卷 7, 编号 2 (2017)

The paper presents a case of the generalized form of severe tetanus in a 9‑year-old child with a relatively short incubation period. Decisive in preserving the life of the patient were complex efforts of specialists of different profiles: infectious diseases, resuscitators, pediatricians,  but only active surgical tactics provided a favorable result of the disease.

An own clinical observation of vascular malformation of ileac mesentery with torsion around the peduncle and strangulation in the  right inguinal canal in a 9-year-old girl is presented. The girl was admitted for suspected acute appendicitis. Diagnostic laparoscopy, laparoscopic removal of the fixed formation and its video-assisted removal were carried out considering lack of obvious clinical and laboratory signs of acute appendicitis and pain syndrome preservation. The clinical case shows that it is possible to come across a rare cause of abdominal pain syndrome reconfirming the diagnostic value and therapeutic possibilities of laparoscopy.

The paper summarizes the reports on the surgical forum, devoted to the problems of medical care in terrorist attacks and serious injuries.

The purpose of the study: to compare the results of treatment of  patients with pectus excavatum in different methods of thoracoplasty in children

Materials and methods: 542 patients with pectus excavatum were  operated from 1996 to 2016. For the purpose of comparative  estimation, the patients operated using various methods were  divided into two groups. The first group included 90 children who  underwent surgery using the method of Salamaa-Paltia. The second  group embraced 452 patients using the Nass procedure of modified  thoracoplasty. The following parameters were estimated and  compared for the groups: surgery duration, length of epidural  anesthesia, duration of anesthetics intake, intra- and postoperative complications, number of days spent at the hospital following the surgery. 

Results: no epidural anesthesia was given to the patients from the  1st group. The children who underwent a surgery received narcotic  analgesics combined with non-steroid anti-inflammatory agents  prospectively. The protocol of postoperative analgesia of the 2nd  group included prolonged epidural anesthesia combined with non- steroid anti- inflammatory agents. Narcotic analgesics were used  only when the above mentioned agents failed to stop the pain  syndrome. Thoracoscopy was performed in 9 (1.9%) of patients. Simultaneous surgeries were done in 10 (2.2%) patients. Groups I  and II have significant differences as related to the time of an  operation and intraoperative blood loss. The surgery duration using  the Salmaa-Paltia procedure 2.7 times exceeded the length of  thoracoplasty using the modified Nass procedure; intraoperative blood loss was 4 times as much.

Conclusions: the modified Nass procedure to correct the pectus  excavatum is safe and effective in most cases including syndrome- based forms of the disease and enables to obtain an excellent  cosmetic result. It reduces the risk of such complications as damage  to the chest organs during a surgery and displacement of the plate  during the postoperative period.

Purpose: comparative analysis of the functional state of the hip  joint and life quality in children following various types of surgical  treatment of Legg-Calve-Perthes disease.

Materials and methods: the surgery was performed in two groups  of patients with Perthes disease. In the first group consisting of 12  children, the proximal portion of the femur was stabilized using a L- shaped plate. In the second group, 29 patients were operated using  the internal method and intramedullary titanium elastic nail (TEN)  fixation. According to TEN, medialization, varization and elimination  of the epiphyseal subluxation of the femoral fragment are performed immediately using two flexible elastic rods.  Functional capabilities of the operated joint were estimated  radiologically and using the Iowa Hip Score. Patients (n=41) operated using various methods
were included in the perspective health-related study of life quality.  They used the MOS 36‑item short-form health survey.

Results: dynamics of restoration of the operated joint using the  proposed method occurred from 1.5 to 1.7 years in one group, and  within 2.4 years in the other group. Analyzing the results obtained in the study of functional outcomes and life quality, we  found the advantages of TEN osteosynthesis in treatment of Legg- Calve-Perthes disease in children leading to the soonest positive  physophysical treatment result.

Conclusion: pathogenetically substantiated method of surgical  treatment of the 2nd and 3rd stage of Legg-Calve-Perthes disease in  children is intramedullary titanium elastic nail (TEN) fixation. The  minimally invasive and effective method of surgery promotes early  vertical orientation of the patient without specific prevention of  depressive and asthenic states and improves the patient’s life quality in the early and remote period.

The aspects of present-day terminology and classification of acute  kidney injury are considered in the article. Retrospective study of  245 patients with AKI over the last 5 years was performed. The analysis of AKI severity depending on pediatric classification  RIFLE criteria was performed. It had shown that the RIFLE classification is highly informative for predicting disease outcome It  had shown that the anuria duration period constituted on the average 12.1±6.4 days. Renal replacement therapy was required  in 72.2% of patients, and conservative treatment turned  out to be effective in 27.8% children. The study demonstrated that requirement in renal replacement therapy and/or neurological disorders presence and the need of performing artificial lung  ventilation is the predictor of poor prognosis in children with AKI.

The article is based on the memories of a great pediatric surgeon of the XX century, which are of historic interest for pediatric surgeons of today. Our colleague Ken Kimura who is an honorable professor of surgery of Iowa state have demonstrated his scientific view of the most discussed issue of effective treatment of duodenal atresia within the last decades. We collaborated with him to describe the operation, which is currently named after him, and added original pictures of surgery stages in the form of illustrations made at the time when the anastomosis was created.