[Prolonged spinal and sacral neurostimulation in children with pelvic organ dysfunction: preliminary analysis]. / Dlitel'naya spinal'naya i sakral'naya neirostimulyatsiya u detei pri narusheniyakh funktsii tazovykh organov: predvaritel'nyi analiz.

OBJECTIVE: To evaluate the clinical efficacy of long-term spinal and sacral programmable neurostimulation for pelvic organ dysfunction in patients with myelodysplasia and chronic dysfunction of the bladder and rectum. MATERIAL AND METHODS: A retrospective study included 32 children aged 1-17 years (mean 10.7) with myelodysplasia, pelvic organ dysfunction and ineffective therapy including botulinum therapy and exclusion of tethered spinal cord syndrome. All children underwent comprehensive urodynamic examination with analysis of bladder and residual urine volume, mean flow rate, intravesical pressure and total urine volume, as well as electromyographic examination. Examination was carried out before surgery, after 6, 12 and 36 months. We applied urinary diary, NBSS questionnaire and urodynamic examination data. All patients underwent neurological examinations (neurological status, magnetic resonance imaging of the spinal cord, computed tomography and radiography of the spine, electroneuromyography). The study was conducted at the neurosurgical department of the Republican Children's Clinical Hospital in Ufa between 2014 and 2022. There were 32 implantations of epidural neurostimulators for pelvic organ dysfunctions. RESULTS: Patients used epidural spinal and sacral stimulation up to 6 times a day for 10-15 min turning on the pulse generator. This method significantly increased urinary volume, decreased episodes of urinary leakage and fecal incontinence, residual volume after urination and number of periodic catheterizations compared to baseline data. Sixteen patients were very satisfied, 10 ones were moderately satisfied, and 2 patients were not satisfied with therapy. The number of bladder catheterizations per day decreased by 51.1%. Urine volume significantly increased from 131.5±16.1 to 236±16.7 ml, intravesical pressure decreased from 23.5±4.2 to 18.5±2.1 cm H2O (by 20.3%). CONCLUSION: Chronic epidural spinal and sacral stimulation can improve the quality of life in patients with pelvic organ dysfunction. This technique may be effective for pelvic organ dysfunction caused by myelodysplasia.

[ANALYSIS OF THE POSTOPERATIVE COURSE OF COMPLEX CONGENITAL HEART DISEASES SIMULTANEOUS CORRECTION WITH AN OPEN STERNOTOMY IN CHILDREN DURING THE FIRST MONTHS OF LIFE].

UNLABELLED: In children during the first months of life delayed sternum closure is one of the few techniques increasing cardiac output after simultaneous correction of complex congenital heart defects (CHD). The aim of study was evaluating mortality, predictors of adverse outcome and frequency noncardial complications at of delayed sternum closure after correction of CHD. METHODS: Study design: a prospective, uncontrolled, cohort. 22 children were studied 6 children died. Anesthesia was carried out on the basis ofpropofol (3 mg/kg/h) and fentanyl (5 pg/kg/h) infusion with sevoflurane inhalation in a dose of 1-1.5 WT, including during perfusion. Cardiopulmonary bypass (IR) was carried out by the "Stockert S50" using oxygenators ("Medtronic"). After IR in all cases the use of arterio--venous modified ultrafiltration. Sternum closure was performed on average 2.7 ± 1.4 days after surgery. RESULTS: The odds ratio (OR) of death development at the mean arterial pressure (MAP) < 35 Hg was 3.7, the OR for the risk of death development if SVO2 < 40% was 0.94. OR for risk of death when blood lactate level > 10 mmol/l during the first three days ofpostoperative intensive care was 2.1. CONCLUSIONS: The technique of delayed sternum closure is an acceptable method of maintaining cardiac output in children during the first months of life with CHD in the postoperative period. High blood lactate level (> 10 mmol/l) and especially its further growth and the MAP < 35 mm Hg can be predictors of adverse outcomes of surgical interventions with an open sternotomy.

[FEATURES OF FLUID THERAPY IN CHILDREN WITH SEVERE MAJOR TRAUMA].

BACKGROUND: Fluid and transfusion therapy is proved to be a required component of treating children with severe major trauma significantly influencing the case outcome. OBJECTIVE: To analyze efficiency of fluid and transfusion therapy in children with severe major trauma and assess its correspondence with current recommendations. MATERIALS AND METHODS: 150 children aged from 0 to 18 years getting treatment in intensive care units of children's city hospitals of Saint Petersburg, Archangelsk, Ufa, Samara, and Leningrad region were included in the research. The main course of severe major trauma were car injury and catatrauma. The coefficient according to Pediatric trauma score (PTS) was 6.4 points. The mean duration of hospitalization in emergencies units was 3 (2-7) days, the duration of artificial lung ventilation was 48 ± 99.9 hours, the duration of hospitalization in the department ward was 24 (15-32) days. Favorable outcome (transferring from emergencies units to department wards) was reported in 147 (98%) children, death cases were registered in 4 (2.6%) children. RESULTS: There was determined that the basic crystalloid solutions used for infusion therapy in children were the following: Ringer solution, Plasma-lit solution and 10% glucose solution. "Gelofisin" and "Voluven" had more frequent administration rate among colloidal solutions. Transfusion of blood was performed in 26% patients. The infusion therapy in the first three days did not exceed the necessary physiological requirements that provided stabilization of the patient's condition and did not produce a negative influence on the status of hemodynamics and gas exchange. CONCLUSION: Administration of current well-balanced crystalloid and colloidal solutions to children with severe combined trauma in an amount within the limits of required physiological indicators does not produce a negative influence on the status of gas exchange and the case outcome.

[PREVENTION OF VENTILATOR ASSOCIATED INFECTION IN NEONATES WITH RESPIRATORY DISTRESS SYNDROME].

UNLABELLED: The aim of the research was to reduce the risk ventilator-associated infections (VAI) in neonates with respiratory distress syndrome. DESIGN: retrospective, observational, single center, historical control. MATERIALS AND METHODS: 113 newborns were included in the study. Ventilator-associated pneumonia was diagnosed based on the criteria of VAP CDC/NNIS. Ventilator-associated tracheobronchitis was determined on the basis of criteria of Code LRI-BRON proposed CDC National Healthcare Safety Network. Patients divided into two groups. In the main group (n=54) hand hygiene, closed suction system and non-invasive mechanical ventilation were used as a methods of prevention of ventilator-associated infection (IAI). In comparison group (n = 59) hand hygiene only. RESULTS: The frequency of VAI was 27.5 per 1000 days of ventilation. Timing of development and the etiology of VAI were comparable in both groups of patients the duration of mechanical ventilation was significantly (p = 0.01) lower in the main group. In the main group length of stay in the intensive care unit (p = 0.01) and duration of hospital treatment (p = 0.047) decreased The incidence of VAI was significantly lower in the main group (p < 0.05). CONCLUSIONS: Closed suction system with hand hygiene and early weaning from the respirator are acceptable methods of prevention of lower respiratory tract infection associated with mechanical ventilation in neonates with respiratorv distress syndrome.

[Anaesthetic maintenance with laryngeal mask for a laparoscopic surgery in pediatric patients].

UNLABELLED: Research objective was to make a comparative assessment of haemodynamics, ventilation and oxygen status and perioperative complications during laparoscopic surgeries anaesthetic maintenance with intubation and laryngeal mask use in Pediatric patients. METHODS: A retrospective observational controlled study. STUDY TERMS: from 2000 to 2012. Two groups of Pediatric patients were recruited in the study: 127 patients for general anaesthesia with laryngeal mask and 86 patients for general anaesthesia with endotracheal tube. Laparoscopy duration was 51.3 +/- 14.4 minutes. LMA-classic laryngeal mask was used. Study results showed that laryngeal mask use provided haemodynamics stability adequate ventilation and oxygen status and shorter awakening time when compared with endotracheal tube use. CONCLUSION: General anaesthesia with laryngeal mask can be used for a short laparoscopic surgery in Pediatric patients without respiratory disorders and I-II classes due to ASA physical status classification.

[Diagnostics and treatment of sepsis in the acute phase of severe heat injury].

A prospective non-randomized, single-centered controlled study aimed the optimization of treatment and diagnostic algorithm of the early burn sepsis. 47 patients were included. The combination of bacterial wound colonization and procalcitonin blood level > or =2 ng\ml was the reliable marker of the early burn sepsis and indicates the necessity of de-escalation antibiotic therapy.

[Estimation of the validity of pediatric severity rating scales in multidisciplinary children's intensive care units].

The aim of this study was to estimate the validity of pediatric severity rating scales at general pediatric intensive care units. This was a prospective, observational multicenter study that was performed from November 1, 2007, to January 31, 2008. The end points were the estimation of the severity of disease, by using the PRISM, PIM II, RELOD scores, and 28-day survival. The investigation covered 226 patients whose mean age was 4.1 +/- 0.3 years. Twelve (5.3%) patients died during the study. The Medcalc computer program was employed for statistical analysis. The area under the receiver operating curve (ROC) was 0.623 +/- 0.116 for PRISM (p = 0.289); 0641 +/- 0.116 for PELOD (p = 0.224); 0.833 +/- 0.096 for PIM II (p < 0.001). The calibration of scores according to the intervals of mortality risk (Hosmer-Lemeshov test) showed that the observed and predicted mortality rates were similar for PIM II scores (chi2 = 8.23; p = 0.084) and were different for PRISM scores (chi2 = 203.5; p < 0.001) and PELOD ones (chi2 = 26.16; p < 0.001). Thus, the PIM II scores showed the best validity. PRISM and PELOD can be used to estimate the severity of disease in individual subgroups of high mortality-risk patients.

[Genetic markers of predisposition to infectious complications in neonatal infants with respiratory distress syndrome].

Neonatal respiratory distress syndrome (NRDS) is the commonest cause of death and morbidity of the newborn. A genetic risk for NRDS is currently recognized. The aim of this study was to determine whether there was an association of the polymorphisms of the SP-B, SP-D genes and the interleukins (IL)-1alpha, IL-10 genes with the development of infectious complications in neonatal infants with the respiratory distress syndrome. It was found that the certain genotypes by the polymorphic loci of surfactant proteins and interleukins might be associated with infectious diseases in the newborn with respiratory distress syndrome.

[High epidural anesthesia as a component of anesthetic support for cardiosurgical interventions in infants].

The aim of the study was to determine whether it was expedient to include epidural anesthesia into a complex of anesthetic support of surgical correction of ventricular septal defect in infants. This was a prospective, nonrandomized, monocenter case-control study. Seventy-nine infants met the inclusion criteria. A control group included 41 patients in whom total intravenous anesthesia was based on the infusion of propofol and fentanyl; a study comprised 38 patients in whom anesthetic support was potentiated by high prolonged epidural anesthesia. In the study group patients, the total dosage of anesthetics and the duration of inotropic support decreased intraoperatively and there was a reduction in the duration of postoperative artificial ventilation.

[Elective video-laparoscopic sanation for the treatment of general peritonitis at children].

Results of traditional and video-laparoscopic relaparotomy at children with appendicular general peritonitis are analyzed. Design--one-center, retrospective, case-control study. It is demonstrated that variant of relaparotomy does not correlate with survival and intensive care content. Long-term results are more favorable after laparoscopic surgery.

[Comparative estimation of currently available approaches to early identification of severe acute pancreatitis].

It is difficult to precisely predict the severity of each specific patient with acute pancreatitis (AP), by using conventional statistical methods or single clinical and laboratory criteria. By using the patient database, the authors developed an artificial neuronal network (ANN) to predict the severity of AP and compared it with the Ranson, Imrie/Glasgow, APACHE II, and Physiological Condition Severity scoring systems, ultrasound/radiological criteria, and linear regression analysis. ANN was found to be significantly better than all the scoring systems, but not better than a linear regression model (the area under the receiver operating characteristic curves were equal to 0.83). With 81% sensitivity, ANN showed a 70% specificity, and positive/negative predictive values of 73 and 79%, respectively. ANN is an effective tool in developing prediction models for poor outcomes in patients with AP that is precisely similar with linear regression models.

[Prognostic value of the pattern of multiple organ dysfunctions in severe acute pancreatitis].

A relationship was studied between the outcomes of severe acute pancreatitis and the pattern and multiple organ dysfunctions in 72 patients. Organ dysfunction was observed in 39 (54.2%) patients: multiple organ dysfunction (MOD) in 20 (27.8%) patients and dysfunction of an organ or a system in 19 (26.4%). The deceased patients had a statistically significantly higher incidence of MOS than the survivors (88.2% versus 9.1%; p < 0.01). Logistic regression showed that only respiratory and neurological dysfunctions were the factors that predispose to death.

[The effect of organ dysfunction on the outcomes of acute destructive pancreatitis].

The relationships between outcomes of severe acute pancreatitis (SAP) and organ dysfunction in 72 patients were studied. A total of 39 (54.2%) patients had organ dysfunction, 20 (27.8%) patients -- multiple organ dysfunction (MOD), 19 (26.4%) patients -- dysfunction of single organ or system. Died patients had higher incidence of MOD compared with those who alive (88.2 vs 9.1%, p<0.01). In multiple logistic regression analysis the main predicting factors of death were pulmonary failure and neurological dysfunction. Pulmonary failure was the most common organ dysfunction among both single organ dysfunction (57.9%) and MOD (95.0%), with a total morbidity of 41.7%. Mortality rate was lower at isolated pulmonary dysfunction, and was higher at MOD (18.2 vs 78.9%, p<0,01). Irregular specialized intensive treatment protocol led to groundless surgical interventions at 10 from 46 patients with sterile pancreonecrosis. Organ dysfunction makes worse the prognosis in patients with SAP. Choice of the optimal treatment strategy at SAP with MOD is determinative.

[Diagnosis and treatment of ventilator-associated pneumonia in children].

The purpose of the investigation was to optimize the diagnosis and treatment of ventilator-associated pneumonia (VAP) in children. The prevalence, etiology, and onset of VAP in a pediatric intensive care unit, and the diagnostic value the clinical pulmonary infection score scale were studied. The prevalence of VAP was found to be 37.56 per 1,000 mechanical ventilation days, and the CPIS scale was not always useful in diagnosing VAP in children. The most common causative agents of VAP were Enterobacteriaceae spp, and its major pathogen is P. aeruginosa. Early adequate antibacterial therapy prevents and treats VAP, without causing any complications.

[Comparative assessment of rocuronium bromide and cysatracurium besylate used during endosurgical operations in children].

The authors have studied the effects of the muscular relaxants rocuronium bromide and cysatracurium besylate on neuromuscular conduction, respiration mechanics, and hemodynamics in 120 children during endosurgical operations. The paper comparatively assesses the muscular relaxants and the procedures of their use, which made it possible to ensure controlled and deep relaxation.

[Modern approaches to volemic compensation in children with severe thermal injury during acute period].

To determine the minimally allowable levels of oxygen delivery and consumption in infants with acute severe thermal injury, the authors studied the oxygen transport system in 36 patients aged 1 year and 2 months to 3 years who had burns of more than 15%, but less than 50% of the body surface in February 2001 to January 2004. The findings indicate that in infants, the acute period of thermal injury is characterized by oxygen debts despite the hyperdynamic circulatory regimen. By calculating the coefficients of paired correlation and deriving the linear regression of oxygen uptake with other parameters of the oxygen transport system, the authors estimated the minimum allowable levels of performance of the oxygen transport system: less than 623.2 ml/min/m2 for oxygen delivery, more than 190.0 ml/min/m2 for oxygen consumption with the cardiac index of greater than 4.31 l/min/m2.

[Problems of diagnosis of surgical sepsis in children]. / Voprosy diagnostiki khirurgicheskogo sepsisa u detei.

Results of treatment of 263 children with surgical sepsis aged from 3 to 14 years were analyzed. Diagnosis of sepsis was based on recommendations of ACCP/SCCM (1991). For diagnosis of sepsis in children it is recommended to use criteria of syndrome of systemic inflammatory response (SSIR) in M.Parker's modification, scale of assessment of severity state - PRISM, classification of organ insufficiency by L. Doughty et al. Diagnosis of sepsis may be regarded as timely when 3 and more symptoms of SSIR persist in a child with pyoinflammatory disease during 24 hours of intensive care and in PRISM scale severity corresponding to experted lethality > or = 1,0%. When syndromes of multiorgan insufficiency are revealed, diagnosis of sepsis must be regarded as delayed.