卷 12, 编号 3 (2022)

BACKGROUND: Cerebral palsy (CP) patients commonly present with unilateral hip dislocation. However, the decision for concurrent prophylaxis surgery on the contralateral hip in this condition is still controversial.

AIM: This study aims to explore the prognostic factors for contralateral hip dislocation and develop a scoring system.

MATERIALS AND METHODS: Data on CP patients with unilateral hip dislocation between January 2005 to January 2019 were reviewed. We explored the difference of preoperative parameters between the group in which the contralateral hip is eventually dislocated or remains stable. A multivariable logistic regression analysis was performed to develop a model for predicting contralateral hip dislocation.

RESULTS: Seven of included 30 patients (23.3%) developed contralateral hip dislocation. Pre-operative contralateral hip’s Reimer’s Migration Index (RMI), Acetabular Index (AI), Lateral Center Edge Angle of Wiberg (CEA), and Pelvic obliquity (PO) were significantly different (p = 0.049, 0.019, 0.030 and 0.038 respectively). The multivariable logistic regression analysis reveals that RMI > 25% (mOR 36.66, 95% CI 1.13–1185.50, p = 0.042) and age <9 years old (mOR = 22.55, 95% CI 0.76–665.37, p = 0.071) are significant predictors. Both parameters were included in the model, which revealed an AuROC of 0.84 (95% CI 0.69–0.99). Each factor was assigned a score of 1. There was no contralateral hip displacement in patients with a score of 0. Two out of 15 patients (28.6%) with a score of one developed contralateral hip displacement. Five out of eight (71.4%) patients with a score of 2 developed contralateral hip dislocation.

CONCLUSIONS. Significant predictors for contralateral hip dislocation in CP patients are RMI >25% and age <9 years old. The proposed scoring system might help guide the surgeon’s decision to perform contralateral prophylactic surgery.

BACKGROUND: To date, N.F. Filatov Children’s Hospital has great experience in the surgical correction of pectus excavatum in children. For 22 years, >1000 minimally invasive repair procedures of pectus excavatum were performed in the thoracic surgery department. Despite the satisfactory and excellent outcomes of the surgical correction of pectus excavatum, the search for alternative nonsurgical methods of treating this pathology continues. In world practice, a vacuum bell is used as a conservative treatment. However, its effectiveness and indications are still in question.

AIM: To evaluate the first experience of using a vacuum bell in the treatment of pectus excavatum in children.

MATERIALS AND METHODS: A vacuum bell is a device consisting of sight glass, silicone ring, and manual pump, lifting chest wall deformities through a vacuum. The device is selected individually depending on the growth and shape of the ventral surface of the chest. According to instructions, the vacuum bell should be used a minimum of 1 h per day. All patients underwent a standardized assessment of the results of treatment every 3–6 months: measuring the depth of deformation, visual treatment control, analysis of photo documentation, and questionnaires.

RESULTS: In the N.F. Filatov Children’s Hospital from 2015 to 2021, treatment results of 35 children using vacuum bell for 6–36 months were analyzed. Patients were divided into two groups depending on the percentage of deformation correction. The first group included 23 (65.7%) patients, and the percentage of correction was >50%. The second group included 12 (34.3%) patients, and the percentage of correction was <50%. In these groups, the main differences in the age of treatment initiation, regularity of use, and time of daily use have influenced the results. In the first and second groups, the average ages were 8.7 ± 2.69 and 13.7 ± 3.56 years, and the average daily use times were 5.7 ± 2.04 and 3.6 ± 1.61 h/day, respectively.

CONCLUSIONS: Vacuum bell therapy is an effective and safe method for correcting pectus excavatum in children, and in some cases, it can be an alternative to surgical treatments.

BACKGROUND: Pilonidal cyst (other names: pilonidal disease and epithelial coccygeal tract) is a common congenital pathology and most often manifested in adolescence.

AIM: To determine the optimal treatment and diagnostic measures that lead to a reduction in complications and improvement in the quality of life of sick children with pilonidal cysts.

MATERIALS AND METHODS: Case histories of 310 children with pilonidal cysts who were treated at the N.F. Filatov Children’s City Clinical Hospital (Moscow) and Republican Children’s Clinical Disease in Izhevsk in 2013–2018 were analyzed. The patients (95%) were predominantly adolescents. The patients were divided into four groups: group 1 (n = 78), acute inflammation of the cyst; group 2 (n = 75), cyst without signs of inflammation; group 3 (n = 125), cyst with chronic inflammation; group 4 (n = 32), disease relapse. For diagnosis, clinical and ultrasound examination was conducted for uncomplicated cysts. The surgery was performed after fistulography and consisted of cyst excision to the sacral fascia with tight tightening or installation of an aspiration drain. Surgical intervention was preceded by laser treatment in the surgical field.

RESULTS: The severity of infiltration of the surrounding tissues in the postoperative period, depending on the drainage of the wound, was significantly different. More pronounced infiltrative changes were noted in patients with drainage and, accordingly, later terms of wound healing. Following double epilation with a neodymium laser, the frequency of postoperative purulent inflammatory complications was reduced (7.3%). The excision of the pilonidal cyst 1 month after acute inflammation with wound closure and involvement of the sacral fascia without drainage was the most effective.

CONCLUSIONS: Ultrasound examination is a highly informative method that allows for determining the parameters of uncomplicated cysts. Laser epilation in the preoperative period helps reduce purulent inflammatory complications.

BACKGROUND: A life-threatening organ dysfunction is a strong predictor of in-hospital mortality and adverse outcomes in pediatric patients and full-term neonates. Predictors of outcomes of multiple-organ failure in preterm newborns have not yet been sufficiently determined.

AIM: To compare the discriminatory ability of neonatal sequential organ failure (nSOFA) and NEOMOD organ dysfunction scales as predictors of poor outcomes in very preterm newborns.

MATERIALS AND METHODS: This prospective observational study included 109 newborns with a birth weight of 1071 (772–1451) g and gestational age of 29 (26–32) weeks; 22 (20.4%) of them died.

RESULTS: The area under the receiver operating characteristic curve was 0.796 (95% confidence interval (CI) 0.763–0.827) for the nSOFA scale and 0.771 (95% CI 0.721–0.817) for the NEOMOD scale.

CONCLUSIONS. Both scales are suitable for measuring the severity of organ dysfunction in preterm newborns. nSOFA appears to predict mortality in preterm newborns.

Massive blood loss that develops during surgery is a common cause of life-threatening conditions and deaths in patients of any age.

This study aimed to analyze domestic and foreign publications that present methods for determining the volume of intraoperative blood loss.

The literature sources were searched in PubMed, Scopus, Web of Science, MEDLINE, eLibrary, and Russian Science Citation Index databases. The search was conducted in Russian and English using the following keywords: intraoperative blood loss, severity of blood loss, methods for assessing blood loss, direct methods, and indirect methods. The literature review included five articles from PubMed, nine from Scopus, six from Web of Science, two from MEDLINE, six from eLibrary, and four from Russian Science Citation Index.

Massive blood loss is understood as a one-time loss according to some authors of >30% and according to others of >50% of the volume of the circulating blood or blood loss equal in volume to 2–3 mL/kg/min. Risk factors for the development of intraoperative complications such as massive blood loss are, in addition to surgical interventions, the features of surgical intervention, i.e., size of the incision, surgical duration, and anesthesia, which can increase blood loss. The intensity and degree of blood loss are very important in determining the indications for transfusion of blood components, replenishing the volume of circulating blood, and determining indications for intraoperative hemostasis, both medical and surgical. In neonates and young children, the risk of dangerous intraoperative blood loss is associated with anatomical and physiological features, i.e., a small volume of circulating blood and insufficiently mature compensatory mechanisms. In older children, a high risk of massive blood loss is associated with comorbidities, features of hemostasis, and use of drugs that slow down the blood coagulation process.

To date, several methods are available for assessing intraoperative blood loss, but only a few are used in routine clinical practice. Each method has advantages and disadvantages. One of the main disadvantages is the complexity of the mechanisms for assessing blood loss, for example, weighing surgical materials or the patient before and after surgery, determining hemoglobin in the liquid after soaking the used surgical materials, and calculating indices using formulas. Most often, the assessment of blood loss is conducted according to the clinical picture (pallor of the skin and mucous membranes, weak pulse, lowering blood pressure, etc.).

The results of the literature analysis showed insufficient research on determining the volume of intraoperative blood loss in pediatric practice, as evidenced by the small number of published scientific papers and the complete absence of randomized trials. Thus, further study of this problem is necessary.

Situs inversus totalis is an extremely rare anomaly in which the organs of the chest and abdominal cavity lie in the opposite direction. With complete transposition, clinical manifestations may be absent, and diagnostic and therapeutic problems may arise in the presence of other malformations or diseases.

A 4-year-old girl was admitted for treatment in the hematology department of the National Medical Center of the Republic of Tajikistan, with complaints of nausea, periodic vomiting, lethargy, lack of appetite, malaise, and skin pallor. Owing to the ineffectiveness of conservative therapy, surgical treatment was recommended, i.e., splenectomy. During the preoperative examination, radiography and radiopaque examination of the organs of the gastrointestinal tract with barium sulfate revealed that the fundus and body of the stomach were located in the left half of the chest, and the heart was symmetrically deployed to the right. An ultrasound examination revealed signs of displacement of the liver to the left half of the abdomen, the spleen to the right, and the heart in the right half of the chest. The diagnosis was “hiatal hernia on the left, situs inversus totalis, hereditary hemolytic anemia, fermentopathy, and G-6-PD deficiency.” Laparoscopic surgery was performed, which included splenectomy, elimination of a hiatal hernia, chiatoplasty, and esophagogastrofundoplication with the creation of a Nissen cuff. The girl was discharged on day 10. On control examination after 6 and 12 months, she had no complaints and has grown and developed according to age.

This clinical case is the first in the Russian literature to describe the treatment of a child with a hiatal hernia against the background of complete transposition of internal organs. This case highlights the need for imaging techniques for any unclear symptoms, especially in children with hereditary diseases. Minimally invasive intervention could contribute to a favorable outcome.

The paper describes the professional activities and merits of the pediatric surgeon, science editor of “Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care”, Vladimir I. Petlakh in celebration of his anniversary.