[Chronic duodenal obstruction in children]. / Khronicheskaia duodenal'naia neprokhodimost' u detei.

Chronic duodenal obstruction was observed in 18 children aged from 2 months to 14 years. The disease was caused by different malformations of the intestine. In children younger than 7 years of age the main clinical manifestation of the disease was the syndrome of vomiting. Older children were admitted for examination for the chronic abdominal pain syndrome. Roentgen-contrast methods of examination of the stomach and duodenum were of decisive significance. All the children were operated upon. The operative method was chosen according to the intestinal malformation.

[Neutral alpha-glucosidase activity in the urine in congenital hydronephrosis in children]. / Aktivnost' neitral'noi al'fa-gliukozidazy v moche pri vrozhdennom gidronefroze u detei.

Enzymuria was studied in children who had undergone surgery for congenital hydronephrosis. A total of 109 patients were operated on according to Andersen-Hynes-Kucher with ureteral intubation and pelvic drainage. The course of renal tissue tubular function recovery upon elimination of the obstruction in the pyeloureteral segment was followed up by urine activity of neutral alpha-glucosidase as was the enzyme activity dynamics in dysplastic congenital hydronephrosis. The latter evidences reduced, but satisfactory functional capacity of the operated on organs.

[Diagnosis and treatment of ceco-ileal reflux in children]. / Diagnostika i lechenie tsekoilea'nogo refliuksa u detei.

A cecoileal reflux detected in children under the age of 5 years may be related to the manifestations of relative immaturity. In older children experiencing continuous pain, irrigography must be performed to verify the diagnosis and the degree of the reflux. In a group of 111 patients, 51 with Degree 2 and 3 passive reflux underwent operation. Appendectomy was performed in which the purse-string suture created conditions for tightening the frenuli, which explains the effectiveness of interventions verified by late results.

[The choice of the method of urinary diversion in bladder exstrophy in children]. / K vyboru metoda derivatsii mochi pri ékstrofii mochevogo puzyria u detei.

Transplantation of the ureters into the sigmoid colon by Tikhov-Coffey in the authors' modification has been carried out in 10 children. The ureters were placed into the channel made by supramucosal dissection. Good response was achieved in 9 patients. One case of transplantation of the only ureter of heminephrectomized kidney was fatal.

[Surgical treatment in different variants of the duplicated kidney in children]. / Operativnoe lechenie razlichnykh variantov udvoennoi pochki u detei.

The paper details various surgical treatment of double kidney variants. A total of 49 children have been treated, of whom in 3 cases the subdivision was incomplete. The causes and characteristics of the kidney lesions varied. They had arisen most frequently due to tissue embryonal inferiority. The method of operative correction requires a careful approach to parenchymal affection form and degree, to the examination policy and is predetermined by timely and thorough diagnosis.

[The morphofunctional status of the contralateral kidney in hydronephrosis as the criterion of the efficacy of surgical treatment in the past]. / Morfofunktsional'noe sostoianie kontralateral'noi pochki pri gipernefroze kak kriterii éffektivnosti operativnogo lecheniia v otdelennom periode.

An x-ray examination has been performed for 109 patients operated on for unilateral hydronephrosis since 1980. All the children underwent surgery according to Andersen-Hines-Kucher. Long-term follow-up excretory urography determined the coefficient of surface area for the contralateral and operated on kidney. The coefficient served a criterion of the kidney morphology and function. The paper provides follow-up morphological parameters for both kidneys in relation of the obstruction degree, postoperative period, age of the child at the moment of the surgery. In hydronephrosis of the 1 degree morphological changes in the kidney did not occur, 2-degree hydronephrosis abnormalities in the kidney disappeared after the surgery by the 3 postoperative year. In severe disease morphological recovery was observed to the end of postoperative year 6, whereas intensive growth of the parenchyma owing to immature renal structures lasted for 3 postoperative years. In similar obstruction, more serious changes in the renal tissue occurred in younger children which may be due to more pronounced shifts in renal tissue differentiation.

[Radioisotope renography in the assessment of kidney function and urodynamics in children following the surgical treatment of hydronephrosis]. / Radioizotopnaia renografiia v otsenke funktsional'nogo sostoianiia i urodinamiki pochek u detei posle operativnogo lecheniia gidronefroza.

The paper provides radionuclide findings in children surgically treated for hydronephrosis. Altogether 109 children were operated on according to the technique by Andersen-Hines-Kucher with ureteral intubation and pelvic drainage. The radionuclide investigation allows determination of the time needed for functional recovery of the operated on kidney as well as visualization of changes in the contralateral follow-up period. Preoperative age-related changes in recovery of secretory and excretory functions of the operated on kidney were investigated.

[Extracorporal and endogenous detoxication in appendicular peritonitis in children]. / Ekstrakorporalnaia i éndogennaia detoksikatsiia pri appendikuliarnom peritonite u detei.

The article deals with the method for detoxification of patients with diffuse and generalized peritonitis. Exogenous detoxification was accomplished by the open method for peritonitis management (laparotomy), endogenous detoxification was achieved by well-founded intraperitoneal and intravenous administration of proteolysis inhibitors. Comparison of the two groups of patients who were operated on showed marked reduction of mortality from 22.2% to 2.7% in generalized peritonitis and from 9.6% to zero in diffuse peritonitis.

[Early commissural ileus after appendectomy in children]. / Ranniaia spaechnaia neprokhodimost' kishechnika posle appendektomii u detei.

The results of treatment of early commissural ileus (ECI) after appendectomy in children for the period of from 1971 to 1988 are presented. Before 1980, the active tactics of treatment was predominantly used. Of the 4412 patients who underwent appendectomy, ECI developed in 28 (0.68%), 18 were operated on, including the 7--repeatedly. Since 1980, the complex of conservative measures permitting to avoid the operative intervention more than in 60% of the patients has been introduced. Of the 4281 patient operated on for acute appendicitis, ECI developed in 12 (0.28%). The conservative measures has proved to be effective in 2/3 patients. Recurrency of commissural ileus was noted in 1 patient. There were no lethal outcomes.

[Laparoscopy in the diagnosis of acute appendicitis in children]. / Laparaskopiia v diagnostike ostrogo appenditsita u detei.

In the period between 1984 and 1988 laparoscopy was conducted 846 times in children with suspected acute appendicitis. In 301 children the diagnosis was confirmed in atypical forms of appendicitis. In 418 children laparoscopy revealed diseases which are recognized with great difficulties (mesadenitis, primary peritonitis, genital diseases, etc.), in which the final diagnosis is usually established during laparotomy. In 39 children laparoscopic diagnosis was conducted during intercurrent diseases in which the abdominal pain syndrome simulated the clinical picture of acute appendicitis. As the result of laparoscopic examination the number of operations for simple forms reduced from 38.3 to 6.2% and the timely diagnosis of acute appendicitis improved.

[Ways of improving results of the treatment of appendicular peritonitis in children]. / Puti uluchsheniia rezul'tatov lecheniia appendikuliarnogo peritonita u detei.

The analysis of the results of treating 849 children with appendicular peritonitis for 1975-1989 was carried out. In 1975-1982, the reoperations for early intraabdominal complications were performed in 28 (5.4%) patients, the lethality was 1.7%. Use in the clinic of the common classification of peritonitis permitted to enhance the effectiveness of preoperative diagnosis, and improve the results of its treatment. The incidence of relaparotomy reduced to 0.8%, and lethality--to 0.3%.

[Surgical treatment of myasthenia gravis in children]. / Khirurgicheskoe lechenie miastenii u detei.

The article deals with the treatment of myasthenia in 33 children whose ages ranged from 3 to 15 years. Myasthenia of moderate severity was diagnosed in 14, severe in 15, and extremely severe in 2 children. To make a precise diagnosis, loading, neostigmine methylsulfate, cold, and D-tubocurarine tests were conducted. Thymectomy was performed in 32 patients. The operation was carried out through a T-shaped sternotomy approach. Thymogenic myasthenia was verified in 31 patients and thymomogenic only in one patient. There were no fatal outcomes. The late-term results were studied in 12 patients in follow-up periods of 3 to 6 years. Adaptational activity of the patients, anticholinesterase agents and the results of stimulant electric myography served as the criterion in appraising the late-term results. Modern diagnostic methods and surgical intervention ensure a favourable result in 75% of patients.