Vol 8, No 4 (2018)

This article describes the different levels of trauma center designation in the United States and focuses on the pediatric trauma centers in the state of Colorado. These urban centers serve a large geographic area that is characterized by rugged mountains, wide open plains and rapidly changing weather patterns. Critical care ground and aeromedical transport are utilized for severely injured children and the quality of care, from initial management in the feld until discharge from the hospital, is critically evaluated by a robust trauma performance improvement (PI) program. The PI program uses audit flters, data analytics and bench-marking to continuously evaluate the network of care to optimize outcomes.

Introduction. Esophageal atresia is often accompanied by some form of tracheomalacia. Soon after birth, tracheal collapse can result in respiratory disturbances of various degrees – from mild to severe – requiring artifcial pulmonary ventilation. In this study, we describe the use of a new treatment method of tracheomalacia with posterior tracheopexie.

Material and methods. A patient with tracheomalacia that developed against the background of esophageal atresia was presented in the study. A newborn boy of 2,720 g had a prenatally established diagnosis of esophageal atresia. The infant was born with the signs of respiratory disturbances. Following tracheoscopy, severe tracheomalacia was established with complete collapse of tracheal lumen. During the next thoracoscopic procedure, the trachea was fxed to the anterior longitudinal spinal ligament with several sutures.

Results. Thoracoscopic posterior tracheopexie was performed prior to esophageal anastomosis. Overall duration of surgery was 85 minutes. Spontaneous breathing was restored at day 3 after the surgery. Tracheoscopy performed at day 10 after the surgery demonstrated a complete opening of the tracheal lumen.

Conclusion. Promising results of the surgery prove that the procedure is effective for the treatment of tracheomalacia. Moreover, more complex (aortopexy) recurrent surgeries can be prevented using this approach as posterior tracheopexie can be performed during the primary thoracoscopic correction of esophageal atresia.

A treatment case of a child aged 14 y. o. with pleural empyema against the background of severe organic brain damage and resistant epilepsy was presented. Considering premorbid background, unsuccessful treatment attempts using drainage and thoracoscopic sanitation of the pleural cavity, the child underwent a recurrent thoracoscopic sanitation of the pleural cavity using a hydrosurgical unit. Treatment results show high effectiveness of this method in 3 stage pleural empyema when other treatment methods are less effective and there are limitations related to rehabilitation activities due to severe premorbid status of a child.

The article considers the history of the pediatric surgery department of N. N. Burdenko Voronezh State Medical University. The department was founded in 1947. Based on the results of the research undertaken by associates of the department by now, 3 manuals for doctors and students and 12 collections of scientifc papers were issued and 12 investor’s certifcates were obtained. The role of the Student’s scientifc circle was noted: the students struck 5 gold medals during the last fve years. During the last 8 years, the scientifc circle was considered the best and was awarded a gold medal and frstclass honours degree. A close interrelation between the research work of associates of the pediatric surgery department and practical work of pediatric surgeons from the Central Black Earth region was underlined.

The article describes modern technologies of medical rehabilitation in children with a hyperactive bladder (HAB) aimed at the perfection of a urinary act at any levels of bladder innervation. Medical rehabilitation of children with HAB includes behavioral therapy and drug therapy. Physiotherapeutic methods are popular due to the effect on the basic links of pathogenesis, lack of adverse effects and possibility of use in infants. The complex treatment of neurogenic bladder dysfunction uses a wide spectrum of physiotherapeutic methods aimed at the regulation of urination acts at the level of supraspinal and spinal urination centers, system of detrusor stabilizing reflexes and improvement of blood supply and metabolic trophic processes in the detrusor. Natural and preformed methods of physiotherapy are currently used along with exercise therapy, massage and biofeedback therapy.

Purpose. A prospective study was carried out. It compared treatment outcomes in children who underwent esophagoplasty with stomach or colon esophagoplasty.

Materials and methods. Clinical records of 172 patients who underwent esophagoplasty at N. F. Filatov Children’s Clinical Hospital No. 13 of Moscow from 2009 to 2015 were analyzed. The operated children were divided into two groups. 46 children from group 1 (basic group) aged 2 months to 13 years underwent esophagoplasty with stomach. 126 children aged 2 months to 18 years who had colon esophagoplasty were enrolled in group 2 (control group). In both groups, the majority was presented by children with atresia and corrosive strictures of esophagus. Clinical observation, esophagogastroduodenoscopy, contrast radiography, CT and MRI study, survey of patients were used to estimate direct and remote treatment outcomes.

Results. The analyzed groups were comparable for the course of the early postoperative period. The early postoperative period had no complications in 54% of cases in group I and in 54.4% of cases in group II. Recurrent surgeries for complications were more frequent in group I (23.9%) as compared to group II until signifcant indices were reached (10.3%, p = 0.04). In the comparison groups, patients’ quality of life were signifcantly different by the rate of almost any complications in the remote period. They demonstrated better quality of life for children after colon esophagoplasty.

Conclusion. Higher quality of life in children after colon esophagoplasty compared to children following esophagoplasty with stomach indicates that this is a surgery of choice in children.

The problem of treatment of fractures of long tubular bones in newborns is relevant due to the lack of unifed standards of rendering medical aid and lack of common criteria for the estimation of the treatment outcomes. The purpose of the study was to improve the treatment outcomes of fractures of long tubular skeletal bones in newborns obtained during the intranatal and postnatal periods using intramedullary osteosynthesis. Of 45,623 children born alive in 2016 and 2017, 4 (0.087%) newborns got fractures of humeral and femoral bones during the perinatal period. To establish the clinical diagnosis of traumatic bone lesions, methods of examination typical of emergency traumatology were used such as collection of complaints and anamnesis, clinical examination, radiography of the affected segment and paraclinical methods. Out of 4 children, one child underwent a conservative treatment whereas three newborns had surgeries. In all three clinical observations, unsuccessful closed manual fracture reposition with plaster immobilization and high probability of soft tissue trauma in a recurrent reposition were indications to surgeries. The scope of surgical treatment consisted in minimally invasive osteosynthesis of long tubular bone fracture under radiologic control. No complications were found in neither clinical observation following a surgery. Study of follow-up enabled to register satisfactory treatment results of humeral and femoral fractures in newborns.

Purpose: pilot development of the system estimating the risk for sepsis in newborns and determining its discrimination power.

Methods. Design: a retrospective observational single-center study. 124 newborns with sepsis are included; 34 of them died. Kullback’s measure was used to estimate the information value of the examined clinical and laboratory variables. Disease outcome (whether survived or dead) was the response function. The discrimination power was determined using ROC-analysis.

Results. The information value of the examined clinical and laboratory variables in the newborns was analyzed as related to the risk for sepsis. Early neonatal sepsis predictors include platelet count, total protein content, body mass and neutrophil count. Discrimination power of the mentioned predictors was calculated.

Result. Determination of the risk for sepsis in a newborn based on the estimation of platelet count, neutrophil count, total protein and body mass is of moderate value.

The review describes the history of varicocele treatment development from ancient times to the present day; from the frst mentioning of the disease by early Greeks (works by Celsus and Galen), surgeries of middle-age surgeons until the prime of modern varicocele surgery. In the middle and at the end of the XX century the understanding of this disease and methods of its therapy underwent significant changes. Many methods of varicocele surgery failed to stand the test of time and are of historical interest only. Other methods formed the basis for modern varicocele surgery and promote effective treatment with minimum risk for complications and recurrence.