The article presents a clinical case of melorheostosis with lesion of the left lower limb in a 30-year-old woman, involving the hip, knee joints, and foot lesion. Arthrotomy with removal of osteophytes in the posterior part of the knee joint and removal of osteophytes of the foot were performed. In the postoperative period, peroneal nerve neuropathy developed, which required neurolysis and a course of conservative treatment; the neuritis resolved. Later, total hip arthroplasty of the left hip joint was performed and the function of the limb was restored. New surgical interventions may be required in the future.

Анализ заболеваемости острыми отравлениями химической этиологии (данные годовых отчетов ФГБУ НПТЦ ФМБА России) показывает, что в течение года в РФ за специализированной медицинской помощью по причине острых отравлений обращаются от 21,5 до 30,6 тысяч детей в возрасте до 18 лет. По статистическим данным отделения токсикологии ГБУЗ ДГКБ им. Н.Ф. Филатова г. Москвы, ежегодно в стационаре проходят лечение в среднем 104–116 детей с диагнозом: острое отравление прижигающими веществами. Среди них причиной отравления в 5–7 % случаев является прием внутрь кристаллов перманганата калия. Перманганат калия (KMnO4) относится к категории прижигающих ядов, вызывает тяжелые химические повреждения тканей. Является сильным окислителем, в организме преобразуется до едкой щелочи, атомарного кислорода, марганцевой двуокиси. Помимо прижигающего действия марганец обладает и нейротоксическим эффектом в связи с тем, что свободно проникает через гематоэнцефалический барьер, обладает высокой тропностью к подкорковым структурам головного мозга. Летальная доза перманганата калия для взрослых при приеме внутрь — 0,3–0,5 г/кг. Данных о летальных дозах у детей не найдено. The analysis of the incidence of acute poisoning of chemical etiology (data from the annual reports of the FSBI NPTC of the FMBA of Russia) shows that 21.5 to 30.6 thousand children under the age of 18 seek specialized medical care in the Russian Federation. According to statistical data of the Department of Toxicology of the N.F. Filatov State Medical University of Moscow, an average of 104–116 children with a diagnosis of acute poisoning with cauterizing substances are treated annually in the hospital. Among them, the cause of poisoning in 5-7 % of cases is ingestion of potassium permanganate crystals. Potassium permanganate (KMnO4) belongs to the category of cauterizing poisons, causes severe chemical damage to tissues. It is a strong oxidizer, in the body it is converted to caustic alkali, atomic oxygen, manganese dioxide. In addition to the cauterizing effect, manganese also has a neurotoxic effect due to the fact that it freely penetrates the blood-brain barrier, has a high tropicity to the subcortical structures of the brain. The lethal dose of potassium permanganate for adults when ingested is 0.3–0.5 g/kg. No data on lethal doses in children found.

Aim. To enhance the treatment outcomes in children with complications following an esophageal burn caused by a disk battery.Materials and Methods. We analyzed the treatment outcomes of 102 patients suffering from esophageal burns from a disk battery, who were treated at the N.F. Filatov Children’s City Hospital of the Moscow Healthcare Ministry from 2009 to 2021. Children who developed complications (n=57) were divided according to the treatment strategy employed: conservative tactics (n=36, 63.2%) and radical surgery (n=21, 36.8%).Results and Discussion. The types of surgical interventions carried out for tracheoesophageal fistula (TEF) (n=31) included laparoscopic fundoplication and gastrostomy (38.7%), separation of TEF (41.9%), and tracheal plastic surgery with an esophageal flap and extirpation of the esophagus (19.4%). Assessment of the outcomes of TEF post laparoscopic fundoplication and gastrostomy demonstrated spontaneous closure in 63.6% of the cases. The average time until closure was 5 months. Among children with esophageal stenosis (n=24), esophageal bougienage was performed in 95.8% of the cases. All children identified with esophageal perforation (n=4) were successfully treated conservatively. Tactics for managing laryngeal paresis or paralysis included conservative therapy and observation in 33.3% of cases, tracheostomy in 29.2%, and lateralization procedures in 37.5%.Conclusion. Conservative tactics demonstrated superior results in all complications, minimizing the number of postoperative complications (16.7%) and ensuring favorable long-term outcomes.

Introduction. Over the past 10 years, the number of severe and fatal cases of burns in the esophagus caused by button batteries in children has increased significantly. The tactics of managing children with complications after such burns has not been defined worldwide yet; few clinical cases are described in Russian sources. Material and methods. The literature search has covered databases of RSCI, Medline and GoogleScholar published in 1983–2022. More than 350 publications on this topic have been analyzed. Results. Electrolysis is recognized as the main mechanism of tissue destruction, which is accompanied by the development of colliquative necrosis in the area of negative pole of the battery. The National Capital Poison Center, Washington, USA, recommends to neutralize burns with honey and 0.25 % acetic acid solution. The most optimal tactics for managing tracheoesophageal fistulas caused by batteries is to perform laparoscopic fundoplication and gastrostomy, as a result of which spontaneous closure of the fistula may occur. In case of large defects and patient’s severe unstable condition more complicated reconstructive interventions have to be done. Esophageal stenoses should be treated with bougienage, and perforations are preferably treated conservatively. In case of laryngeal paresis or paralysis, laryngoscopy is required at the early stage so as to understand if tracheostomy is better instead of tracheal intubation. Esophageal aortic fistulas require aggressive surgical tactics even in the absence of visible bleeding. Conclusion. Currently, there is no common management strategy in any of the possible complications. Further statistical analysis of clinical cases and assessment of existing conservative and surgical techniques are needed; development of new surgical techniques to be applied in patients with abovementioned pathology is needed as well. Rational diagnostics and curative tactics will reduce high mortality rate and improve the quality of life of such patients.

OBJECTIVE:To determine the optimal treatment of patients with complications of esophageal electrochemical burns by batteries.MATERIAL AND METHODS:There were 75 children with esophageal electrochemical burns by batteries between 2010 and 2019. All children underwent X-ray of the cervical spine, chest and abdomen, esophagoscopy with removal of the battery, tracheoscopy. Complications occurred in 39 children: TEF - 21, esophageal stenosis - 19, laryngeal paresis - 14, esophageal perforation - 3. Patients with TEF were divided into 2 groups: clinically stable children without respiratory failure and severe illness with respiratory failure including mechanical ventilation. Group I consisted of 6 children, four of them underwent laparoscopic Nissen fundoplication and gastrostomy. Group II consisted of 15 children. In acute period, 3 children underwent laparoscopic fundoplication and gastrostomy, 8 ones - TEF ligation, 4 patients - tracheal repair with esophageal flap and esophageal extirpation. Patients with esophageal stenosis underwent bougienage. Patients with esophageal perforation required therapy. Tracheostomy was necessary for respiratory failure and bilateral laryngeal paresis. Lateralization procedures were performed in patients with negative course of disease.RESULTS:In the 1st group, spontaneous closure of TEF was found in 3 children after fundoplication and gastrostomy. One child underwent thoracoscopic disconnection of TEF after reduction of fistula. In the 2nd group, fundoplication resulted spontaneous closure of fistula after 2-5 months. In 4 children, recanalization of the fistula or esophageal failure were observed in acute period after TEF ligation.CONCLUSION:Laparoscopic fundoplication and gastrostomy are optimal for TEF and can result complete or partial spontaneous closure of TEF. If radical procedure is necessary in acute period, tracheal repair with esophageal flap and extirpation of the esophagus with subsequent coloesophagoplasty should be considered.

Treatment of congenital diaphragmatic hernia is one of the most critical neonatal surgery challenges, which is associated with high mortality rate. Despite the progress achieved in the treatment of congenital diaphragmatic hernia, the choice of surgical approach and time of hernial correction remains controversial. Material and methods : From 2000 to 2018, 39 children with congenital false diaphragmatic hernia were hospitalized in the department of surgery of the Nizhny Novgorod Regional Children's Clinical Hospital. Of these, 26 (66.7%) were boys and 13 (33.3%) were girls. Cases of successful treatment of bilateral diaphragmatic hernia and correction of persistent right Bochdalek defect with underlying right tension pneumothorax with “late manifestation” of diaphragmatic hernia deserve a special presentation. Results : Most typical set of symptoms includes respiratory failure, cardiovascular disorders, and intestinal pseudo-obstruction syndrome. Left-sided hernia was detected in 35 children (89.7%), while right-sided hernia was detected in 3 (7.7%), and a bilateral hernia was detected in one child. The mortality rate accounted for 25.6% (10 children) of children due to progression of cardiopulmonary complications. Conclusions : Despite the extensive clinical experience in the management of children with diaphragmatic hernias, of the prenatal diagnostics potential and technical capacities of modern medicine, individual cases of diaphragmatic hernias are associated with challenges regarding timely detection of malformation in the postnatal period, since the diaphragmatic hernia with persistent diaphragmatic defect tend to demonstrate a late pattern of manifestation. Diaphragmatic hernia can develop at a later time—age 4–6 months, which could be explained by an intra-abdominal pressure increase when the child is becoming more active, while underlying Bochdalek defect is persisting.