The objective of the research was to analyze personal experience and world literature on the diagnosis and treatment of boys with testicular torsion and to improve the process of providing specialized care. Problem statement and analysis of the recent researchTesticular torsion (TT) is an emergency condition caused by twisting of the spermatic cord which results in strangulation of the blood supply leading to testicular infarction and organ loss [5,9,10,14]. TT is one of the most common acute conditions accompanied by syndrome of hyperemic and swollen scrotum [1,3,4,6]; it is reported to occur in approximately 90% of adolescents [2,7]. The objective of the research was to analyze personal experience and world literature on the diagnosis and treatment of boys with TT and to improve the process of providing specialized care. Materials and methods of the researchThe results of diagnosis and treatment of 141 children with TT who were treated in the surgical department of the IvanoFrankivsk Regional Children's Clinical Hospital over a period of 10 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) were analyzed. The patients' age ranged within 1 month to 18 years. All the boys were hospitalized to the emergency department and examined: a complete anamnesis was collected, testicular examination and Doppler ultrasound examination were performed, the organs of the scrotum were palpated. In addition, all children underwent a standardized clinical examination. Results of the research and their discussionThere was a tendency toward the increase in the incidence of pathology during the following years (2007 -9 cases, 2008 -12 cases, 2009 -13 cases, 2010 -9 cases, 2011 -18 cases, 2012 -10 cases, 2013 -11 cases, 2014 -14 cases, 2015 -19 cases, 2016 -26 cases). Torsion of the left testicle was observed in 98 (70%) boys; torsion of the right testicle was found in 43 (30%) boys. Torsion of cryptococcal testicle was detected in 18 (12.8%) children. 1 (0.7%) child was at the age of 0 -1 months; 15 (10.6%) children were at the age of 1 month -1 year; 13 (9.2%) children were at the age of 1-3 years; 11 (7.8%) children were at the age of 3-6 years; 16 (11.3%) children were at the age of 6-12 years old; 85 (60.3%) children were at the age of 12-18 years. The degree of twisting of the testicle ranged from 180 to 10800. In 133 cases, surgery was performed (44 (33.3%) children underwent detorsion, ipsilateral and contralateral orchiopexy; 29 (21.9%) children underwent orchiectomy with contralateral orchiopexy, 24 (18.1%) boys underwent orchiectomy, 24 (18.1%) boys underwent orchiopexy and in 12 (9.09%) cases, detorsion was performed); manual testicular detorsion was attempted in 8 (5.7%) cases only. Only 24 (17%) children were hospitalized timely (up to 6 hours). In this group, 18 boys were surgically treated, 3 boys underwent detorsion, and in 4 cases, manual detorsion was attempted.64 (45.4%) children were examined 7-24 hours after TT. In this group, the auxiliary procedures including heating of the
Вроджена діафрагмальна грижа: чи це патологія тільки неонатального періоду? Комунальне неприбуткове підприємство «Івано-Франківська обласна дитяча клінічна лікарня Івано-Франківської обласної ради», Україна WĂĞĚŝĂƚƌŝĐ ƐƵƌŐĞƌLJ͘hŬƌĂŝŶĞ͘ϮϬϮϬ͘Ϯ;ϲϳͿ͗ϵϭͲϵϱ͖ ĚŽŝ ϭϬ͘ϭϱϱϳϰͬW^͘ϮϬϮϬ͘ϲϳ͘ϵϭ For citation: ^ĂůŽŬŚĂ &͕ ŽƌLJƐ KzĂ͕ /|ĂŶŽĐŚŬŽ Zs͘ ;ϮϬϮϬͿ͘ /Ɛ ĐŽŶŐĞŶŝƚĂů ĚŝĂƉŚƌĂŐŵĂƚŝĐ ŚĞƌŶŝĂ Ă ƉĂƚŚŽůŽŐLJ ŽĨ ƚŚĞ ŶĞŽŶĂƚĂů ƉĞƌŝŽĚ ŽŶůLJ͍͘ WĂĞĚŝĂƚƌŝĐ ^ƵƌŐĞƌLJ͘hŬƌĂŝŶĞ͘ Ϯ;ϲϳͿ͗ ϵϭͲϵϱ͘ ĚŽŝ ϭϬ͘ϭϱϱϳϰͬW^͘ϮϬϮϬ͘ϲϳ͘ϵϭПісля неонатального періоду, вроджена діафрагмальна грижа проявляється широким спектром клінічних симптомів, що сприяє затримці в діагностиці та може призвести до помилкового діагнозу. Втручання, зумовлені помилковим діагнозом є причиною ятрогенних пошкоджень, що призводить до прогресування захворювання. У пацієнта з рецидивуючими неспецифічними симптомами з боку дихальних шляхів чи шлунково-кишкового тракту, необхідно завжди в диференціальній діагностиці враховувати вроджену діафрагмальну грижу.У статті описаний клінічний випадок та основні симптоми перебігу пізнього прояву вродженої діафрагмальної грижі у дитини 6-ти років, а також сучасні методи діагностики й лікування цього захворювання. Незважаючи на дані літератури, клінічні прояви цього захворювання викликають великі труднощі щодо своєчасного його розпізнавання та лікування.Дослідження виконані відповідно до принципів Гельсінської Декларації. Протокол дослідження ухвалений Локальним етичним комітетом зазначеної у роботі установи. На проведення досліджень було отримано інформовану згоду батьків дитини.Автори заявляють про відсутність конфлікту інтересів.Ключові слова: вроджена діафрагмальна грижа, пізній прояв, діти.
The objective of the research was to establish the causes of complications of intestinal intussusception in children as well as to determine the optimal diagnostic and treatment strategy.Materials and methods. The analysis of medical records and examinations of 100 children with intestinal intussusception at the age of 1 month to 17 years who were treated at the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University was made. Ileocecal intussusception was diagnosed in 77 children; 13 patients had small intestinal intussusception; there were no patients with colonic intussusception; in 10 patients the localization of intussusception was not established. Treatment of intestinal intussusception was performed urgently immediately after the diagnosis. High priority was given to conservative treatment (74 patients); it was effective in 64 (86.5%) patients. The remaining 36 patients underwent surgery, 9 (25%) of them underwent a laparoscopic disinvagination. In 27 cases open surgery – disinvagination – was used.Results and discussion. The typical age (4-12 months) was observed in 50% of patients only, however, 38% of patients were over 1 year of age, and 20% of children were older than 3 years. All children with intestinal intussusception recovered. The complications of intestinal intussusception were observed in 7 patients, most of them were admitted to the clinic 24 hours after the onset of the disease. Re-laparotomy was used in three cases; two patients underwent elective (programmed re-laparotomy) and one patient underwent urgent re-laparotomy due to the presence of signs of peritonitis. Recurrent intussusception was observed in 5 patients; 4 patients developed this condition after conservative disinvagination, one child - after surgery.Conclusions. The complications of intussusception in children are usually associated with untimely diagnosis and treatment.Diagnostic laparoscopy is a highly informative method of diagnosis in the absence of typical symptoms of intussusception being also an effective minimally invasive treatment.When selecting the method of intussusception treatment you should be guided by the duration of rectal bleeding and Doppler data being the most important criteria for determining the degree of the impairment of hemomicrocirculation in the invaginated intestine.Conservative disinvagination is the priority method of treating intussusception.
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