Vol 7, No 1 (2017)

Appeal to readers.

The article analyzes the procedure of rendering essential surgical care to children in hospitals for adults in Karelia. Almost 60% children suffering from surgical diseases that require urgent surgery are operated by general surgeons at central regional hospitals. A vast number of tactical and technical mistakes are made due to insufficient knowledge of peculiarities seen in children. Regulation of regional medical and prophylactic institutions was done in the region 15 years ago depending on their possibilities to render urgent surgical care to children at different ages and in different conditions. This enabled significant improvement of treatment results for these patients. 

The article presents the data obtained during a clinical observation of the recurrent reconstructive posterosagittal rectoplasty in situ performed in an 11-year old adolescent with stenosis of colorectal anastomosis following the V. Duhamel’s procedure for rectosigmoid form of Hirschprung’s disease. The patient was observed for two and a half years, had one course of anastomotic bougienage and sigmostoma closed. The obtained result was estimated clinically using irrigography, sonography, magnetic resonance imaging, anorectal manometry, colonoscopy and confocal microscopy. The result was found satisfactory, the child has a good life quality. 

The articles states the results obtained during the clinical observation of a patient with multiple parasitic granulomas found in the liver and lungs that simulate metastases of a tumor of unknown primary location. The diagnosis was made with certain complications. The course of the disease with the lacking signs of tumor intoxication, no laboratory data without severe changes and histological conclusions could not relate to the clinic of a generalized malignant tumor. A parasitic disease was suspected. The ELISA test found IgG to toxocarosis (0.41). The antiparasitic therapy with albendazole gave a positive effect. Thus, the clinical case presented shows that unclear processes mistaken for a generalized tumor can be a parasitic granulomatous process. 

Purpose of the study: to estimate the efficacy of treatment and remote results of delayed esophago-esophageal anastomosis in children with EA.

Material and methods. We analyzed 18 case histories of children with delayed esophago-esophageal anastomosis performed at N. F. Filatov Children’s Municipal Clinical Hospital No. 13 from 2006 to 2016.

Results. Postoperative complications occurred in 16 children out of 18 (88.9%). Esophageal anastomotic leakage was developed in 4 patients (22.2%), anastomotic stenosis in 11 patients (61.1%) and gastroesophageal reflux in 14 children (77.8%). Lethality amounted to 16.7% (3 children) in the early postoperative period. As per the analysis of delayed results, dysphagia was noted in 92.3% of children. After delayed anastomosis 9 children underwent recurrent surgery, 4 of them had subsequent esophageal extirpation.

Conclusions. Considering the high rate of complications (88.9%) and bad delayed results, our observations do not allow us to recommend the delayed esophago-esophageal anastomosis as the surgery of choice for children with EA. 

The article is devoted to an important issue of pediatric resuscitation such as acute kidney injury (AKI). A retrospective study of 245 patients with AKI was carried out. It was found out that the majority of patients were three years old. The causes of AKI were analyzed. In the entire group of patients the majority of causes were of renal nature. Meanwhile, the hemolytic-uremic syndrome (HUS) was the main cause of AKI in children. Children of different age had different causes and frequencies of AKI. The most serious population of patients suffered from AKI was represented by one-month-old babies. 

The scientific review presents the data related to the combination of atresia with genetic disorders that must be discussed before the surgery to make a correct decision on the fate of the patient with esophageal atresia. 

The article states possible complications in long-term nutritional support. Doctors rarely think of schedules and dosages of fatty emulsions especially in infants. They frequently forget about such important components of nutritional support as microelements especially calcium and phosphorus. The article clarifies schedules and dosages of fatty emulsions, vitamins and microelements in newborns and infants. 

Anniversaries.