Introduction. Crohn’s disease (CD) is a chronic, recurrent disease characterized by inflammation of the large and/or small intestine or the entire gastrointestinal tract with the formation of local and systemic complications. Diarrhea can act as a mask of CD, which increases the time for diagnosis and timely administration of therapy. The aim of our work is to determine the diagnostic significance of diarrhea as a marker of CD in children. Materials and methods. Eighty six patients aged of 3 to 17 years and 6 months with a verified diagnosis of CD who were in the Gastroenterological department and the surgical department with routine care from 2018 to 2024 were examined. The analysis of clinical symptoms, activity. and endoscopic picture of CD in children was carried out. The assessment of CD activity in children was carried out according to the PCDAI scale. Results. 65% of CD patients showed symptoms of intestinal infection: fever, abdominal pain, and diarrhea syndrome, vomiting, weight loss. Fever was observed in 23.3%, abdominal pain syndrome in 69.7%, and diarrhea syndrome in 50% of patients. At the same time, clostridial infection was detected in only 17% of patients. Lesions of the small and large intestine were detected in 65%, lesions of the colon in 22%, lesions of the small intestine in 9%, total lesions of all parts of the gastrointestinal tract in 4% of cases. Characteristic changes in CD children were hypoalbuminemia, anemia, and a significant increase in fecal calprotectin levels. Conclusion. CD children require a special approach when conducting a systemic diagnostic search due to the high frequency of nonspecific and extra-intestinal manifestations.

Introduction: Recently, the use of thoracoscopic methods in spinal deformity surgery has increased, however, the issue of the effectiveness of combining anterior release with posterior spinal fusion compared to single-stage posterior instrumentation remains controversial, which raises the issue of the effectiveness and feasibility of their use. Purpose: To evaluate the effectiveness of endoscopic anterior release for thoracic scoliosis in children. Material and method: A retrospective analysis of the results of surgical treatment of 48 patients with idiopathic scoliosis of the thoracic spine aged 12-17 years, with a thoracic curve of more than 60 degrees, was carried out. To determine the stability of deformity, the stability index according to A.I. Kazmin was used. (SI) defined as the ratio of the angle of deformity in the supine position to the angle of deformity in the standing position. Indications for anterior release were incomplete skeletal growth and relatively stable deformities (SI 0.75-0.85). Group 1 included 27 patients operated on in one stage without anterior release, and group 2 included 21 patients in two stages, with preliminary anterior release using video-assisted thoracoscopy. Results: In group 1, the average Cobb angle of deformity was 71.8 degrees with an average stability index of 0.8. In the second group, the average cobb angle of deformity was 69.7 degrees, the average stability index was 0.82. In group 1 after surgery, the average Cobb angle was 27.8 degrees, with an average correction of 63.39%. In the second group, the postoperative deformity angle was 17.4 degrees, the average correction was 76.26%. Thus, we found a statistically significant increase in postoperative correction when using a combined anterior/posterior approach (p < 0.05). Conclusion: In the study, in patients with relatively stable deformities, a statistically significant increase in the degree of postoperative correction was revealed (p < 0.05) when using a combined anterior/ posterior approach. Performing an anterior thoracoscopic release for thoracic deformities can improve long-term results due to the formation of 360 degrees spinal fusion at the apex of the deformity, as well as turning off the pathogenetic links in the progression of the deformity. Level of Evidence: III. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Introduction. The results of treatment of children who are preparing or have already undergone major surgery depend on many factors, including the nutritional status — the presence/absence of malnutrition. Aim: to assess the nutritional risk and nutritional status in children with surgical diseases during pre- and postoperative periods. Materials and methods. A prospective, single-center, non-comparative study included 60 children aged from 1 month to 17.5 years with diseases of the esophagus, intestines, urogenital system, admitted for surgical treatment. In all patients, the anamnestic data of life and disease were analyzed, screening of nutritional risk was assessed according to the validated Russian version of the STRONG-kids screening tool, nutritional status was evaluated using the WHO AnthroPlus program (2009) and the anthropometric indices (Z-scores: weight/age, height/age, BMI/age), the biochemical parameters (concentrations of C-reactive protein, total protein, albumin, prealbumin, transferrin) were estimated. Results. A high nutritional risk at admission was established in more than half (57%) of patients, moderate — in 36% of patients, low — only in 7% of cases. Malnutrition (Z-score BMI/age from –1 to –3) was diagnosed in 24 (40%) patients, 58% of them suffered from diseases of the esophagus, 37% had pathology of the intestine and 36% — the genitourinary system. Conclusion. Nutritional risk screening and nutrition status assessment are necessary in all patients admitted to pediatric surgical hospitals for the timely appointment of adequate nutritional support, which will reduce the incidence of postoperative complications and decreasing the length of hospital stay.

Introduction: Dystrophic epidermolysis bullosa (DEB) is one of the most severe forms of congenital epidermolysis bullosa and characterized by the formation of many surgical complications. Esophageal stenosis is a common complication of DEB and occurs in almost 76% of cases. Balloon dilatation (BD) under X-ray control is the main therapeutic technique, however conservative treatment is necessary to prevent restenosis. The use of the drug losartan is promising due to its antifibrotic effect through the suppression of transforming growth factor-I31 (TGF-I31). Purpose: To evaluate the efficacy of losartan in the prevention of restenosis after BD of esophageal stenosis in children with DEB. Materials and methods: The study included 19 children from 2 to 16 years old (mean age 9.2 +/- 3.58 years) with DEB and X-ray confirmed esophageal stenosis. All children underwent BD. In the main group 9 children after BD have received losartan, in the control group of 10 children -only standard therapy. The observation period was 12 months. Results: In the main group, 1 child (11.1%) required repeated dilatation, in the control group -4 children (40%). Indicators of nutritional deficiency (THINC scale) and the disease severity index (EBDASI) were significantly lower in the group of children treated with losartan. No undesirable actions of the drug were recorded. Conclusions: In this study losartan showed its safety, contributed to a decrease in the restenosis frequency and an improvement in the nutritional status of children with DEB after BD. However, further studies are required to confirm its effectiveness. Level of Evidence: IV. (c) 2022 Elsevier Inc. All rights reserved.

Crohn's disease (CD) is a chronic, immune-mediated inflammatory bowel disease characterized by transmural damage of various parts of the gastrointestinal tract. The aim of the study is to present our experience in pre-surgical diagnosis, selection of surgical tactics and volume of intervention in different variants of gastrointestinal tract lesions and disease activity. We undertook cross-sectional, retrospective-prospective study of 64 children who underwent surgery due to complicated CD. We analyzed CD activity via PCDAI, medications used, inflam-mation localization, and changes in mass-growth parameters at pre-surgery stage. Three patients from the group of 44 children with two-stage surgical treatment later showed inefficacy of GEBD in post-operative period. The disease progression was revealed and, therefore, subtotal colectomy was required. Three children had secondary adhesion of surgical wounds by means of active immunosuppressive therapy at preoperative period, and five patients developed suture sinuses at post-operative period. Early adhesive intestinal obstruction was revealed in 3 (4.7%) cases, and they required re-surgery. Personalized approach to the surgical treatment of children with complicated CD has shown its efficacy due to the small percentage of postoperative complications with re-surgery. There was significant improvement in mass-growth parameters, recovery of albumin levels, and anemia decrease in 96.9% of cases in the long-term postoperative period (6 months or more). Two children (3.1%) had the narrowing of anastomotic zone lumen, thus, without any obstruction. These cases were associated with violations in drug treatment

Introduction. Cholelithiasis in children is a rare disease. Making a decision on cholecystectomy in children is an urgent problem due to the lack of consensus on the tactics of managing children with cholelithiasis. Aim: determine the indications for surgical treatment of cholelithiasis in children based on laboratory and instrumental examination methods. Materials and methods. The study analyzed twenty seven patients operated on for cholelithiasis from 2018 to 2023. Results. Me = 18.7 months elapsed from the moment of diagnosis of cholelithiasis to surgery. In the prospective part of the work, 27 patients were studied, of which 26 were operated on. In 7 (26%) — the disease proceeded without symptoms, in 20 (74%) — pain syndrome was observed, in 4 — dyspeptic disorders were observed in the form of nausea and vomiting associated with food intake, in 2 — biliary sludge. According to the study, there was no statistically significant change in the level of C-reactive protein (p = 0.4). Analyzing the ESR data before and after surgical treatment, there was no statistically significant difference in the dynamics of this indicator (p = 0.223). In the trend in laboratory parameters, a statistically significant change in the parameters of leukocytes (p = 0.023) and neutrophils (p = 0.014) was revealed in the general blood test before and after surgical treatment. Conclusion. In children diagnosed with uncomplicated cholelithiasis, changes in laboratory parameters before and after surgery are uninformative and unreliable. In children with uncomplicated cholelithiasis, medical treatment was ineffective, as a result of which surgical treatment was indicated. The ineffectiveness of drug treatment and the deterioration of the general condition of the child are indications for surgical treatment. As a minimally invasive surgical intervention, laparoscopic CE is recommended.

Background. Numerous studies aimed at assessing the nutritional status and organizing nutritional support for surgical patients cover the adult patients, only a handful assess underaged patients with surgical pathology in the pre- and postoperative period and their needs for assessment of the nutritional status and approaches to their dietary correction. Aim. To assess the possible risks of developing malnutrition in children with various pathologies of the chest organs during the preoperative period, and to conduct a comprehensive assessment of their nutritional status. Materials and methods. The single-center non-comparative cross-sectional study included 50 children between 5 months and 17 years 7 months, hospitalized in the thoracic department of the National Medical Research Center for Children's Health of the Ministry of Health of the Russian Federation. All patients underwent an assessment of clinical and anamnestic data, somatometric and clinical laboratory parameters, and Z-scores analyzed: body weight/age, height/age, BMI/age, shoulder circumference, skin-fat folds above the triceps and under the scapula, as well as a number of biochemical parameters (concentrations of total protein, albumin, prealbumin, transferrin and C-reactive protein). Results. When assessing the nutritional status of children upon admission to the thoracic department, acute malnutrition was detected in 21 (42%) patients (of which 10% had mild, 14% moderate, and 18% severe malnutrition), chronic malnutrition was found in 18% of children. For the first time in Russia, using a validated Russian-language version of the STRONGkids screening questionnaire, nutritional risks of malnutrition have been assessed. The vast majority of patients were at moderate (28%) or high (70%) risk of developing malnutrition or its aggravation. Z-scores of skin-fat folds above the triceps and under the scapula, as well as the circumference of the shoulder were within the reference values. 16 (36%) patients had a decrease in the concentration of total protein, 10 (22%) had a drop of prealbumin accompanied by an increase (40%) of the C-reactive protein level. The levels of other proteins were within the reference values. Conclusion. The identified risks of malnutrition and its moderate/severe manifestations in children with surgical pathology are able to contribute to the development of infectious and non-infectious postoperative complications, increase the length of stay in the clinic, and require nutritional support from the first day of hospitalization in a surgical hospital.

Introduction. Crohn’s disease (CD) is an inflammatory disease of the digestive tract of unknown etiology with segmental transmural inflammation of various parts of the gastrointestinal tract. The annual increase in the number of children with newly diagnosed CD, late diagnosis and untimely surgical treatment is one of the urgent problems due to the lack of a single algorithm of surgical treatment. The aim: to determine the effectiveness of surgical treatment of CD in children. Materials and methods. The study included thirty six patients with complicated CD Over the period from 2018 to 2022, a re­trospective and prospective analysis of children who received medical care for CD with two-stage surgical treatment (resection of the affected area with enterostomy and subsequent restoration of gastrointestinal continuity) was carried out. Results. Clinical activity according to Pediatric Crohn’s Disease Activity Index (PCDAI) in 23 (63.8%) children before treatment was recorded as high (30.0–75.2 points), in 15 (36.2%) children had average activity (11–29 points). After the staged surgical treatment, there was a change in the indicators — the onset of remission in 2 (5.5%) children and in 34 (94.5%) mild course (p < 0.05). Statistical analysis of anthropometric indicators revealed positive changes (HAZ p < 0.05 and BAZ p < 0.001) with increase in weight and height criteria. Assessment of laboratory dynamics revealed positive changes (p < 0.001) — the absence of anemia, hypoalbuminemia and relief of bacterial inflammation. CD debuted before the age of 10 years in 7 children (19.4%), aged 10 to 16 years — in 29 (80.5%). In 24 (66.7%) children, genetic engineering biological therapy (GEBT) at the time of the development of surgical complications was not performed, from them 15 (62.5%) received hormonal and immunomodulatory therapy while it was not effective, while for 9 (37.5%) patients the timely verification was diagnosed at the stage of development of CD complications. However, the development of surgical complications was noted in 12 (33.3%) children, despite the timely verification and appointment of treatment for genetic engineering biologic therapy (GEBT). Biological therapy was continued for 7 (58.3%) children who received GEBT before surgery, and in 5 (41.7%) patients, treatment was continued with a change of GEBT. The period of stay with a stoma was found to be from 7 to 31 months (Me = 8). Conclusions. In complicated forms of CD in children, despite drug therapy, including GEBT, the development of complications requiring surgical treatment was noted, which indicates an aggressive and progressive course of CD. However, the use of stage-by-stage surgical treatment showed efficiency due to the positive dynamics of anthropometric indicators, laboratory markers, the potency of surgical treatment, and made it possible to achieve stable remission against the background of specific therapy and improve the quality of life in CD children.

Introduction. To improve the quality of surgical treatment and prevent postoperative complications, there is needed an integrated multidisciplinary professional approach including a combination of nutritional support with therapeutic methods and psychological assistance that reduces stress throughout the perioperative period. Clinical guidelines and standards to manage the patients on this issue in pediatric surgical hospitals have not been developed. Objectives: to assess the nutritional risk of malnutrition and nutritional status in children with surgical diseases, to elaborate algorithms for nutritional support over the pre- and postoperative periods. Materials and methods. The single center non-comparative study included sixty children aged from 1 month to 17 years 5 months, with diseases of the esophagus, intestine, and genitourinary system, were admitted for surgical treatment at the Research Institute of Pediatric Surgery of the Federal State Autonomous Institution «National Medical Research Center for Children’s Health» of the Ministry of Health of Russia. All patients underwent a nutritional risk screening according to a validated Russian version of the STRONGkids. Clinical and anamnestic data were analyzed. Anthropometric indices (Z-scores: weight/age, height/age, BMI/age) using the WHO AnthroPlus program (2009), and biochemical parameters (concentrations of C-reactive protein, total protein, albumin, prealbumin, transferrin) were evaluated. Results. A high nutritional risk at admission was established in more than half (57%) of patients, moderate — in 36% of patients, low — only in 7% of cases. Malnutrition (Z-score BMI/age from –1 to –3) was diagnosed in 26 (43%) patients, 58% of them suffered from diseases of the esophagus, 37% — the intestine pathology, and 36% of the genitourinary disorders. Conclusion. Nutritional risk screening and nutrition status assessment are necessary in all patients admitted to pediatric surgical hospitals for the timely appointment of adequate nutritional support, which will reduce the incidence of postoperative complications, and allow diminishing the length of the hospital stay.

Background. Crohn's disease (CD) in children is characterized by a more severe and progressive course, with the development of a form that is not susceptible to drug therapy, and the development of surgical complications. Up to 50% of cases, inflammation is localized in the ileocecal region. Isolated inflammation of the colon is diagnosed in the smallest number of patients with Crohn's disease, in adults from 18.1 to 28.3%, in pediatric patients from 5.1 to 24.4%. Aim. To substantiate the effectiveness of three-stage surgical treatment in children with colon lesions in CD. Materials and methods. From 2018 to 2022, 75 children with complicated Crohn's disease underwent surgical interventions in the National Medical Research Center for Children's Health. A single-stage retrospective-prospective study of 7 (9.3%) children with isolated colon lesion was conducted. Four (57%) children stenosis in the left colon; 3 (43%) children continuously recurrent inflammation of the colon, not amenable to drug therapy. The effectiveness of staged surgical treatment was evaluated after 6, 12, 18, 24 months based on statistical analysis of clinical, endoscopic and laboratory activity of CD, changes in anthropometric indicators. Results. In 4 children, the onset of remission was noted, and in 3 children, clinical activity was mild (p0.05). The onset of endoscopic (p0.05) and laboratory remission (p0.05) was noted in all children. The assessment of the growth-to-age ratio also showed statistically significant positive dynamics, however, when assessing the ratio of body mass index to age, no statistically significant changes were detected (p=0.066). Conclusion. Isolated colon lesion is the rarest phenotype in children with CD. The formation of colon stricture requires surgical treatment, but predicting the volume of surgical treatment at the preoperative stage is a difficult task. The chosen tactics of conducting surgical treatment in three stages, with the correction of drug therapy after disconnecting the colon from the digestive tract, allowed not only to avoid postoperative complications associated with the formation of an anastomosis on the affected intestinal wall, but also to achieve remission of the disease.

We present a case of tubular esophageal duplication in a 3-day-old female newborn (38 weeks, 2,500 g) without concomitant abnormal development. Esophageal duplication was diagnosed based on the clinical picture, direct laryngoscopy, esophagography and computed tomography. The duplicated esophagus was resected by thoracoscopy leaving the orthotopic esophagus in place. Isolation from the pharynx was performed via a separate cervical incision. After a follow-up period of 20 months, the child returned to normal growth and development.

INTRODUCTION:Complete tracheal rings are a rare malformation that occurs in 1 out of 100,000 live births. It is rare, isolated tracheal or tracheobronchial anomaly developed due to abnormal cartilage growth with formation of complete ring and often resulting in airway stenosis. Slide tracheoplasty, as it was originally described by Tsang et al. and popularized by Grillo et al., overlaps stenotic segments of trachea, shortening trachea itself, thus, doubling the circumference and diameter of the stenotic area. MATERIALS AND METHODS:We have performed slide tracheoplasty in 12 children during the period of 2019-2021 in thoracic surgery department of our center. Median age was 15 ± 21,1 months (2 months-6 years),median weight - 8,04 ± 4,75 kg (3-20,7 kg),tracheal lumen varied from 2.5 to 3.0 mm, stenosis length - from 40 to 70% of the trachea length. RESULTS:Slide tracheoplasty was performed using central veno-arterial extracorporeal membrane oxygenation in 7 cases and using cardiopulmonary bypass in 5 cases. Concomitant heart disease was revealed in 5 children (pulmonary artery sling in 3 cases, ventricular septal defects - 1, aberrant subclavian artery -1). 5 children underwent one-stage correction of VSD: plastic VSD -1; left pulmonary artery reimplantation - 3; subclavian artery reimplantation - 1. All patients were on mechanical ventilation for 4,3 ± 2,78 days at postoperative period. Patients were discharged 16,3 ± 5,14 days after surgery. Satisfactory result of treatment in the form of respiratory failure relief was achieved in 10 patients. It was possible to increase the trachea lumen from 1.5 to 2 times in all cases. There were 2 (16,6%) fatal cases due to sepsis and multi-organ failure development. CONCLUSIONS:Children with complete tracheal rings are very complicated patients with various comorbidities. Despite the advances in medicine, sometimes it is impossible to save lives of these children. The use of extracorporeal circulation (ECMO and bypass) allows us to safely perform reconstructive surgery on the trachea and save the child from respiratory failure manifestations. If needed, simultaneous correction of heart and tracheal defects is possible. Slide tracheoplasty allows to increase trachea lumen at least in 1.5-2 times. Mechanical ventilation is an unfavorable predictive factor for the outcomes of congenital tracheal stenosis management. LEVEL OF EVIDENCE:III.

Perioperative nutritional support reduces the healthcare burden of pediatric malnutrition and its risk. Strategic preventive, diagnostic and therapeutic nutritional management guidelines are now available for their optimization. The global needs for pediatric surgery are vast, amounting to millions of children and adolescents, with a corresponding workforce requirement, especially in less socioeconomically developed regions, and where malnutrition is endemic. Acute and elective surgery from neonate to adolescent, for congenital to infective, neoplastic and traumatic conditions, are involved. To identify, highlight and critique current perioperative pediatric nutrition guidelines with regard to availability, utility, affordability and accuracy. Advantages and limitations of nutritional methodologies are taken into account in an algorithmic approach to perioperative decision-making to optimise outcomes. Routine documentation, monitoring and surveillance of pediatric nutritional status as a contributor to surgical risk management should increase its benefits, and reduce costs.

Rectal prolapse (RP) is one of the most expected complications following the treatment of anorectal malformations that occurs in 3.8% to 60% of cases. The main method of surgical treatment of RP is anoplasty with a recurrence rate after surgery of up to 33%. The authors describe the indications, technique and results of transanal rectal mucosectomy and muscular plication (TRMMP) proposed by Dr. Luis De La Torre-Mondragon, MD, Pediatric Colorectal Surgeon with the Children's Hospital Colorado (CHCO), Aurora, Colorado, United States, for the treatment of RP in children with anorectal malformations (AM). Materials and methods used: in a retrospective analysis of 234 patients with AM, 8 patients with RP (all males) were identified. In 2 patients, a displacement of the rectum was detected, and subsequently they underwent the posterior sagittal anorectoplasty (PSARP). Another 6 patients underwent the TRMMP. Results: all patients had previously undergone the open surgery without PSARP. The average age of patients at the time of surgery was 4.6 years (Q1-2.5, Q3-7.9; SD-2.2; min/max 2.0-5.0; 95% CI: 2.1-5.5). In all patients, the RP length averaged 2.3 cm (Q1-1.5, Q3-3.9; SD-0.9; min/max - 1.6-4.0; 95% CI: 1.4-3.3). There were no intraoperative and postoperative complications. There were no relapses of RP and stenoses of anastomoses during the dynamic follow-up after surgery for 7.6 months recorded as well (Q1-5.0, Q3-10.9; SD-2.4; min/max - 5.0-11; 95% CI: 5.1-10.2). Conclusion: the authors’ first experience confirms the efficacy of TRMMP in RP in children with AM.

Background. The approaches to the managing of nutrition for healthy children are not always applicable to patients with neurological disorders, since their body composition, muscle tone, level of physical activity, and energy requirements significantly differ from healthy children and, therefore, must be personalized with the mandatory involvement of a nutritionist/dietitian. The purpose is to assess nutrition in children with cerebral palsy (CP) depending on Gross Motor Function Classification System (GMFCS) level. Materials and methods. Eighty-eight 2 to 16 years nine months CP children rehabilitated at the National Medical Research Center for Children’s Health from 2019 to 2021 were included in this study. Participants were divided into two groups. The main group was patients with GMFCS levels IV-V (48 children) and the comparison group - GMFCS levels I-III (40 children). The medical and dietary history of participants was analyzed. Anthropometric parameters using the WHO AnthroPlus (2009) software were assessed in all participants, the ability to eat and drink was determined by questioning the EDACS scale (Eating and Drinking Ability Classification System). Results. The mean values of weight/age, height/age, BMI/age Z-scores were significantly below 0 (p = 0.01) in all patients (88): WAZ -1.54 ± 1.9, HAZ -1.03 ± 1.48, BAZ -1.5 [-3.11; -0.35]. Children of the main group had significantly lower Z-scores. As a result of the survey, patients of the main group were revealed to have indicators characterizing eating disorders significantly more often (p < 0.001) than the comparison group. EDACS survey revealed that children of the main group were significantly more likely (58% and 10%, respectively; p < 0.001) to have disorders corresponding to levels IV-V, characterized by significant safety restrictions. We have developed a nutritional assessment and management algorithm for children with cerebral palsy, admitted for rehabilitation at the neurological department. Conclusion. Children with cerebral palsy need regular nutritional assessment and management for timely and adequate nutritional support, including enteral nutrition.

Omicron is a newly discovered new variant virus, which spreads rapidly around Russia and the world and has a great impact. It is designated as a variant of concern (VOC) by the World Health Organization. Its characteristic of epidemiology, distribution, pathogenic and clinical diagnosis, treatment, and prevention is still being observed and summarized, and Clinical manifestations of COVID-19 infection are nonspecific, especially in preterm infants. Since there are few reports on the diagnosis and treatment of children with this infection. This article studies the diagnosis, treatment, and prevention of omicron in Russian children, to improve the understanding and attention to the disease.

The article presents a review of modern domestic and foreign literature, which reflects the current problems associated with the diagnosis of malnutrition in children admitted to surgical hospitals. The article gives definition of the concept of «nutritive insufficiency», and its prevalence. The clinical, anthropometric, instrumental and laboratory research methods used to assess the nutritional status are characterized in detail. It has been shown that malnutrition has a negative impact on the course of surgical pathology, reduces immunological protection, increases the risk of complications, nosocomial infections, and length of hospital stay. Various methods for assessing the risks of malnutrition in surgical patients upon hospital admissions are presented.

Objective: Chronic appendicitis (CA) is a diagnosis characterized by long-standing right lower quadrant pain. We analyzed clinical, morphological, and immunohistochemical studies of the appendix to confirm the adequacy of surgery for CA in children with chronic right lower quadrant pain. Patients and Methods: We carried out comparative studies of clinical presentations and results of morphological and immunohistochemical studies of remote appendicitis in 55 children with chronic recurrent lower quadrant pain (CRLQP). Results: Morphological and immunohistochemical studies revealed three types of changes in the appendix. Type 1 (n = 21)-chronic inflammation. Inflammatory leukocyte infiltration was localized within the mucous membrane of the appendix. An immunohistochemical study revealed a significant (P < .01) increase in the expression of CD106 (vascular cell adhesion molecule 1) and in the number of matrix metalloproteinase 9 (MMP-9) positive cells. Type 2 (n = 20)-lymphoid hyperplasia. Morphological changes were characterized by lymphoid infiltration of the mucosa and submucosa of the appendix. Immunological changes were characterized by an increase (P < .01) in the expression and number of MMP-9, expression of CD106 positive cells, an increase in the expression of collagen IIIα in combination with a decrease in the expression and number of positive vascular endothelial growth factor (VEGF) and vasoactive intestinal peptide cells. Type 3 (n = 12)-catarrhal inflammation. Morphological changes were characterized by impaired blood circulation only in the mucous membrane, without destructive or inflammatory changes. Immunological changes were characterized by an increase (P < .01) in the expression and number of VEGF-positive cells, which may indicate a response to local hypoxia of the appendix and explain neovascularization in a chronic condition. The abdominal syndrome after appendectomy was noted to disappear in 89% of patients. The established changes in remote appendicitis, other than acute inflammation, make it possible to consider reasonable appendectomy a way of treating CRLQP in children. Conclusions: We have identified immunohistochemical and morphological changes pointing to autoimmune and vascular mechanisms of appendix damage in children with CRLQP. Laparoscopic appendectomy helps to eliminate abdominal pain in most CA patients.

Crohn's disease (CD) is chronic recurrent bowel disease of unknown etiology, characterized by segmental transmural granulomatous inflammation, mainly with the development of local and systemic complications. Despite the active development of conservative therapy methods, the number of drug-resistant forms of CD and complications of the disease requiring surgical treatment continues to increase. The article reflects modern scientific ideas about the methods of diagnosis, conservative and surgical treatment of CD in children.

The main human species mission is fertility, which is an important point of the concept of health in general and of reproductive health in particular. Endocrinologists, obstetrician-gynaecologists, urologists and paediatricians are focused in this field of medicine. A decline in male fertility of up to 30–35% results in infertility which becomes serious concerns growing for human population. Many of the problems that lead to impaired male fertility are rooted in childhood, or rather, in prenatal ontogenesis. The penetration of vascular-bed substances into the cavity of the seminiferous tubules depends on the maturity and functional status of the structures constituting the blood-testicular barrier (BTB). A breach of BTB results in damage to the sperm epithelium and, as a consequence, in different grades of impairment of spermatogenesis. Among the diseases that predispose men to infertility varicocele predominates (up to 30%). One of the reasons for infertility is the impaired integrity of BTB when the process of spermatogenesis changes, sometimes in combination with infection, trauma, and toxic effects. Given the unfavorable prognosis of the consequences of these diseases in children, their careful and timely diagnosis is important. Fertility estimation places special emphasis on the state of BTB, which can be determined by the content of claudine-11, antisperm antibodies, inhibin B, and other markers.