CHALLENGES AND MANAGEMENT OF CONGENITAL ABDOMINAL WALL DEFECTS (REVIEW).

Management of congenital abdominal wall malformations is still a challenge in paediatric surgery due to visceroabdominal disproportion, large defects of abdominal wall and immature abdominal cavity. Most of the patients treated with primary closure need artificial substitutes like patches or biomaterials for non-permanent abdominal wall closure. Patches represent the source of constant infections and complications like separation of prosthesis from fascia. Removal of these patches and ventral hernia repair is essential afterwards. As for component separation technique, this method helps to restore normal anatomy of anterior abdominal wall, results in good cosmetic appearance, requires only one-stage operation procedure, minimal skin flap advancement and is associated with lower infection risk. Although, while performing component separation technique, perforator branches of epigastric artery (periumbilical perforators) are damaged and puts the vascularization of the skin at the risk. Only pudendal artery branches and intercostal arteries are left to supply the skin with the blood, which from our point of view is insufficient. Accordingly, for successful treatment of congenital abdominal wall defects, further research in order to develop new operation techniques, as well as search for the ideal biomaterials for the closure of the large defects of anterior abdominal wall is essential. These biomaterials should possess unique biological properties that are important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, as well as a reasonable cost and low immunogenicity.

BILIARY ATRESIA: CURRENT CONCEPTS AND FUTURE PROSPECTS (REVIEW).

Treatment of biliary atresia is a major challenge in pediatric surgery. Early diagnosis and availability of Kasai procedure with its modern modifications improve outcome of biliary atresia treatment. But Kasai procedure does not fully restore anatomical integrity of biliary tract, because Oddi sphincter is not included in reconstructed system. Constant reflux of intestinal content into the biliary tree is a cause of recurrent cholangitis and change in biliary epithelium that, which is a predisposing factor for cholangiocarcinoma. Various methods have been developed to improve Kasai procedure and prevent the reflux (anti-reflux valve, different enteric conduits, etc.). Many authors used biological grafts made from artery, vein, appendix, urether as well as synthetic materials to restore hepaticocholedochus. Although, neither of these methods were implemented in clinical practice. Nowadays, huge attention is paid to organ and tissue bioengineering. Present advances of tissue bioengineering may assist to create bile duct equivalent, which can be used to restore biliary tract in patients with biliary atresia.

Capillaroscopy and ECG parameters in children and adolescents with diabetes mellitus type I.

AIM OF THE RESEARCH: Evaluate ECG parameters and detect changes in capillaroscopy parameters in children and adolescents with Diabetes mellitus type 1 (DMT1). ECG and capillaroscopy were performed in 32 children and adolescents (6-15 years old, 17 boys,15 girls) with DMT1. Disease duration - less than 2 years -13, 2-4 years - 10, 5-10 years - 9 cases. The patients were divided into two groups: I group - 12 patients with no complications of DMT1 (in all them duration of disease was less than 2 years), II group - 20 patients with diagnosed cardiac complications of DMT1 (diabetic cardiomyopathy, angiopathy). Additionally 6 of them had diabetic encephalopathy , 4 - diabetic encephalopathy and peripheral neuropathy, 4 - nephropathy and retinal antipathy. Level of glycosides hemoglobin was 8-11%, level of glucose 4 to 15 mmole/L. Control group included 20 healthy children of the same age. In group I ECG is less informative. Hypertrophies of left ventricle and atrium and disorders of repolarization were mainly found in group II. In 62.5% of cases rhythm and conduction disorders were revealed, which were more often in group II. Capillaroscopy changes (pale and cyanotic background, decreasing of the number of capillaries in sight, dilated and contracted diameter, pathological shape and order of capillaries, slow blood flow) were seen both in I and II groups with more prevalence and intensity in the latter one. In children and adolescents with Diabetes mellitus type 1 ECG and capillaroscopy should be performed on the regular basis in order to reveal early changes and start the appropriate treatment in time.

Assessment of anthropological, physical and functional indices in sportsmen (basketball players) against the background of high physical loading.

The goal of the investigation was the estimation of functional condition of anthropometrical, physical and cardiovascular system of sportsmen-basketball players against the background of high physical loading. 100 basketball players at the age from 12 till 18 years underlay the study. Randomized and open controllable research was carried out during 6 months. The following characteristics have been studied: how many days the sportsman is training in a week, how many hours the sportsman is training per day, his mood after training, over fatigue and overtension, frequency of heartbeat, time of breath holding, the general condition, the height in sitting and standing position; circumference of lumbus, chest, arm and limbs, the pulse, pulse, systolic and diastolic arterial pressure before and after physical loading. According to these factors the following sport indices are calculated: Index of Rufe (physical work capacity), the coefficient of endurance (Kvas formula), Shtange test (breath holding at sighing), Genchi test (breath holding at exhalation), average arterial pressure, systolic and cardiac output of blood circulation (the formula of Lilienstrad and Tsander), the coefficient of blood circulation effectiveness, Ketle index (the ratio of height and weight), Minuvre index (the ratio of body and feet length), Pinie index (power of body-build). Statistically authentic increase of breath and pulse in frequency was observed in sportsmen-basketball players after physical loading. The study of amplitude parameters of cardiac cycle among sportsmen-basketball players before and after physical loading has revealed the ability of rather low adaptation of cardiovascular system to physical loading.