Vol 4, No 3 (2014)

Modern approach to diagnostics of urinary disorders in children is traditionally based on the application of different invasive instrumental methods causing a number of negative reactions in patients and distorting the results obtained. According to literature data analysis, the issue is pressing in Russia and abroad. Different ways to reduce negative effect produced on a child’s organism and increase study validity are offered including standardization and wide implementation of methods of clinical evaluation of the function of the lower urinary tract. Systematized approach to the clinical evaluation of urination in different groups of patients enables to avoid unjustifiable usage of invasive diagnostic methods and reduce the negative physiological stress on the developing organism.

A program of complex examination and treatment of children with functional disorders of the pelvic organs of organic genesis was initiated on the basis of a multipurpose level III medical treatment facility of Moscow Heath Department in summer 2014. 30-bed assisted uronephrological health care facility for simultaneous hospitalization of a disabled child and his/her mother (or custodian) was located at the division of nephrology. In total 36 children (with parents) with a disturbed function of the pelvic organs such as disturbed spontaneous evacuation of the urinary bladder and bowel in 26 children and incomplete evacuation of the urinary bladder and bowel in 10 children were hospitalized. Vegetovascular dystonia with fixed bradycardia on ECG was found in 19 children (68%). Hydrocephalus was observed in 16 cases (57%). Primary shunting operation was performed at the age of 28-56 days. On the part of social adaptation, there was a lack of communication with peers in 7 children, disturbed relationships between parents and children due to the presence of disorder in 5 patients, acute concerns for the future in 6 children, depression in 8 children, and social ills in 10 patients. The conducted examination included consultations by a neurologist, urologist, nephrologist, orthopedist, neurosurgeon, physical therapist, physiotherapist, and doctor engaged in laboratory and instrumental diagnostics. 12 people had the syndrome of spinal cord fixation, disturbed support of the lower extremities, and disturbed independent evacuation and defecation (group 1). 10 other patients had no syndrome of spinal cord fixation in disturbed evacuation of the urinary bladder and intestine without preliminary attempts to restore urination and defecation acts (group 2). 14 people who had undergone orthopedic interventions had partially restored urination and defecations acts (group 3). The conducted course of diagnostics and treatment accounted for 12-16 bed days. It included 8-12 procedures of physiotherapy, massage and therapeutic exercise. Consultation of a child and his/her parent by a psychologist was conducted for at least 10 days. The most successful methods of mental therapy for adults and children were represented by Jungian art therapy and clinical conversation. Patient appointment scheduling was formed considering the results of diagnostics and treatment. Group (1) with the syndrome of spinal cord fixation was sent for planned surgical treatment to the department of neurosurgery. Children with disturbed support were shifted to the group of planned surgical treatment at the orthopedic department whereas the 3rd group of children with incontinence of urine and fecal incontinence was sent for planned treatment to the department of neurourology. From a multidisciplinary perspective, disabled children with myelodysplasia require a complex examination and treatment of organs and systems to optimize medical aid.

Short bowel syndrome (SBS) is a severe disease which is most frequently developed following massive intestinal resection and manifested through pronounced malabsorption. Children with SBS have to obtain parenteral feeding. Survival rate is low in this case and treatment of people with SBS is currently a complex issue. Methods of surgical treatment of SBS can be divided into two main groups such as operations aimed at slowing down of intestinal transit and operation of intestinal lengthening. The following operations of intestinal lengthening are very popular today: longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP). They provide for the best results. Meanwhile all the surgical methods have definite limitations, complications and are associated with risks. Intestinal transplantation is one of SBS treatment methods which must be used very carefully.

This clinical case of a child of 3 years from cystic duplication of the colon, as manifested clinic acute intestinal obstruction and the presence of space-occupying lesion in the abdomen. Surgical treatment was the only effective method of treatment. Indications for surgical treatment clinic served as intestinal obstruction, refractory to conservative treatment.

Keel-shaped deformation is characterized by protrusion of chest and its sinking down across the rib edge. The deformations of chest have different character, most often they are inherent, and progress with age. Thoracoplasty, that is reconstruction of chest, is difficult and traumatic surgical intervention that is a certain danger for a child. In after operation period the straight result was recognized as good by all patients, the farther results were among) 67 children (88,1%).

Biological and synthetic skin equivalents were developed to improve cosmetic and functional results of treatment of children with deep burns. They include both ReCell® technology and Suprathel® synthetic cover. The usage of these innovative technologies in pediatric combustiology is proven to be effective on the basis of remote therapy results considering the state of cicatricial tissue with the help of appliance of three-dimensional analysis.