卷 4, 编号 2 (2014)

The aim of the study was to estimate the interrelation between the type of nutrition support with the course of system inflammatory response in children with acute appendicular peritonitis and early adhesive ileus obstruction undergoing videoendosurgery. It was a prospective, controlled, nonrandomized unicentral study. 92 patients were included in the study. The endpoints were as follows: dynamics of clinical signs of SIRS, level of C-reactive protein, levels of pro-inflammatory cytokines (tumor necrosis factor and interleykin-6), procalcitonin (PCT) level. 49 patients (main group) received the combination of early parenteral nutrition (Nutriflex from the first postoperative day) with enteral tube feeding from the second postoperative day and sipping from the 3-4^th days. 43 patients (control group) received the full parenteral nutrition (Nutriflex) from the second postoperative day with transition to sipping nutrition from the 4^th postoperative day. The postoperative period was accompanied by a comparable growth of levels of CRP and pro-inflammatory cytokines. the accelerated recovery of nutrition status, normalization of procalcitoninum level in the blood serum, and reducted duration of SIRS was noticed in the children from the main group.

From 2011 to 2013 years we investigated hemostasis system at 79 children with sharp violations of brain blood circulation with hemorrhagic type. It is revealed that adhesion of platelets was sharply reduced with collagen, ristomycin, adrenaline and ADF in comparison with control group in all days of research. It means that at children thrombocytopenia or a thrombocytopathy is noted. Decrease in activity of platelets can cause recidivous character of bleeding. The received results testify to the combined thrombocytive and coagulative violations. Activation of the vascular thrombocytive mechanism is cornerstone to start of DVS syndrome.

The purpose of the technical report consists in showing opportunity and efficiency of thoracoscopic treatment of tracheomalacia at children.

Objective: analysis of self-reported results of the Malone procedure and drawing attention of colorectal surgeons to this method of treatment 23 patients i.e. 17 boys and 6 girls aged 5 to 10 years were treated with a Malone procedure in the department of urology and coloproctology of the Russian Children’s Clinical Hospital from 1998 to 2013. They included 20 children with myelodysplasia who had been operated on for cerebrospinal hernias and 3 patients with anorectal malformations following recurrent proctoplasty with intractable constipation and fecal overflow incontinence. Most patients got a smooth postoperative period. No serious complications were observed. There had been no stool passage from the stoma. 5 patients experienced early complications in the form of swelling of the skin around the stoma. Remote results were assessed in 20 children aged 1-13. Satisfaction of parents and children with Malone antegrade continence enema was rather high. The children felt much more comfortable and mood in the families improved in all observations. Only single episodes of incomplete control of stool passage were reported in patients with digestive disorders and loose stool. Malone procedure is a valuable option of social adaptation in children with severe fecal incontinence which can be successfully used in domestic medical practice.

The article represents analysis of diagnostic results of 298 children aged from 1 to 15 with echinococcosis of various localization and 53 patients with cavitary lesions of parenchymatous organs of nonparasitic ethiology. It is established that the basic diagnostic methods for echinococcosis are plan radiography and ultrasound examination of organs in chest and abdominal cavities. Multispiral computed tomography is an accurate way to confirm diagnosis of echinococcosis, carry out differential diagnosis with nonparasitic cysts. It has been proved that immunoenzymometric analysis with test-system «Echinococcus IG-strip» serves as a reliable evidence of not only primary echinococcosis, but also the presence of backsets of the process and residual deprivation.

The article deals with the effect of altered biocenosis of the cecum on the development of acute appendicitis in children and simulation of acute appendicitis of local dysbiosis in the cecum and intestinal infection. To this end, investigations of microflora in the cecum and the rectum in 96 children who were operated for acute catarrhal appendicitis (ACA) and 42 children (control group) hospitalized with injuries, fractures and wounds of ileocecal angle. Of the 96 children, diagnosis of acute catarrhal appendicitis was histologically confirmed in 58. In 41 children the diagnosis was not confirmed. A decreased bifidobacteria count was revealed in 95% of children. In control group, bifidobacteria count in ileocecal angle of the cecum was 10⁹-10¹² and fecal bifidobacteria count was 10⁷-10¹⁰. Also, pathogenic and conditionally pathogenic bacteria were detected in the cecum of children with unconfirmed diagnosis of acute catarrhal appendicitis, i. e. they simulated acute appendicitis. Fecal bacteria count was lower than that in the cecum. The children with confirmed ACA showed the presence of conditionally pathogenic bacteria.

The article is devoted to the results of negative-pressure wound therapy to treat wounds of different etiology in children from the first years of their life. Outcomes of two clinical observations show the positive effect produced by the application of an evacuated dressing on a soft-tissue defect to accelerate the removal of devitalized tissues from the wound surface and stimulate formation of a vital granulation tissue capable of dealing with a skin graft. It is indicated that restoration of soft tissues is possible only in the usage of multicomponent approach to the wound management.

Infantile fibrosarcoma (IF) is a rare soft tissue tumor in the pediatric age group. Domestic and foreign literature usually provides single case reports of oncopathology in newborns and infants. A 2-month-old child was examined in a department of surgical oncology of the Scientific and Practical Center for Medical Aid to Children of the Moscow Department of Health who was admitted to the clinic in the end of December of 2013 for examination and treatment for a soft tissue tumor of the right femur. Fibrous soft tissue hamartoma was diagnosed based on the results from medical imaging studies (ultrasound examination, CT angiography) and verification by histology (tumor biopsy). The soft tissue tumor was removed. Histological and immunohistological analysis oftumor tissue confirmed the diagnosis of infantile fibrosarcoma. Radicality of the performed surgical intervention was confirmed microscopically. The child underwent multiagent chemotherapy in the postoperative period. Literature data regarding tumor frequency are provided stating an opinion of oncologists in treatment methods of this rare tumor in newborns and infants.

Представлен опыт многоэтапного хирургического лечения пострадавшей девочки 5 лет с обширной посттравматической скальпированной раной волосистой части головы, затрагивающей теменные, височную и затылочную области (500 см²). Проводили поэтапное замещение раневого дефекта при помощи таких методов пластической хирургии, как острое растяжение мягких тканей, дозированное растяжение мягких тканей при помощи баллонных экспандеров, аутодермопластика расщепленным трансплантатом. Достигнут удовлетворительный результат в виде полного замещения раневого дефекта.