[Early respiratory support in anti-shock therapy of children with severe thermal trauma]. / Ranniaia respiratornaia podderzhka v protivoshokovoi terapii u detei s tiazheloi termicheskoi travmoi.

Search for effective method for decreasing the mortality of children with severe thermal injuries and approaches to preventing and treating multiorgan dysfunction in severe thermal injury is a pressing problem of reanimatology. The majority of scientists consider disorders in the ventilation-perfusion function of the lungs the main factor in the pathogenesis of burn shock. Lung injury is most often the first manifestation of multiple organ dysfunction. The depth of disorders in the gas exchange function of the lungs clearly correlates with the severity of burn injury and the terms of the beginning of respiratory support. The severity of burn shock, preclinical diagnosis of acute respiratory distress syndrome and disseminated intravascular blood coagulation, depth of hemodynamic disorders and disorders in the oxygen transporting system can serve as a criterion of the compensatory stress and be an indication for active respiratory therapy. Comparison of the main and control groups demonstrated the efficiency of early respiratory therapy in children with severe burns, because such therapy normalizes the blood oxygen transporting function and hemodynamic parameters sooner and with less strain for the compensatory potential of the organism.

[Diagnosis and treatment of pancreas ectopy in the gastric wall in children]. / Diagnostika i lechenie éktopii podzheludochnoi zhelezy v stenku zheludka u detei.

The authors describe 6 children with pancreas ectopy to the gastric wall. Their age was between 8 and 14 years. The main clinical and endoscopic signs were: prolonged pain, dyspepsia and a "polyp" in pyloroantral part of the stomach. In 4 of 6 children the pancreas ectopy to the gastric wall was suspected. All patients had been operated on. The indications for surgery were the following: severe pain with no effect of conservative therapy, suspicion for "polyp" malignancy and ulceration, bleeding. In one patient Bilroth-1 resection has been performed and in 2 cases sectoral dissection of the gastric wall pancreatic ectopy has been done. In 3 patients enucleation of the ectopic pancreas was performed. All patients had ineventful postoperative period. The pancreas ectopy in children is an indication for the surgery because of severe pain and possibility of severe complications. The surgery relieves pain and provides recovery.

[Subdiaphragmatic abscesses in children]. / Poddiafragmalnye abstsessy u detei.

At the clinic of pediatric surgery of the Sverdlovsk Medical Institute 30 children aged from 3 to 14 years were treated for subdiaphragmatic abscesses in 1979-1989. In 27 of them the abscesses occurred in 6 days to 6 months after an emergency operation. The largest group (19 children) was formed of patients who underwent operation for destructive appendicitis and peritonitis. The subdiaphragmatic abscess was found on the left side in 16 (53.3%) and on the right side in 14 (46.6%) cases. In 11 (36.6%) patients in was combined with abscesses of other localization. X-ray and ultrasonic studies and, occasionally, computed tomography were used along with clinico-laboratory methods in establishing the diagnosis of subdiaphragmatic abscesses. Operations were performed on 29 patients. One patient was treated by puncture followed by drainage of the abscess after Seldinger. The choice of the approach was determined by the localization of the abscess. The intraperitoneal approach was used in 11 cases (36.6%), Klermon's extraperitoneal approach in 16 (53.3%), Melnikov's extrapleural approach in 2, and the posterior retropleural approach in one case. Complex intensive therapy was applied in the postoperative period. Among the 30 patients one died from sepsis and developed polyorganic insufficiency.

[Kidney trauma in children]. / Travma pochek u detei.

The article analyzes methods of diagnostics and treatment of 198 children aged from 3 to 14 years with closed traumas of the kidney. To diagnose the closed traumas of the kidneys excretory urography and echography were used. Laparoscopy was used for associated injuries in the complex of diagnostic methods. Conservative methods were used for treatment of 159 children with closed traumas of the kidney, 39 of them (14%) had indications for operative treatment. Nephrectomy was performed in 13 of these children having severe injuries. Long-term results were followed-up in 123 children. In 14 of them different sequelae of the trauma mere detected at the remote period.

[Rehabilitation of children with external intestinal fistula]. / Reabilitatsiia detei s naruzhnymi kishechnymi svishchami.

Experience in the treatment of 153 children with external intestinal fistulas is discussed. In 6 children the intestinal fistulas occurred as the result of a pyodestructive process in the abdominal cavity, in 147 children they were formed for therapeutic purposes. The choice of the method of treatment is individual and is determined by the character of the fistula. A magneto-++-compressive inter-intestinal++ anastomosis (MCIA) was formed for exclusion of the intestinal fistulas. Under conditions of peritonitis in gun-barrel enterostomy intraoperative formation of the MCIA can be undertaken. The method was applied in 21 children, no complications occurred. In closure of gun-barrel enterostomy an operative method was elaborated with preservation of the greater part of the magneto-++-compressive anastomosis.