Vol 6, No 3 (2016)

The results of monitoring of provision of Russian children with surgical specialists and specific beds in 2010-2015 in accordance with the period of healthcare reforms referred to as optimization are submitted. Tendencies in the country, federal districts and constituent units of the Russian Federation are stated. It is indicated that reduction in the number of specialists and surgical beds carried out without proper scientific substantiation doesn’t only contain risks of decreased availability of specialized medical aid rendered to children but also fails to correspond to the concept of national safety. The necessity of development of regulatory framework regulating territorial planning of the system of medical aid to children depending on geographical, demographic, transport and infrastructure peculiarities of the regions is substantiated.

Congenital diaphragmatic hernia (CDH) is a severe pathology connected with the defect in diaphragm development. It occurs in 1 case per 2000 to 4000 of newborns. Hernias of the esophageal opening, diaphragmatic cupula and retrosternal area are found in elder children. David C. Van der Zee and Klass (N.) M.A. Bax were the first to offer the endosurgical method of diaphragmatic hernia correction using laparoscopic approach. The presented case of laparoscopic correction of diaphragmatic hernia in a 5-years-old kid shows the experience of surgery of this pathology using ENDO STITCH,10 mm (USA, 2004).

The article presents the results of retrospective analysis of treatment of 71 newborns with necrotizing enterocolitis admitted to the Centre of Pediatric Surgery from 2007 to 2015. Peculiarities related to the course of pregnancy, labor, volume and quality of rendered aid at labor, duration of newborns’ stay at the resuscitation departments, treatment type, time of beginning and method of enteral feeding raising, clinical and laboratory data of initial manifestations and signs of necrotizing enterocolitis at the stages of rendering specialized aid before admittance to the hospital. Data are analyzed using https:// medcalc.net/stats/ online program. The most significant factors influencing the outcome of NEC in mature and premature patients considering the body mass at birth and gestational age are established. Groups of risk among pregnant women and premature newborns are revealed. It is established that the most significant factors influencing the outcome of NEC in premature and mature children are represented by the body mass at birth and gestational age.

In the period from 1991 to 2015 years under our supervision were 203 patients with ultrashort form of Hirschsprung’s disease. All patients were divided into two groups, depending on the used methods of surgical treatment: Group 1-Lynn (58.6% of patients), group 2-rear miektomia (41.4% of patients). In the near period through 3 months after surgery in a group 1 good results reported for 34%, satisfactory-in the same way at 34%, unsatisfactory-32% of children. In Group 2 the good result was 33.3%, satisfactory-by 27.8%, unsatisfactory-38.9% have children. In the long term through 12 months after surgery in a group 1 good results reported for 55%, satisfactory-45% have children; There were no unsatisfactory results. In Group 2 the good result was at 55.6%, satisfactory-44.4% have children; There were no unsatisfactory results. Complications in the immediate postoperative period (2.9%), 6 were patients. In Group 1 (n = 119), complications were noted in 1.7% of patients, and in Group 2 (n = 84) - 4.8% of patients. On quality of life in comparison with preoperation data in both groups had a positive dynamics, but in Group 1 the results reliably surpassed those of Group 2 and is close to normal. But even in the distant postoperative quality of life indicators have not reached normal parameters in any of the above groups.

Purpose of the study: determine clinical and laboratory signs in patients with invagination enabling to suspect development of irreversible circulation disturbances in the intussusceptum. Materials and methods. The results of treatment of 216 patients aged 2 months to 15 years old with the intestinal intussusceptum and complications from 2000 to 2015 were analyzed in 146 boys (67%) and 70 girls (33%). Intussusception was the most frequently met at the age of 5 to 11 months old (123 children - 57%). The main symptoms of intussusception were attack-like anxiety in 197 patents (91%), vomiting in 164 (75%), blood admixture in feces in 53 (24%) and volumetric formation in the abdomen in 103 (47%) found on palpation. Symptoms of intoxication and dehydration were found in all the patients with intussusception complications. Results. Conservative treatment (pneumodisinvagination) was performed in 168 children. 48 patients were operated. Irreversible circulation disturbances were found in 6 (12.5%) patients only. Clinical and laboratory criteria such as fatigue, vomiting with bile, blood in feces, fever, pronounced leukocytosis, electrolytic disturbances, change in the acid-base balance (metabolic acidosis), increased level of lactate indicating at the high risk of intestinal necrosis are found in patients with irreversible circulatory disturbances in the intussusceptum. Conclusions. There are signs of irreversible circulatory disturbances in the intussusceptum. It’s the combination of clinical and laboratory criteria but not every separate sign that proves there is a high risk of irreversible circulatory disturbances in the intussusceptum and which is the ground for a surgery.

The article states data on the frequency of rare, the so-called regional forms of ARM in 50 girls examined at out clinic in 2004-2015. Clinical and anatomical peculiarities of separate nosological forms are provided in detail. The concomitant abnormalities and surgical tactics are analyzed.

The article is devoted to the development of the method evaluating the severity of the condition and anestesiological risk of patients with acute lymphoblastic lymphoma. It is indicated that bioimpedansometry enables to reveal considerable tissue disbalance, nutritive disturbances, risks of dehydration and hypovolemia development. Decrease of functional reserves of the cardiovascular system against the background of chemoradiation therapy is found. Conclusion. On the basis of the conducted study the author offers to use bioimpedansometry as part of pre-operative study in patients with chemoradiation therapy.

VACTERL association is a set of certain abnormalities in one newborn which include defects of the esophagus, rectum, heart, kidneys, vertebral column and extremities. Research papers devoted to the study of this complex disease are still rare. The majority of researchers insist that the syndrome was composed at least of three components (abnormalities of vertebra, tracheoesophageal fistula and anal atresia) though others believe that the constituents of VACTERL are constant. Treatment of the syndrome is usually restricted by surgeries which are needed to restore the esophagus, anus, eliminate abnormalities of the cardiovascular and excretory system and extremities. The scientific research is devoted to the study of VACTERL, correct interpretation of its components, determination of knowledge weaknesses and description of modern therapeutic approaches intended for the correction of surgical abnormalities included into the syndrome.

The presented data are based on the publications freely accessed from PudMed, Scopus, Medline databases, reviewed medical journals, monographies, clinical recommendations, and guidance manuals. The issues of using succinate containing preparations in the complex of therapeutic preparations in patients in critical conditions are reviewed. In spite of ambiguous position in relation to effective usage of the preparations in domestic and foreign medical practice, the data of widely usage of these preparations in patients of different age and in various pathological conditions are submitted.

The article stresses the necessity to use modern technologies of parenteral nutrition in newborns and infants. The problem is urgent as in parenteral nutrition doctors unfortunately fail to pay needed attention to the terms and dosage of fatty emulsions leaving behind such important components of parenteral nutrition as microelements and vitamins. The authors consider the terms of administration and dosage of fatty emulsions, vitamins and microelements in children under 3 years old. The importance of parenteral nutrition in complex therapy of nursing in newborns and infants is revealed.

The article deals with the data found in the course of two interviews with anesthesiologists within expert boards with 87 participants in total with different time record, age and professional level when estimating the usage of suxamethonium and nondepolarizing myorelaxants, methods and medicines in elimination of residual curarization, usage of monitoring during control of myoplegia level in children. The obtained results make us conclude that the majority of interviewed anesthesiologists never or seldom use suxamethonium in children and report residual curarization whereas 25% believe it to be insignificant, up to 60% prefer using different medications to eliminate it and around 30% never use hardware monitoring of myoplegia as they lack the possibility.