[A case of surgically removed retroperitoneal rhabdomyosarcoma in a child requiring vascular reconstruction]. / Sudovi rekonstruktsii pri radikalno otstraniavane na retroperitonealen rabdomiosarkom u dete.

Retroperitoneal tumors engaging large vessels require vascular reconstruction when surgically removed. We present a case of retroperitoneal rhabdomiosarcoma in a child, which required inferior vena cava (IVC) grafting, creating a new bifurcation of IVC, and an A-V fistula between greater saphenous vein and femoral artery as well as grafting of right common iliac artery.

[Traumatic lesions of the thoracic and abdominal organs in childhood]. / Prouchvaniia vurkhu travmatichnite uvredi na grudni i koremni organi v detskata vuzrast.

This is a retrospective analysis of 651 children, aged 0 to 14 years, presenting chest and abdominal injuries, treated over a 6-year period in the section of pediatric surgery of the Emergency Medicine Institute "Pirogov". The results of studies on the etiopathogenesis of chest and abdominal trauma, patterns of associated lesions and quality of prehospital aid are discussed. Experience with the application of updated noninvasive and invasive methods of diagnosis, as well as the scope of surgical approach to the variety of lesions by resorting to organ sparing and organ salvaging operative procedures are analyzed. On the basis of observations and experience gained to date, the indications for application of the prospective method of nonoperative treatment of certain organic lesions in the practice of pediatric surgery are broadened. The overall research project provides good reason to work out an algorithm of the therapeutic approach to children presenting abdominal and chest trauma.

[Idiopathic perforation of the extrahepatic bile ducts in a nursing infant]. / Idiopatichna perforatsiia na ekstrakhepatalnite zhluchni putishta u kurmache.

The report concerns a two-month-old suckling, affected on the 20th day of life with occurrence of icterus, dark urine and acholic stool, and on the 34th day--fever, vomiting and enlargement of the abdomen. Bile ascites is demonstrated by abdominal puncture, and perforation of the extrahepatic biliary ducts--by hepatobiliary scintigraphy. In the course of emergency laparotomy, diffuse bile peritonitis is established against the background of punctiform perforation at the site of d. cysticus and d. hepaticus communis union. Following sanation of the abdominal cavity, a draining catheter is inserted into the perforation area. The serious postoperative course, characterized by progressive hepatic failure, results in a fatal outcome on the third postoperative day. The etiopathogenesis, clinical symptomatology, timely diagnosis and effective operative management of this exceptionally rare surgical disease in children are discussed against the background of pertinent literature data survey.

[The results of coloesophagoplasty in childhood]. / Rezultati ot koloezofagoplastikata v detskata vuzrast.

Over a six-year period (1988 through 1993), a total of 380 children with congenital and acquired esophageal diseases undergo treatment in the Second Pediatric Surgery Clinic. Plastic replacement of esophagus using a graft from the colon is performed in 31 children. The indications and procedures for colo-esophagoplasty in children are discussed. Two basic operative methods are employed--retrosternal transposition of the colon transplant (with preservation of the esophagus or in children with previous extirpation, as well as in children with esophageal atresia), or transhiatal (transabdominal) esophagectomy with simultaneous placement of the transplant into the esophageal bed. The underlying cases of early and late postoperative complications are analyzed. Emphasis is laid on the good results of the method described (operative lethality amounting to 9.7 per cent) accordingly considered as the most appropriate for children.

[Postoperative invagination in early childhood]. / Sledoperativna invaginatsiia v ranna detska vuzrast.

Postoperative intussusception is a rare but serious complication which occurs usually during the early postoperative period with intermittent, but progressing intestinal obstruction with characteristic appearance of mucus-bloody stools. Two children with postoperative intussusception have been observed among 381 children who have had abdominal operations during the last three years (1985-1987) (0.5 per cent). Various postoperative complications developed in 45 children (11.8 per cent), in 2 of them (4.4 per cent) the complication being intussusception. Both children were operated for tumors. In one (1 1/2 years old) the postoperative intussusception was not diagnosed until it was re-operated; the child died. In the second child (3 months old) the postoperative intussusception was diagnosed by clinical and X-ray examination; the ileocolic portion of the intussusception was reduced by pneumocoloscopy, while the ileo-ileal required re-operation with manual reduction. The infant survived. Early diagnosis of this rare postoperative complication, especially when mucus-bloody stools appear and pneumocoloscopy is performed, is feasible. Appropriate treatment will help for a favourable outcome.

[Retroperitoneal and pelvic-presacral teratogenic tumors in early childhood--the diagnostic and surgical treatment problems]. / Retroperitonealni i tazovo-presakralni teratogenni tumori v rannata detska vuzrast--diagnostichni i khirurgichno-lechebni problemi.

Teratogenic tumors are characteristic for childhood. For a period of 15 years the authors have observed 12 children with retroperitoneal and pelvic-presacral localization of teratogenic tumors. They were most common in girls under one year of age. The clinical symptoms, the methods applied for diagnosis are analysed; the diagnostic importance of rectal digital examination, inferior venacavography and especially of computer tomography is emphasized. Radical removal of the tumor was performed in 11 children and biopsy in 1. The most convenient operative access to pelvic-presacral-retroperitoneal tumors is a one-step double access (abdomino-sacrococcygeal). As a result of complex treatment--surgical and chemotherapy--the postoperative results were good in 9 children.

[Heat denaturation of crystalline and dissolved leghemoglobin]. / Teplovaia denaturatsiia leggemoglobina v kristalle i rastvore.

Heat transitions in crystals of leghemoglobin (LH) are studied by means of scanning microcalorimetry and microscopy. It has been found that LH crystals do not melt and their loss of crystal lattice is due to the denaturation of protein globules inside the crystal. Peculiarities of the crystal state (as compared to the solution) are shown in an increase in the cooperative character of heat transition and relaxation time of the system. Subsequent consideration of different variants of correlation of two stages of heat absorption by LH crystals made it possible to determine the type of physical process proceeding in the object by the shape of calorimetric curve. Both observed peaks of heat absorption were grouped with intramolecular processes of different thermodynamic properties. The first peak of heat absorption is a manifestation of intramolecular mobility, both of individual protein segments in relation to each other and of individual segments of alpha-helical regions. Thus microcalorimetry allows a study of peculiar intramolecular dynamics of globular proteins precisely in the crystal state, because the crystal as if synchronizes the movement of individual molecules at the expense of the unification of their kinetic energy, surroundings and mutual orientation.