[Thoracoscopic treatment of esophageal atresia in infants].

Atresia of esophagus result in absolute lethality without surgical treatment. Posterolateral thoracotomy is a traditional access during such operations, however thoracoscopic methods esophageal atresia has come into practice. Since 2008 all infants (n=22) in our clinic with esophageal atresia have been operated on thoracoscopically. Conversion was performed in 3 observations, 2 children died. Anastomosis insufficiency was diagnosed in 3 patients. 11 children received gullet bougienage in different terms after the operation. Tracheoesophageal fistula recurrence was observed in 2 cases, both were successfully treated thoracoscopically.

[High-frequency oscillatory lung ventilation in neonatal infants with surgical diseases].

The paper presents data on the varieties and modes of the present artificial ventilation and high-frequency artificial ventilation (AV). It describes the basic impact of various ventilation modes on gas exchange, hemodynamics, and mechanical lung properties. The data on the use of high-frequency AV in neonatal infants with various surgical diseases are given. Its place and indications in malformations, such as diaphragmatic hernia and esophageal atresia, are defined. High-frequency oscillatory AV may be recommended for use as an alternative method in the treatment of respiratory failure in neonates with difuse lung lesion and in those with congenital surgical diseases when it is impossible to ensure adequate gas exchange.

[Nutritional therapy in children during perioperative period]. / Nutritivnaia terapiia u detei v perioperatsionnom periode.

The efficiency of nutritive therapy was analyzed in cases of 37 patients with gastrointestinal pathologies. Group 1 comprised 12 patients with fistulas of different etiologies and localizations; and group 2 comprised 15 patients with esophageal pathologies, including 7 children with esophageal atresia and 8 children with post-burn cicatricial stenosis of the esophagus. A method of nutrition-status correction by means of both enteral and parenteral feeding is suggested on the basis of examination findings comprising both clinical and laboratory-and-instrumental data. Preparations for parenteral feeding, i.e. 10-20% fatty emulsions, 10% amino acids solutions and 15-20% glucose solutions, were made use of. Enteral diets: semi-element oligopeptide solutions, like Nutrilon pepti TSC, Alphare. Balanced mixtures: sour-milk Nan, AL 110, Nutrizon, Nutridrink. Practical recommendations were defined, on the basis of study results, as to the therapeutic feeding schemes during the in-hospital treatment stages.

[Artificial esophagus in children]. / Iskusstvennyi pishchevid u detei.

The aims of the study were: 1) to formulate up-to-date principles of coloesophagoplasty (CEP) and to compare methods of CEP; 2) to determine the optimal age for esophagoplasty in children with esophageal atresia; 3) to evaluate quality of life and long term results after esophagoplasty performed in childhood; 4) to present results of surgical treatment of pharynx stenosis in children. Over the last 50 years more than 2 thousand surgeries on the esophagus in children were performed including more than 600 operations of artificial esophagus creation. From 1995 in some patients we carried out extirpation of the esophagus with one-stage plastic operation coloesophagoplasty taken the transplant in the posterior mediastinum. From 1992 on the pharynx with free revascularized intestinal segment was performed in isolated stenosis of the pharynx. Case histories of 54 children aged from 3 months to 15 years were analyzed to compare methods of esophagoplasty when the esophagus was taken behind the sternum and in posterior mediastinum. Case histories of 27 children with atresia of the esophagus were analyzed for determination of optimal age for coloesophagoplasty. Responses to questionnaires were analyzed to evaluate quality of life. From 1980 ive hase operated 28 patients with scarry stenosis of the pharynx (isolated or in combination with esophageal stenosis). Current policy of surgical treatment of pharyngeal stenosis which is considered as surgery of choice-pharyngoplasty with a free intestinal transplant--is described. Development and clinical appliance of up-to-date principles of CEP permitted to reduce the number of complications and to decrease lethality from 3 to 0.5%. After introduction of antireflux cologastroanastomosis the number of complications due to reflux reduced. Extirpation of the esophagus may be valid in peptic stenosis, Barrett's metaplasia, tumors, portal hypertension or angiodisplasia, and in the majority of cases of scarry stenosis of the esophagus.

[Postoperative analgesia with tramal in newborn children using the method of continuous intravenous infusion]. / Posleoperatsionnoe obezbolivanie tramalom u novorozhdennykh detei metodom postoiannoi vnutrivennoi infuzii.

The purpose of the study was to evaluate the efficiency of postoperative analgesia with tramal in the newborns. Analgesia with tramal (5% solution for injections, "Gruonental GmbH", Germany) was administered postoperatively in 20 newborn children. Thirteen children were operated for congenital malformations in the gastrointestinal and urinary tracts, three children were operated for purulent-septic diseases and four children were operated for neoplasms. Hemodynamics indices, i.e. heart rate (HR) and arterial pressure, as well as SaO2, respiratory rate (RR), acid-base condition and behavioral reactions were assessed. Analgesia was implemented by the method of continuous intravenous infusion of tramal, 0.1-0.2 mg/kg.h combined with boluses, 1-2 mg/kg. The newborns were asleep for a major part of time during analgesia with tamal; the stable indices of hemodynamics, acid-base balance, glycemia and of the cortisol level were registered. Arterial hypertension, caused by several factors including the effect produced by tamal, was noted in 70% of children. Dose-dependent hypercapnia was registered in 80% of tests in children at unassisted respiration during the infusion of tamal, which is indicative of that tamal affects the respiratory center during the neonatal period and that it is necessary to monitor thoroughly the respiratory functions, i.e. RR, SatO2, pO2, pCO2, and to choose accurately a preparation dose. The continuous infusion of tamal ensures a sufficient analgesia after different operations and especially after medium-traumatic operations.

[Preoperative care and surgical treatment of small-intestinal fistulas in children]. / Predoperatsionnaia podgotovka i khirurgicheskoe lechenie tonkokishechnykh svishchei u detei.

Experience in using complex treatment in 42 children with unformed small-intestinal fistulas, generalized defects of the anterior abdominal wall and severe disorders of alimentary status is presented. Their preoperative preparation included parenteral alimentation, enteral probe feeding with special elementary milk formulas, correction of metabolic disorders. Intestinoplication during surgery was carried out with the medicinal glue MK-7 to prevent intestinal obstruction and formation of interloop abscesses. The use of portions of the tendinous part of the musculus tensor fasciale late was one the simple and effective methods for plasty of anterior abdominal wall defects.

[Ways to reduce mortality of newborns with developmental defects]. / Puti snizheniia letal'nosti u novorozhdennykh s porokami razvitiia.

Technological progress contributed to progress in surgery on the newborns. However, despite the progress in surgery and intensive care of the newborns, the results of treatment of patients with congenital defects are sometimes disappointing. The priority problems for today are the respiratory distress syndrome, hemodynamic disorders, and renal dysfunction, which can be united into the syndrome of general dysadaptation of the newborns. Based on experience gained in the treatment of newborns in pediatric surgical hospital, protocols of treating newborns with developmental defects (congenital diaphragmatic hernia, esophageal atresia, and gastroschisis) have been developed. These protocols are a stage and a prerequisite for development of more effective methods for treating such patients. Common intensive care should be supplemented by such important measures as maintenance of adequate temperature regimen at all stages of medical transportation and therapy of a newborn, obligatory preoperative preparation for stabilization of vital functions, multicomponent endotracheal anesthesia, use of inotropic agents (dopamine and dobutrex), synchronic prolonged artificial ventilation of the lungs and prolonged analgesia, limitation of indications to the use of blood preparations and wide use of hydroxyethylated starch solutions in infusion therapy, rational antibiotic therapy with constant monitoring of the microecological status, and early detection and correction of concomitant diseases. Solution of these problems will essentially decrease the postoperative mortality of newborns with developmental defects.

[Energy metabolism during intensive care of children in the early postoperative period]. / Energoobmen pri intensivnoi terapii v rannem posleoperatsionnom periode u detei.

Energy metabolism have been investigated using indirect calorimetry technique combined with determination of daily nitrogen excretion with urine, in the early postoperative period in children, aged 4 to 14 years after thoracic surgery. No significant increase in total energy expenditure in the earliest postoperative period have been observed. The changes were associated predominantly with the structure of energy expenditure and were most vividly manifested in younger children aged 4 to 8 years.

[Disorders of hemodynamics and their correction in children with nonhepatic portal hypertension during the course of surgical treatment]. / Narusheniia gemodinamiki i ikh korrektsiia u detei s vnepechenochnoi portal'noi gipertenziei na étapakh khirurgicheskogo lecheniia.

Twenty children with the extrahepatic portal hypertension syndrome were examined; echo- and doppler-cardiography were employed to assess the central hemodynamic status before and after mesenterial-caval H-shunting, making use of a vascular insert from the internal jugular vein. The status of the circulatory system varied in the patients prior to surgery, and a risk group was distinguished with the maximal deviations of the hemodynamic parameters from the age-specific norms. 70% of the patients developed within 3 h after surgery pulmonary hypertension and right-ventricular dysfunction in the presence of a drastic rise of venous reflux to the right heart. Later an attempt was made at correction of the circulatory disorders by dopamine infusion at the rate of 3-6 micrograms/(kg.min) (19 patients). The authors emphasize that directly after shunting inotropic dopamine maintenance is necessary to prevent the development of hemodynamic disorders.

[Changes in the homeostatic indices in children with the prolonged crush syndrome receiving complex intensive therapy]. / Izmeneniia nekotorykh pokazatelei gomeostaza u detei s sindromom dlitel'nogo sdavleniia v komplekse intensivnoi terapii.

Crush syndrome was assessed clinically in 22 children, 16 of whom had renal failure. For objective evaluation, different techniques of extracorporeal detoxication were performed under dynamic control over the level of some homeostasis parameters. It has been established that the most marked changes were associated with the signs of colloid-osmotic condition and the following development of hyperosmolar syndrome. A complex approach to the management of this group of patients, using various intensive care techniques (plasmapheresis, hemodialysis, hemosorption, hyperbaric oxygenation, etc.) is assessed. Using the data of biochemical control, the most informative parameters characterizing the severity of crush syndrome in children have been determined.

[Experience with the use of plasmapheresis in the combined treatment of children with the crush syndrome]. / Opyt primeneniia plazmafereza v kompleksnom lechenii detei s sindromom dlitel'nogo sdavleniia.

Plasmapheresis (PP) was applied to the treatment of 5 children aged 6-14 years with the crush syndrome. The multimodality treatment using antibiotics, erythrocytic mass, rheologically active preparations, hemodialysis and blood rheologically active preparations, hemodialysis and hemoperfusion carried out for 6-7 days before PP did not bring about any appreciable improvement of the patients' status. The patients failed to get rid of anuria and manifested the signs of increasing intoxication. The treatment with PP consisted of 1 to 6 procedures, in the course of which 70 to 85 of the design volume of the circulating plasma was removed. The use of PP resulted in the disappearance of myoglobin from the patients' blood and urine, in the normalization of the coagulogram, a considerable decrease of the content of medium molecules, and in the appearance of the first urine towards the end of the procedure. Thus, the introduction of PP into multimodality treatment of the crush syndrome made it possible to eliminate anuria, disseminated intravascular coagulation, and to noticeably reduce intoxication and to clear the blood off myoglobin.

[The diagnostic and prognostic value of the indices of the colloid-osmotic state of the blood in children with the crush syndrome]. / Diagnosticheskoe i prognosticheskoe znachenie pokazatelei kolloidno-osmoticheskogo sostoianiia krovi u detei pri sindrome dlitel'nogo razdavlivaniia.

Eighteen infants with compression syndrome (CS) were managed with simultaneous evaluation of changes in the blood colloid osmotic status. The examination findings showed that plasma osmolality is an integral index of endogenous intoxication which objectively reflects the gravity of the general condition of patients and requires adequate correction. The osmolality gap was measured by the difference between the measured and calculated osmolalities; its stable two- or threefold increase was found to be the most unfavourable factor in the disease course and prognosis. It was found that control of osmotic homeostasis in infants with CS is essential to decide that extracorporeal blood clearance techniques be used and to elaborate effective infusion therapy programmes.

[Secretion of alpha-L-fucosidase by human embryonal skin fibroblasts]. / Sekretsiia al'fa-L-fukozidazy émbrional'nymi kozhnymi fibroblastami cheloveka.

The amount of alpha-L-fucosidase secreted by normal human fibroblasts was higher in the medium containing 10% bovine serum than in the medium containing 0.1% bovine serum. Glycosidase secretion was twice higher at the advanced than at the initial stage of subcultivation. Extracellular activity of alpha-L-fucosidase from 3 different fibroblast strains differed insignificantly in the medium containing 0.1% bovine serum, while intracellular activity of the enzyme in these strains was altogether different. The results suggest that the lysosomal glycosidase secretion is determined by the level of cellular endocytosis.

[Intracellular activity and secretion of various lysosomal glycosidases in cultured human skin fibroblasts]. / Vnutrikletochnai aktivnost' i sekretsiia nekotorykh lizosomnykh glikozidaz kul'tiviruemykh fibroblastov kozhi cheloveka.

The intracellular activities of four lysosomal glycosidases (alpha-L-fucosidase, beta-D-hexosaminidase, beta-D-galactosidase and beta-D-glucuronidase) in human skin fibroblasts cultured in a medium with 0.1% serum increased in a greater degree than that in a medium with 10% serum. Only two glycosidases (alpha-L-fucosidase and beta-D-hexosaminidase) were secreted by fibroblasts in the culture medium. The extracellular activity of alpha-L-fucosidase and beta-D-hexosaminidase was equivalent to 80 and 25% of their intracellular activity in serum-sufficient fibroblasts and 40 and 15%--in serum-restricted fibroblasts. These results suggest that the observer phenomena are controlled by the levels of autophagy, endocytosis and membrane recycling.

[Lysosomal glycosidase activity in cultured human fibroblasts]. / Aktivnost' lizosomnykh glikozidaz v kul'tiviruemykh fibroblastakh cheloveka.

A study was made of the activity of 3 lysosomal glycosidases -beta-D-galactosidase (K. P. 3.2.1.23), alpha-L-fucosidase (K. P. 3.2.1.51), N-acetyl-beta-D-hexosoaminidase (K. P. 3.2.1.52) depending on the time after subcultivation and duration of the passage of human skin embryonal and postembryonal fibroblasts. It was established that changes in the specific activity of the enzymes should be calculated with reference to the cell rather than to protein whose amount might vary considerably. It was also found that for measuring the specific activity of enzymes, of great importance are the procedures of cell removal from the base layer (by mechanical scraping off or by trypsin solution) and the regimen of the homogenization of cell preparations.