PAEDIATRIC SURGERY. UKRAINE

Fracture of the neck of the radius in children: clinic, diagnosis, methods of treatment

Fri, 28 Jun 2024 00:00:00 +0300

Radial neck fractures are most common in children aged 8 to 11 years, accounting for 5% to 10% of all fractures of the bones that make up the elbow joint and up to 1% of all fractures in the pediatric population. Most often, the injury occurs as a result of a fall on an outstretched arm in the position of extension in the elbow joint. indirect injury from the fall with emphasis on the arm straightened at the elbow joint with the forearm deflected outward, and less often due to the direct effect of a damaging effect. The most typical damage in the area of the proximal radius in children is transverse fractures of the neck, in which the plane of the fracture passes through its metaphysis.

The aim is to compare the experience of treating fractures of the radial neck, to analyze the possibilities of postoperative complications based on the literature and our own observations.

In children with radial neck fractures, depending on the type of displacement of bone fragments and their angulation, there are different options for repositioning, which, accordingly, provide different treatment efficiency.

Treatment of radial neck fractures in the pediatric population, necessarily taking into account the type of fragment displacement, should involve starting with low-traumatic and minimally invasive closed methods, and only in cases of their failure and/or impossibility (inappropriateness) it is possible to determine the choice of indications for open surgical intervention. The results which we obtained from the application of the open reposition technique for radial neck fractures according to the Metaizo method with fixation of fragments with elastic intramedullary rods in childhood clinically, radiologically and functionally coincide with the existing modern data of literary sources. Based on this, we believe that this technique is a good option for surgical treatment of pathology, simple and reliable, with minimal possibilities of postoperative complications, even with the most significant values of angulation of bone fragments.

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 institution mentioned in the work. The informed consent of the patients was obtained for the research.

No conflict of interests was declared by the authors.

Experience of treating calculi of the urinary tract in children

D.V. Shevchuk, R.A. Nakonechnyy, A.Y. Nakonechnyi, I.А. Kyslova — Fri, 28 Jun 2024 00:00:00 +0300

Aim - to analyze the treatment of children with urolithiasis (urolithiasis), taking into account the location of stones in the urinary tract, their size and density, to select further individual patient management tactics.

Materials and methods. The study included 48 patients with single urinary tract stones aged 6 months to 18 years. X-ray structural analysis and determination of the chemical composition was carried out with 39 stone fragments.

Results. In 5 (10.4%) patients with calculi in the distal part of the ureter up to 5 mm in size, medical expulsive therapy was started. 17 (35.4%) patients with kidney and ureter calculi measuring 6-14 mm and density up to 900 HU underwent extracorporeal shock wave lithotripsy. In 3 (6.3%) patients with kidney and ureter calculi 6-14 mm in size and with a density of more than 900 HU, ureterorenoscopy (URS) and extraction using a Dormia basket or forceps to capture fragments were performed. 20 (41.7%) children with kidney stones larger than 15 mm or density greater than 1200 HU underwent contact lithotripsy. Contact endovesical lithotripsy was performed in 2 (4.2%) patients with massive calculi in the urinary bladder who underwent cystoplasty for an exstrophy-epispadias malformation. Results of X-ray structural stones analysis: calcium oxalate (wevelite, wedelite) - 31 (79.5%), calcium phosphate (hydroxyapatite) - 5 (12.8%), brushite - 2 (5.1%), cystine - 1 (2.6%).

Conclusions. Modern minimally invasive technologies make it possible to remove calculi of any density and localization from the urinary system in a minimally traumatic, effective and sufficiently safe manner, regardless of the age of the child. In the treatment of urolithiasis in children, it is advisable to follow a personalized approach with the step-by-step use of the optimal arsenal of means to remove the stone.

The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the local ethics committee of the listed institution. Informed consent of children and their parents was obtained for the research.

No conflict of interest was declared by the authors.

The FLIR One non-contact thermography application in the assessment of the burn wound depth

T.I. Farmaha, O.V. Lukavetskyi, O.M. Chemerys, I.V. Stoianovskyi — Fri, 28 Jun 2024 00:00:00 +0300

The treatment of burn injuries is complicated by the proper diagnosis of areas requiring immediate necrectomy (deep burn) and those that can heal on their own (superficial burn). Non-contact thermography using the FLIR One device may be a reliable, non-invasive, and cost-effective method for assessing the depth of thermal injury.

Aim - to study the temperature of healthy skin, deep and superficial burns using the FLIR One non-contact thermograph, the temperature difference between them, and the diagnostic value of the method for assessing burn depth.

Materials and methods. The study involved 22 patients with limb burns. Thermometry of the affected areas was performed using the FLIR One thermograph within the first 48 hours after injury, before and during wound sanitation, with images analyzed using the FLIR One application.

Results. The temperature of healthy skin was 34.7°C (34.4-35.1°C), the temperature of superficial burns was 35.8°C (35.5-36.2°C), and the temperature of deep burns was 32.4°C (32.0-32.8°C). The difference between healthy skin and deep burns was 2.3°C (2.2-2.4°C), and between superficial and deep burns was 3.4°C (3.0-3.8°C). A temperature of 33.7°C with non-contact thermography indicated a deep burn with 95% sensitivity and specificity. A decrease in the temperature of the affected skin by more than 2.0°C compared to healthy skin (2.2-2.4°C) or superficial burns (3.0-3.8°C) also indicated deep thermal damage.

Conclusions. Thermography using FLIR One is a reliable and accessible method for analyzing the depth of burn wounds. The temperature of healthy skin during thermography is 34.7°C (34.4; 35.1)°C and is lower than the temperature of superficial burns (35.8°C (35.5; 36.2)°C) but higher than the temperature of deep burns (32.4°C (32.0; 32.8)°C). A temperature of 33.7°C with high sensitivity and specificity indicates a deep burn. The study showed that a temperature decrease of more than 2.0°C compared to healthy skin or superficial burns indicates deep thermal damage.

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 authors declare no conflict of interest.

Surgical complications of Henoch-Schönlein purpura in children

K.V. Lapshyn, A.A. Pereyaslov, B.I. Hyzha, L.Y. Hyzha, N.M. Opikan — Fri, 28 Jun 2024 00:00:00 +0300

Henoch-Schönlein purpura is the systemic pathology that affected the small vessels of the skin, gastrointestinal tract, kidneys, and joints. Typical clinical manifestation of Henoch-Schönlein purpura include palpable purpura, abdominal pain syndrome, arthralgia, renal involvement, and, in some children, externa genitalia involvement.

The aim of this study was to present the own experience in the management of three children with the surgical complications of Henoch-Schönlein purpura.

The own experience includes three children with Henoch-Schönlein purpura, particularly two children with ileum intussusception (both of 3 years old) and one patient of 4 years old with the syndrome “acute scrotum”.

Gastrointestinal involvement may appear in most of patients with Henoch-Schönlein purpura and intussusception is the most common complication, which require the urgent treatment. Appearance of typical palpable purpura followed the abdominal pain syndrome and ultrasonography is the main method of diagnostic in this group of patients. Ileum and ileocolic are the common types of intussusception in children with Henoch-Schönlein purpura. The main method of treatment in case of ileum intussusception is surgical reduction, while in case of ileocolic intussusception non-surgical reduction can be applied.

Besides the typical manifestation of Henoch-Schönlein purpura, in some children could be the scrotal involvement, which developing after appearance of palpable purpura, and rare caused by inflammation or torsion of testis or hydatid. It is believed that patients with Henoch-Schönlein purpura and scrotal involvement have more severe clinical course when compared with patients with abdominal manifestation, which agreed with our observation.

Conclusions. In children older than one year, with the abdominal pain, with or without bloody stools, and ultrasonographic signs of intussusception, it is necessary consider about possibility the presence of Henoch-Schönlein purpura in these patients.

In children with Henoch-Schönlein purpura despite the corticosteroids’ treatment, could be developed the syndrome of “acute scrotum”, which required emergent surgery.

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 institution mentioned in the work. Informed consent of the patients was obtained for the research.

No conflict of interests was declared by the authors.

A rare observation of simultaneous removal of a giant sacrococcygeal teratoma, with massive presacral and external components, and preoperative endovascular occlusion of the feeding arteries of the tumor, in a newborn

Fri, 28 Jun 2024 00:00:00 +0300

Aim - to analyze and describe the experience of a one-moment removal of a giant sacrococcygeal teratoma (SCT), with massive presacral and external components (III type), and preoperative endovascular occlusion of the feeding arteries of the tumor, in a newborn, based on a clinical case.

Clinical case. A unique clinical case of a giant SCT with massive presacral and external components and preoperative endovascular occlusion of the feeding arteries of the tumor in a newborn is presented. Features of perinatal support, preoperative endovascular occlusion of the feeding arteries of the SCT and surgical intervention are described, which are important elements of optimizing the treatment of children with this life-threatening pathology.

Conclusions. In the diagnosis and treatment of SCT, a scientifically based, differentiated approach is necessary, which includes: early (up to 22 weeks of gestation) complex prenatal diagnosis for choosing rational tactics of pregnancy management, examination of the fetus, delivery by cesarean section, postnatal diagnosis, preoperative preparation and surgical treatment. The first described preoperative endovascular occlusion of the feeding arteries of the presacral and external components of the SCT provides tumor devascularization and minimization of intraoperative blood loss during one-moment resection of a highly vascularized giant tumor. Adequate assessment and rational conservative treatment of a severe complication of the early postoperative period - thrombosis of the infrarenal section of the aorta made it possible to eliminate the life-threatening complication and achieve complete recanalization of the thrombosed section of the aorta and restore full blood flow in the lower extremities.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting studies.

No conflict of interests was declared by the authors.

The treatment strategy for giant neck teratoma in newborns: clinical case

O.O. Kalinchuk, O.M. Kulyk, A.O. Dvorakevych, A.I. Karpiv — Fri, 28 Jun 2024 00:00:00 +0300

Teratoma can be diagnosed with ultrasound examination and screening, which is carried out in intrauterine period of the fetal development. Early diagnostics of the pathology is of the great importance of its treatment. The detailed management of newborns with giant neck teratoma have not been found in current literature. Furthermore, there is no information concerning preparation of the patient for the radical operation.

The aim is to present the clinical case of surgical treatment of giant neck teratoma in newborn child using EXIT-procedure (intrauterine treatment to establish a functioning airway) and angiography before the radical excision of the tumor.

The clinical case describes the diagnostics and treatment of newborn child with giant neck teratoma, who was taken to the first clinical Lviv association “St. Nicholas hospital”. The tumor was diagnosed intrauterine. The child underwent EXIT-procedure. Selective angiography and embolization of carotid branches were carried out on third day after birth. The surgical intervention regarding the removal of the tumor, which was removed radically with blood loss up to 50 ml, was performed on fourth day after birth.

Conclusions. Prenatal screening with alpha-protein detection in mother blood is essential for diagnostics of probable pathologies of the fetal development. EXIT-procedure has led to save lung ventilation and effective support of the cardiovascular system. The selective angiography allowed to assess the bloodstream within branches of the internal carotid artery. The embolization of the branches of the external carotid artery, which vascularized the tumor, led to minimization of the blood loss up to 50 ml. As the removal of tumor was radical, further specialized treatment was not needed.

The research was carried out in accordance to principles of the Helsinki declaration. The informed consent of the child’s parents was given for conducting the research.

The authors declare no conflict of interest.

Optimization of surgical treatment of congenital anal and rectal stenosis in children

O.Р. Dzham — Fri, 28 Jun 2024 00:00:00 +0300

Congenital anal (CAS) and rectal stenosis (CRS) are variants of anorectal malformations (ARM) in children.

Aim - to evaluate the results of surgical correction of CAS and CRS, based on this, to develop the main tactical requirements for the treatment of this complex pathology in children.

Materials and methods. The study included 18 children with congenital anorectal stenosis: 7 (38.9%) - with CAS, 11 (61.1%) - with CRS, which accounted for 11.7% of all treated anorectal anomalies (n=154). The ratio of boys to girls was 5:1. After complex diagnostics, in 44.4% (n=8) of children were found to have associated malformations: 42.9% (n=3) of patients with CAS and 45.5% (n=5) - with CRS.

Results. All (n=7) patients with CAS underwent one-stage surgical correction, without complications. In 90.9% (n=10) of children with CRS staged surgical treatment was performed, and one-stage in 9.1% (n=1). At the stages of primary correction of CRS postoperative complications occurred in 18.2% (n=2): stoma stenosis (n=1); urethro-perineal fistula (n=1), which were surgically corrected. After the primary correction of CRS was completed, persistent constipation was noted in 2 (18.2%) children. Repeated staged reconstructive operations were performed on these patients.

Conclusions. The use of the diagnostic, treatment and rehabilitation algorithm for CRS, developed in the clinic, made it possible to obtain good results in the long postoperative period in 63.6% (n=7) of children, and satisfactory results in 36.4% (n=4). The improved technique of surgical treatment of CAS made it possible to carry out primary correction of the defect with a good functional result in 71.4% (n=5) and satisfactory results in 28.6% (n=2) of children.

The research was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

The authors declare no conflict of interest.

Clinical aspects of diagnosis and prognosis of acute necrotic pancreatitis

A.I. Banadyga, N.V. Banadyha — Fri, 28 Jun 2024 00:00:00 +0300

Aim - to evaluate diagnostic markers of acute pancreatitis.

Materials and methods. The study was conducted in the period from 2014 to 2023 and was based on the assessment of the severity of acute pancreatitis (AP) in 237 patients. All patients were divided due to the severity of AP. Mild AP was detected in 85 (35.86%), moderate - in 90 (37.97%), severe - in 44 (18.56%), critical - in 18 (7.59%) patients. Also, two study groups were formed: the Group 1 (patients with mild and moderate AP) and the Group 2 (severe and critical AP).

Results. The level of procalcitonin in the blood was increased in 29 (12.23%) patients of the Group 2 (severe and critical AP) and was >2.0 ng/ml. Among them in 25 (86.2%) patients early surgical treatment was perfomed and septic inflammation was detected in operating room. Typical ultrasound signs of AP were in 207 (87.34%) patients. Correlation roots between amylase and diastase on the first day of illness were: r=0,71 in the Group 1 and r=0.73 in the Group 2.

Conclusions. The diagnosis of AP should be based on a comparative evaluation of the results of instrumental, laboratory tests and clinical symptoms. Levels of PCT, amylase, blood glucose, and urine diastase together with other clinical parameters helped to confirm the diagnosis of AP on admission to the hospital in 162 (92.57%) and 54 (87.09%) patients of the Group 1 and the Group 2. PCT should be used to predict complications and evaluate the efficiency of antibacterial therapy.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants.

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

No conflict of interests was declared by the authors.

Features of the occurrence of disseminated peritonitis and the effect of 5,10-methylenetetrahydrofolate reductase gene polymorphism

O.O. Bilyayeva, I.V. Karol, S.V. Ziablitzev — Fri, 28 Jun 2024 00:00:00 +0300

It is relevant in modern surgery to clarify the risk factors of widespread peritonitis and to improve the treatment and diagnostic algorithms for the management of such patients.

Aim - to establish the features of the occurrence of widespread peritonitis and the influence of MTHFR gene polymorphisms on the risk of its occurrence.

Materials and methods. The study included 100 patients who underwent surgical interventions for acute abdominal diseases complicated by peritonitis: acute appendicitis (48%), acute cholecystitis (32%), perforated ulcer of the stomach or duodenum (8%), tumor perforation (3%), injuries of the abdominal cavity (3%), pinched hernia (2%) and intestinal obstruction (4%). Genotypes of MTHFR gene polymorphisms rs1801131 and rs1801133 were determined by real-time polymerase chain reaction. Mathematical processing of the research results was carried out using the Statistica 10 program.

Results. The risk of disseminated peritonitis was increased with perforated gastric or duodenal ulcer, tumor perforation, abdominal trauma, herniated hernia, or intestinal obstruction compared with acute appendicitis and cholecystitis. The risk of disseminated peritonitis was lower in II blood group carriers compared and was associated with temperature at hospitalization and pulse rate.

Conclusions. The factors determining the risk of disseminated peritonitis in the multivariate regression model were the diagnosis, heart rate, and the rs1801131 genotype of the MTHFR gene.

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

No conflict of interests was declared by the authors.

Advanced minimally invasive retromuscular alloplasty in patients with diastasis recti abdominis

Ya.P. Feleshtynsky, O.M. Koval, V.F. Vatamaniuk — Fri, 28 Jun 2024 00:00:00 +0300

Diastasis recti abdominis contributes to the occurrence of defects with the formation of hernias of the white line. The recurrence of diastasis after alloplasty may also be associated with the presence of thinned posterior aponeurotic walls of the rectus abdominis muscles.

Aim - to іncrease the effectiveness of surgical treatment of diastasis recti abdominis by using minimally invasive retromuscular techniques.

Materials and methods. An analysis of surgical treatment of patients with diastasis recti abdominis was conducted in 126 patients. Average age - 51±1.2 years old. Diastasis width from 3 to 10 cm. In the I (main) group (n=64) surgical treatment it was performed according to the mini-invasive method we improved retromuscular technique. In the II group (comparison) (n=62) surgical treatment was performed according to the traditional «onlay» technique. In the postoperative period in patients of the I and II groups evaluated term stay of a patient in a hospital, direct and remote results. The methods of variational statistics were used: the averages for each studied feature, the errors of the arithmetic mean.

Results. Term stay in a hospital patients of the I group was 2.1 days, the II group - 6.2 days. Among complications and on the side of the surgical wound in patients of the I group, a hematoma was observed in 2 (3.1%), seroma - in 4 (6.2%), wound infection was not observed, while in patients of the II group a hematoma was observed in 6 (9.7%), seroma - in 10 (16.1%), wound infection - in 3 (4.8%). Distant the results in terms of 2 to 36 months showed that among 35 patients of the II group, chronic postoperative pain was relapses were diagnosed in 2 (3.1%). diastasis direct muscles occurred in 7 (11.3%), and among 34 patients of the I group chronic postoperative pain diagnosed in 6 (9.7%) and relapse only in 1 (1.5%).

Conclusions. Advanced mini-invasive retromuscular alloplasty is more effective, which is confirmed by a decrease in hospital stay and a decrease in postoperative complications.

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 specified institution. Informed consent of the patients was obtained for the research.

The authors declare no conflict of interest.

Alagille syndrome in the clinical practice of a paediatric surgeon

H.V. Kurylo — Fri, 28 Jun 2024 00:00:00 +0300

Alagille syndrome (AGS) is one of the most problematic for the diagnosis of hereditary, multisystem, cholestatic liver diseases in combination with other congenital defects. Timely diagnosis and treatment (including liver transplantation - LT) improves the quality of life (QoL), prevents irreversible liver changes, multiple organ failure and mortality.

Aim – to study the possibilities and features of the differential diagnosis of AGS, the impact of complex treatment, surgical correction (including LT) on the course of the disease, the dynamics of clinical and laboratory indicators, physical development (FD) and neuropsychological development (NPD), QoL.

Materials and methods. Verification of the diagnosis of AGS included clinical, biochemical, instrumental examinations, genetic markers of AGS. Quality of life was evaluated: assessment of skin itching (on a categorical scale, according to the visual analogue scale of pruritus; the level of anxiety was determined according to the Hamilton scale (modified). FD and NPD were evaluated by pediatricians and pediatric neurologists before and after treatment. The assessment of FD according to centile tables was carried out in accordance with WHO standards. The assessment of NPD was carried out: development delay for one, two, three epicrisis terms; degree of NPD delay.

Results. Against the background of treatment, biochemical and clinical indicators improved. Itching of the skin (according to the categorical scale of itching, visual analogue scale of pruritus), decreased the anxiety index. The dynamics of the FD and NPD were positive.

Conclusions. Modern possibilities of diagnosis of AGS include genetic and histological methods, which makes it possible to start pathogenetic therapy early, to decide the time and ways of surgical intervention (including LT). The presence of concomitant congenital defects of other organs and systems, the characteristic appearance of children with AGS require a multidisciplinary examination with the involvement of multidisciplinary specialists. Complex and timely treatment of AGS contributes to the normalization of clinical and biochemical indicators, FD, NPD, quality of life. Radical treatment of AGS by means of LT should be considered before the period of irreversible multiorgan changes, taking into account the preservation of FD and NPD.

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.

Long-term results of radical surgical interventions for malignant neoplasms of the pancreatoduodenal zone, complicated by the syndrome of mechanical jaundice

Fri, 28 Jun 2024 00:00:00 +0300

One of the priority tasks of modern oncopancreatology is the involvement of new strategies to improve patient’s survival rates.

Aim - to analyze and compare the course of the long-term period after pancreatoduodenal resection in patients with malignant tumors of the pancreatoduodenal zone, complicated by the syndrome of mechanical jaundice.

Materials and methods. The long-term results of surgical treatment of 101 patients with malignant neoplasms of the pancreatobiliary area, complicated by the syndrome of mechanical jaundice, were analyzed. The main group included 33 (32.7%) patients in whom pancreatoduodenal resection was combined with extended lymphodissection; the comparison group included 68 (67.3%) patients who underwent a similar operation, but lymphodissection was performed in the standard volume.Variational and non-parametric statistics methods were used.

Results. The overall 1-year survival rates of patients in the main group and the comparison group were not significantly different and amounted to 71.3% and 69.2%. Median survival after standard PDR was 15.8 months, after extended - 20.2 months. The overall disease-free 1-year survival rates of patients in the main group and the comparison group did not differ significantly and amounted to 54.1% and 48.3%. Median disease-free survival in the main group was 15 months, and in the comparison group - 12 months.

Conclusions. According to the results of the comparative analysis of long-term results, the use of pancreaticoduodenal resection of different lymph node dissection volume in patients of the compared groups did not reveal statistically significant differences in survival.

No conflict of interests was declared by the authors.

Secondary chest deformation after Nuss funnel chest correction

O.A. Danylov, V.R. Zaremba, O.V. Shulga — Fri, 28 Jun 2024 00:00:00 +0300

Aim - studying the influence of the elasticity of the chest on the formation of secondary pectus carinatum and secondary protrusion of costal arches after Nuss procedure in order to determine the risk groups for the occurrence of data of secondary postoperative deformations in order to optimize a surgical intervention in these groups .

Materials and methods. We analysed the data of 6 patients with pectus carinatum and 5 children with rib arches protrusion, which were formed as a result of Nuss funnel chest correction. The elasticity of the chest was studied by determining the ratio of its circumference during maximum inhalation and exhalation (mobility index - MI) as well as the ratio of the distance between the support plane in the supine position and the front surface of the chest in a neutral position and at the moment of compression (compliance index - CI). To calibrate the indicators, the data were calculated in a group of 30 healthy children. Depending on the obtained values, 3 degrees of chest elasticity are distinguished: high, medium and rigid chest.

Results. 3 degrees of chest elasticity were determined in children without chest deformity: high (MI - 9.1±0.9%; CI - 28.1±1.8%), medium (MI - 6.8±0.2%; CI - 22.7±2.1%) and a low or rigid chest (MI - 4.9±0.2%; CI - 15.6±1.8%). The following data were recorded in patients with secondary deformities: 80% of patients with secondary pectus carinatum had a high degree of elasticity of the chest, 20% - average degree. In 83.33% of cases, patients with secondary rib arches protrusion had a high degree of elasticity of the chest, and 16.67% had an average degree. Secondary rib arches protrusion in 80% of cases is combined with the use of one horizontal bar. All cases of occurrence of secondary deformations are associated with a symmetric local type of funnel chest with or without deformations of costal arches or with an asymmetric local type.

Conclusions. Using the Nuss operation technique with short plates in patients in the period of rapid growth with a high degree of elasticity of the chest with type IA and IIA1 of funnel chest can reduce the risk of secondary pectus carinatum; and in cases of high level risk of secondary protrusion of the rib arches the "flare buster" technique can help avoid this complication. The vast majority of secondary deformations are prone to spontaneous regression.

The research was adhered to the principles of the Declaration of Helsinki. The research protocol was agreed by the Local Ethics Committee of the mentioned institution. The patients' informed consent was obtained for the study.

No conflict of interests was declared by the authors.

Isolated hypoplasia of the right ventricle: diagnosis, treatment and observation experience of pediatric patients

O.V. Stogova, A.O. Mykhaylovska, O.S. Stychinsky — Fri, 28 Jun 2024 00:00:00 +0300

Isolated hypoplasia of the right ventricle (IHRV) is a rare congenital heart defect characterized by a reduction of the right ventricular cavity due to hypoplasia of its trabecular part.

Aim - to analyze the anatomical variants of IHRV and their influence on the choice of treatment tactics based on the experience of observing pediatric patients.

Materials and methods. This retrospective study included 11 consecutive patients diagnosed with IHRV from 2012 to 2024. Patients were divided into 3 groups based on the ratio of RV to left ventricle (LV) length. The Group I (n=4): mild IHRV (RV/LV length ratio >0.8). The Group II (n=4): moderate IHRV (RV/LV length ratio = 0.7-0.8). The Group III (n=3): severe IHRV (RV/LV ventricle length ratio <0.67).

Results. From the Group I (n=4), one patient required medication therapy with beta-blockers and others did not require any treatment. From the Group II (n=4), one patient underwent Glenn shunt and patent foramen ovale (PFO) closure, another - Glenn shunt and PFO closure with fenestration. Two patients have stable clinical conditions. Patients from the Group III (n=3) had duct-dependent pulmonary blood flow in the neonatal period. One patient received treatment with beta-blockers; the second patient underwent patent ductus arteriosus stenting; and the third - systemic-to-pulmonary shunt.

Conclusions. Patients with severe IHRV may have critical hemodynamic disturbances requiring urgent cardiac surgical interventions, whereas patients with mild and moderate hypoplasia may require medical treatment with possible surgical intervention at a later age. Long-term follow-up in this defect reveals a slow progressive growth of the right heart chambers.

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 authors declare no conflict of interest.

Intravenous infusion of lidocaine for the prevention of chronic postoperative pain in children after various types of surgical interventions

Fri, 28 Jun 2024 00:00:00 +0300

Chronic postoperative pain is a serious postoperative complication. Inadequate pain management in the early postoperative period can contribute to the development of hyperalgesia.

Aim - to evaluate the effectiveness of intravenous infusion of lidocaine in the prevention of chronic postoperative pain after various types of surgical intervention in children and adolescents.

Materials and methods. 150 children who underwent under general multicomponent anesthesia surgical interventions due to traumatic pathology (I group, n=40), abdominal (II group, n=48) and urological (III group, n=62) surgical interventions were examined. Each of these groups was divided into two subgroups: in the subgroups Ib (n=17), IIb (n=19) and IIIb (n=24) children received intravenous lidocaine (according to the instructions) as a component of multimodal analgesia in the perioperative period, in the control subgroups Ia (n=23), IIa (n=29) and IIIa (n=38) children did not receive lidocaine. The presence of chronic postoperative pain 6 and 12 months after the operation, its frequency, localization, intensity according, the impact on the child’s daily activity were analyzed. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0.

Results. Perioperative use of intravenous lidocaine infusion inpediatric patients was associated with a lower incidence of chronic pain 6 and 12 months after trauma surgery (odds ratio (OR): 5.13; 95% confidence interval (95% CI): 1.13-23.3 and OR: 4.24; 95% CI: 1.01-93.48, respectively) and after abdominal surgery (OR: 5.19; 95% CI: 1.02-26.94), as well as a higher level of functional activity after trauma (OR: 5.52; 95% CI: 1.08-28.2; p=0.028) and abdominal surgery (OR: 8.1; 95% CI: 1.01-70.36; p=0.032), but not after urological operations.

Conclusions. This study demonstrated the efficacy of intravenous infusion of lidocaine to prevent of chronic pain after trauma and abdominal surgery in pediatric 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 interests was declared by the authors.