Subtotal resection of the colon in intestinal agangliosis depends on the level of lesion and secondary decompensatory changes in the intestinal wall. Rational choice of reconstructive plastic surgery in such pathology is necessary to restore patency, normalize functional changes in the intestine and stabilize the general condition of patients. Purpose - to evaluate the results of reconstructive-plastic surgery to restore patency at different levels of subtotal resection of the colon in children with intestinal agangliosis. Materials and methods. We analyzed the surgical treatment of 182 children with intestinal agangliosis aged from 1 month to 8 years, who underwent reconstructive-plastic surgery to restore patency at different levels of subtotal resection of the colon. Results. In 58 (31.86%) patients after subtotal resection of the colon performed the pullthrough of the remaining segment of the colon on the left mesenteric sinus (lateral canal), in 51 (28.02%) - pullthrough of the remaining segment of the colon on the right mesenteric sinus in front of the terminal ileum, in 63 (34.62%) - pullthrough of the ascending colon or caecum on the right flank with a rotation of 180° and in 10 (5.50%) children - replacement of the left half of the colon with an ileograft with intrarectal pullthrough. In 161 (88.46%) cases good results were obtained, and in 21 (11.54%) patients - satisfactory functional results in the long term follow up. Conclusions. Restoration of intestinal patency after subtotal resection of the colon in children with intestinal agangliosis should be aimed at providing favorable conditions for anastomosis between the remaining part of the colon and rectum. If it is impossible to directly anastomose the remaining segments of the colon and rectum, it is advisable to replace the left half of the colon with an ileograft with its intrarectal pullthrough. Differential approach in the choice of reconstructive plastic surgery for subtotal resection of the colon allows to normalize functional changes in the intestine and stabilize the general condition of patients. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: agangliosis, intestine, children, surgical treatment, results.
Chronic postsurgical pain (CPSP) is defined as pain that develops or increases in intensity after a surgical procedure and persists for at least three months. Its prevalence rate ranges from 5% to 54%. Aim - to assess the prevalence of CPSP among children at the age of 7-18 years residing in the Precarpathian region at three and six months after herniorrhaphy, orchiopexy and Bernardi procedure. Materials and methods. There were observed 92 children at the age of 7-18 years, who underwent treatment for abdominal wall hernia, cryptorchidism, varicocele, and hydrocele at the surgical department. Children were divided into the following groups: Group 1a included children at the age of 7-12 years with acute pain syndrome in the postoperative period; Group 1b comprised children at the age of 13-18 years with acute pain syndrome in the postoperative period; Group 2a included children at the age of 7-12 years with chronic pain syndrome; Group 2b included children at the age of 13-18 years with chronic pain syndrome. Results. The prevalence of CPSP following surgery among children of the Precarpathian region was found to be 33.7%, with a male predominance (р<0.05). There was an increased need for postoperative pain management with paracetamol in children of Group 2a (р<0.05). The mean scores of the Face, Legs, Activity, Cry, Consolability (FLACC) scale were significantly higher in children of Group 2a, 2b as compared to Group 1a, 1b (р<0.05). The Visual Analogue Scale (VAS) confirmed greater pain intensity in children of Group 2a on the second and third days of treatment (р<0.05). Conclusions. The high prevalence of chronic pain in children after herniorrhaphy, orchiopexy by Petrivalsky / Schoemaker technique, Ross and Bernardi procedures is due to ineffective perioperative pain management that requires the use of additional analgesia techniques, including regional ones. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
Despite advances in the diagnosis and treatment of necrotizing enterocolitis (NEC), the associated morbidity and mortality rates remain high. Purpose - to establish risk factors for mortality of necrotizing enterocolitis in preterm born infants, as well as to analyze histological changes of the intestinal lining. Materials and methods. The course of NEC in 21 preterm neonates who died of this disease (group 1, n=21) over a period of 3 years was analyzed. To establish risk factors for mortality rate health indicators of children in group 1 were compared with the course of NEC in children who survived with similar stages of the disease (group 2, n=43). The following research methods were used: general clinical, laboratory, instrumental, histological and statistical. Results. Our data show that the main causes of severe stages of NEC in preterm infants is infection, often in combination with severe asphyxia. The identified risk factors for mortality allowed to establish that the risk of death for children with NEC was associated with: male sex (OR=4.675; χ2=7.679; p=0.006) - increases the risk for mortality by 4 time; inflammatory changes in the placenta (OR=6.139; χ2=10.501; p=0.002) - increases the risk by 6 times; red blood cell transfusion in children (OR=8.262; χ2=8.557; p=0.004) - increases the risk by 8 times; thrombocytopenia (OR=4.320; χ2=4.866; p=0.028) - increases the risk by 4 time; the developmen of multiple organ system failure (OR=12.364; χ2=17.578; p<0.001) and DIC syndrome (OR=10.725; χ2=14.592; p<0.001) - increases the risk by 12 and 11 times, respectively; the positive symptoms - oedema of the anterior abdominal wall (OR=14.025; χ2=19.258; p<0.001) and vasodilation of the anterior abdominal l wall (OR=5.333; χ2=5.444; p=0.02) - increases the risk by 14 and 5 times, respectively; the intestinal pneumatosis on abdominal when x-ray detected (OR=6.840; χ2=6.867; p=0.009) and the peritoneal effusion detected by abdominal ultrasound (OR=8.750; χ2=14.448; p<0.001) - increases the risk of mortality by 7 and 9 times, respectively. During histological examination of the intestinal wall with NEC lymphohistiocytic infiltration of submucosa indicates perinatal hypoxia and its crucial role in the thanatogenesis of the disease, while polymorphonuclear segmental neutrophil infiltration is associated with perinatal infection. In 15 children (71.4%) changes of both types were noted, which indicates mixed etiology of intestinal lesions. Conclusions. Study results confirmed that necrotizing enterocolitis is a serious disease of newborns with a high mortality rate. The severe forms of NEC occur against the background of infection in combination with hypoxia. The obtained risk factors for the mortality rate of NEC allow to improve the prognosis of the course of this disease, will provide an opportunity to identify children who need increased attention of doctors to the treatment and further management of these patients with the use of preventive technologies that can prevent catastrophic consequences. The presence of congenital intestinal defects in combination with premature birth contribute to the development and aggravate the course of NEC, up to the development of stage III and a negative prognosis of the disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the parents of patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: necrotizing enterocolitis, preterm neonates, risk factors for mortality, histological changes.
Purpose – to analyze treatment results and to improve algorithms of diagnostic, treatment and rehabilitation of children with acute hematogenous osteomyelitis (AHO). Materials and methods. A study of 884 patients with AHO, who were treated at the Zhytomyr Regional Children’s Clinical Hospital and O. F. Gerbachevsky Zhytomyr Regional Hospital surgical department (child surgical department has been at the adult regional hospital until 1986) in the period from 1978 to 2019. 60.5% patients were boys, the vast majority – 488 (55.1%) – villagers. School-age children (7–15 years) – 353 (39.9%), first-year children – 228 (25.8%). General clinical and laboratory tests, X-ray, ultrasound, CT and MRI, microbiological and immunological test were used to control the course of the disease and the treatment effectiveness. Results. The most common AHO pathogen remains the same – Staphylococcus aureus, however it’s frequency dropped from 60.4% to 46.1% because of increased Kl. pneumoniae, sticks of blue-green pus, to a lesser extent – Klebsiella and mixed flora. Also we established dependence AHO form from the pathogens number and age. The most often AHO determinants (provocation or trigger) were limb traumas (352 patients – 39.8%), lesser – respiratory diseases, skin and soft tissue inflammation. In 37.4% cases (341 patients) there was no such symptoms. Differences in the immunological characteristics of the three clinical forms of AHO disease become clear only during comparative assessment of the dynamics of immunological parameters by stages of the disease. The main subpopulations of T lymphocytes and their interrelated indicator, the helper-suppressor index, are the structural basis for the formation of differences in the immune response. Phlegmon disclosure (subperiosteal, paraosal, periarticular) in total was performed in 863 patients (97.6%), of which 84 children (9.5%) had recurrence. Bone needles puncture was performed in 613 patients (69.3%), of which osteoperforation – in 589 (66.5%). In newborns, antibiotic administration into the bone (metaepiphysis, close to the affected joint) and into the joint was performed by puncture 1–2 times a day for 7–10 days. In young children, decompression of the inflammatory focus in the bone was achieved by setting Dufox needles. Soft tissue abscesses were opened as they appeared, and in purulent pleurisy and pyopneumothorax (in 25 of 52 patients) pleural cavities were drained. There was reduction of local edema, hyperemia in children of experimental groups with generalized forms (septicopia and toxicoseptic) during the first week in 44.4% and 45.4% in the control group – 0.0%-15.9%, p<0.05). The reparation activity increased in 2.5–4.5 times. During the first week, right after starting liposomal therapy, body temperature in children with generalized AHO normalized, while in the control group it occurred only in 12.5–23.1% of patients. The duration of hospital treatment was reduced In the experimental group: 90.0% patients with local forms were treated less than 32 days, 88.9% patients with toxicoseptic and 72.7% of patients with septicopiaemic forms (in the control group, accordingly 92.8%, 37.5%, 38.5%, p1<0.05, p2–3<0.05). Conclusions. Diagnosis of AHO requires today a comprehensive examination: history, local changes and generalization of the process, MRI, ultrasound, radiography at a later date. Decisive in the treatment of AHO in children is the timely and complete irrigation of the lesion area, so the leading specialists in the treatment of acute hematogenous osteomyelitis should be pediatric surgeons. Consultation of related specialists proceeding if necessary. Empirical antibiotic therapy should be planned with consideration of sterile body fluid cultures in patients with various forms of the disease and their antibiotic sensitivity. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: hematogenous osteomyelitis, children, diagnostic, treatment and rehabilitation.
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