Vol 13, No 4 (2023)

BACKGROUND: The difference in the levels of total infant mortality in certain administrative territorial entities of the country is an acute medical and social problem of domestic healthcare, which indicates the absence of a single standard of accessibility and quality of medical care. This indicator in the Far Eastern Federal District significantly exceeds the corresponding indicators in the Central and Northwestern districts.

AIM: This study aimed to identify unresolved problems and identify ways to improve the availability and quality of surgical care for children by modeling the process of making administrative and clinical decisions by employees of medical organizations and heads of healthcare in the Far Eastern Federal District in the interests of children in need of specialized, including high-tech, medical care, including medical evacuation.

MATERIALS AND METHODS: A “business game” with simultaneous implementation of the simulation process in 11 regions of the Far Eastern Federal District was conducted using distributed communication channels and technical capabilities of audiovisual fixation of the opinions of the study participants. A series of five business games on the following profiles were implemented: neonatal surgery, thoracic surgery, neurosurgery, oncology, and combustiology. The scenarios of the games were prepared by the organizers of the study: “Russian Association of Pediatric Surgeons” (LLC) and “Agency for Strategic Initiatives to promote new projects” (ANO). The moderators of the games were leading specialists from specialized federal medical organizations. The game participants were regional teams of the subjects of the Far Eastern Federal District. The observers of the games were representatives of federal legislative and executive authorities and healthcare experts.

RESULTS: In this study, 9–11 regions of the Far Eastern Federal District participated in a series of five games. The total number of participants in business games ranged from 126 to 151, and the number of connection points was 42–66. The identified problematic issues included organizational (9), personnel (8), transport (7), equipment (7), and financial (6) aspects.

CONCLUSIONS: The ideology of the interregional centers of specialized surgical care for children corresponds to the vision of representatives of the professional community and organizers of territorial healthcare as a promising way to increase the availability and quality of medical care to the pediatric population.

BACKGROUND: In recent years, neonatal surgery has been developing and improving, among other things, because of a deeper study of anesthesiological approaches and the introduction of acquired knowledge into the daily practice of an anesthesiologist-resuscitator. One of the basic factors that influence treatment outcomes in the future is a thorough study of infusion therapy methods in newborns, considering the anatomical and physiological characteristics of the neonatal period.

AIM: This study aimed to examine the electrolyte balance, acid–base state, and hemodynamic parameters in newborns, depending on the choice of basic infusion medium during surgery.

MATERIALS AND METHODS: A prospective study was conducted in 99 newborns. All children were given an infusion of saline solutions of 10 mL/kg/h during surgery. Groups I, II, and III were administered intraoperatively with isotonic Sterofundin, saline solution, and Ringer’s solution, respectively. A hypotonic sodium chloride solution of 0.45% was administered to 11 children. The indicators of the acid–base state and electrolyte composition of the venous blood, hemodynamic parameters, and need for perioperative inotropic support were evaluated.

RESULTS: A tendency to hyponatremia was detected in children who were infused with 0.45% sodium chloride hypotonic solution, which resulted in the abandonment of further recruitment of children in the group and the implementation of this study option. After surgery, the pH-compensated state was maintained in all three groups. Moreover, metabolic disorders in the form of a decrease in bicarbonates and ВE were recorded in all groups. Electrolyte disturbances were detected in all groups, whereas electrolyte balance was most often registered in group I. In groups II and III, common ionogram findings included a decrease in potassium and an increase in sodium, chlorine, and calcium levels. In the analysis of the hemodynamic parameters, no significant statistical difference was recorded during surgery when comparing the groups infused with different saline media.

CONCLUSIONS: In this study, no significant differences were found in the indicators of acid–base state and hemodynamic parameters when using different saline solutions as basic intraoperative infusion therapy in newborns. Regarding the electrolyte balance, the most common complications were hypokalemia, hypernatremia, and hyperchloremia in the 0% saline group.

Neonatal necrotizing enterocolitis (NEC) is a multifactorial disease of unspecified etiology. The lack of data on etiological factors and the complexity of pathogenetic mechanisms determine the complexity of NEC modeling. The authors involved in the study of the pathogenesis of NEC and the development of current treatments seek to model in the experiment the conditions that occur in clinical practice. Thus, this study aimed to analyze the options for the experimental modeling of neonatal NECs described in the public domain. Thus, more than 50 relevant scientific publications in databases such as Google Scholar, PubMed, Scopus (publishers Elsevier), and eLibrary (from 2000 to 2022) were reviewed. This paper describes the most current methods of modeling NEC, including in vitro (using cells and cell cultures), in vivo (in laboratory animals such as mice, rats, rabbits, and pigs), and ex vivo (using cadaver material) experiments.

Hip joint diseases are one of the most common and difficult problems in pediatric orthopedics, often requiring surgical treatment. In children, intra- and postoperative analgesia after hip surgery is more conservative and limited to epidural anesthesia, which has known disadvantages and limitations, despite the high quality of pain relief. Peripheral regional blocks in hip surgery are widespread in adults. Ultrasound navigation makes peripheral blockades safer and more effective. This largely influenced the spread of their use in children and contributed to the introduction of new methods of planar blockades into practice. The authors analyzed studies on the efficacy and safety of modern methods of peripheral regional blockade used in children during hip surgery. The literature search was conducted in the eLibrary, PubMed, and Scopus databases. By using keywords, 750 literature sources were found, and 65 sources relevant to the purpose of the study were included in the review. The lumbar plexus block and fascia iliaca block are the most studied regional techniques in children, which are not inferior in analgesic efficacy to lumbar epidural and caudal anesthesia. A new and promising method of regional anesthesia of the hip is the pericapsular nerve group block, which has been well studied in adults. However, none of the peripheral regional techniques used for analgesia after hip surgery, has not proven its advantages. Further clinical studies are needed to investigate peripheral regional anesthesia techniques and determine their efficacy and safety in pediatric hip surgery.

This study presents a patient with pyeloureteral segment obstruction caused by aberrant inferior polar vessels using the robotic Hellström – Chapman procedure and reports its short-term results. A 14-year-old girl was admitted to Irkutsk Regional Children’s Clinical Hospital because of obstruction of the pyeloureteral junction caused by external compression by aberrant lower polar vessels. The diagnosis was established by ultrasonography and Doppler sonography and confirmed by contrasted computed tomography. Surgery was performed using the Versius surgical robot manufactured by CMR (UK). Delicate actions were used to mobilize the abnormal vessels and move them to the anterior wall of the pelvis. Then, they were “wrapped” with the anterior wall of the pelvis. Postoperative follow-up included clinical evaluation and renal ultrasound examination 1, 3, and 6 months after surgery. The operative duration was 65 min. During the robot-assisted Hellström – Chapman operation, no intraoperative complications, such as damage to the vessels supplying the kidney and neighboring organs, were noted. The patient did not require internal or external drainage of the upper urinary tract or perinephric space. The anteroposterior diameter of the pelvis decreased from 30 to 8 mm. The resistive index of the blood flow in the renal vessels decreased from 0.74 to 0.58. The Hellström – Chapman robotic procedure is a safe and effective procedure for the correction of vasorenal hydronephrosis. However, this surgery requires patient selection to ensure future treatment success.

The practice of injecting various substances into the tissues of the penis in order to increase its size is found among adult men in different countries. An analysis of domestic and world literature revealed only one publication of a clinical case of treatment of a 16-year-old teenager with penile oleogranuloma. A 13-year-old boy was admitted to the pediatric surgical department with complaints of pain and severe swelling of the penis. According to the patient (found out later), these symptoms appeared 3 days after injecting 4 ml of Vaseline oil with a syringe under the skin of the penis. Swelling and hyperemia of the skin appeared, the next day the temperature rose to 40 °C, dizziness, nausea appeared, there were repeated vomiting and loose stools. The cause of the disease was established only after detailed questioning in the department. Local status: the penis is sharply increased in volume due to pronounced vitreous edema, mainly along the dorsal surface, the skin is hyperemic with dark areas and detachment of the epidermis. Diagnosis: “Necrotizing phlegmon of the penis, condition after injections of Vaseline oil”. After medical preparation, surgery was performed. Under endotracheal anesthesia, a 2 cm incision was made along the dorsal surface of the penis. A turbid liquid of 35–40 ml was released from the wound cavity, drainage was done with rubber drains. After the operation, antibacterial therapy and dressings with hydrophobic ointment were carried out. The general condition of the child returned to normal, the wound was cleaned, a defect measuring 5 × 3 × 0.2 cm was formed. After 2 weeks, plastic surgery was performed according to the Diettel method: the foreskin was cut to the area distal to the granulating wound, the outer and inner leaves of the foreskin were sharply separated, a graft was formed from the outer layer and fixed to the wound. The postoperative period was favorable, healing was by primary intention. The patient was discharged in satisfactory condition on the twenty-fourth day from hospitalization. When examined after 4 months, the patient has no complaints; on the dorsum of the penis there is a normotrophic scar measuring 2 × 3.5 cm, which does not interfere with skin mobility. The introduction of foreign bodies under the skin of the penis, accompanied by serious complications, began to be practiced among adolescents. Therefore, this case report will be of interest not only for pediatric surgeons and urologists, but also for doctors of other specialties who may be approached by patients with changes in the penile area, since a true history cannot always be ascertained.

With the advent of traumatic self-defense weapons among Russian civilians (weapons of limited destruction and nonlethal kinetic weapons), several studies on injuries among the adult population have been published in the medical literature. Skull injuries are the most severe, often fatal, injuries. To date, there are only isolated descriptions of such injuries in children.

Description of the observation. According to the parents, the 3-year-old boy shot himself in the face with an Osa-4 pistol at home. He did not lose consciousness, and the bleeding was light. He was admitted to the central district hospital, from where he was evacuated by an ambulance team to Children’s City Clinical Hospital No. 9 named after. G.N. Speransky, Moscow. Upon admission, the patient was in a serious condition, conscious, and lethargic, reacted negatively to examination, and had 14 points on the Glasgow coma scale, and his hemodynamics was stable. Local status: In the upper part of the dorsum of the nose, a bullet entry hole was observed in the form of a bruised wound of irregular shape, pronounced swelling in the area of the left orbit, and hematoma of the upper eyelid. X-ray images of the skull showed a shadow of a foreign body (bullet) in the projection of the left orbit and ethmoidal labyrinth. The location and extent of damage were clarified by computed tomography. Under endotracheal anesthesia, a supraorbital trans-eyebrow approach on the left with layer-by-layer tissue dissection along the wound canal exposed a part of the bullet, wedged into the medial wall of the orbit and cells of the ethmoid bone. The bullet was removed, and bone fragments and layer-by-layer sutures were removed. Diagnosis: Gunshot causing a blind craniofacial non-penetrating wound in the dorsum of the nose and left orbit, multiple comminuted fractures of the ethmoid bones and superior and medial walls of the left orbit, contusion of the basal parts of the left frontal region of the brain, blunt trauma OS stage 2, local contusion, and retinal hemorrhage The postoperative period passed without complications. The child received a combination of antibacterial and restorative therapy. Vision was preserved, no neurological disorders were detected, and the cosmetic result was good. The patient was discharged in satisfactory condition under the supervision of an ophthalmologist, neurologist, and maxillofacial surgeon. This observation is presented to demonstrate damage to skull structures from traumatic weapons and will aid in further generalization of the treatment results of this type of wound in children. Prevention of injuries in children from traumatic weapons requires extensive educational work among parents who own these weapons.

This paper describes the professional activities and merits of the pediatric and orthopedic surgeon Igor V. Shvedovchenko in celebration of his birthday.