[Intestinal-urinary fistula in children]. / Kishechno-mochevye svishchi u detei.

The authors report their 15-year experience with diagnosis and treatment of 63 boys at the age of 6 months to 15 years having various intestino-urinary bypasses. Clinical manifestations of the latter are polymorphic. The examination of the patients included ultrasonic, histomorphological, x-ray contrast and other investigations. An original classification of the fistulas are proposed. Congenital, acquired, primary, recurrent fistulas are distinguished. Location, topographoanatomic form and diameter are also considered. Surgical policy is discussed in respect of the above factors.

[Results of surgical treatment of bronchiectasis in children]. / Rezultaty khirurgicheskogo lecheniia bronkhoéktazov u detei.

Among the causes of complications occurring in the early postoperative period in children is purulent endobronchitis which in most cases cannot be arrested in the preoperative period by the traditional methods of bronchoscopic cleansing. Endobronchial application of a helium--neon laser beam in a complex with the traditional methods in the preoperative period allows endobronchitis to be arrested and the postoperative complications to be reduced to 3% of cases.

[Anoplasty for anorectal anomalies in children]. / Anoplastika pri anorektalnykh anomaliiakh u detei.

The work analyses the causes of insufficient air-tightness of the anal canal in the postoperative period (in children operated on for anorectal developmental anomalies), which leads to anal incontinence. The authors suggest a method for anoplasty based on: (1) performance of sphincteroplasty with consideration for the function of three muscles forming the external sphincter of the anal canal; (2) formation from the musculo-serous coat of the intestine subjected to the pull-through procedure a soft elastic pad lining the canal on the inside; (3) creating conditions for adherence of the mucous coat of the intestine to the walls of the neoanal canal. Manometric, CT, and ultrasonic special methods of examination showed that with the use of the suggested method the obturative pressure in the neoanal canal increases, "prolapse" of the mucosa of the operated on intestine is prevented, the accumulative and evacuative functions of the rectum are improved. The causes and errors which led to poor results (2 cases) are analysed. In the remaining 42 cases the results were good and satisfactory.

[Congenital stenosis of the anus and rectum (Problems of nosology and pathogenesis)]. / Vrozhdënnyi stenoz zadneprokhodnogo kanala i priamoi kishki (voprosy nozologii i patogeneza).

The work deals with the differential analysis of two forms of congenital rectal stenosis--"membranous" which is consequent upon incomplete obliteration of the anal membrane and "tubular" with involvement of the rectum along its length. It is pointed out that in most cases tubular rectal stenosis is a component of the complex of anomalies of the caudal region described for the first time by G. Currarino (1981) and called the ASP-triad. From analysis of 12 cases of the ASP syndrome a new scheme of the pathogenesis of the complex of anomalies constituting the syndrome is suggested. The authors identified a component of the syndrome which was not described earlier, namely, specific dysplasia of the pelvic floor and the external sphincter muscles of the anus, which provided the basis for naming the complex the PFASP syndrome (PF--Pelvic Floor Dysplasia). Problems of surgical correction of the PFASP complex of anomalies are discussed. A pathogenetically substantiated analysis of postoperative complications is made.

[Computed tomography of the pelvis in pediatric proctology]. / Komp'iuternaia tomografiia taza v detskoi proktologii.

The article shows the wide possibilities of computed tomography (CT) diagnosis of the topography of muscles forming the external sphincter of the anus (ESA) in patients with developmental anorectal anomalies and in trauma and rupture of the perineum. It is shown that in anorectal anomalies with fistulas opening into the urinary system the puborectal muscular sling is "drawn up" ventrally in relation to the external sphincter elements lying closer to the surface. Analysis of the results of CT examination of the pelvic floor in 16 children with anorectal anomalies showed that the degree of development of the sphincter muscles does not always correspond to the level of atresia. For instance, the mass of the ESA muscles is manifested more in some forms of cloacal atresia than in "tubular" stenoses of the rectum (anorectal stenosis--Curravino-triad component) (G. Curravino, 1981). CT examination of children with this complex of caudal anomalies allowed the authors to reveal a fourth constant component: dysplasia of the pelvic floor and a specific developmental anomaly of the anal sphincter. CT is the method of choice in the examination of children with this pathological condition because it makes it possible to recognise the presence of presacral masses. The use of CT in traumas and ruptures of the perineum allows the depth and extension of ruptures of the ESA muscles to be authentically determined.

[Treatment of children with diffuse polyposis of the colon]. / Lechennie detei c diffuznym polipozom tolstoi kishki.

In 1971-1990 the authors treated 41 children 3 to 15 years of age with diffuse familial polyposis of the colon (juvenile form). Forty-four operations were carried out (3 patients underwent the second operation. The authors conducted several variants of colon resection with due account for the sites of greatest accumulation of the polyps--resection of the sigmoid colon, hemicolectomy, combined resection. Progressive growth of polyps was encountered in the remaining areas in the late-term periods. In view of this, the authors recommend total colectomy with the creation of an ileorectal or ileoanal anastomosis as the method of choice. The article describes an original operative method suggested by the authors. Twenty-eight similar operations were performed with good results.

[Surgical treatment of low fistulous forms of anal atresia using postero-sagittal approach in children]. / Operativnoe lechenie nizkikh svishchevykh form atrezii zadnego prokhoda s primeneniem zadnesagittalnogo dostupa u detei.

The problems of surgical treatment of the low fistulous forms of anal atresia in children with the use of postero-sagittal approach are considered. A modification of this method is described. The postoperative results are presented, and the possible complications as well. A conclusion about the advantages of the operative approach described is made.

[Pathogenesis and treatment of rectal prolapse in children]. / Patogenez i lechenie vypadeniia priamoi kishki u detei.

On the basis of functional investigations of the rectoanal zone and sphincter apparatus of the rectum in its prolapse in children, the complex of conservative measures has been developed, which permitted to obtain good and satisfactory results in 98.9% of the patients.

[Enteroscopy in surgical diseases of the small intestine in children]. / Enteroskopiia pri khirurgicheskikhzabolevaniiakh tonkoi kishki u detei.

The possibilities of combined enteroscopy in children with suspected surgical diseases of different parts of the small intestine are evaluated. Examination of the jejunum 40-150 cm below the Treitz ligament by means of a standard pediatric fibroscope followed by retrograde ileoscopy allowed an exhaustive diagnosis to be established (including localization of the pathological process) in 18 of 19 children who were operated on. No hyperdiagnosis of surgical diseases occurred. Complications of enteroscopy were not registered.

[Postoperative rehabilitation of children with Hirschsprung disease]. / Posleoperatsionnaia reabilitatsiia detei pri bolezni Girshprunga.

Under study were remote results in 174 patients with Hirschsprung's disease operated upon by the method of Soave-Lyonyushkin. Among functional disturbances the patients had considerably decreased pressure in the anal canal, change of threshold parameters of the recto-anal reflex showing disturbed neuro-reflectory connections of the newly-formed rectum with the sphincter system. The restorative period after operation was considerably shorter due to purposeful curative-prophylactic measures which are necessary to be started from the very early postoperative period. The developed scheme of rehabilitation of patients after surgical treatment of Hirschsprung's disease is fairly effective which is demonstrated by high level (96.5%) of good and excellent long-term results.

[Retention cysts of the lungs in children]. / Retentsionnye kisty legkikh u detei.

The authors has 34 children with retention cysts of the lungs under observation. The most frequent localization of the cyst is the anterior segment of the superior lobe (20), central localization is characteristic of retention cysts. The disease must be differentiated first of all from tuberculosis. Not in all cases is this an easy problem. Before admission to the surgical clinic 16 children were given specific therapy for a long time. Two children had a suppurating cyst. The diagnosis of the cyst is based on careful study of the medical history and the characteristic findings of radiography and tomography of the chest. All of the children were operated on. The volume of the operation was determined by the condition of the surrounding segments. Segmentectomy was the most frequently performed operation.

[Extensive resection of the colon in children]. / Nekotorye aspekty obshirnoi rezektsii tolstoi kishki u detei.

On the basis of the analysis of 98 major colonic resections in children with Hirschsprung's disease, anorectal developmental defects, diffuse colonic polyposis, the problems of mobilization of bringing down the different portions of the intestine are considered.

[Functional state of the recto-anal segment in normal conditions and in various diseases in children]. / Funktsional'noe sostoianie rektoanal'nogo segmenta v norme i pri nekotorykh zabolevaniiakh u detei.

The functional state of the anorectal segment was studied in normality and in chronic constipation and incontinence of feces of different genesis. Continuous profilometry of rectal pressure, registration of motility of the rectum and sphincters, EMG and reflexometry were performed. A complex assessment of the findings helps to reveal the pathogenetic essence of the disease, to make differential diagnosis between organic and functional disorders, to find the rational tactics of treatment.