[Abdominal tuberculosis in children]. / Abdominal'nyi tuberkulez u detei.

OBJECTIVE: To determine the features of diagnosis and clinical course of abdominal tuberculosis in children. MATERIAL AND METHODS: Eighteen children aged from 5 days to 16 years with abdominal tuberculosis have been followed-up throughout 50 years. Diagnostic process implied anamnesis, objective examination, laboratory data and specific samples, ultrasound, X-ray examination, MRI, CT and morphological examination of specimens. RESULTS: Intestinal form was diagnosed in 2 children with abdominal tuberculosis, mesadenitis - 3 patients, liver tuberculosis - 4 ones, tuberculosis of uterine appendages - 3 patients, peritonitis - 6 ones. CT of the abdomen, diaskintest and morphological examination were the most important diagnostic methods. Laparotomy was performed in 16 children. Five cases are decsribed. CONCLUSION: Abdominal tuberculosis in children is mostly secondary. Several anatomical regions are simultaneously involved in specific process. Isolated lesion of one abdominal organ is rare. Active tuberculosis of respiratory organs in pregnant women has a significant negative impact on the fetus and newborns.

[Diagnosis and surgical treatment of hypospadia in girls].

AIM: To suggest new method of surgical correction of hypospadias in girls. MATERIALS AND METHODS: For 50 years under our supervision there were 220 girls diagnosed with hypospadias of various forms. In the diagnosis used anamnesis, examination, catheterization and cystoscopy of the bladder, vaginoscopy, ultrasound and X-ray research methods. RESULTS AND DISCUSSION: Of 220 girls with a diagnosis of hypospadias, vestibular (partial) hypospadias occurred in 201 girls, vestibulovaginal (subtotal) in 16, and vaginal (total) in 3. Of 201 girls with vestibular hypospadias, 37 suffered from urinary incontinence, 16 had vesicoureteral reflux, 21 had doubling, 5 had renal hypoplasia, and 12 had renal dystopia. The vulvovaginal form was manifested not only by the dystopia of the external opening of the urethra, but also combined with the underdevelopment of the sphincteral apparatus of the bladder. All children had daytime and nighttime urinary incontinence, vulvovaginitis. Cystoscopy revealed hyperemia of the urethra and bladder neck. X-ray urological examination revealed VUR in 6 children, ureterohydronephrosis - in 2. All children suffered from chronic pyelonephritis, 8 - day and night urinary incontinence. There were 3 girls (14-16 years old) with vaginal (total) hypospadias. All suffered from constant urinary incontinence, vulvovaginitis, cystitis, chronic pyelonephritis, all had VUR. The new operation for the vaginal (total) form of hypospadias, proposed by us, restores the closure function of the bladder sphincter by suturing the defect in the posterior wall of the bladder neck. CONCLUSION: Hypospadias is rare in girls. There are vestibular, vestibulovaginal and vaginal forms of hypospadias. In most cases, the vestibular form does not require surgical treatment. With the vestibulovaginal and vaginal (total) form of hypospadias, surgical treatment is indicated.

[Acquired internal intestinal fistulae in children]. / Priobretennye vnutrennie mezhkishechnye svishchi u detei.

OBJECTIVE: To analyze the diagnosis and treatment of children with acquired internal intestinal fistulae. MATERIAL AND METHODS: There were 3 infants and young children with acquired internal intestinal fistulae. Clinical, laboratory and radiological diagnostic methods were used. RESULTS: Two out of 3 children with acquired internal intestinal fistulae underwent surgical treatment for congenital intestinal obstruction. Acute intestinal ulcers appeared after surgery. In a premature child, intestinal fistula arose on the background of necrotizing colitis. Conservative approach was applied in this case. All children were operated on; intestinal fistula was eliminated. Two children are alive, 1 died after surgery (multiple organ failure). CONCLUSION: Acquired internal intestinal fistulae are rare in children. Their causes may be acute intestinal perforation after surgery or covered (not diagnosed) ulcer as a complication of necrotizing colitis in premature children.

[Urogenital tuberculosis in children].

AIM: To analyze the clinical spectrum of urogenital tuberculosis (TB) in children from 1993-1997 to 2013-2017, who were treated at the FSCU "Kiritsy". MATERIALS AND METHODS: Clinical forms of urogenital tuberculosis were diagnosed in 195 children (stage 1) and 158 children (stage 2). Conventional methods of TB diagnosis, including clinical, laboratory, imaging studies, tuberculin skin test and urine culture for BCG were used. In all cases, standard treatment for TB in combination with physiotherapy were performed. RESULTS: When comparing the clinical spectrum of urogenital tuberculosis in children in 1993-1997 yy. (stage 1) and 2013 and 2017 yy. (stage 2), who were treated at the children's tuberculosis clinic "Kiritsy", the authors concluded that during the last 5 years the number of children with urogenital tuberculosis had decreased by 1.5 times (195 children in 1 stage, 158 in 2 stage) and proportion of children with a destructive form of urogenital tuberculosis decreased by 4 times (15 children in stage 1, 4 in stage 2). The contemporary diagnostic methods (urine culture, Diaskintest, ultrasound, instrumental methods) contributed to improved diagnosis of urogenital tuberculosis. Novel powerful antituberculous antibiotics allowed to significantly improve treatment outcomes. RESULTS: 1) The incidence of urogenital tuberculosis in children over the past 5 years has decreased by 1.5 times compared with 90th years of the the last century. 2) At the current stage, the use of urine culture, Diaskintest, ultrasound, x-ray and instrumental methods contributes to the diagnosis of urogenital tuberculosis in children. 3) Multidisciplinary team consisted of pediatricians, pediatric urologists, phthisiopediatric as well as sanitary and educational work in the foci of infection allow to identify the urogenital tuberculosis in children.