition of federal clinical guidelines.

Information is provided on the Russian Symposium of Pediatric Surgeons “Esophageal Atresia” held in April 2022 and the student conference.

The paper provides information about the sudden death of pediatric surgeon Anatoly A. Tarasov.

Information about the death of the pediatric surgeon Munavara G. Mavlyutova, the organizer of pediatric surgery in Bashkiria.