PAEDIATRIC SURGERY. UKRAINE

Congenital malformation - diaphragmatic eventration in children: clinic, diagnosis and treatment tactics

O.K. Sliepov, O.A. Danilov, Ie.O. Sliepov — Sat, 28 Sep 2024 00:00:00 +0300

The first scientific work in Ukraine to describe congenital diaphragmatic eventration (DE) in children.

Aim - to identify a group of children with congenital DE based on a retrospective study; to analyze the clinical course, diagnostic methods and therapeutic tactics in this pathology.

Materials and methods. A retrospective study of medical records of 28 children with congenital DE over the past 30 years who were undergoing inpatient examination and treatment in the clinic of pediatric surgery at the SI «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova of the NAMS of Ukraine». The following data were analyzed: age, sex, clinical symptoms, diagnostic methods, localization (and magnitude) of the eventration, associated anomalies, and treatment tactics: indications for conservative therapy and surgical correction.

Results. The study included 28 children aged from birth to 14 years, on average 39.1±38.7 months. There were 5 girls and 23 boys, with a ratio of 1:4.6. DE in 53.6% was left-sided, in 46.4% - right-sided. A diagnostic algorithm was created to identify DE, its complications and concomitant pathology. Therapeutic tactics for DE, indications for surgical treatment and dynamic monitoring were developed. Out of 28 children with DE, 18 were operated on.

Conclusions. Congenital DE occurred in children from the period of newborn to 14 years of age, predominantly in boys and was always unilateral. Clinical manifestations of DE were present in 60.7% of cases. Their onset was more frequent at birth or at 1 year of age. Respiratory disorders predominated, and gastrointestinal disorders were less common. The asymptomatic course of the defect was observed in 39.3% of patients. The developed diagnostic algorithm for DE included: X-ray, ultrasound, computed or magnetic resonance imaging and consultations with related specialists. Surgical treatment was indicated for the vast majority of children with DE.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Parental informed consent was obtained for the study.

The authors declare no conflict of interest.

Morphological features of compensatory and reparative processes of the cecum in the long term of the experiment using polycaprolactone thread modified with L-arginine

Sat, 28 Sep 2024 00:00:00 +0300

When performing surgery, the surgeon should be aware of the direct impact of the suture material on the structure of the sutured tissues and the condition of the postoperative scar, as the right surgical material is the key to rapid and successful wound healing. Therefore, searching for the safest surgical material, especially in pediatric abdominal surgery, is an urgent problem today.

The aim is to determine the morphological changes in the tissues of the cecum over the long term of the experiment using polycaprolactone thread modified with L-arginine.

Materials and methods. Colotomy was performed on 35 sexually mature outbred domestic rabbits (of different sexes) aged 8-10 months and weighing (2.6±0.2) kg. The experimental animals were divided into two groups: control and experimental. The first group was control (5 animals), and the second group was experimental (30 animals), where a monofilament absorbable thread with polycaprolactone modified with L-arginine was used to close the wound defect. The following research methods were used: histological, method of semi-thin serial sections, morphometric, and statistical methods.

Results. Fibroblasts play the most crucial role in the process of reorganization of the postoperative scar among cellular elements. Their activation and increase occur by day 14 of the experiment. On the 30th day of the study, the structural organization and restoration of connective tissue are determined. The reorganization of the muscle component changes: a layer of young myocytes is formed in the gap between the connective tissue capsule around the surgical thread and the fibrous component of the connective tissue fibrillar framework. By the 30th day of the study, the inflammatory reaction involving plasmocytes ceases, and single plasmocytes already perform the function of local immune surveillance. Also, the role of lymphocytes that actively migrate to the focus of the inflammatory process is suppressed by day 30 of the study, and single lymphocytes perform the function of local immune surveillance.

Conclusions. Thus, the dynamic changes in the cellular composition of the tissues of the perivulnar area of the cecum demonstrate the acceleration of the healing process and the formation of a loose scar when using polycaprolactone thread modified with L-arginine.

No conflict of interests was declared by the authors.

Surgical treatment of megaduodenum in children who underwent correction of duodenal atresia in the neonatal period

O.K. Sliepov, V.V. Kotsovsky, O.P. Ponomarenko — Sat, 28 Sep 2024 00:00:00 +0300

Aim - to determine the tactics of diagnosis and surgical correction of megaduodenum and its complications in children operated on in the neonatal period for duodenal atresia.

Materials and methods. A retrospective analysis of the medical records of 5 patients with megaduodenum who were treated at the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine» was performed for the period from 2018 to 2023. In the neonatal period, these children were operated on for duodenal atresia at their place of residence (n=3) or at the Institute (n=2).

Results. The diagnosis of megaduodenum was confirmed in 100% of cases. All patients underwent surgery. Stapled longitudinal constrictive duodenoplasty was performed. Intraoperatively, the anatomy of the megaduodenum was examined in detail: its diameter ranged from 42 mm to 90 mm, on average 63.4±21.16 mm, length from 50 mm to 140 mm, on average 98±37.01 mm. In all cases, the patency of the previous duodeno-duodenal anastomosis was monitored. Its diameter ranged from 18 mm to 30 mm. The effect of the surgical treatment in all patients was good.

Conclusions. The developed diagnostic algorithm includes: radiography of the abdominal cavity, X-ray contrast study of the gastrointestinal tract, ultrasound of the ENT organs, EGD, and others if necessary.

Surgical correction of megaduodenum and its complications consists of stapled longitudinal narrowing duodenoplasty, which, in combination with conservative treatment methods, leads to good functional results.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research.

The authors declare no conflict of interest.

Prediction of postoperative adhesives intestinal obstruction and its recurrence in children

O.D. Fofanov, I.M. Diduh, V.O. Fofanov — Sat, 28 Sep 2024 00:00:00 +0300

It is known that the expressiveness of the adhesion process (AP) depends on the individual characteristics of the connective tissue metabolism. In recent years, the role of acetylation processes in predicting pathological adhesion formation has been actively studied. A genetically determined fast type of acetylation is an unfavorable background for the development of peritoneal adhesion disease (PAD).

Aim - to study the effectiveness of predicting postoperative adhesive intestinal obstruction (AIO) and its recurrence in children based on determining the acetylation phenotype (APh).

Materials and methods. In order to reveal the prognostic value of the acetylation phenotype in the formation of postoperative (AIO), we studied the activity of acetylation in 30 children aged 4-16 years, operated on for appendicular peritonitis (the main group). The control group consisted of 30 somatically healthy children. In addition, a study of APh was conducted in 42 children aged 3-17 years, who underwent surgery for postoperative AIO, to study the informativeness of this test as a prognostic factor for AIO recurrence. APh was established in children by determining the biochemical activity of the enzyme N-acetyltransferase (NAT).

Results. It was established that in children operated on for appendicular peritonitis, in which postoperative AIO occurred, rapid acetylation phenotype (RAP) prevailed (57.14% of children), and in children without signs of AIO, RAP was detected in only one case (6.25%). Among the children operated on for postoperative AIO, the proportion of patients with RAP was even higher (63.64%). Opposite results were noted regarding slow acetylation phenotype (SAP). Among children with recurrent AIO, RAP was detected in 57.14% of cases, and among patients without relapse RAP was diagnosed in 25.0% of children. The opposite pattern was observed in patients with SAP. A direct correlative relationship between NAT activity and the value of the peritoneal adhesion index (PAI) was noted - the higher level of NAT activity, the higher PAI.

Conclusions. Determination of APh in children based on the biochemical activity of the NAT enzyme allows to establish the degree of risk of AIO. AIO and its recurrence are significantly more common in patients with RAP. Detection of RAP in a patient can serve as a prognostic criterion for the severity of AP.

The authors declare no conflict of interest.

The effectiveness of infrared thermography in the diagnosis of necrotizing fasciitis

I.V. Stoianovskyi, S.D. Khimich, O.M. Chemerys — Sat, 28 Sep 2024 00:00:00 +0300

The aim of this study was to investigate the effectiveness of digital infrared thermography in the early diagnosis and detection of areas of impaired perfusion and tissue necrosis in patients with necrotizing fasciitis.

Materials and methods. This scientific work is based on observations of 10 patients with suspicion of necrotizing fasciitis during 2022-2023. The patients underwent thermography using a digital infrared thermal imaging camera to obtain heat maps and thermograms, which were then analyzed for abnormal thermal patterns. The results of the thermography were compared with other signs of necrotizing fasciitis to assess the accuracy of the method.

Results. The study found that in patients with necrotizing fasciitis, there were three concentric zones with different surface temperatures around the main locus of infection. The central zone (N) had a lower temperature, the intermediate zone (F) had an increased temperature, and the outer zone (S) had a temperature close to normal for that area of the body. The results of statistical analysis indicated that there was no significant difference in temperature between the outer and intermediate zones. However, there were significant differences between the outer and central zones, as well as between the intermediate and central zones. The researchers found that the 5.72±0.23°С temperature difference between the central zone (N) with reduced thermal emission and the intermediate zone (F) with increased thermal emission, is a sign of the late stage of necrotizing fasciitis. However, at the early stage of development of necrotizing fasciitis, the "N" zone is absent, although a pronounced "F" zone is observed, which is surrounded by the "S" zone with a temperature difference of approximately 1.92±0.28°С.

Conclusions. Distinct thermal patterns observed in patients with necrotizing fasciitis provide an opportunity to improve diagnostic accuracy and assist in timely surgical intervention. Continuing the study and improvement of medical thermography can make it possible to include it in standard clinical practice in the future to improve the diagnostic and treatment process of necrotizing fasciitis.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institutions indicated in the work. The informed consent of patients was obtained for participation in the study.

No conflict of interests was declared by the authors.

The paradigm of anthropocentrism in contemporary pediatric surgery

V.О. Dubinina, І.V. Ksonz, S.М. Bilash, L.V. Abyzova, О.S. Bilanov — Sat, 28 Sep 2024 00:00:00 +0300

The idea of anthropocentrism is a key marker of the state of medical theory and practice in the technocratic society of the twenty-first century and demonstrates the global reflection of human society on its axiological attitudes.

Aim. The paper aims at theoretical and methodological analysis of the paradigmatic dimensions of anthropocentrism in pediatric surgery.

The theoretical basis of the study was formed by philosophical concepts of anthropocentric orientation, modern scientific substantiation of the problems of deontology and medical education. The methodology of the study was determined by the cultural approach based on the use of philosophical hermeneutics (interpretation of texts). The method of extrapolation allowed the use of philosophical heritage to analyze contemporary deontological issues. The method of synergetics provided an integrating function. The methods of analysis, synthesis, and generalization determined the logic of our scientific research.

Anthropocentrism is one of the leading trends in philosophy, which, at different historical stages, from ancient times to the present, defines topical issues, including deontological ones. Subject-object relations in medicine are relations in the “person-to-person” and “healthcare professional-to-patient” systems. The current and most realistic model is the contractual model, in which pediatric surgeons, parents of patients, and patients themselves establish relationships that are most acceptable to all participants in the treatment process.

Conclusions. The obtained results provide a more advanced level of analysis of both general and specific cognitive interests and preferences of pediatric surgery professionals from the angle of cognitions that characterize the discourse of the idea of anthropocentrism. The practical significance of the study is determined by the possibility of using the material of the paper in teaching deontological disciplines and as a factor that motivates medical students to scientific and worldview reflection.

No conflict of interests was declared by the authors.

Postnatal diagnosis and strategy of preoperative care for newborns and older children with sacrococcygeal teratomas

O.K. Sliepov, O.V. Perederii — Sat, 28 Sep 2024 00:00:00 +0300

Aim - to determine the importance of postnatal diagnosis in the perinatal care of newborns, and older children with sacrococcygeal teratomas (SCT).

Materials and methods. A retrospective analysis of the medical records of 40 children with SCT who underwent surgical correction of the defect between 1981 and 2023 was performed. A study of the main criteria for postnatal diagnostic examination of newborns and older children with SCT was conducted.

Results. An algorithm for postnatal examination of newborns and older children with SCT has been developed. A classification of SCTs was developed, according to their size (volume), using postnatal ultrasound. Complicated forms of SCT in the preoperative period were diagnosed in 40% (n=16) of children. There were 2 cases of tumor recurrence. Survival after surgical correction of this pathology was 97.5% (n=39).

Conclusions. Delivery strategy and postnatal diagnosis are one of the main stages of perinatal care of newborns with sacrococcygeal teratomas and an important component of preoperative preparation of older children with SCT. The developed classification of SCTs according to their volume, when performing a postnatal ultrasound, has a prognostic importance in assessing the risk of developing SCT complications, depending on the volume of the tumor and its morphological structure. X-ray research methods provide a detailed description of the tumor process, contribute to effective management and the choice of optimal surgical tactics.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the local ethics committee of the institutions mentioned in the work. Parents' informed consent was obtained for children's participation in the study.

The authors declare no conflict of interest.

Diagnosis and treatment of injuries of the lower alveolar nerve in nonincendiary fractures of the lower jaw

Sat, 28 Sep 2024 00:00:00 +0300

Aim - to systematize injuries of the lower alveolar nerve in fractures of the lower jaw and to develop schemes for their diagnosis and treatment.

Materials and methods. Examination and treatment of 280 patients with fractures of the lower jaw aged from 15 to 67 years were carried out. All patients during hospitalization and in the course of treatment underwent a general clinical examination, radiography of the lower jaw, computer tomography and color stereolithography, contact thermometry, electroodontodiagnostics, electrophysiological parameters of areas of soft tissues innervated by the trigeminal nerve were studied using the «DIN- 1». Tactile, pain and temperature sensitivity of the skin and mucous membrane of the alveolar process was determined, which was measured and evaluated according to Neimark (1981).

Results. According to the results of the analysis, it was found that among the injuries of the lower alveolar nerve in the examined subjects, contusion occurred in 28.6%, stretching - in 39.3%, incomplete (partial) rupture - in 32.1%. It has been proven that among the well-known clinical signs and complaints of patients with a fracture of the lower jaw basis, there are no pathognomonic symptoms that can be used for the differential diagnosis of contusion, stretching and incomplete rupture of the lower alveolar nerve. Indirectly, the severity of lower alveolar nerve injuries can be judged by the degree of displacement of the fragments of the jaws. It was found that patients with fractures of the lower jaw during hospitalization have significantly different indicators of conductivity and resistance of the mandibular branch of the trigeminal nerve, which are directly dependent on the severity of lower alveolar nerve injuries. Proposed treatment schemes for patients depending on the severity of lower alveolar nerve injuries using electrical stimulation of the nerve and intravenous injections of corvitin.

Conclusions. Determination of electrophysiological indicators of the mandibular nerve (conductivity and resistance) at the mental point of measurement on the side of the fracture is an objective test for diagnosing the severity of lower alveolar nerve injuries. The scheme of treatment of patients with basis lower jaw fractures proposed by us allows to shorten the period of treatment and rehabilitation of patients by 10 days - 2 months, depending on the severity of lower alveolar nerve injuries.

The authors declare no conflict of interest.

Properties of the antimicrobial activity of polyhexanide drugs against the dominant pathogens of wound infection in Ukraine: modern realities

Sat, 28 Sep 2024 00:00:00 +0300

The treatment of acute and chronic wounds with critical colonization by wound pathogens remains a serious problem, which is becoming more and more threatening every year due to the global problem of antibiotic resistance.

Aim - to study the antimicrobial activity of modern antiseptic Polyhexanide and antimicrobial biomaterials based on it against most common pathogens of wound infections.

Materials and methods. Antimicrobial activity of polyhexanide solution were studied against MLS -resistant clinical isolates of S. aureus, MDR- strains of E. coli, clinical XDR-isolates of K. pneumoniae, P. aeruginosa, and A. baumannii as well as referent strains S. aureus ATCC 25923, E. coli ATCC 25922, K. pneumoniae ATCC 708603, P. aeruginosa ATCC 27853, A. baumannii ATCC ВАА-747. MIC and MBC of polyhexanide were detected by standard dilution method; bactericidal index of antiseptic activity (BC IAA) for 0.1% polyhexamethylen-biguanide solution for wound irrigation (PHMB) was calculated. The bioactivity of wound antimicrobial dressings with polyhexamethylenguanidyn-hydrochoridi (PHMB-HCl) and PHMB was determined by standard disk diffusion method; growth inhibition zones (GIZ) were measured and compared.

Results. MLS-resistant strains of S. aureus were the most susceptible to the action of the antiseptic: the MIC and MBC of PHMB were on average 22.69±4.6 μg/ml and 40.55±8.57 μg/ml, respectively. The MIC values against S. aureus was lower than those against E. coli by 1.97 times, against K. pneumoniae – by 1.78 times, against A. baumannii – by 2.97, against P. aeruginosa – 3.9 times. The MBC of PHMB against clinical strains of S. aureus had the lowest values and differed significantly from those against E. coli by 2.21 times, K. pneumoniae by 1.99 times, A. baumannii by 3.4 times, P. aeruginosa by 4.52 times. The bactericidal index of antiseptic activity (BC IAA) of PHMB had the highest values in relation to clinical strains of S. aureus (BC IAA=24.7), K. pneumoniae (BC IAA=12.4) and E. coli (BC IAA=11.2). Wound dressings PHMB-HCl and PHMB demonstrated high antimicrobial properties against reference and clinical strains of S. aureus, E. coli, K. pneumoniae. Reference and clinical strains of P. aeruginosa were the least susceptible to PHMB-based wound dressings.

Conclusions. Polyhexanide antiseptic solution for wound irrigation and polyhexanide-containing dressings with PHMB and PHMB-HCl have the high antimicrobial properties in relation to the most common types of wound pathogens.

No conflict of interests was declared by the authors.

Morphofunctional characteristics of the wound process during the treatment of purulous-necrotic wounds in rats with modern antiseptic means and collagenase

V.P. Rautskis, S.D. Khimich — Sat, 28 Sep 2024 00:00:00 +0300

Infected and purulent wounds remain both a medical and economic challenge for the healthcare system today. Scientific and practical interest leads to the use of collagenase enzyme in wound care products.

Aim: to study and evaluate morphological changes in the wound process during the treatment of purulent-necrotic wounds in rats with drugs based on modern antiseptics and collagenase.

Materials and methods. The object of study: purulent-necrotic wounds. The experimental study was performed on 64 white laboratory rats. The simulated wound was contaminated with a pathogenic strain of S. aureus in combination with P. aeruginosa. Rats were divided into 4 groups of 16 animals each: I - control group (without treatment); II - collagenase-based gel with myramistin was used to treat the wound; III - ointment based on chloramphenicol and methyluracil; IV - myramistin-based ointment. 2 days after the start of the experiment, the drug and an aseptic gauze bandage were applied to the wound surface of animals of the II, III and IV groups, in the control group - only an aseptic bandage was applied. The dressing was changed daily for 14 days in all animals. Tissues were collected for histological and morphometric examination by excision of a fragment of skin with underlying tissues from the location of the wound defect followed by fixation in a 10% solution of neutral buffered formalin. The prepared histological sections with a thickness of 4 μm were stained with hematoxylin and eosin.

Results. It was found that in the II group, where collagenase was used, the number of leukocyte elements at the bottom of the wound defect from the 3^rd day was significantly lower than in other groups. At the same time, the vascular component progressively increased. The obtained data correlate with the results of a histological examination: a faster reduction of the inflammatory process and the development of epithelialization. Complete coverage of the wound surface with the newly formed epithelium occurred already on the 10th day.

Conclusion. The obtained data indicate the appropriateness of collagenase in the treatment of purulent wounds not only as an enzymatic debridement, but as a substrance affecting important aspects in the first and second phases of the wound process.

The experiments with laboratory animals were provided in accordance with all bioethical norms and guidelines.

No conflict of interests was declared by the authors.

Expander reconstruction of tissues in children with pigment and vascular lesions

І.М. Benzar, V.V. Khrapach, V.O. Sydorov, A.F. Levytskyi — Sat, 28 Sep 2024 00:00:00 +0300

The main indications for surgical treatment of congenital nevi and vascular malformations of superficial tissues are the reduction of psychosocial problems (58%) and the achievement of aesthetic improvement (51%). In the case of large lesions, the problem is the replacement of large tissue defects, which can be solved using tissue expanders.

Aim - establishing the effectiveness and safety of expander reconstruction of surface tissues after removal of large and giant pigment and vascular lesions.

Materials and methods. We performed a retrospective study of 8 patients undergoing superficial tissues expander reconstruction in National children hospital OKHMATDYT in the period 2019-2023. Preoperative planning was carried out in order to determine the shape, size and volume of the expander.

The aim of the first operative intervention was the placement of the expander. During the second planned operation, the expander was removed, the walls of the formed capsule were damaged, a pigment or vascular lesions was completely or partially removed, and the formed flap was moved to the site of the tissue defect.

Results. 19 expanders were used in 8 children for the following indications: congenital nevi (n=6) and vascular malformations (n=2). The age of patients at the time of treatment was from 3 to 17 years. From 1 to 6 expanders were placed in patients. Round (n=1), rectangular (n=10), and sickle-shaped (n=8) expanders were used, the volume of expanders was from 100 to 500 ml. The duration of tissue expansion ranged from 34 to 63 days, on average 43±19. Complete removal of lesions was achieved in 6 (75%) patients, partial removal in 2 (10.5%). Complications that led to the removal of the expander occurred in 2 (10.5%) cases, in particular, hematoma and infection in the area of the scalp and in 1 (5%) case on the background of Herpes zoster infection.

Conclusions. Tissue expansions in order to replace large defects after the removal of pigmented and vascular lesions is safe, effective and aesthetic, as it ensures the replacement of the defect with homogeneous tissues. The overall complication rate was 10.5%. Limitation of tissue expansion use is the young age of the child, skin damage and insufficient area of healthy tissue.

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 participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.

Trichobezoars as a manifestation of children's mental health disorders: the view of a surgeon and a psychiatrist

Sat, 28 Sep 2024 00:00:00 +0300

Aim - to summarise the experience of treating children with trichobezoars, to consider aspects of the relationship between surgery and psychiatry, and to determine the tactics of postoperative psychiatric/psychological care.

Materials and methods. In the period from 2002 to 2023, 6 girls aged 9 to 13 years with trichobezoars were treated. In 3 cases the children had gastric trichobezoars, in 2 cases Rapunzel syndrome was diagnosed, and in 1 case a small intestinal trichobezoar was found. In one child, a small gastric trichobezoar was removed endoscopically, in 5 children, large trichobezoars were removed during laparotomy.

Results. The presented clinical cases illustrate this rare pathology in terms of the relationship between pediatric surgery and psychiatry. Effective correction of mental disorder, which is a predictor of trichobezoar formation in children, allows stabilising the patient's emotional condition and prevents the disease recurrence. A comprehensive multidisciplinary approach to the management of patients with trichobezoars after surgery should include patient consultation by a mental health professional, psychoeducational consultation of parents and relatives regarding trichotillomania and trichophagia as pathological conditions that precede the formation of trichobezoars. Neuropsychiatric examination and treatment, long-term follow-up, and behavioural therapy are recommended as a regular part of comprehensive treatment and relapse prevention.

Conclusions. Trichobesoars in children are rare foreign bodies of the stomach and small intestine that have the ability to increase imperceptibly in size over time, clinically manifesting as dyspeptic disorders, tumour-like masses in the epigastric region, and symptoms of high gastroduodenal or small intestinal obstruction. Children with documented episodes of trichotillomania and trichophagia require consultation with a psychiatrist and psychotherapist, as well as fibrogastroduodenoscopy to exclude trichobesoar. Children who have been operated on for trichobezoar require postoperative psychiatric care and psychological support to prevent relapse.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from parents (or guardians) and children.

The authors declare no conflict of interest.

A rare case of blast injury of the chest and spine on the background of a congenital malformation in the form of a complete mirror image arrangement of internal organs

Sat, 28 Sep 2024 00:00:00 +0300

The aim is to demonstrate a clinical case of blast injury of the chest and spine against the background of a complete mirror image arrangement of internal organs.

Clinical case. The injured S., 37 years old, received a blast injury during mortar shelling. Upon admission, the injured person complained of aching pain in the area of the X rib on the left and in the lumbar region. The pain worsened during movement. He has known about the malformations of internal organs since childhood, but only about the right-sided location of the heart. The final established diagnosis is combined blast injury of the chest and spine. Closed chest injury on the left, closed fracture of the X rib on the left. Closed fracture of the lumbar processes L3-4 on the right. Congenital malformation. A complete mirror image arrangement of internal organs. The injured person was taken to a territorial hospital base for further treatment, where he received painkillers, anti-inflammatory therapy, and prescribed multivitamins. The total bed-day was 7 days. The injured was taken to the Military Medical Commission and discharged in satisfactory condition to implement the decision of the Military Medical Commission.

Conclusions. A congenital malformation in the form of a complete mirror image arrangement of internal organs is a rare pathology. Diagnosing a complete mirror image arrangement of internal organs is not difficult and is an accidental finding during the examination for the injury in this case. Anamnestic data help in the diagnostic search.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of a participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Byler's disease: conservative and surgical treatment strategies

H.V. Kurylo — Sat, 28 Sep 2024 00:00:00 +0300

Byler's disease (BD) is rare and difficult for diagnosing hereditary cholestatic liver disease. Proper diagnosis, early correction and treatment (including liver transplantation (LT)) improves the quality of life (QoL), prevents irreversible liver changes, multiple organ failure and death.

Aim - to study the features of differential diagnostics, feasibility, terms, strategies, methods of conservative treatment, surgical correction (palliative surgery (PS), LT) in five children with BD.

Materials and methods. Five clinical episodes of chronic disease with data on hematological indicators during treatment, physical development (PD) (harmony, body mass index - BMI), neuropsychiatric development (NPD), QoL before treatment, after PS, after LT.

Results. Five clinical episodes of chronic disease were analyzed, one of which was fatal. All indicators (hematological, FD, NPD, QoL) improved after PS, but completely normalized after LT.

Conclusions. Differential diagnosis of severe hereditary rare disease progressive familial intrahepatic cholestasis (BD) is possible using genetic research methods as a marker of this disease among all cholestatic diseases in young children. The first clinical signs of the disease appear in the neonatal period and progress in the first months of life. Early modern diagnosis and diversion of bile prevent liver damage and death. Palliative surgical intervention is performed in the case of rapid progression of cirrhosis and the threat of liver failure as a temporary measure to better prepare the patient for transplantation and obtain the results of genetic analysis, carry out the necessary vaccinations and correct concomitant congenital and acquired diseases, improve PD, NPD, QoL, biochemical indicators, ultrasound data. LT is an effective method of radical treatment of BD, normalization of FD, NPD, QoL, biochemical and sonographic indicators.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.

The author declares no conflict of interest.

The results of using thoracoplasty in adolescent idiopathic thoracic scoliosis

A.O. Mezentsev, D.E. Petrenko, D.O. Demchenko — Sat, 28 Sep 2024 00:00:00 +0300

Due to the high efficiency of modern methods of spinal deformity correction and the likelihood of intra- and postoperative complications after thoracoplasty, the frequency of its use has decreased significantly.

Aim - to estimate the results of thoracoplasty after surgical deformity correction in adolescent idiopatic scoliosis.

Materials and methods. A retrospective analysis of the results of 560 patients whit adolescent idiopatic scoliosis, who were operated since 2010 to 2019. Mean age was 14.7 years old. Patients were divided into 5 groups: posterior correction with derotation techniques without using of thoracoplasty (group 1) - 336 patients, posterior correction with derotation techniques with using of thoracoplasty (group 2) - 126 patients, posterior correction with cantilever maneuver with using of thoracoplasty (group 3) - 42 patients, anterior spinal mobilization & posterior correction with derotation techniques with using of thoracoplasty (group 4) - 35 patients, anterior spinal mobilization & posterior correction with cantilever maneuver with using of thoracoplasty (group 5) - 21 patients.

Results. The correction of the main curve after surgical treatment was 50-75%, and the secondary curve correction was 50-80%. The rib hump height after surgical treatment decreases in all groups, especially in patients underwent anterior mobilization as a first stage. Also, apical rib hump prominence index increases in all groups of patients. The results of pulmonary function test after surgical treatment were almost the same or little bite change between 10%. The level of self-assessment by SRS-30 scale increase from 34% to 90%.

Conclusions. Using of thoracoplasty lead to improvement of cosmetic results due to restoration anatomical form of the chest and postoperative results of pulmonary function test after 1 year follow-up were the same as before operation.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of all the institutions mentioned in the study. Informed consent was obtained from the patients.

No conflict of interests was declared by the authors.

Study of the stress-deformation state of models of the humerus in cases of supracondylar oblique fractures in children and adolescents with different options of percutaneous fixation

O.A. Bur'yanov, V.P. Kvasha, V.O. Naumenko, M.Yu. Karpinsky, O.V. Yaresko — Sat, 28 Sep 2024 00:00:00 +0300

Fractures of the distal epimetaphysis of the humerus in children and adolescents are one of the most common injuries, accounting for 16 to 50% of all bone fractures. Among the injuries of this location, supracondylar (3-18%) and transcondylar fractures (57.5-70%) prevail, mainly in children aged 6-7 years. A significant problem when using a crossed fixation structure is iatrogenic damage to the ulnar nerve (2-8%), which requires a mini-open technique of medial spica or sonographic monitoring.

Aim - to compare the level of stresses in the model of the humerus with a supracondylar oblique fracture with different options of percutaneous fixation under the influence of different loads.

Materials and methods. A basic finite-element model of the humerus was developed, on the basis of which a model of an oblique supracondylar fracture was created. Two versions of osteosynthesis were modeled: with two spikes arranged crosswise and a bundle of three spikes. The stress-strain state of the models was studied under the influence of tensile, bending and twisting loads.

Results. The presence of an oblique epicondylar fracture of the humerus leads to asymmetric changes in the distribution of stresses in the epicondyles above and below the fracture line during cross fixation with two spikes. With lateral fixation with three spikes under the influence of tensile load, the tension in the medial epicondylum is reduced to a minimum and their level on the lateral one is doubled. This is related to the one-sided conduction of a bundle of spikes. At the same time, the medial epicondyle remains unfixed and, accordingly, the loads on it are practically not transferred. The bone regenerate for this is too soft to prevent movement of the distal fragment. At the same time, a tighter fixation of the lateral epicondyle than in the version with two needles across, causes an increase in the level of stress in the lateral epicondyle. The total size of the cross-sectional area of the spike bundle with lateral fixation ensures a twice lower stress level in them, compared to cross fixation. Under bending loads, cross fixation with two spikes and lateral fixation with a bundle of three spikes work about the same. Under torsional loads, both methods of fixation of fragments of the humerus showed approximately the same results. In favor of the method of lateral fixation with a bundle of three spikes, the low level of stresses in the spikes can be attributed. The asymmetric arrangement of the bundle of three spokes during lateral fixation is compensated by the asymmetry of the passage of the fracture line. All this indicates that in the treatment of oblique supracondylar fractures of the humerus, both methods of fixation are equivalent from the point of view of stress distribution in the bone tissue, and the choice of one of them can be determined by other criteria.

Conclusions. Mathematical modeling of the humerus with a supracondylar oblique fracture did not determine significant advantages of one or another method of fixation. The asymmetric location of the spikes during lateral fixation of bone fragments is compensated by the asymmetry of the fracture line. In favor of the method of lateral fixation with a bundle of three spikes, the low level of stresses in the spikes can be attributed.

No conflict of interest was declared by the authors.

Limited contact multiplane osteosynthesis of shinbone fractures

P.I. Bilinsky, V.P. But, T.E. Marthuk — Sat, 28 Sep 2024 00:00:00 +0300

Aim - to improve the results of treatment of shinbone fractures with limited contact multiplane osteosynthesis device, to investigate its fixation capabilities.

Materials and methods. On the base of systemic approach, conceptual substantiation, theoretic methods of mathematic and computer modeling a new method of limited contact multiplane osteosynthesis of diaphyseal shinbone fractures (SBF) and device for its realization were developed. Comparative analysis of fixing capabilities of the developed device and full-contact plate was performed by means of finite element method. Stress-strain state of the “fixative-bone” system of different fixation methods of SBF was investigated.

Results. Theoretic data about the size of the micromobility of bone fragments depending on the fracture line pattern, imposed force, specific features of the fixative construction were obtained. Stressed state of plates, its dependence from fixative construction, fracture pattern, load size was studied. Influence of reposition stabilization of fragments by screws in oblique and comminuted fractures on fixation rigidity, micromotion of fragments, stress of fixative construction elements and bone fragments was investigated.

Fragment fusion was noted in all 380 patients with SBF operated on with a limited contact osteosynthesis device.

Conclusions. The developed device for limited contact multiplane osteosynthesis of shinbone fractures and the method of its application simplifies surgical intervention, minimises trauma to the fragments, and ensures their stable fixation and optimal conditions for fusion.

No conflict of interest was declared by the authors.