EXPERIENCE OF APPLICATION OF VOLUME FORMING AGENT «DAM+¼ IN TREATMENT OF ANAL INCONTINENCE ASSOCIATED WITH INCOMPETENCE AND TRAUMA OF ANAL SPHINCTER.

The attempts of introduction of volume forming agent in submucous layer started at the beginning of 1990th. The aim of these innovations was to rise of basal pressure. This research has been performing since 2007. It included experimental and clinical phases with participation of 41 patients with anal incompetence aged 3­26 years old. The agent «DAM+¼ was introduced in submucous layer of anal сanal in four points. The basal pressure was risen in 2­3 times after implantation and it was at the average more 65% of age standards. The application of volume forming agent «DAM+¼ is effective method of correction of anal incontinence. It'll require the re-introduction procedure in longterm period.

[EMBOLIZATION OF BRONCHIAL ARTERIES IN ACUTE PULMONARY BLEEDING IN CHILDREN].

Children with acute pulmonary bleeding (8 cases) due to different pathology of trancheobronchial tree were followed-up at the period from 2008 to 2014. Diagnostic angiography and X-ray endovascular occlusion of bronchial arteries were performed in the case of insufficiency of conservative and endoscopic methods of hemostasis. Microembolic spheres were used for embolization of distal vessels. The embolization coils and micro-coils were applied for occlusion of great vessels. Children (5 cases) were discharged from the hospital after embolization at the terms of 6-12 months. They hadn't any ischemic complications associated with bronchial artery occlusion. The sequelae of main disease caused deaths of 3 other kids. The X-ray occlusion is a low-invasive and highly effective method of arrest of all types of bleeding from pool of bronchial arteries. The method could be applied even in extremely severe condition of the patients.

[Using dissection of the internal anal sphincter with its hypertrophy in children].

Treatment of chronic constipations in children still remains an actual problem. In the period from 1996 to 2008 we made 4739 ultrasonic investigations in 3526 patients. Thickness of the internal anal sphincter was found in 1.72% of children. Operation of sphincterotomy of the internal anal sphincter was performed on 41 patients, its efficiency being studied within 1-2, 3-5 and 7-10 years. This intervention was shown to reestablish independent emptying in more than 70% of patients.

[First experience with gel plasty of the anal canal in children with fecal incontinence].

Fecal incontinence in children after surgical correction of anorectal defects and trauma of the holding apparatus of the rectum in certain cases can be dependent on low basal pressure in the anal canal at the expense of incompetence of the interior sphincter muscle of the anus. In order to eliminate low pressure in the anal canal we introduced polyacrylamide gel "DAM +" into its submucous layer. The introduction of this volume-forming substance into the anal canal was an effective procedure. Fecal incontinence became less in all cases, and completely regressed in 50% of the patients.

[Evolution of diagnostics and treatment methods of closed isolated spleen injuries in children].

An analysis of treatment of 75 children of the age from 3 years to 17 admitted to the St. Petersburg Pediatric Medical Academy was made. All the children were admitted with the diagnoses of blunt (closed) injuries of the abdomen, ruptures of the spleen, intra-abdominal bleedings. The patients were divided into 3 groups according to the periods of hospitalization. In each group the patients were examined and treated which corresponded to the surgical strategy for rupture of the spleen at that period. Different methods of examinations and therapy were determined in the three groups of patients with similar pathology.

[Dissection of the anal internal sphincter in children with anal achalasia].

Since 1996till 2008 we have performed 13 864 colodynamic investigations in 3466 patients. In 136 (3.92%) of them a disturbance of the rectoanal reflex was detected and the diagnosis of anal achalasia was made. Dissection of the anal internal sphincter was performed in 93 patients and its efficiency was studied within 1-2, 3-5 and 7-10 years. This intervention was shown to allow recovery of independent emptying in more than 70% of children with anal achalasia.

[Features of colonic fixation in children with chronic abdominal pain]. / Osobennosti fiksatsii tolstoi kishki u detei s khronicheskimi boliami v zhivote.

Complex examination (clinical, rentegenological, endorectal ultrasonography and colodynamic investigations) of 73 children with chronic pains in the abdomen has shown that the cause of the disease might be the impaired fixation of the colon. Four main variants of the abnormal position of the colon in the abdominal cavity are determined which manifested themselves as a combination of pain syndrome with constipation. They are: "moving" blind gut, right-sided colonoptosis, total colonoptosis and the Payr syndrome. Most frequently the abdominal pains as well as their combination with constipation were noted in children with the Payr syndrome. The treatment was started with conservative measures directed to cupping the pain syndrome and elimination of intestinal stasis. The conservative therapy was effective in 75% of cases. The indication for surgical correction of the wrong fixation of the colon were: pronounced pain syndrome not cupped by conservative methods and deterioration of the quality of life of the patient. Surgical correction of the impairment of fixation of the colon was fulfilled on 10 patients. Good immediate and long-term results were obtained in 8 of them. If the cause of constipation was intumescence of the internal sphincter of the anus, the first step of surgery was internal sphincterotomy after Lynn (7 patients).

[Complex radiologic investigation for disorders of defecation in children]. / Kompleksnoe luchevoe issledovanie pri narusheniiakh defekatsii u detei.

The work presents findings obtained by the radial examination of the anorectal area including routine methods such as irrigography and balloon proctography as well as modern technologies such as endorectal ultrasonography with a transducer of high resolution (7.5 MHz) and computed tomography in 250 children with more common syndromes in colonoproctology: constipation and incontinence of feces. Results of the endosonographic investigation of the normal sphincter apparatus in children are described. It is confirmed that endosonography is of great importance for the detection of the isolated intumescence of the anal sphincter. Computed tomography is also necessary for traumas of the anorectal area in children.

[The classification and choice of the method of treatment in fecal incontinence in children]. / K voprosu o klassifikatsii i vybore metoda lecheniia nederzhaniia kala u detei.

Complex examinations of 682 children with fecal incontinence including the colonodynamic investigation, computed tomography of the pelvis and endorectal sonography have shown that disturbance of the reservoir function and defecation urge mainly take place in cases of functional disorders. Anal incontinence of an organic type can also arise without an injury of the sphincter apparatus as a result of prolapse of the mucose membrane or stenosis of the distal portion of the rectum. In such cases the operative treatment is indicated. In patients with the incompetent internal and partially injured external sphincter treatment should be started by conservative measures. When the function of the pubo-rectal muscle or of all the elements of the closing apparatus is disturbed the operative treatment is indicated. The operative correction is possible for neurogenic incontinence in order to create the ano-rectal angle. A classification of anal incontinence in children is proposed which takes into account the etiology, pathogenesis and allows the optimum treatments to be chosen.

[The surgical treatment of fecal incontinence in children]. / Khirurgicheskoe lechenie nederzhaniia kala u detei.

Based on his experience with treatment of 112 children the author considers that severe and various disturbances of the rectum abturative apparatus function arising from surgical interventions in the anorectal area require the differentiated approach to choice of the method of surgical correction of the incontinence. The transplantation of the denervated muscle, transplantation of the vascular-nervous thoraco-dorsal flap, a lavsan band were used to make a pubo-rectal loop, plasty of the outer and inner sphincters being performed mainly with local tissues.

[The possibilities for the surgical treatment of neurogenic fecal incontinence in children]. / Vozmozhnosti khirurgicheskogo lecheniia neirogennogo nederzhaniia kala u detei.

Treatment of anal incontinence in children with a pathology of the distal portion of the spine is a serious problem. We observed 36 children aged from 3 to 6 years with the 3rd degree of fecal incontinence. Twenty patients had spina bifida, 12 had meningocele, 4 children had the following symptoms: disturbed formation of the arches, sacrum agenesia, deformity of the distal portion of the spine. The conservative treatment was effective but in children without concomitant neurological disorders (motor disorders of the lower extremities, disturbance of the perineum sensitivity). Great increase of the ano-rectal angle and decreased pressure in the anal canal were found in 12 patients with meningocele and in 4 children with severe defects of the vertebral column. They were subjected to operation of free transplantation of the preliminarily denervated muscle by the Hakelius method. Good effects were obtained in 10 cases of 12 operations.

[Treatment of anal incompetence in children by free graft of denervated muscle]. / Lechenie anal'noi nedostatochnosti u detei metodom svobodnoi transplantatsii denervirovannoi myshtsy.

Transplantation of a denervated muscle imitating a levator loop allows pathogenetic correction of anal incompetence. Its results depend on the patient's participation in the rehabilitation process to a lesser extent than the results of plastics of the external sphincter ani by the traditional methods. This is of certain significance in pediatric practice and makes it possible to operate on younger children. This method produces satisfactory results in the so-called hopeless patients suffering from meningocele and concomitant developmental anomalies of the spine. This makes it possible to widen significantly the indications for surgical treatment of children with fecal incontinence.

[Fecal incontinence in Hirschsprung's disease in children]. / Nederzhanie kala pri bolezni Girshprunga u detei.

Among the criteria of evaluation of the results of operative treatment of Hirschsprung's disease in children, along with the absence of constipation is the function of defecation control. The authors examined 27 patients with fecal incontinence after Duhamel's operation. It was established that fecal incontinence in children after operative treatment of Hirschsprung's disease may be caused not only by affection of the external sphincter muscle of the anus, the nerve plexuses, and adaptation of the rectum to the new conditions after the pull-through operation, but also by trauma inflicted to the levator ani muscle. In children with severe damage to the levator group of muscles consequent upon operative treatment of Hirschsprung's disease, operative intervention for creating the anorectal angle is indicated.

[Use of electrodiagnosis and electrostimulation in the combined treatment of children with anal sphincter incompetence]. / Ispol'zovanie élektrodiagnostiki i élektrostimuliatsii v kompleksnom lechenii detei s nedostatochnost'iu anal'nogo sfinktera.

Results of the examination and treatment of 23 children with the incompetent sphincter ani were analyzed. The method of electrical excitation is recommended for exact determination of the degree of disturbance of the sphincter function. These data were used for the selection of methods of treatment. The application of electrostimulation in the pre- and post-operative period facilitated more rapid restoration of the obturator system of the rectum and sometimes allowed avoiding surgical interventions.

[Pharmacokinetics of ampicillin in peritonitis in children]. / Farmakokinetika ampitsillina pri peritonite u detei.

Ampicillin levels in the blood serum and abdominal cavity biosubstrates of children with appendicular peritonitis were studied. The antibiotic was administered as intravenous jet infusion in single doses of 12--15 and 25--30 mg/kg and drop infusion continuously for 24 hour in doses of 150 and 250--300 mg/kg. Administration of the drug as intravenous jet infusion provided therapeutical ampicillin levels in the appendix tissue and abdominal cavity exudate. Administration of increased doses of the drug resulted in its higher biosubstrate levels. It was found that the level of the appendix destruction had a significant effect on the antibiotic level in this organ. In cases with gangrenous appendititis the ampicillin levels were 1.5--2.2 times lower than those in cases with catarrhal appendititis. The studies on the effect of the infusion therapy on ampicillin pharmacokinetics showed that the volume of the liquids administered intravenously had no significant influence on the antibiotic circulation in the blood. A continuous drop infusion provided high and stable ampicillin levels in the blood serum which significantly exceeded the antibiotic MIC. During the post-operative period the antibiotic levels in the blood serum after intraperitoneal administration were determined. The data showed that ampicillin administered intravenously 2--3 days after the operation was absorbed into the blood in insignificant amounts.

[Pharmacokinetics of ampicillin in acute appendicitis in children]. / Farmakokinetika ampitsillina pri ostrom appenditsite u detei.

The pharmocokynetics of a semisynthetic penicillin-ampicillin in acute appendicitis in children has been studied. Intramuscular and intravenous injections of 12,5 mg/kg and 25 mg/kg single doses of the antibiotic were administered. 50 children aged from 4 to 14 years were examined. Both ways of administration led to the creation of the ampicillin therapeutic concentration in the blood serum, but in case of intramuscular injection the circulation of the antibiotic in the blood was more prolonged. With the increase of the dose the antibiotic concentration in the blood and tissues of the abdominal cavity rises but without any significant prolongation of its circulation time in the blood.