In children with mild and severe traumatic brain injury (TBI), the role of various damage/repair neuromarkers in the outcomes of trauma was studied. It has been shown that in the first days after TBI with adverse outcomes, there was a significant increase in NSE, S100b, NO products and a decrease in the content of BDNF and autoantibodies to NMDA (NR2) glutamate receptors (Glu) in the blood serum. After 6 months with unfavorable outcomes, there was an increase in aAb to S100b and a decrease in BDNF.

Brain biomarkers (protein S100b and neuron-specific enolase (NSE)), antibodies (aAb) to the NR2 subunit of N-methyl-D-aspartate (NR2(NMDA)) and to the GluR1 subunit of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (GluR1(AMPA)) subtype of glutamate receptors (GluR), NR2 and AMPA peptides, nitrogen oxides (NOx; "nitrites and nitrates"), and 3-nitrotyrosine (NT) were measured in blood from 159 children after mild traumatic brain injury (mTBI), moderate traumatic brain injury (mdTBI), or severe traumatic brain injury (sTBI) within 1-2 days and at intervals during the first 15 days after brain trauma. S100b and NSE levels on the first day were not a strict criterion for injury outcomes. Children with mTBI had the most significant elevations in antibodies to NR2(NMDA) and AMPA peptides, a slight increase in NOx, and, in 25% of cases, appearance of NT in the blood right after TBI. The lowest level of antibodies to NR2(NMDA) GluR detected shortly after the initial TBI was found in children with sTBI, with a negative outcome. The opposite characters of antibodies to NR2(NMDA) on the first day in children with mild and moderate versus severe TBI may be associated with an important mechanism aimed at protecting neurons from Glu excitotoxicity. We hypothesized that a slight increase in NOx after the onset of TBI rapidly activates the innate immune system and contributes to an increase in antibodies to NR2(NMDA). An increase in the AMPA peptide level in mTBI may be early signs of diffuse axonal injury.

Objective. To compare the genotypes at the apolipoprotein E (APOE) gene with outcomes and level of neural markers in children with severe traumatic brain injury (TBI). Materials and methods. A total of 69 children with severe TBI underwent typing of APOE polymorphisms and estimation of the contents of the following markers of brain damage/repair: neuron-specific enolase (NSE), S100b protein, autoantibodies (aAB) to glutamate receptors (NR2 subunits of glutamate receptors), aAB to S100b, and brain-derived neurotrophic factor (BDNF). Results and conclusions. The study cohort of children with severe TBI showed no link between the characteristics of the APOE 3/3, 3/4, or 3/2 genotypes and outcomes assessed on the Glasgow scale. The largest number of favorable outcomes was seen with the APOE genotype 3/3 (60%). Among children with the other two genotypes – APOE 3/4 and 3/2 – favorable and unfavorable outcomes were distributed 50:50. A significant link with genotype was seen for BDNF: a normal level was seen for APOE 3/3, while the level was reduced for APOE 3/2. Correlational links between neural marker contents and assessments on the Glasgow scale were seen for BDNF and aAB to S100b. BDNF levels were normal and aAB to S100b levels were low for favorable TBI outcomes. All APOE genotypes were combined by the observation that in the longer term, 95% of children with severe TBI showed significant increases in aAB to glutamate receptors and most showed increases in blood aAB to S100b. We link this observation with cerebral hypoxia, activation of autoimmune processes, and increases in the permeability of the blood:brain barrier, which may promote increases in NO content and intensification of oxidative processes in children with severe TBI.

In children with epilepsy and traumatic brain injury (TBI), the content of autoantibodies (aAb) to glutamate receptors (NMDA and AMPA subtypes) and the level of nitric oxide products - nitrothyrosine (NT) and nitrates/ nitrites (NOx) in the blood were studied. The obtained data make it possible to reveal the specificity of damage to AMPA and NMDA subtypes of glutamate receptors in convulsive states and posttraumatic brain injuries. The participation of NO and its products in the development of autoimmune response was revealed.

Introduction. Currently, there is no any unified approach to the treatment of complicated forms of acute appendicitis in children. The purpose of our study is to evaluate the effectiveness of the local Protocol for diagnostics and treatment of appendicular peritonitis (AP) in children. Material and methods. 149 children with AP, aged 2 - 17 (11 ± 3.5 ), were included into the study. All of them were treated at the Clinical and Research Institute Emergency Pediatric Surgery and Trauma (CRIEPST) in 2015-2018. In the gender structure, boys (104; 69.8%) prevailed over girls (45; 30.2%). The following parameters were evaluated: AP structure, surgical tactics, postoperative course (incidence of postoperative intestinal failure syndrome (IFS), postoperative complications, length of hospital stay). A tactics for surgical treatment and volume of intensive care in the postoperative period were defined depending on AP severity and according to the local Protocol. Laparoscopic appendectomy was performed in 145 (97.3%) patients. There were no intraoperative complications and conversions in the studied group. In case of periappendiular abscess (PA) 3 (2.7%), patients had puncture and abscess drainage under ultrasound control. Results. While analyzing the AP structure by forms , the following picture was shown: free and abscessed forms were approximately equal - 72 (48.3%) and 77 (51.7%), respectively (p > 0.05). Diffuse peritonitis - 31.5%; generalized - 16.8%; combined - 17.4%; periappendicular abscess (PA) stage 1-14.8%; PA 2-16.8%; PA 3-2.7%. Postoperative complications - 4 (2.7%): postoperative abdominal abscesses - 3 (2.0%); early adhesive intestinal obstruction - 1 (0.7%). In postoperative abscesses, puncture and drainage were performed under ultrasound control; in early adhesive intestinal obstruction - laparoscopic adhesiolysis. All the children recovered. Length of intensive care was 2.9 ± 1.8 days; hospitalization - 12.0 ± 5.2 days. Conclusion. The local Protocol developed by the researchers helps to define a surgical tactics and volume of intensive care in the postoperative period. Laparoscopic surgery, in the vast majority of cases, is an optimal and effective technique for AP surgical treatment in children. Contraindications to laparoscopic surgery are PA 3 and total abscessing peritonitis.

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Twenty-nine children (mean age of 12.6 ± 2.3 years) with combined bone trauma were examined. The reference group consisted of 20 conditionally healthy children (mean age of 11.8 ± 2.7 years) without the pathology of the locomotor system. The content of bone biomarkers - osteoprotegerin (OPG), bone isoenzyme of alkaline phosphatase (AP), osteocalcin (OC), hyaluronic acid (HA), as well as matrix metalloproteinases (MMPs) and cytokines - TGF-β, MCP-1 and MIP-1β in serum was determined by the enzyme immunoassay in dynamics: on the 1-3rd, 7-th, 14-th and 30-th days after the trauma. Remodeling of bone tissue after a combined trauma at the stage of formation of the regenerate was established to be characterized by diverse changes in the serum content of bone biomarkers, which are not substantially dependent on the severity of the trauma. At the same time, a significant increase in the concentrations of OPG, AP and HA was combined with a pronounced decrease in the content of OC. At 7-14th days after the injury OC levels were lower by more than 3 times compared with the control, indicating a slowdown in the mineralization of the osteoid and a disturbance in the formation of bone tissue during this period. By 30 days after trauma serum concentrations of gelatinases (MMP-2, MMP-9) and collagenases (MMP-8) increased significantly, stromelysin levels (MMP-3) did not change. By 30th day after the injury serum concentrations of gelatinases (MMP-2, MMP-9) and collagenases (MMP-8) increased significantly, stromelysin levels (MMP-3) did not change, and the TIMP-1 content declined. Early detection of changes in blood levels of bone biomarkers during the process of the recovery after combined trauma in children makes it possible to ensure timely correction of disturbances and choice of optimal individual treatment tactics for the management of a particular patient, taking into account the peculiarities of his bone metabolism

The craniocerebral injury is a global problem of health care and society. The fatal and incapacitating aftermaths developed because of this type of trauma result in significant social and economic losses. To develop effective measures of decreasing these losses epidemiological studies are needed to be implemented considering gender, age, regional and other characteristics. The purpose of study was to analyze regional and epidemiological characteristics of craniocerebral injury in children population of Russia. The study was based on data of state statistic reports in Russia and in its regions in 2003-2004. During analyzed period, dynamics of children morbidity of craniocerebral injury are characterized by its maximal level reached in 2010 (6.3 per 1,000 of children population) and by its decreasing to initial level (5.4% per 1,000 of children population) in 2014. The two-fold increase of percentage of children of the first year of life in mortality of craniocerebral injury was established against the background of stable decrease of craniocerebral injury mortality among children aged from 0 to 17 years. In 2014, every ninth child who died because of head trauma did not survived age of 1 year. In Russia, decreasing of level of hospitalization of children with craniocerebral injury was established. At that, indices of hospitalized morbidity of children of the first year of life increased up to 30%. The actual statistical reporting in Russian Federation provides no full measure evaluation of true levels of mortality, morbidity and hospitalized morbidity. this condition occurs due to limitations of including additional nosological forms in state statistic reporting and to specificity of main disease codification or leading causes of death. The study established significant regional specificity of craniocerebral injury in children that determines necessity of development effective measures considering established epidemiological characteristics.

There were comprehensively examined 55 children, including 35 children with combined bone injury (average age of 12.6 ± 2.3 years), reference group consisted of 20 apparently healthy children (average age of 11.8 ± 2.7 years) without pathology of the motor system. on the 1-3rd and 30th day after the combined bone injury, changes in the content of matrix metalloproteinases (MMP) and cytokines - transforming growth factor-beta (TGF-β), monocytic chemotactic factor (MCP-1) and macrophage inflammatory protein (MIP-1β) were followed in the dynamics by serum immunoassay determination. It was established that after combined bone injury at the stage of post-traumatic formation of the regenerate by 30th days the serum concentrations of gelatinases (MMP-2, MMP-9) and collagenases (MMP-8) significantly increased, the levels of stromelysins (MMP-3) did not change, and the content of TIMP-1 decreased. Early detection of changes in the blood content of bone biomarkers during the recovery process after a combined trauma in children allows the timely implementing the correction of disturbances and the choice of the optimal individual treatment tactics for a particular patient, taking into account the features of his bone metabolism.

Gastrointestinal hemangioma (GIH) is a benign vascular formation located in different parts of the intestinal tube. The clinical significance of hemangiomas of the gastrointestinal tract is usually associated with the development of complications such as gastrointestinal bleeding, invagination, intestinal obstruction or bowel perforation. Aim of the study. Demonstration of a rare clinical observation of jejunal cavernous hemangioma as a cause of recurrent intestinal bleeding. Material and methods. A boy, 11 years old, admitted to the Institute with complaints of chronic anemia and recurrent intestinal bleeding of unknown etiology. There was made a complex diagnostic search, including laboratory and instrumental methods, with a video capsular study of the gastrointestinal tract and angiography of the abdominal cavity. Results. At the base of the video capsular study of the gastrointestinal tract, the vascular formation of the jejunum, which is a possible source of intestinal bleeding, is suspected. The vascular structure of the formation is confirmed by angiography. During laparoscopy, a cavernous hemangioma with a diameter of about 1.5 cm was detected. Hemangioma was located in the wall of the jejunum and prolapsed both into the lumen of the intestine and from the side of the serous membrane. Under micro laparotomic access in the umbilical region, there was performed a resection of the jejunum area with the imposition of the anastomosis "end to end". A morphological diagnosis was confirmed. The postoperative period was uneventful. Conclusion. The cavernous hemangioma of the jejunum is rare and difficult to diagnose the cause of recurrent intestinal bleeding. The use of modern diagnostic and surgical technologies ensures timely and mini-invasive treatment, which leads to rapid recovery of the patient and ensures the cost-effectiveness of treatment.

Multi-sliced computed tomography (MSCT) is widely used to study patients with polytrauma, especially when assessing skeletal and spinal injuries as it has provided possible volume visualization. MSCT has long been used to diagnose injuries of pelvic bones and the spine. For the examination of limb injuries, it is used rarely until now. Although traditionally used radiography often underestimates degree and severity of damages, especially in the complex body parts such as shoulder, elbow, wrist, knee and ankle joints. The role of MSCT is extremely important to identify complex and small fractures, their nature and evaluation, planning of treatment. Multiplanar reconstruction clearly visualizes structural features, and three-dimensional images help to understand spatial relationships, which is important for pre-operative planning and classification of fractures. In addition, modern technologies for suppressing metal artifacts in MSCT allow monitoring postoperative results even in the presence of metal implants.

Introduction. Catatrauma is one of the main causes of childhood injuries and deaths in Russia. The severity of the condition of catatrauma is caused by combined injuries, high disability and lethality depend on them. Most often, children fall from the balconies of houses, windows, trees, and playgrounds. The purpose of the study was to show, on a clinical example, the case of a fall of a child from the height of the 16th storey of a dwelling house and the survival with a favorable outcome. Material and methods. The clinical example demonstrates the provision of medical care to a 5 years old child with catatrauma in a metropolis. After falling from a critical height (48 m) at the prehospital stage, he was assisted by ambulance brigades, and transportation was carried out by a helicopter. At the hospital stage, the victim was treated at the Research Institute of Emergency Surgery and Traumatology, where all departments of the clinic were involved. Results. This clinical case is unique in that the child, having fallen from the 16th sorey, from a height of more than 48 m, having received multiple combined injuries with an ISS score of 34 points, survived. An outcome was favorable due to the fact that the child was dressed in winter clothes with a jacket hooded over his head and fell into the snow, as well as coordinated actions of the services and units providing medical care at the prehospital and hospital stages in the metropolis. Conclusion. A favorable outcome after the child had fallen from a critical height, was affected by facts that both the child was dressed in winter clothes with a hood and a hat, put on the head, falling into the snow, and the coordinated activity of the structures and units participating in the prehospital and hospital stages of medical care.

Aim of the study to improve the results of treatment of children with intracranial hypertension in the acute period of severe mechanical trauma by virtue of the use of the “Protocol of step-by-step therapy” Material and methods. The article is devoted to the problem of intracranial hypertension in children with severe mechanical trauma. An analysis of 148 case histories of children with severe mechanical trauma, including brain trauma hospitalized in an intensive care unit. 27 patients out of 148 were excluded from the inclusion criteria: 6 patients (22.2%) due to the “late” admission (more than 72 hours from the time of injury); 21 patients - (77,8%) due to the persistent condition of atonic coma from the moment of trauma. 121 patients, according to indications, monitored intracranial pressure and intensive therapy of intracranial hypertension. All patients were divided into two groups: one group (the main one - 84 patients), in which the treatment was carried out according to the “Protocol of step-by-step therapy of intracranial hypertension” and approved in the Scientific Research Institute of Emergency Children’s Surgery and Traumatology, characterized by a strict sequence of treatment measures (“steps”), with clear indications for prescribing each subsequent “step” and the time frame for the duration of the “steps” taken; 2 group (control group - 37 patients), in which the treatment was carried out according to existing international guidelines for the management of patients with severe head injury. Conclusion. Comparative evaluation of treatment results showed outcomes of trauma in the main group to be better, including a statistically significantly less mortality rate (p = 0.0002, p < 0.05).

Objectives: Prognostic value of intracranial pressure (ICP) is discussed in the recent literature. The aim of our study was to find the parameter that could be representative of ICP variations and might become a good predictor of severe traumatic brain injury (TBI) outcomes in children.

Introduction. In the structure of the general morbidity rate, trauma and diseases of the musculoskeletal system take the third place after diseases of the respiratory system and pathology of the gastrointestinal tract. In recent years, an intensive indices characterizing the trauma prevalence rate has increased by 1.9 times. Aim. to improve the results of the management of juxta- and intraarticular fractures in children by means of the use of biodegradable implants. Material and methods. Over the period from 2014 to 2016 in the Department of Traumatology of the Research Institute of Emergency Pediatric Surgery and Traumatology there were examined and treated 108 children with juxta- and intra-articular fractures of the upper and lower extremities aged from 5 to 17 years, with an average age of 13.3 ± 1.8, including 38 (34.96 %) girls and 70 (65.04%) boys. All patients underwent complex examination including laboratory and instrumental methods: complete blood count (CBC), Common Urine Examination (CUE), X-Ray, spiral computed tomography, MRI. Results. To describe injuries and determine the tactics of the treatment of juxta- and intra-articular fractures in children, there was used the fracture classification system delivered by Robert B. Salter and W. Robert Harris. All children with metaphyseal fractures of the second, third, and fourth types underwent surgical treatment with the use of biodegradable implants. The postoperative period proceeded without complications. Conclusion. The use of biodegradable screws in juxta- and intra-articular fractures in children is a safe and effective method of treatment, reducing its timing by eliminating repeated surgical intervention.