Paediatric Surgery. Ukraine最新文献

{"title":"Analysis of the effectiveness of the halo-gravitational traction system as a factor influencing blood loss in the surgical correction of complex scoliotic deformities in children","authors":"A. Levytskyi, V.O. Rogozinskyi, I. Benzar, M. M. Dolianytskyi, O. Karpinska","doi":"10.15574/ps.2022.74.34","DOIUrl":"https://doi.org/10.15574/ps.2022.74.34","url":null,"abstract":"Halo-gravity traction (HGT) systems are widely used in leading clinics around the world as a staged method for correcting complex (>100°) scoliotic deformities of the spine in children. Today there is no single approach to the use of this technique, and each doctor makes a decision regarding the treatment regimen empirically, based on his clinical experience. Purpose - to identify the factors that affect the amount of blood loss during surgical correction of scoliotic deformity in children. Materials and methods. 76 patients aged 7 to 17 years were examined, on average 11.0±2.8 years. I (experimental) group - 38 children were treated with HGT using the developed tactics of staged surgical treatment; II (control) group - 38 children who underwent one-step surgical correction. The age of children in the groups in group I was 11.0±2.8 years, in group II - 11.2±2.8 years, the age of children in groups was statistically the same (t=-0.409; p=0.684). There were 28 (36.8%) boys and 48 (63.2%) girls. The distribution of children by age and sex in the groups was the same. Data on operative blood loss were statistically processed. Results. According to the statistical study, it can be argued that the blood loss during surgical correction of scoliotic deformity is most affected by the angle of deformation and age of the patient. At an angle of deformation of >100° blood loss is significantly greater than at an angle of <100°, children over 14 years also observed a significant increase in blood loss, and this is associated not only with greater body weight but also with the fact that these children the greater the angle of deformation of the spine, as well as the use of HGT, the angle of deformation decreases less than in younger children. Conclusions. It was determined that after HGT in children the angle of deformation decreased statistically significantly (p<0.001) by an average of 36.5±14.9°. The change in deformation in boys and girls was the same. With surgical correction of scoliotic deformity <100° blood loss (1025.0±235.9 ml), (statistically significant) (p<0.001) is statistically significantly less than blood loss with correction of deformity greater than 100° (1297.5±327.8 ml). With age, blood loss increases in children, and this difference between age subgroups is statistically significant (α=0.05). The value of the angle of scoliotic deformity after surgical correction has a statistically significant (r=0.576; p=0.001) effect on blood loss, the value of surgical correction of deformity on blood loss (r=0.015; p=0.879) does not affect. 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: intraoperative bleeding, spinal deformity, halo-gravity traction.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128638478","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}

{"title":"Congenital diaphragmatic hernias repair is feasible in peripheral hospitals","authors":"A. Fedorenko, D. Dubin, A. Yulevich","doi":"10.15574/ps.2022.74.99","DOIUrl":"https://doi.org/10.15574/ps.2022.74.99","url":null,"abstract":"Laparoscopic repair of congenital diaphragmatic hernias can be done in suitable infants and children with good long-term results. The benefits includes lower risk of infection, less intra-abdominal adhesions and early recovery, while being a «scar-less» procedure. Materials and methods. The 3 patients included a 9-months-old infant with a late presentation of Bochdalek left diaphragmatic hernia, and 2 patients with Morgagni congenital diaphragmatic hernia - a 1-year-old infant and a 3-year-old toddler. All procedures were performed in abdominal approach using 3- and 5-mm ports, and a 5-mm 30 degrees camera. Suturing of the diaphragmatic defect was done with unabsorbed materials (Ethibond® 4.0). Results. No intra-operative complications were noted, all patients recovered quickly and uneventfully, and were discharged between 3-6 postoperative day. Follow-up period is now between 3-23 months and so far there is no evidence of recurrence. Conclusions. Laparoscopic surgery is used more and more in smaller cavities by pediatric surgeons. Laparoscopic repair of congenital diaphragmatic hernias in infants and toddlers can safely be performed in peripheral hospitals by skilled pediatric surgeons with good results. However, our follow-up period is relatively short, and because of common recurrence rate in those patients, 15-40% in different reports, both in laparoscopic and open repair, long term follow-up is required. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: children, laparoscopic repair, congenital diaphragmatic hernias.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130605251","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}

{"title":"Clinical case report of gigantic thymolipoma in 3-year-old child","authors":"D. Krivchenya, E. Rudenko, O. Metlenko, Y.L. Markin, H.B. Honcharenko","doi":"10.15574/ps.2022.74.87","DOIUrl":"https://doi.org/10.15574/ps.2022.74.87","url":null,"abstract":"Thymolipoma is a rare benign encapsulated tumor of anterior mediastinum. Overall, thymic neoplasms comprise only 4% of all mediastinal tumors. Only 2–9% of these are reported to be thymolipomas. Less than 200 cases have been published in the world literature and its incidence in both genders is equal and usually develops at any age. The youngest case in the literature was described in 6-month-old child. Thymolipoma can be associated with chronic lymphocytic leukemia, myasthenia graves, aplastic anemia, hyperthyroidism and Hodgkin’s disease. Half of the patients are asymptomatic, the neoplasm incidentally is discovered radiologically. The other half mostly represents shortness of breath, cough, chest pain and upper respiratory tract infection. The clinical case, diagnosis and treatment of gigantic thymolipoma in 3-year-old child is described in this article. A clinical case of giant thymolipoma in a 3-year-old child is presented. The child had several respiratory symptoms: episodes of choking, dry cough, groaning breathing during physical exertion and anxiety, chest deformity (enlarging the right half) and signs of type II respiratory failure. Radiographically - subtotal darkening of the right hemithorax with mediastinal shift to the contralateral side with compression of the left lung; laboratory results - hyperleukocytosis(39х109/l). Computed tomography showed a large hypovascular mass formation with inhomogeneous structure and areas of lipomatosis. Most likely, this is the case of congenital nature of thymolipoma, which manifested itself at the age of 3. Correct pathomorphological diagnosis was made with the help of open biopsy, since when performing the puncture method, there is a possibility of verification error due to insufficient amount of histological material given the inhomogeneity of the mass of the formation, as well as taking into account the suspicion of a lymphoproliferative process. Considering the mediastinal and intrathoracic compression syndrome, as well as the benign nature of these tumor, which is characterized by the absence of infiltrative growth, the only correct treatment tactic is radical surgery. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: neoplasms of anterior mediastinum, thymolipoma, children.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130811598","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}

{"title":"Results of reconstructive operations in congenital anocolorectal pathology in children","authors":"V. Fofanov, О.D. Fofanov, O.Ya. Matiash, I. Didukh","doi":"10.15574/ps.2022.74.93","DOIUrl":"https://doi.org/10.15574/ps.2022.74.93","url":null,"abstract":"Fecal incontinence (FI) in children is a serious medical and social problem. FI leads to severe limitations in a child’s development and social adaptation. Pediatric surgeons mainly deal with the mechanical type of FI that occurs after surgical correction of anorectal malformations (ARM) or Hirschsprung's disease (HD). Violation of defecation control is observed in 53-89% of patients who underwent surgery for ARM and HD. Purpose - to study the causes and effectiveness of the proposed complex treatment of FI in children operated on for HD and ARM. Materials and methods. Clinical examination and treatment of 92 children with congenital pathology of the distal colon and anus (55 (59.78%) patients with HG and 37 (40.22%) with ARM) was carried out at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University. Among the surveyed children were 64 boys and 28 girls (ratio - 2.29:1). In terms of age, newborns and children of the first year of life predominated among those who underwent primary surgery - 57 (61.95%) children. FI of varying severity was detected in 48 (52.17%) patients operated on for HD and ARM at different terms after surgical correction - from 6 months to 3 years. The types, causes, and severity of FI in each child were studied. In addition to conventional clinical and instrumental studies, patients underwent anoscopy and rectoscopy, transanal ultrasound, anorectal manometry. The severity of AI was assessed on a S.D. Wexner score. Results. FI occurred in 34 (70.8%) children after HD correction and in 14 (29.2%) patients after ARM surgery. True FI was found in 33 (68.75%) children. Pseudoincontinence was detected in 15 (31.25%) patients it was more common in patients operated on for HD. For conservative treatment of patients with FI a Bowel Management Program was implemented. In 24 (50.0%) patients treated according to this program, the control of defecation was significantly improved, the incontinence severity index was significantly reduced according to the Wexner score. In true AI due to severe anal sphincter damage, we performed minimally invasive surgical correction of postoperative insufficiency or congenital defect of the internal sphincter of the anus using a volume-forming implant in 14 (29.17%) children. Immediate and long-term results of the operation were good, which was reflected in improved control of defecation, a significant increase of basal pressure and a decrease of the incontinence severity index. Conclusions. Tactics of the FI treatment depends on the cause and severity. The implementation of the Bowel Management Program can significantly improve the control of defecation and improve the quality of life of patients. In case of insufficiency of the internal anal sphincter, minimally invasive correction by anal submucosal implantation of a volume-forming gel is effective. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Lo","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133145715","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}

{"title":"Problems of terminology and clinical coding of necrotizing fasciitis","authors":"S. Khimich, I. V. Stoianovskyi, O. Chemerys","doi":"10.15574/ps.2022.74.14","DOIUrl":"https://doi.org/10.15574/ps.2022.74.14","url":null,"abstract":"Purpose - to analyze the typical defects of the formulation of the diagnosis of necrotizing fasciitis (NF), to verify the lexically correct term NF, to develop proposals for the correct coding of NF according to ICD-10-AM. Materials and methods. The medical records of 150 patients who during 1999-2021 were treated in two hospitals of Lviv City (Ukraine) for necrotizing fasciitis was analyzed. Compared diagnoses when referred to the hospital, preliminary and final clinical diagnoses, preoperative and postoperative diagnoses, recorded their statistical codes for ICD-10. An analysis of Ukrainian and Russian-language surgical publications available in Ukraine for the period from 1985 to 2021 on the keywords «surgical soft tissue infection», «necrotizing fasciitis», «soft tissue necrosis». Results. In 142 (95.0%) of the 150 patients operated on for NF, the diagnosis was not correctly formulated during referral. Most often NF was directed and in the initial stages was treated under the guise of other diagnoses: «phlegmon», «erysipelas», «thrombophlebitis», «gangrene», «perianal abscess». NF was suspected by the surgeon prior to the first surgery only in 53 (35.33%) patients. In other cases, it was diagnosed intraoperatively or during repeated interventions. Codes corresponding to other forms of surgical infection were often used for statistical coding of NF. We also worked on lexical variants of the term «necrotizing fasciitis» in Ukrainian language. Conclusions. It was worked out the most correct terminologically Ukrainian equivalent of the diagnosis «necrotizing fasciitis». For statistical coding of NF, it should be designated as the main active disease by code M72.6. The use of a unified term and statistical coding will allow in the future to form a single within the state diagnostic-related group for fair reimbursement of funds to health care providers for treated cases of NF. 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 interests was declared by the authors. Key words: necrotizing fasciitis, terminology, international classification of diseases.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125125518","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}

{"title":"Reconstructive-plastic operations for restoring patency at different levels of subtotal resection of the colon in children with intestinal agangliosis","authors":"V. Prytula, O. Kurtash, S. Hussaini, P. Rusak, S. Petryk","doi":"10.15574/ps.2022.74.45","DOIUrl":"https://doi.org/10.15574/ps.2022.74.45","url":null,"abstract":"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.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127897469","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}

{"title":"Results of surgical correction or conservative management of splenic cysts in children according to remote monitoring changes","authors":"A. Kuzyk, V. Prytula, D. Krivchenya, A. Nakonechnyi, T. Gutor","doi":"10.15574/ps.2022.74.56","DOIUrl":"https://doi.org/10.15574/ps.2022.74.56","url":null,"abstract":"Treatment of splenic cysts (SC) in children is variable and controversial. Depending on the size and location of these formations in the spleen, surgical correction is possible in open or laparoscopic surgery, or conservative (non-invasive) management. The result of SC treatment should be the complete elimination of the cyst cavity. Purpose - to evaluate the results of surgical correction or conservative management of CS in children according to remote monitoring changes. Materials and methods. We conducted the study on 265 children aged 0-17 years (mean age 11.25±4.21 years), who were examined and treated for SC. One hundred seventy-five (66.04±2.91%) children underwent surgery, and 90 (33.96±2.91%) patients received conservative treatment. We subjected all the information recorded in the medical records to statistical processing. The mentioned information could characterize the situation with the treatment process and with dynamic monitoring of this pathology to some extent. Results. The most common localizations of cysts were the upper (33.21±2.89%) or middle segments of the spleen (29.81±2.81%). Almost every fourth patient (27.92±2.76%) with SC had pathology of other organs or systems, and every tenth (9.81±1.83%) had other diseases of the spleen. We detected residual cyst in 46.42±3.06% of patients; it underwent complete regression within 1-3 years. Residual cyst of small size (which persisted after surgical correction) regressed much faster after surgery compared with regression of cystic formation of small size in the spleen with conservative management (p<0.05). Conclusions. Therapeutic tactics for SC in children involve different options for individual surgical correction or conservative management, depending on the location, size, relationship to the architecture of the main vessels and the variant of damage to the parenchyma of the spleen. The outcome of treatment of children with SC depends on the volume, location, etiology of the lesion, the method of correction and compliance with all recommendations in the postoperative period against the background of comorbidities. 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 interests was declared by the authors. Key words: splenic cyst, children, surgical treatment, conservative management, results.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131250361","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}

{"title":"Laparoscopic simultaneous diverticuloectomy of the bladder and ureterocystostomy by Lich-Gregoir","authors":"M. Ponomarenko, A.A. Puzko, I.I. Shtanko, О. Markevich","doi":"10.15574/ps.2022.74.100","DOIUrl":"https://doi.org/10.15574/ps.2022.74.100","url":null,"abstract":"To show the advantages of laparoscopic technique as a method for the best visualization and simplification of the method of surgical intervention in diverticulum of bladder, and the technique of antireflux surgery for vesicoureteral reflux of different degrees in children. Purpose - to share experiences and demonstrate the technique of making the antireflux mechanism, and to show life hacks to make the bladder diverticulectomy easier. Materials and methods. In 2016-2021 there were 23 patients with VUR of different degrees. Two of them had a bladder diverticulum. In one case - ectopia of the ureter into the diverticulum. In another case the ingress of the ureter was anatomically correct. Results. Steps of operation. The patient’s position is on the back with a roller under the lumbar region. The optical port is installed transumbilically. Two working ports are installed: on the middle line between the navel and the «spina illiaca anterior» of pelvic. Pneumoperitoneum - 8-10 mm Hg. Technique. At the same time with laparoscopy, cystoscopy to better visualize of edge of the diverticulum. After that, the diverticulum was excised and the walls of the bladder were sutured. In the case of ectopia of the ureter into the diverticulum made ureterocystomy, followed by antireflux protection by Lich-Gregoir. And in another case only antireflux protection was made. Specificity of antireflux protection technique. Marking and forming of the submucosal tunnel does by a hook and / or scissors. Previously do the traction of the bladder over the ureter in the direction of the anterior abdominal wall. The next step is to fix the bladder with three holders, which are output. This makes it easier to dissect the layers of the bladder. The ureter was placement into the sub mucous tunnel. And muscular tunica and walls were sutured of material 4/0. Specific of drainage. When antireflux protection perform - the stent was not installed into the ureter. At ureterocystoneostomy - the stent was placements for a period of 30 days. Drainage of abdominal was performed in all cases. An urinary catheter was additionally placements in the bladder for 3 days. There were no intraoperative or postoperative complications. Duration of surgery up to 180 minutes. Conclusions. Laparoscopic ureterocystoneostomy is, in our opinion, more convenient for the surgeon and more gentle for the patient. Allows you to significantly reduce the number of postoperative complications. This laparoscopic diverticulectomy of the bladder has been demonstrated, showing a significant advantage in the convenience of visualization of the diverticulum and easier removal of the diverticulum of the bladder. The study was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of parents and children was obtained for the study. No conflict of interests was declared by the authors. Key words: diverticulum of bladder, laparoscopy, ureterocystostomy.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124311077","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}

{"title":"Ultrasonography of the testicles in the context of laparoscopic treatment of left-sided varicocele","authors":"Y. Nakonechnyi, R. Nakonechnyy","doi":"10.15574/ps.2022.74.79","DOIUrl":"https://doi.org/10.15574/ps.2022.74.79","url":null,"abstract":"Purpose - to determine significant sonographic pathogenetic markers of infertility formation in left-sided varicocele of II-III grades and their dynamics after laparoscopic varicocelectomy in the context of fertility restoration. Materials and methods. In the study, 214 patients with left-sided varicocele II-III grades and 25 practically healthy men aged 19 to 33 years were examined. All patients underwent laparoscopic varicocelectomy. The testes volume, the resistance index in the intratesticular arteries, and the diameter of the varicose veins of the left spermatic cord at rest in a horizontal position on the back with the head raised by 15° and during the Valsalva maneuver in a vertical position. During Valsalva maneuver also determined the duration and rate of venous blood reflux in the testes. Results. Ultrasound in patients with left varicocele II-III grades confirmed deterioration of hemodynamics in the spermatic cord and testis. According to the results of sonography in patients with left varicocele II-III grades identified significant prognostic markers of testicular lesions: RI>0.66, VD>2.4 mm, VDvm>3 mm, VRFvm>2 cm/s, and DVR>1.1 s. The negative dynamics of these indicators are an indication for the correction of varicocele, and their normalization in the postoperative period indicates the effectiveness of treatment. Conclusions. Testicular ultrasound is more informative than palpation. In patients of reproductive age with left-sided varicocele II-III grades sonography diagnoses testicular tissue damage in the early stages of the disease. It should be used as a non-invasive screening method for a comprehensive examination to determine testicular lesions and for monitoring in the context of fertility prognosis after varicocelectomy. 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 institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: varicocele, laparoscopic varicocelectomy, ultrasound examination, testicles.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116478078","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}

{"title":"Acute hematogenous osteomyelitis in children: diagnostic and treatment","authors":"P. Rusak, O. Tolstanov, S. O. Rusak, O. Zinkevych, Yurii Voloshyn, O. M. Kontorovych","doi":"10.15574/ps.2021.73.24","DOIUrl":"https://doi.org/10.15574/ps.2021.73.24","url":null,"abstract":"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% pati","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114494282","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}