Cylindrical and button battery ingestion in children: a single-center experience.

PURPOSE: The purpose of our study was to perform a comparative analysis of the examination and treatment outcomes of children with cylindrical and button batteries (BB) ingestion depending on their size and anatomical locations. METHODS: This study was a retrospective analysis of 124 children aged from 1 month to 18 years who ingested batteries and were treated in a tertiary care center from January 1, 2014 to March 31, 2019. The data studied included age, sex, presenting symptoms at the time of evaluation, type and size of battery and modality of management. RESULTS: Twenty-three (18.5%) patients ingested cylindrical batteries (CBs), and 101 (81.5%) ingested BBs. The duration of hospital stay was significantly longer (p = 0.004) in the group of children who ingested BBs larger than 20 mm. Endoscopic removal was performed in 75 (60.5%) children, 46 (37.1%) were followed up and three (2.4%) underwent open surgeries. Children with CBs ingestion, in 55% of cases, had gastric mucosal injuries. Children with BBs impacted in the esophagus in 96% cases had visible severe mucosal damage, whereas patients with gastric BB ingestion 19.5% had superficial gastric mucosal damage. CONCLUSION: Performing timely endoscopic retrieval in children who are admitted early to the hospital will reduce the risk of damage to the gastrointestinal mucosa, especially in the stomach. Unlike BBs, CBs, despite their large size, have advantageous shapes, uneventfully pass the esophagus and are more often retained in the stomach; thus, mucosal injuries are more often observed in the stomach. Consequently, endoscopic extraction is the treatment of choice for children with BB ingestion.

[Scanning electron microscopy of resected ureters in children with ureterohydronephrosis].

Using scanning electron microscopy, various portions of the ureter in reflux and obstructive ureterohydronephrosis in children were evaluated. In the first case, architectonics of the distal portions is preserved, while in the second case connective tissue is proliferated. Differences in the structure of proximal and distal portions in both forms of ureterohydronephrosis consist in inflammatory changes and violation of the integrity of the epithelial lining, edema and infiltration of the underlying layers, especially the inner muscle layer of the distal portion. The wall of the ureter in proximal part is much thinner, especially the muscular and mucous layers.

[On the improvement of surgical treatment of destructive pancreatitis]. / Puti uluchsheniia khirurgicheskogo lecheniia destruktivnogo pankreatita.

Results of treatment of destructive pancreatitis during the recent 20 years have been analyzed. Among 189 patients with this disease there were 54.5% of women and 45.5% of men aged from 20 to 80 years. The main principle of the surgical treatment was active ablation of all foci of destruction in the pancreas, abdominal cavity and retroperitoneal fat. "Closed", "open" and "combined" operations were used according to individual indications established by highly informative methods of diagnostics such as ultrasound, CT, retrograde pancreatocholangiography, laparoscopy. Combined use of the operations, flow lavage of bursa omentalis and retroperitoneum, complex therapy using intraarterial laserotherapy have allowed to reduce postoperative complications from 41 to 17% and mortality from 31 to 11.5%.

[Treatment of middle-lobe syndrome]. / Lechenie srednedolevogo sindroma.

Results of treatment of 242 patients with middle-lobe syndrome are analyzed. Indications for surgical treatment of middle-lobe syndrome must be determined very individually. Organo-saving surgeries are the methods of choice for benign processes in the middle lobe. In malignant tumors, destructive and cirrhotic processes of the middle lobe the resections are indicated.

[Results of drainage operations for the destructive pancreatitis]. / Rezul'taty dreniruiushchikh operatsii po povodu destruktivnogo pankreatita.

Results of treatment of 189 patients with destructive pancreatitis were analyzed. The surgical tactics improvement in 1999-2002 yrs in wide-spreading forms pancreonecrosis had constituted the substantiated active excision of all the pancreatic destruction foci present as well as in retroperitoneal fat and peritoneal cavity, individual performance of "closed", "open" and "combined" operative intervention. Application of the staged programmed sanation interventions have permitted to achieve the postoperative complications frequency occurrence from 41 to 17.9% and mortality from 31 to 11.5%.

[Skin-muscle flaps in reconstructive plastic surgery of the breast]. / Kozhno-myshechnye loskuty v rekonstruktivno-plasticheskoi khirurgii molochnoi zhelezy.

The authors' experience with treatment of 20 patients has shown that musculo-cutaneous thoracodorsal and TRAM flaps are the best methods of breast plasty after mastectomy. These operations provide oncologically safe performing radical mastectomy with the simultaneous restoration of the shape and volume of the breast and give reliable results. The additional application of the axillary fascial-fatty graft from the lateral surface of the chest improves the esthetic results of the breast reconstruction with the thoraco-dorsal flap. Using the TRAM flap for subcutaneous mastectomy can be the operation of choice in surgical rehabilitation of certain forms of tumor-like lesions of mammary glands.

[Some pathogenetic aspects of developing liver failure and preventing it in patients with liver cirrhosis after portosystemic shunting]. / Nekotorye patogeneticheskie aspekty razvitiia pechenochnoi nedostatochnosti i ee profilaktika u bol'nykh s tsirrozom pecheni posle portosistemnogo shuntirovaniia.

Patients with cirrhosis of the liver were found to have a considerable suppression of the system of biotransformation of the liver before operation which correlated with the data of the direct indices of monooxigenase system of hepatocytes--cytochrome P-450 and activity of N-demethylase of amidopyrine. Operative interventions on such patients independent of the type of portosystemic shunting result in considerably decreased content of metabolites of amidopyrine--4AAP and N-ac-4-APP in urine as compared with the preoperative level (p < 0.05). Hyperbaric oxygenation is the optimal stimulator of activity of the liver biotransformation system. Better indicators characterizing the increased metabolic activity of the liver were noted in patients with selective portosystemic anastomoses and hyperbaric oxygenation in the postoperative period.

[Treatment strategy in bleeding from gastroesophageal varicose veins in patients with liver cirrhosis complicated by portal hypertension]. / Taktika lechenii krovotecheniia iz varikoznykh ven gastroézofageal'nogo kollektora u bol'nykh s tsirrozom pecheni, oslozhnennym portal'noi gipertenziei.

The article presents an analysis of results of different operations disuniting the gastroesophageal collector in patients with portal hypertension. Unsatisfactory long-term results of the Pazior operation widely used in CIS are known although this operation meets the requirements of emergency surgery aimed at saving the patient's life. The authors have developed an original method of disuniting the gastroesophageal collector. The method was tested in planned and emergency operations. An analysis of the preliminary results shows good perspectives of this direction.

[Use of the glue composition TachoComb in forming the portosystemic anastomosis]. / Primenenie kleevoi kompozitsii "TakhoKomb" pri formirovanii portosistemnogo anastomoza.

The Tachocomb plates were used by the authors in 15 patients for forming the proximal splenorenal anastomosis and selective decompression of the portal system. The data of sonography have shown the valuable functioning of the shunt in all the patients within the period from 6 months to 3 years. The proposed method provides reliable hemostasis during operation and prevents thrombosis of portosystemic anastomoses.

[The characteristics of the surgical procedure in treating subcompensated portal hypertension in liver cirrhosis]. / Osobennosti khirurgicheskoi taktiki v lechenii subkompensirovannoi portal'noi gipertenzii pri tsirroze pecheni.

The priority of the surgical correction of portal hypertension in patients with liver cirrhosis belongs to proximal spleno-renal anastomosis. The investigations performed have proved that preliminary embolization of the splenic artery with a metallic spiral should be carried out before placing this anastomosis. It has positive effects on the course of the nearest postoperative period. In addition, the preliminary embolization of the splenic artery may be used as a test of endurability of great cavitary operation on the vessels.

[Complications and reoperations after peritoneo-atrial shunting in patients with liver cirrhosis and diuretic-resistant ascites]. / Oslozhneniia i povtornye operatsii pocle peritoneoatrial'nogo shuntirovaniia u bol'nykh s tsirrozom pecheni i diuretikorezistentnym astsitom.

The analysis of postoperative complications, which developed in 33 patients after peritoneoatrial shunting (PAS), was carried out. The effectiveness of PAS is determined by proper choice of the indications, adequate performance of surgical intervention. The use of intraoperative teleroentgenoscopy for control of the venous catheter situation is recommended. Reoperations for postoperative complications are to be performed in presence of a pressure gradient in the valvular system and in patients with shunt infection after elimination of the inflammatory process.

[Combined use of peritoneo-atrial shunting and endoscopic sclerotherapy of esophageal varicose veins in treating liver cirrhosis with portal hypertension and resistant ascites]. / Sochetannoe primenenie peritoneoatrial'nogo shuntirovaniia i éndoskopicheskoi skleroterapii varikozno-rasshirennykh ven pishchevoda v lechenii tsirroza pecheni s portal'noi gipertenziei i rezistentnym astsitom.

The authors in 39 patients with liver cirrhosis and intractable ascites performed peritoneoatrial shunting (PAS), in 16--PAS in combination with prophylactic endoscopic sclerotherapy (ES) of gastric varices (GV). Prophylactic use of ES before PAS permitted to reduce more than 3-fold the incidence of postoperative bleeding from EV.

[Correction of hemodynamics after peritoneoatrial shunt in liver cirrhosis with resistant ascites]. / Korrektsiia gemodinamiki posle peritoneoatrial'nogo shuntirovaniia pri tsirroze pecheni s rezistentnym astsitom.

Complex examination of hemodynamics was performed in 26 patients with cirrhosis of the liver with portal hypertension after operation of peritoneoatrial shunt using the methods of integral rheography, probing of heart cavities and pulmonary artery. Clinical results of the operations were analyzed. A conclusion was made of the absence of substantial alterations of gas exchange and hemodynamics of the lesser circulation. The alteration of the colloido-oncotic properties of blood are thought to be the leading factor in pathogenesis of the appearance of postoperative cardiopulmonary complications.