Veronika S. Novikova, Oleg V. Kuleshov, G. E. Ulrikh
Hip joint diseases are one of the most common and difficult problems in pediatric orthopedics, often requiring surgical treatment. In children, intra- and postoperative analgesia after hip surgery is more conservative and limited to epidural anesthesia, which has known disadvantages and limitations, despite the high quality of pain relief. Peripheral regional blocks in hip surgery are widespread in adults. Ultrasound navigation makes peripheral blockades safer and more effective. This largely influenced the spread of their use in children and contributed to the introduction of new methods of planar blockades into practice. The authors analyzed studies on the efficacy and safety of modern methods of peripheral regional blockade used in children during hip surgery. The literature search was conducted in the eLibrary, PubMed, and Scopus databases. By using keywords, 750 literature sources were found, and 65 sources relevant to the purpose of the study were included in the review. The lumbar plexus block and fascia iliaca block are the most studied regional techniques in children, which are not inferior in analgesic efficacy to lumbar epidural and caudal anesthesia. A new and promising method of regional anesthesia of the hip is the pericapsular nerve group block, which has been well studied in adults. However, none of the peripheral regional techniques used for analgesia after hip surgery, has not proven its advantages. Further clinical studies are needed to investigate peripheral regional anesthesia techniques and determine their efficacy and safety in pediatric hip surgery.
{"title":"Regional anesthesia for hip surgery in children: A review","authors":"Veronika S. Novikova, Oleg V. Kuleshov, G. E. Ulrikh","doi":"10.17816/psaic1548","DOIUrl":"https://doi.org/10.17816/psaic1548","url":null,"abstract":"Hip joint diseases are one of the most common and difficult problems in pediatric orthopedics, often requiring surgical treatment. In children, intra- and postoperative analgesia after hip surgery is more conservative and limited to epidural anesthesia, which has known disadvantages and limitations, despite the high quality of pain relief. Peripheral regional blocks in hip surgery are widespread in adults. Ultrasound navigation makes peripheral blockades safer and more effective. This largely influenced the spread of their use in children and contributed to the introduction of new methods of planar blockades into practice. The authors analyzed studies on the efficacy and safety of modern methods of peripheral regional blockade used in children during hip surgery. The literature search was conducted in the eLibrary, PubMed, and Scopus databases. By using keywords, 750 literature sources were found, and 65 sources relevant to the purpose of the study were included in the review. The lumbar plexus block and fascia iliaca block are the most studied regional techniques in children, which are not inferior in analgesic efficacy to lumbar epidural and caudal anesthesia. A new and promising method of regional anesthesia of the hip is the pericapsular nerve group block, which has been well studied in adults. However, none of the peripheral regional techniques used for analgesia after hip surgery, has not proven its advantages. Further clinical studies are needed to investigate peripheral regional anesthesia techniques and determine their efficacy and safety in pediatric hip surgery.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"120 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138953722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. I. Kuzovleva, Ekaterina Yu. Vlasenko, L. Maltseva, Olga L. Morozova
Metabolomics is the science of studying small molecules (50–5,000 Da) formed because of the implementation of metabolic pathways in cells and the maintenance of their vital functions. The study of urine metabolome is a promising direction for diagnosing early stages of damage to various cells of the urinary system in pediatric urology, allowing the study of biomarkers or their spectrum, which can improve the identification of existing disorders, and multivariate analysis will provide greater accuracy in making a diagnosis. This study aimed to summarize existing information on urine metabolome and its changes in cases of congenital malformations of the urinary system, accompanied by renal dysplasia, leading to acute kidney injury or chronic kidney disease. A literature search and review was conducted using PubMed, Embase, and Google Scholar. The review presents the possibilities of metabolomic analysis to provide a qualitatively new level of diagnosis and monitoring of damage to the structures of organs and tissues of the urinary system, identifying predictors of pathology progression, and personalized techniques for making medical decisions. However, this method is limited by the high cost of the equipment, need for training of highly qualified personnel, and difficulty in interpreting the results. The study of urine metabolome is very promising for the diagnosis and selection of a timely, rational treatment strategy for children with malformations of the urinary system.
代谢组学是一门研究小分子（50-5,000 Da）的科学，这些小分子是在细胞内实施新陈代谢途径并维持其重要功能时形成的。尿液代谢组的研究是小儿泌尿外科诊断泌尿系统各种细胞损伤早期阶段的一个有前途的方向，可以研究生物标志物或其谱系，从而提高对现有疾病的识别能力，多变量分析将为诊断提供更高的准确性。本研究旨在总结泌尿系统先天畸形伴肾发育不良导致急性肾损伤或慢性肾病病例中尿液代谢组及其变化的现有信息。我们使用 PubMed、Embase 和 Google Scholar 进行了文献检索和综述。该综述介绍了代谢组学分析的可能性，它为诊断和监测泌尿系统器官和组织结构的损伤、确定病理进展的预测因素以及制定医疗决策的个性化技术提供了新的质量水平。然而，这种方法受到设备成本高、需要培训高素质人才以及结果解读困难等因素的限制。尿液代谢组研究对于泌尿系统畸形患儿的诊断和选择及时、合理的治疗策略大有可为。
{"title":"Urine metabolome investigation in pediatric urology. Review","authors":"G. I. Kuzovleva, Ekaterina Yu. Vlasenko, L. Maltseva, Olga L. Morozova","doi":"10.17816/psaic1546","DOIUrl":"https://doi.org/10.17816/psaic1546","url":null,"abstract":"Metabolomics is the science of studying small molecules (50–5,000 Da) formed because of the implementation of metabolic pathways in cells and the maintenance of their vital functions. The study of urine metabolome is a promising direction for diagnosing early stages of damage to various cells of the urinary system in pediatric urology, allowing the study of biomarkers or their spectrum, which can improve the identification of existing disorders, and multivariate analysis will provide greater accuracy in making a diagnosis. This study aimed to summarize existing information on urine metabolome and its changes in cases of congenital malformations of the urinary system, accompanied by renal dysplasia, leading to acute kidney injury or chronic kidney disease. A literature search and review was conducted using PubMed, Embase, and Google Scholar. The review presents the possibilities of metabolomic analysis to provide a qualitatively new level of diagnosis and monitoring of damage to the structures of organs and tissues of the urinary system, identifying predictors of pathology progression, and personalized techniques for making medical decisions. However, this method is limited by the high cost of the equipment, need for training of highly qualified personnel, and difficulty in interpreting the results. The study of urine metabolome is very promising for the diagnosis and selection of a timely, rational treatment strategy for children with malformations of the urinary system.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"54 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139169411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper describes the professional activities and merits of the pediatric and orthopedic surgeon Igor V. Shvedovchenko in celebration of his birthday.
本文介绍了儿科和整形外科医生伊戈尔-什韦多夫琴科（Igor V. Shvedovchenko）的专业活动和功绩，以庆祝他的生日。
{"title":"To the Anniversary of Igor V. Shvedovchenko","authors":"V. V. Rybchenok","doi":"10.17816/psaic1574","DOIUrl":"https://doi.org/10.17816/psaic1574","url":null,"abstract":"This paper describes the professional activities and merits of the pediatric and orthopedic surgeon Igor V. Shvedovchenko in celebration of his birthday.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"70 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138954729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: In recent years, neonatal surgery has been developing and improving, among other things, because of a deeper study of anesthesiological approaches and the introduction of acquired knowledge into the daily practice of an anesthesiologist-resuscitator. One of the basic factors that influence treatment outcomes in the future is a thorough study of infusion therapy methods in newborns, considering the anatomical and physiological characteristics of the neonatal period. AIM: This study aimed to examine the electrolyte balance, acid–base state, and hemodynamic parameters in newborns, depending on the choice of basic infusion medium during surgery. MATERIALS AND METHODS: A prospective study was conducted in 99 newborns. All children were given an infusion of saline solutions of 10 mL/kg/h during surgery. Groups I, II, and III were administered intraoperatively with isotonic Sterofundin, saline solution, and Ringer’s solution, respectively. A hypotonic sodium chloride solution of 0.45% was administered to 11 children. The indicators of the acid–base state and electrolyte composition of the venous blood, hemodynamic parameters, and need for perioperative inotropic support were evaluated. RESULTS: A tendency to hyponatremia was detected in children who were infused with 0.45% sodium chloride hypotonic solution, which resulted in the abandonment of further recruitment of children in the group and the implementation of this study option. After surgery, the pH-compensated state was maintained in all three groups. Moreover, metabolic disorders in the form of a decrease in bicarbonates and ВE were recorded in all groups. Electrolyte disturbances were detected in all groups, whereas electrolyte balance was most often registered in group I. In groups II and III, common ionogram findings included a decrease in potassium and an increase in sodium, chlorine, and calcium levels. In the analysis of the hemodynamic parameters, no significant statistical difference was recorded during surgery when comparing the groups infused with different saline media. CONCLUSIONS: In this study, no significant differences were found in the indicators of acid–base state and hemodynamic parameters when using different saline solutions as basic intraoperative infusion therapy in newborns. Regarding the electrolyte balance, the most common complications were hypokalemia, hypernatremia, and hyperchloremia in the 0% saline group.
{"title":"Effectiveness of saline solutions in surgical interventions in newborns","authors":"M. M. Nasser, Yulia V. Zhirkova, Y. Kucherov","doi":"10.17816/psaic1550","DOIUrl":"https://doi.org/10.17816/psaic1550","url":null,"abstract":"BACKGROUND: In recent years, neonatal surgery has been developing and improving, among other things, because of a deeper study of anesthesiological approaches and the introduction of acquired knowledge into the daily practice of an anesthesiologist-resuscitator. One of the basic factors that influence treatment outcomes in the future is a thorough study of infusion therapy methods in newborns, considering the anatomical and physiological characteristics of the neonatal period. AIM: This study aimed to examine the electrolyte balance, acid–base state, and hemodynamic parameters in newborns, depending on the choice of basic infusion medium during surgery. MATERIALS AND METHODS: A prospective study was conducted in 99 newborns. All children were given an infusion of saline solutions of 10 mL/kg/h during surgery. Groups I, II, and III were administered intraoperatively with isotonic Sterofundin, saline solution, and Ringer’s solution, respectively. A hypotonic sodium chloride solution of 0.45% was administered to 11 children. The indicators of the acid–base state and electrolyte composition of the venous blood, hemodynamic parameters, and need for perioperative inotropic support were evaluated. RESULTS: A tendency to hyponatremia was detected in children who were infused with 0.45% sodium chloride hypotonic solution, which resulted in the abandonment of further recruitment of children in the group and the implementation of this study option. After surgery, the pH-compensated state was maintained in all three groups. Moreover, metabolic disorders in the form of a decrease in bicarbonates and ВE were recorded in all groups. Electrolyte disturbances were detected in all groups, whereas electrolyte balance was most often registered in group I. In groups II and III, common ionogram findings included a decrease in potassium and an increase in sodium, chlorine, and calcium levels. In the analysis of the hemodynamic parameters, no significant statistical difference was recorded during surgery when comparing the groups infused with different saline media. CONCLUSIONS: In this study, no significant differences were found in the indicators of acid–base state and hemodynamic parameters when using different saline solutions as basic intraoperative infusion therapy in newborns. Regarding the electrolyte balance, the most common complications were hypokalemia, hypernatremia, and hyperchloremia in the 0% saline group.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"161 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139170853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dmitriy A. Morozov, V. Rozinov, Sergey G. Suvorov, F. Ampar, Sergey V. Strizhnev, Nikolay N. Vaganov
BACKGROUND: The difference in the levels of total infant mortality in certain administrative territorial entities of the country is an acute medical and social problem of domestic healthcare, which indicates the absence of a single standard of accessibility and quality of medical care. This indicator in the Far Eastern Federal District significantly exceeds the corresponding indicators in the Central and Northwestern districts. AIM: This study aimed to identify unresolved problems and identify ways to improve the availability and quality of surgical care for children by modeling the process of making administrative and clinical decisions by employees of medical organizations and heads of healthcare in the Far Eastern Federal District in the interests of children in need of specialized, including high-tech, medical care, including medical evacuation. MATERIALS AND METHODS: A “business game” with simultaneous implementation of the simulation process in 11 regions of the Far Eastern Federal District was conducted using distributed communication channels and technical capabilities of audiovisual fixation of the opinions of the study participants. A series of five business games on the following profiles were implemented: neonatal surgery, thoracic surgery, neurosurgery, oncology, and combustiology. The scenarios of the games were prepared by the organizers of the study: “Russian Association of Pediatric Surgeons” (LLC) and “Agency for Strategic Initiatives to promote new projects” (ANO). The moderators of the games were leading specialists from specialized federal medical organizations. The game participants were regional teams of the subjects of the Far Eastern Federal District. The observers of the games were representatives of federal legislative and executive authorities and healthcare experts. RESULTS: In this study, 9–11 regions of the Far Eastern Federal District participated in a series of five games. The total number of participants in business games ranged from 126 to 151, and the number of connection points was 42–66. The identified problematic issues included organizational (9), personnel (8), transport (7), equipment (7), and financial (6) aspects. CONCLUSIONS: The ideology of the interregional centers of specialized surgical care for children corresponds to the vision of representatives of the professional community and organizers of territorial healthcare as a promising way to increase the availability and quality of medical care to the pediatric population.
{"title":"Business game “High-tech Pediatric Surgery”: Modeling of management decisions in children’s health protection in the Far Eastern Federal District","authors":"Dmitriy A. Morozov, V. Rozinov, Sergey G. Suvorov, F. Ampar, Sergey V. Strizhnev, Nikolay N. Vaganov","doi":"10.17816/psaic1561","DOIUrl":"https://doi.org/10.17816/psaic1561","url":null,"abstract":"BACKGROUND: The difference in the levels of total infant mortality in certain administrative territorial entities of the country is an acute medical and social problem of domestic healthcare, which indicates the absence of a single standard of accessibility and quality of medical care. This indicator in the Far Eastern Federal District significantly exceeds the corresponding indicators in the Central and Northwestern districts. \u0000AIM: This study aimed to identify unresolved problems and identify ways to improve the availability and quality of surgical care for children by modeling the process of making administrative and clinical decisions by employees of medical organizations and heads of healthcare in the Far Eastern Federal District in the interests of children in need of specialized, including high-tech, medical care, including medical evacuation. \u0000MATERIALS AND METHODS: A “business game” with simultaneous implementation of the simulation process in 11 regions of the Far Eastern Federal District was conducted using distributed communication channels and technical capabilities of audiovisual fixation of the opinions of the study participants. A series of five business games on the following profiles were implemented: neonatal surgery, thoracic surgery, neurosurgery, oncology, and combustiology. The scenarios of the games were prepared by the organizers of the study: “Russian Association of Pediatric Surgeons” (LLC) and “Agency for Strategic Initiatives to promote new projects” (ANO). The moderators of the games were leading specialists from specialized federal medical organizations. The game participants were regional teams of the subjects of the Far Eastern Federal District. The observers of the games were representatives of federal legislative and executive authorities and healthcare experts. \u0000RESULTS: In this study, 9–11 regions of the Far Eastern Federal District participated in a series of five games. The total number of participants in business games ranged from 126 to 151, and the number of connection points was 42–66. The identified problematic issues included organizational (9), personnel (8), transport (7), equipment (7), and financial (6) aspects. \u0000CONCLUSIONS: The ideology of the interregional centers of specialized surgical care for children corresponds to the vision of representatives of the professional community and organizers of territorial healthcare as a promising way to increase the availability and quality of medical care to the pediatric population.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"104 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138958749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Kozlov, S. Poloyan, E. V. Sapukhin, A. S. Strashinsky, M. V. Makarochkina, A. A. Marchuk, Alexander P. Rozhanskii, A. A. Byrgazov, Elizaveta S. Romanovich, A. N. Narkevich
This study presents a patient with pyeloureteral segment obstruction caused by aberrant inferior polar vessels using the robotic Hellström – Chapman procedure and reports its short-term results. A 14-year-old girl was admitted to Irkutsk Regional Children’s Clinical Hospital because of obstruction of the pyeloureteral junction caused by external compression by aberrant lower polar vessels. The diagnosis was established by ultrasonography and Doppler sonography and confirmed by contrasted computed tomography. Surgery was performed using the Versius surgical robot manufactured by CMR (UK). Delicate actions were used to mobilize the abnormal vessels and move them to the anterior wall of the pelvis. Then, they were “wrapped” with the anterior wall of the pelvis. Postoperative follow-up included clinical evaluation and renal ultrasound examination 1, 3, and 6 months after surgery. The operative duration was 65 min. During the robot-assisted Hellström – Chapman operation, no intraoperative complications, such as damage to the vessels supplying the kidney and neighboring organs, were noted. The patient did not require internal or external drainage of the upper urinary tract or perinephric space. The anteroposterior diameter of the pelvis decreased from 30 to 8 mm. The resistive index of the blood flow in the renal vessels decreased from 0.74 to 0.58. The Hellström – Chapman robotic procedure is a safe and effective procedure for the correction of vasorenal hydronephrosis. However, this surgery requires patient selection to ensure future treatment success.
{"title":"Robot-assisted transposition of aberrant lower polar renal vessels in a 14-year-old child with vasorenal hydrophnerosis","authors":"Y. Kozlov, S. Poloyan, E. V. Sapukhin, A. S. Strashinsky, M. V. Makarochkina, A. A. Marchuk, Alexander P. Rozhanskii, A. A. Byrgazov, Elizaveta S. Romanovich, A. N. Narkevich","doi":"10.17816/psaic1544","DOIUrl":"https://doi.org/10.17816/psaic1544","url":null,"abstract":"This study presents a patient with pyeloureteral segment obstruction caused by aberrant inferior polar vessels using the robotic Hellström – Chapman procedure and reports its short-term results. A 14-year-old girl was admitted to Irkutsk Regional Children’s Clinical Hospital because of obstruction of the pyeloureteral junction caused by external compression by aberrant lower polar vessels. The diagnosis was established by ultrasonography and Doppler sonography and confirmed by contrasted computed tomography. Surgery was performed using the Versius surgical robot manufactured by CMR (UK). Delicate actions were used to mobilize the abnormal vessels and move them to the anterior wall of the pelvis. Then, they were “wrapped” with the anterior wall of the pelvis. Postoperative follow-up included clinical evaluation and renal ultrasound examination 1, 3, and 6 months after surgery. The operative duration was 65 min. During the robot-assisted Hellström – Chapman operation, no intraoperative complications, such as damage to the vessels supplying the kidney and neighboring organs, were noted. The patient did not require internal or external drainage of the upper urinary tract or perinephric space. The anteroposterior diameter of the pelvis decreased from 30 to 8 mm. The resistive index of the blood flow in the renal vessels decreased from 0.74 to 0.58. The Hellström – Chapman robotic procedure is a safe and effective procedure for the correction of vasorenal hydronephrosis. However, this surgery requires patient selection to ensure future treatment success.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"5 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139171004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Toes to hand transfer is still the most promising and relevant method for restoring fingers that are missing from birth or after injury. In cases where it is necessary to restore 2 or more digits, simultaneous transplantation of tissue complexes from both feet, including one or two toes, is possible and necessary. Thus, during one operation it is possible to restore a maximum of 4 fingers. Such operations, according to literature, are performed extremely rarely, because are very considerable and time-consuming. AIMS: To present the results of experience of simultaneous microsurgical autotransplantation of 4 toes to hand in children with congenital and acquired pathologies. MATERIALS AND METHODS: Using clinical, radiological, and biomechanical methods, we assessed results of 9 patient’s treatment with congenital and acquired deformities of upper limb, who underwent simultaneous microsurgical autotransplantation of 2 tissue complexes from each foot, including 2nd-3rd toes. Indications for performing this method of microsurgical reconstruction in children with absence of 4 (or all five) fingers have been determined. The results, postoperative complications, and condition of donor and recipient zones were analyzed. RESULTS: To date, 914 such operations have been performed in children. In 9 cases, 4 toes were simultaneously transplanted (two from each foot). The average age of patients was 4.2 years. 2 children had congenital malformations of hand and 7 had consequences of trauma. In 8 cases, the 2nd to 5th fingers were restored, and in one case, the 1st to 4th fingers were restored. Complications associated with impaired blood circulation in the grafts were observed in 22%, but they were temporary. All transplanted grafts survived. All patients required continued surgical treatment after toes transfer to improve their appearance and function. Biomechanical examination methods showed complete restoration of their function on average 4 months (± 1 month) after surgery. CONCLUSIONS: This study showed possibility and effectiveness of multiply toes to hand transfer in children with both congenital and acquired hand pathologies when it is necessary to restore 4 fingers. Simultaneous microsurgical transplantation of toes ensures the restoration of good appearance of the hand and its functionality.
{"title":"One-stage reconstruction of 4 fingers in children using microsurgical autotransplantation of foot tissue complexes","authors":"Sergei Goliana","doi":"10.17816/psaic1562","DOIUrl":"https://doi.org/10.17816/psaic1562","url":null,"abstract":"BACKGROUND: Toes to hand transfer is still the most promising and relevant method for restoring fingers that are missing from birth or after injury. In cases where it is necessary to restore 2 or more digits, simultaneous transplantation of tissue complexes from both feet, including one or two toes, is possible and necessary. Thus, during one operation it is possible to restore a maximum of 4 fingers. Such operations, according to literature, are performed extremely rarely, because are very considerable and time-consuming. AIMS: To present the results of experience of simultaneous microsurgical autotransplantation of 4 toes to hand in children with congenital and acquired pathologies. MATERIALS AND METHODS: Using clinical, radiological, and biomechanical methods, we assessed results of 9 patient’s treatment with congenital and acquired deformities of upper limb, who underwent simultaneous microsurgical autotransplantation of 2 tissue complexes from each foot, including 2nd-3rd toes. Indications for performing this method of microsurgical reconstruction in children with absence of 4 (or all five) fingers have been determined. The results, postoperative complications, and condition of donor and recipient zones were analyzed. RESULTS: To date, 914 such operations have been performed in children. In 9 cases, 4 toes were simultaneously transplanted (two from each foot). The average age of patients was 4.2 years. 2 children had congenital malformations of hand and 7 had consequences of trauma. In 8 cases, the 2nd to 5th fingers were restored, and in one case, the 1st to 4th fingers were restored. Complications associated with impaired blood circulation in the grafts were observed in 22%, but they were temporary. All transplanted grafts survived. All patients required continued surgical treatment after toes transfer to improve their appearance and function. Biomechanical examination methods showed complete restoration of their function on average 4 months (± 1 month) after surgery. CONCLUSIONS: This study showed possibility and effectiveness of multiply toes to hand transfer in children with both congenital and acquired hand pathologies when it is necessary to restore 4 fingers. Simultaneous microsurgical transplantation of toes ensures the restoration of good appearance of the hand and its functionality.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"284 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139232738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Aleksandrovich, K. V. Pshenisnov, K. Ermolenko, G. E. Ulrikh, D. V. Prometnoy
RATIONALE. In recent years there has been an increasing number of publications demonstrating the efficiency and safety of ultrasound imaging techniques in anesthesiology and intensive care, which reduce the risk of complications during invasive manipulation and detecting life-threatening conditions at the earliest stage; however, the practical implementation of these techniques is associated with great difficulties, and this has served as the basis for this research. RESEARCH OBJECTIVE. To estimate the adherence of experts in pediatric departments of anesthesiology and intensive care to the use of ultrasound imaging techniques in practical use.METHODS. Voluntary anonymous questionnaire survey of heads of pediatric intensive care units in 65 regions of the Russian Federation.RESULTS. Responses were obtained from 32 (38.4%) respondents. In 30% of cases the work experience of specialists of pediatric intensive care unit was around 5-10 years, and there was no relation between the introduction of ultrasound imaging techniques into the routine practice of the departments and the work experience of the specialists. In 100% of the cases, all the specialists participating in the study had 24-hour ultrasound scanner availability. When assessing adherence to the use of ultrasound imaging techniques in providing venous access, in 5 (15%) hospitals it was not used at all and only in 4 (12.5%) medical organizations it was used in 100% of cases. The average frequency of ultrasound imaging techniques use for main vein catheterization is 49 35.5%. Twenty-six (81%) respondents use ultrasonography to assess myocardial systolic function; in 50% it is routine in patients requiring continuous catecholamine infusion. Most frequently, systolic heart function is assessed by the Teicholz method (56%); the Simpson method was used in 34% of cases. Ultrasound imaging to assess pulmonary status is used by 56% of respondents and only in 28% of cases it is a routine in patients requiring control mechanical ventilation. To assess the status of ventilation volume, ultrasound imaging is used in 47% of cases. Assessment of cerebral perfusion and diagnosis of intracranial hypertension syndrome, ultrasound is used in 72% of cases. For the purpose of screening diagnostics of life-threatening syndromes in children with polytrauma, ultrasound imaging methods are used by 56% of respondents, in 44% of cases it is a routine examination. 57% of respondents believe that ultrasound diagnostic techniques are highly effective, and 71% believe that their use provides a high level of patient safety.CONCLUSION. The main obstacle to the wide use of the methods of ultrasound navigation in pediatric intensive care units is the lack of necessary knowledge and practical skills.
{"title":"ULTRASOUND NAVIGATION IN PEDIATRIC INTENSIVE CARE UNIT: REALITIES OF THE PRESENT","authors":"Y. Aleksandrovich, K. V. Pshenisnov, K. Ermolenko, G. E. Ulrikh, D. V. Prometnoy","doi":"10.17816/psaic1532","DOIUrl":"https://doi.org/10.17816/psaic1532","url":null,"abstract":"RATIONALE. In recent years there has been an increasing number of publications demonstrating the efficiency and safety of ultrasound imaging techniques in anesthesiology and intensive care, which reduce the risk of complications during invasive manipulation and detecting life-threatening conditions at the earliest stage; however, the practical implementation of these techniques is associated with great difficulties, and this has served as the basis for this research. RESEARCH OBJECTIVE. To estimate the adherence of experts in pediatric departments of anesthesiology and intensive care to the use of ultrasound imaging techniques in practical use.METHODS. Voluntary anonymous questionnaire survey of heads of pediatric intensive care units in 65 regions of the Russian Federation.RESULTS. Responses were obtained from 32 (38.4%) respondents. In 30% of cases the work experience of specialists of pediatric intensive care unit was around 5-10 years, and there was no relation between the introduction of ultrasound imaging techniques into the routine practice of the departments and the work experience of the specialists. In 100% of the cases, all the specialists participating in the study had 24-hour ultrasound scanner availability. When assessing adherence to the use of ultrasound imaging techniques in providing venous access, in 5 (15%) hospitals it was not used at all and only in 4 (12.5%) medical organizations it was used in 100% of cases. The average frequency of ultrasound imaging techniques use for main vein catheterization is 49 35.5%. Twenty-six (81%) respondents use ultrasonography to assess myocardial systolic function; in 50% it is routine in patients requiring continuous catecholamine infusion. Most frequently, systolic heart function is assessed by the Teicholz method (56%); the Simpson method was used in 34% of cases. Ultrasound imaging to assess pulmonary status is used by 56% of respondents and only in 28% of cases it is a routine in patients requiring control mechanical ventilation. To assess the status of ventilation volume, ultrasound imaging is used in 47% of cases. Assessment of cerebral perfusion and diagnosis of intracranial hypertension syndrome, ultrasound is used in 72% of cases. For the purpose of screening diagnostics of life-threatening syndromes in children with polytrauma, ultrasound imaging methods are used by 56% of respondents, in 44% of cases it is a routine examination. 57% of respondents believe that ultrasound diagnostic techniques are highly effective, and 71% believe that their use provides a high level of patient safety.CONCLUSION. The main obstacle to the wide use of the methods of ultrasound navigation in pediatric intensive care units is the lack of necessary knowledge and practical skills.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132209564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Morozov, Anzhelika E. Agavelyan, R. Khalafov, V. Shumikhin, O. Mokrushina
BACKGROUND: The incidence of anorectal malformations is from 1:1500 to 1:5000 live births. There is currently no consensus regarding the choice of an operative method of treatment of some types of anorectal malformations occurring in boys. Anorectoplasty could be performed both through the posterior sagittal approach and using laparoscopic techniques.AIMS: to assess the risk of postoperative complications and determine their specificity in boys with anorectal malformations, depending on the surgery approach.MATERIALS AND METHODS: A single-center retrospective cohort study was performed. Male patients with anorectal malformations were included, who underwent surgical correction of anorectal malformation by performing posterior sagittal (group I) or laparoscopic-assisted anorectoplasty (group II) at the age of up to 1 year at the N.F. Filatov Children's City Clinical Hospital in the period from 2008 to 2022. Postoperative and intraoperative complications were recorded, as well as the number of necessary redo surgical interventions to correct complications.RESULTS: Group I included 33 patients, of which 18 (55%) were diagnosed with anorectal malformations with bulbar fistula, 12 (36%) - anorectal malformations without fistula, 3 3 (9%) - prostatic fistula. Group II consisted of 99 patients, of which 53 (54%) were diagnosed with anorectal malformations with prostatic fistula, 30 (30%) with anorectal malformations with bulbar fistula, 9 (9%) with anorectal malformations with bladder neck fistula, 7 (7%) - anorectal malformations without a fistula. The overall incidence of intra- and postoperative complications was statistically significantly higher in children after posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I - 19 (58%) vs II - 33 (33%); p = 0.014. The number of redo surgical interventions for the correction of complications did not differ significantly between the studied groups: I - 8 (24%) vs II - 26 (26%); p = 0.819. A significantly greater risk of urethral injury was identified with posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I - 4 (12%) vs II - 0 (0%); p 0.001.We did not find postoperative complications more typical for both laparoscopic-assisted and posterior sagittal anorectoplasty.CONCLUSIONS: The results define laparoscopic-assisted anorectoplasty as a viable and promising method that does not have specific postoperative complications if it is technically correctly performed. It is required to develop clear criteria for the mobilization of the rectum and the volume of rectourethral fistula dissection during laparoscopic-assisted anorectoplasty, which will minimize the risks of postoperative complications and the need for redo surgery.
背景:肛门直肠畸形的发生率为1:1500 ~ 1:50 000活产。目前，对于某些类型的男孩肛肠畸形的手术治疗方法的选择还没有达成共识。肛肠成形术可以通过后矢状入路和腹腔镜技术进行。目的:根据手术入路的不同，评估男童肛肠畸形术后并发症的风险并确定其特异性。材料和方法:采用单中心回顾性队列研究。纳入2008年至2022年期间在N.F. Filatov儿童城市临床医院接受后箭头状(I组)或腹腔镜辅助肛肠成形术(II组)的男性肛肠畸形患者，年龄不超过1岁。记录术后和术中并发症，以及纠正并发症所需的手术干预次数。结果:第一组33例患者，其中诊断为肛肠畸形伴球瘘18例(55%)，诊断为无瘘肛肠畸形12例(36%)，诊断为前列腺瘘33例(9%)。II组99例，其中诊断为肛肠畸形伴前列腺瘘53例(54%)，肛肠畸形伴球瘘30例(30%)，肛肠畸形伴膀胱颈瘘9例(9%)，无瘘的肛肠畸形7例(7%)。与腹腔镜辅助下的肛肠成形术相比，后矢状面肛肠成形术后儿童术中和术后并发症的总发生率有统计学意义上的显著提高:I - 19 (58%) vs II - 33 (33%);P = 0.014。修复并发症的手术次数在两组间无显著差异:I - 8例(24%)vs II - 26例(26%);P = 0.819。与腹腔镜辅助下的肛肠成形术相比，后矢状肛肠成形术尿道损伤的风险明显更高:I - 4 (12%) vs II - 0 (0%);0.001 p。我们没有发现腹腔镜辅助和后矢状肛肠成形术的术后并发症更典型。结论:研究结果表明，如果技术正确，腹腔镜辅助肛肠成形术是一种可行且有前景的方法，没有特定的术后并发症。在腹腔镜辅助肛肠成形术中，需要制定明确的直肠活动和直肠尿道瘘清扫量的标准，以尽量减少术后并发症的风险和重做手术的需要。
{"title":"Postoperative complications in boys with anorectal malformations depending on the surgical approach","authors":"D. Morozov, Anzhelika E. Agavelyan, R. Khalafov, V. Shumikhin, O. Mokrushina","doi":"10.17816/psaic1528","DOIUrl":"https://doi.org/10.17816/psaic1528","url":null,"abstract":"BACKGROUND: The incidence of anorectal malformations is from 1:1500 to 1:5000 live births. There is currently no consensus regarding the choice of an operative method of treatment of some types of anorectal malformations occurring in boys. Anorectoplasty could be performed both through the posterior sagittal approach and using laparoscopic techniques.AIMS: to assess the risk of postoperative complications and determine their specificity in boys with anorectal malformations, depending on the surgery approach.MATERIALS AND METHODS: A single-center retrospective cohort study was performed. Male patients with anorectal malformations were included, who underwent surgical correction of anorectal malformation by performing posterior sagittal (group I) or laparoscopic-assisted anorectoplasty (group II) at the age of up to 1 year at the N.F. Filatov Children's City Clinical Hospital in the period from 2008 to 2022. Postoperative and intraoperative complications were recorded, as well as the number of necessary redo surgical interventions to correct complications.RESULTS: Group I included 33 patients, of which 18 (55%) were diagnosed with anorectal malformations with bulbar fistula, 12 (36%) - anorectal malformations without fistula, 3 3 (9%) - prostatic fistula. Group II consisted of 99 patients, of which 53 (54%) were diagnosed with anorectal malformations with prostatic fistula, 30 (30%) with anorectal malformations with bulbar fistula, 9 (9%) with anorectal malformations with bladder neck fistula, 7 (7%) - anorectal malformations without a fistula. The overall incidence of intra- and postoperative complications was statistically significantly higher in children after posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I - 19 (58%) vs II - 33 (33%); p = 0.014. The number of redo surgical interventions for the correction of complications did not differ significantly between the studied groups: I - 8 (24%) vs II - 26 (26%); p = 0.819. A significantly greater risk of urethral injury was identified with posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I - 4 (12%) vs II - 0 (0%); p 0.001.We did not find postoperative complications more typical for both laparoscopic-assisted and posterior sagittal anorectoplasty.CONCLUSIONS: The results define laparoscopic-assisted anorectoplasty as a viable and promising method that does not have specific postoperative complications if it is technically correctly performed. It is required to develop clear criteria for the mobilization of the rectum and the volume of rectourethral fistula dissection during laparoscopic-assisted anorectoplasty, which will minimize the risks of postoperative complications and the need for redo surgery.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122960258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic intestinal failure is a pathogenetic component in children with short bowel syndrome. Short bowel syndrome limits the patient's capacity to socialize fully, the bad prognosis of the child's physical and spiritual development, and the patient's family's organizational and material issues. The severity of the problem is aggravated by the limited prospects for surgical treatment of patients, including transplantology, the imperfection of the legal framework for health care, particularly in terms of parenteral nutrition at home, and the supply of expensive drugs, consumables, and equipment to children with short bowel syndrome under state guarantees. Developing an equivalent of glucagon-like peptide-2 (GLP-2), a drug teduglutide representing the endogenous intestinal growth factor and intestinal adaptation, created an additional therapeutic possibility for individuals with short bowel syndrome. There are no data in Russian academic literature on the efficacy and safety of teduglutide in pediatric practice. This study aims to conduct a systematic search and critical analysis of publications on the effectiveness and safety of using teduglutide in children with short bowel syndrome. Publications from the PubMed, Scopus, and eLibrary databases, as well as scientific journals, were examined from 2012 to 2022. The articles were reviewed in English and Russian. Seven hundred seventy publications on using teduglutide in experimental and clinical practice were found; 94 sources matched the keywords; and eight articles were selected according to the PRISMA criteria. The risks of confounding bias were assessed using the ROBINS-I tool. Most patients received the therapeutic impact of teduglutide, and 8.4%64.7% of patients achieved enteral autonomy. The drug's dose was 0.05 mg/kg/day. Without a therapeutic effect, the time limits for the inappropriate use of teduglutide ranged from 6 months to 1 yr. There is no causal relationship between taking teduglutide and undesirable reactions to treatment. The review of publications revealed an insufficient evidence foundation for the efficacy of teduglutide due to a lack of control groups in most studies, a small sample size, and errors in data methodology. Despite the encouraging preliminary results of individual studies, the problem of a shortage of randomized controlled tests of teduglutide remains.
{"title":"The assessment of the effectiveness and safety of teduglutide in the treatment of children with chronic intestinal insufficiency. A systematic review","authors":"F. Ampar, V. Rozinov, Maria M. Chernobabova","doi":"10.17816/psaic1513","DOIUrl":"https://doi.org/10.17816/psaic1513","url":null,"abstract":"Chronic intestinal failure is a pathogenetic component in children with short bowel syndrome. Short bowel syndrome limits the patient's capacity to socialize fully, the bad prognosis of the child's physical and spiritual development, and the patient's family's organizational and material issues. The severity of the problem is aggravated by the limited prospects for surgical treatment of patients, including transplantology, the imperfection of the legal framework for health care, particularly in terms of parenteral nutrition at home, and the supply of expensive drugs, consumables, and equipment to children with short bowel syndrome under state guarantees. Developing an equivalent of glucagon-like peptide-2 (GLP-2), a drug teduglutide representing the endogenous intestinal growth factor and intestinal adaptation, created an additional therapeutic possibility for individuals with short bowel syndrome. There are no data in Russian academic literature on the efficacy and safety of teduglutide in pediatric practice. \u0000This study aims to conduct a systematic search and critical analysis of publications on the effectiveness and safety of using teduglutide in children with short bowel syndrome. \u0000Publications from the PubMed, Scopus, and eLibrary databases, as well as scientific journals, were examined from 2012 to 2022. The articles were reviewed in English and Russian. Seven hundred seventy publications on using teduglutide in experimental and clinical practice were found; 94 sources matched the keywords; and eight articles were selected according to the PRISMA criteria. The risks of confounding bias were assessed using the ROBINS-I tool. Most patients received the therapeutic impact of teduglutide, and 8.4%64.7% of patients achieved enteral autonomy. The drug's dose was 0.05 mg/kg/day. Without a therapeutic effect, the time limits for the inappropriate use of teduglutide ranged from 6 months to 1 yr. There is no causal relationship between taking teduglutide and undesirable reactions to treatment. The review of publications revealed an insufficient evidence foundation for the efficacy of teduglutide due to a lack of control groups in most studies, a small sample size, and errors in data methodology. Despite the encouraging preliminary results of individual studies, the problem of a shortage of randomized controlled tests of teduglutide remains.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125829569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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