Introduction: A duplication cyst (DC) of the gastrointestinal (GI) tract is a rare developmental anomaly of the digestive system. The latency and variability of clinical manifestations hamper the physician's ability to make the correct diagnosis, often leading to a marked delay in diagnosing the disease. The patient in the current report repeatedly sought medical help for four years before the correct diagnosis was made. Case presentation: A 14-year-old boy was admitted to the emergency department complaining of abdominal pain and repeated vomiting. A more thorough history revealed that similar pain accompanied by vomiting of gastric contents had been periodically noted for the last four years. According to the parents, the boy has had a poor appetite throughout the period, resulting in minor weight loss. On physical examination, the patient's abdomen was not distended and could be examined with only moderate pain on deep palpation in the epigastric and right mesogastric regions. To exclude perforation of a hollow organ and intestinal obstruction, plain abdominal radiography in two standing projections was performed, which showed no free air under the diaphragm and no features characteristic of intestinal obstruction. Ultrasonography of the abdomen, in the area of the major curve of the stomach near the head and body of the pancreas, revealed a cystic mass with echogenic contents 40 x 30 mm in size. The patient underwent an esophagogastroduodenoscopy (EGD). In the antrum, along the posterior gastric wall, there was an ovoid-shaped mass measuring about 40 x 30 mm and covered with smooth pink mucosa. According to the MRI, there was a clearly outlined cystic mass, 38 x 36 x 40 mm in size. A complete examination allowed for the diagnosis of a gastric DC and a decision was made to perform laparoscopic surgery. The laparoscopy was performed under general anesthesia using the threeport technique. The duplication cyst in the stomach was removed laparoscopically. The course of the postoperative period was smooth. Conclusion: The latency and variability of clinical manifestations of gastric DC in children complicate the correct diagnosis and lead to a delay in definitive diagnosis. Modern imaging techniques allow for diagnosing rare GI pathology before surgery. Minimally invasive surgical techniques facilitate the early recovery of patients.

Introduction. Polytrauma (PT) in children is an important medical and social issue because it leads to a high percentage of disability and mortality in pediatric population. Destruction of the muscle mass in patients with PT causes traumatic rhabdomyolysis (TR) in 85% of cases. Such patients develop endogenous intoxication called “toxic-resorbtive state” (TRS) which is caused by the absorption of tissue degradation products into the systemic circulation.Purpose. The aim of the present study was to analyze publications on the diagnostics and treatment of “toxic-resorbtive state”, including extracorporeal techniques.Material and methods. We searched PubMed, Web of Science, Scopus, MEDLINE, eLibrary, and RSCI databases and found about 1800 references and 268 articles. We selected 38 articles for reviewing in traumatology, intensive care and extracorporeal methods.Results. In the acute period of injury, TRS is complicated by the acute kidney injury (AKI) in 5–25% of cases. Mortality in TRS is up to 20%; the leading cause of death is multiple organ failure. TRS markers are myoglobin, creatine phosphokinase lactate, LDH, AST and others. TRS therapy is aimed to prevent and to treat AKI. Continous renal replacement therapy (CRRT) for treating TRS allows to remove myoglobin, CPK and LDH from the circulation and to reduce mortality by half.Conclusion. In TRS management, there are no unified approaches to CRRT indications, regimens, session duration, and choice of optimal filters. In the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, a trial is planned aiming to assess CRRT effectiveness and safety of TRS treatment in children with polytrauma injuries.

Introduction. A comparative study on the effects of osmotic diuretics (OD) at parameters of water-electrolyte metabolism in children with brain injury was conducted. The researchers analyzed these effects depending on the treatment algorithm whether it was done by the Protocol or by generally accepted indications. Material and methods. 51 case-histories of children with severe, combined TBI were taken for the analysis. The patients were treated with osmotic diuretics (OD) to relieve intracranial hypertension (ICH). All patients were divided into two groups: Group 1 ( studied group) – 25 children enrolled prospectively. In this group, OD were administered according to the Protocol. Group 2 (control group) – 26 children (retrospective group). In this group, OD was administered according to the accepted clinical recommendations. Results. As it has been revealed, OD in the control group (Group 2) were used 8.7 % more often than in patients from Group 1 at Step 3 of the Protocol. In patients from Group 2, hypernatremia and hyperosmolarity had more persistent and pronounced type; such tendency persisted for the next 5–7 days of the study. However, there were no statistically significant differences between the groups in average values of sodium levels and osmolarity of blood plasma under ICH therapy. The conducted statistical analysis has shown that the lack of reliable differences is associated with a significant variance of analyzed indicators in Group 2. At the same time, we registered a statistically significant increase (p 0.05) of unfavorable outcomes in Group 2 by 24.9 %. Conclusion. Regular and rationally frequent administration of osmotic diuretics leads to less persistent violations of water-electrolyte metabolism. A prerequisite for the effective management of traumatic ICP in children is monitoring the intracranial pressure (ICP) and cerebral perfusion pressure (CPP).

Introduction. The authors present their experience in experimental and clinical studies on the application of Xenon (Xe) in subnarcotic concentrations for pain relief and for the treatment of acute stress disorders. Preparing wounds for plastic closure in children is a long and painful process which requires many anesthesia procedures during dressings. It leads to cognitive disorders, affects memory and learning potentials. Every third child who survived a severe trauma suffers of acute stress disorders: bad sleep, emotional imbalance, anxiety, asociality, inappropriate actions. Xenon is a non-toxic anesthetic. In the concentration of 20–50%, it is not only anesthetizes, but also decreases acute stress disorders, has sedative and anti-stress effects and normalizes sleep.Objectives. To study literature data on the potentials of gas Xe in subnarcotic concentrations for pain relief and for decreasing acute stress disorders at the stage of preparing a child for plastic closure of a wound defect.Material and methods. Literature search was done in PubMed, Scopus, eLIBRARY, Cyberleninka in English and Russian using key words: “Xenon”, “Xenon and anesthesia”, “Xenontherapy” “Actions of Xenon”, “Treatment of extensive wounds in children”, “Acute stress disorders”.Results. The analysis of the data of the conducted studies showed the non-toxicity of Xe, which makes it possible to use it repeatedly for anesthesia in children. The fact that Xe reduces the manifestations of anxiety, depressive and psychosomatic symptoms in patients with acute and chronic stress disorders allows us to count on its positive effects in the treatment of children with extensive wounds of traumatic origin at the stage of preparing them for plastic closure.Conclusion. The practical absence in the available scientific literature of a study to assess the effectiveness of the use of subnarcotic concentrations of Xe, when dressing extensive wounds at the stage of preparation of the wound process for plastic closure in children with acute stress disorders, justifies the conduct of an appropriate scientific study.

The paper discusses the topical issues of prevention of complications during puncture and catheterization of internal jugular veins (IJV) in children. Variants of anatomical organization of major vessels in the region of IJV puncture identified through ultrasound examination both at the time of screening and prior to IJV catheterization, which explain the high risk of complications during this manipulation, are described. The main directions for prevention of possible perforation of the vein posterior wall entailing injuries of anatomical substructures (branches of the carotid artery, vagus nerve) are given. The proprietary methodology of safe step-by-step catheterization of principal veins is provided. Reduction of the risk of complications during internal jugular vein catheterization thanks to usage of all steps described above has been convincingly demonstrated. Key words: intensive care in children, ultrasound examination, venous access, internal jugular vein catheterization

In the presented clinical case, we consider the surgical treatment of a 9-year-old girl with an extensive post-traumatic scalp wound in the parieto-occipital region resulting from hair getting into the moving mechanism of a go-kart car and incomplete separation of the scalp in the parieto-occipital region of the head. The early postoperative period (surgical treatment with primary wound closure) was complicated by the development of skin necrosis. An extensive wound defect in the soft tissues of the scalp (up to 150 cm2) was replaced with local related tissues. For this, various methods of plastic surgery were used in different areas of the wound defect: plastic surgery with local tissues, replacement of the defect with a rotated fascio-cutaneous flap and plastic surgery with local tissues using the dosed stretching method. The combined use of these methods made it possible to completely restore full-fledged soft tissues and hair of the injured parieto-occipital region.

Inferior gluteal artery pseudoaneurysms are rare, and most of the cases are due to blunt (pelvic fractures, femur’s dislocations) or penetrating trauma. Herein, we present a case of traumatic blunt rupture of an inferior gluteal artery pseudoaneurysm in adolescent 15th years old. Patient went through the complex examination and endosurgical treatment: endovascular occlusion of inferior gluteal artery and endoscopic evacuation of the large hematoma. Patient in short time came back to his ordinary live and sport.

Purpose. To draw the attention of specialists to the question of incidence of catheterassociated and catheter-induced thrombosis in patients in intensive care units. To assess methods of visualization and monitoring of the great veins state using ultrasound. To evaluate various links in the pathogenesis of thrombus formation and the possibilities of prevention and treatment. Materials and methods. More than 3500 ultrasound examinations have been performed in over 850 patients, both in the ICU and after the transfer of patients to specialized departments. The study included children aged from 1,5 months to 18 and adults, with one or more central venous catheters (CVCs). In the absence of contraindications, patients received prophylactic anticoagulant therapy (heparin at a dose of 50-100 U/kg/day). Ultrasound was performed with a frequency of 4 to 85 times in one patient, depending on the detection and severity of CAT. The studies were carried out in B-mode using color and/or energy mapping on ultrasound scanners Philips HD 11 (Philips, USA), SonoSite MicroMaxx (USA), Logiq E8 (GE, USA), Mindrey M 7 (Mindrey, China), Samsung HM 70 (Samsung, South Korea) using linear multi-frequency sensors 10-16 MHz. The patients underwent a complex ultrasound examination of the superior or inferior vena cava (depending on the assumed main vein thrombosis (TMV) localization), as well as the main veins of the extremities. Conclusions. The multifactorial nature of TMV development in ICU patients requires increased alertness to this complication, which necessitates ultrasound monitoring of the great veins in patients in intensive care units with installed CVCs. It should be noted that, despite the ongoing prophylaxis of TMV (including the use of anticoagulants), there is still a high risk of their development.

Purpose. To assess the effectiveness of sub-narcotic concentrations of xenon in the local treatment of extensive wounds in children with severe injuries.Material and methods. 14 patients (average age 9.3 ± 4.0 years) with extensive wounds were taken into the trial. 67 dressings in them were done with 30 % xenon and oxygen. Pain intensity was assessed by the numerical rating scale of pain (NRSp) (1–10 points); sedation depth – by Ramsay scale (1–6 points) and BIS index.Results. Inhalations of 30 % xenon with oxygen during wound dressings reduced the intensity of pain from Me 3.67 (1.2; 6.0) to Me 2.0 (1.0; 3.3) points by NRSp scale (p < 0.05); after sedanalgesia, it increased again to Me 3.0 (1.0; 5.3). Analgesia with 30 % xenon was effective in 55 (82.0 %) dressings; in 8 (11.9 %) patients with trauma, xenon concentration was increased to 50 %, and in 4 (5.9 %) cases 50 % xenon was added with Fentanyl 1–2 mcg/kg. The depth of sedation assessed by the Ramsay scale decreased (p < 0.05) from 6.0 (5.6; 6.0) to 3.1 (2.2; 4.5) points; after sedanalgesia it increased to Me 5.0 (4.5; 5.4) points. At the same time, the mean value of BIS index decreased (p < 0.05) from 97.5 ± 1.5 to 86.5 ± 5.0 U; after dressing, it rapidly increased to 93.0 ± 2.1 U. During dressings, 82 % of children were calm, had contact with a doctor. Afterwards, their sleep was restored, their mood improved.Conclusion. Sedanalgesia with xenon in sub-narcotic concentrations is an effective technique to relieve pain during treatment of extensive wounds in children.

Introduction. Foreign bodies in the gastrointestinal tract are various objects of organic and inorganic origin, which are swallowed - not as food - either accidentally or intentionally. The article describes a clinical case of a 13-year-old child with multiple foreign bodies in his gastrointestinal tract which could cause serious complications, such as: perforation of hollow organs, peritonitis, intestinal obstruction, internal bleeding. By statistics, every fourth patient of the conscious age with foreign bodies in the gastrointestinal tract can potentially have problems in the neuropsychic sphere.Material and methods. A 13-year-old boy was admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) with nausea, repeated vomiting after each meal and water drinking. The careful anamnesis revealed that before the boy’s state deteriorated, he had swallowed a large number of magnets and metal objects within a short period of time. X-rays examination found multiple foreign bodies in his gastrointestinal tract. They were removed during esophagogastroduodenoscopy (EGDS) and surgical intervention.Results. The plain-film X-ray examination of the abdomen in the projection of the stomach revealed a radiopaque group of foreign bodies of a rounded shape as a conglomerate. At FEGDS, 54 objects were removed: 4 metal balls up to 0.5 cm in diameter, 47 round magnets up to 1.5 cm in diameter, a metal chain and two screws. During laparotomy and gastrotomy 99 foreign bodies were removed: 82 magnet balls 0.5 cm in size, 16 metal balls 1.5 cm in size, 1 bolt. The postoperative period was uneventful. The child was discharged on the 12 th day after surgery in the satisfactory state.Conclusion. Due to timely diagnostics and proper curative tactics, multiple foreign bodies were revealed and removed from the child’s stomach endoscopically and surgically within a short period of time. A correctly chosen curative tactics resulted in a complete recovery of the patient without complications on the 12th hospitalization day.

Objective. To identify risk factors of injuries to femoral vasculature of femoral vessel injuries, optimize the process of cannulation, reduce the risk of injury to femoral artery and its branches. Patients and methods. A screening sonography of the femoral puncture area was carried out in 466 patients. Of those, 240 patients had the bilateral sonography of the recommended optimal point for femoral vein access. The sonography of major vessels in the femoral vein access areas was performed using the ultrasound scanners Phillips HD 11 ХЕ, SonoSite М-turbo. Mindrey M7, M9, Samsung HM 70, and others; linear multi-frequency transducers with the working frequency range of 7 to 18 mHz, of 40mm and 20mm aperture. Sonography was perfromed from the level of inguinal ligament downwards, in the plane orthogonal to the major vessels in B mode and later with color Doppler mapping (CDM) of venous and arterial vessels. Results. Ultrasound findings of 240 patients were analyzed and anatomic variants of the femoral vascular bundle were identified: 29% patients had high origin of the deep femoral artery on one of the sides; 17.9% had high origin of the deep femoral artery combined with high origin of the medial circumflex femoral artery immediately behind the femoral vein; 5% had high origin of the medial circumflex femoral artery immediately from the femoral artery behind the femoral vein; in 2%, the femoral vein was located between the deep femoral artery and femoral artery 2 cm inferiorly to the inguinal fold. Sonography demonstrated that the femoral vein is easily compressible during venipuncture, and the distance between the anterior and posterior walls of the compressed femoral vein gets less than the access needle diameter. Special techniques were suggested to avoid perforation of the posterior femoral vein wall during access. It was clearly demonstrated that utilization of these techniques combined with ultrasound-assisted placement of a peripheral venous catheter on a trocar needle during femoral vein access has decreased injuries of the femoral artery and its branches from 10% to 1.3% of cases. A proprietary technology of safe stepwise cannulation of femoral veins is described. Conclusion. Ultrasound examination facilitates detection of vascular anatomy nuances and choice of the safer approach to femoral vein access. Measures preventing inadvertent puncture of the posterior wall, such as increased blood filling of the femoral vein, utilization of peripheral venous catheters for initial access, and a stepwise vein catheterization, have made it possible to achieve high percentage of successful cannulations and reduce complications. Key words: intensive care in children, ultrasound examination, venous access, femoral vein cannulation

Introduction. In the present trial, the authors studied anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe traumas. Purpose. To study anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe injuries. Material and methods. 10 children, aged 13 ± 3 years, with severe trauma were taken into the study: 6 girls with mine-explosive injuries ( a terrorist attack in Kerch in 2018), 3 boys with multiple dog bites and one patient after a traffic accident. To treat them, 20-30% Xe with O2 was used. A session lasted for 20 minutes; the course included from 5 to 12 sessions. Device KTK-01 (LLC “KseMed”, Russia) was used. Pain intensity was assessed with the numerical rating scale (NRS) , sedative effect - with BIS index and Ramsey sedation scale. Patients’ blood was also examined for the level of somatotropic hormone (STH), cortisol (Co) and insulin. Results. Indications for Xe therapy in children were: persistent pain syndrome (PS) and acute stress disorder (ASD). Patients fell asleep (drug-induced sleep) under 20-30% Xe concentration in the respiratory mixture. The average values of BIS index decreased from 95.5 ± 2.5 U to 86.5 ± 5.0 U (p

Introduction.The authors discuss their first experience of applying the inert gas xenon (Xe) for relieving a persistent pain syndrome (PPS) and acute stress disorders (ASD) in children with severe injuries.Material and methods.Seven children with severe trauma were taken into the trial: the five with severe combined trauma after a terroristic attack (Kerch, 2018) and the two with multiple dog bites. All victims had PPS and ASD after the survived fear of death. Xenon had 15–30 % concentration in oxygen . Xe-therapy lasted for 15–20 minutes.Results.During Xe-sessions, patients were sedated. BIS-index decreased from 95.5 ± 2.5 to 86.5 ± 5.0 U (p < 0.05); mean values by Ramsay scale decreased from 5.5 ± 0.5 to 2.7 ± 1.2 scores (p < 0.05). Pain intensity by Numeric Rating Scale for Pain decreased from 4.1 ± 1.8 to 1.1 ± 0.4 scores (p < 0.05). Five sessions were needed for controlling PPS and refusing of analgesics; 12 session for phantom pains; 3 sessions for sleeplessness; 5 sessions for erasing tragic events from the memory.Conclusion.15–30 % Xe inhalations were effective in controlling PPS and ASD in children with severe injuries.

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.

The review discusses experimental and clinical trials on applying noble gas Xenon to treat therapeutic conditions in adults, as well as the prospects for its applying in children. Xenon therapeutic effects on the body are based on the healing properties of a noble gas. Xenon is close to the ‘ideal anesthetic’ by its anesthetic properties; but in addition, it possesses organoand neuroprotective as well as anti-stress properties which have been proved in experiment and clinically. Xenon in pediatric practice is an attractive agent because it is non-toxic, effective for the treatment of posthypoxic and traumatic impairments of the central nervous system, pain syndromes and stress conditions at its therapeutic concentration up to 30%.

The measurement of glomerular filtration rate (GFR) in intensive care unit patients is strategically important and determines the further treatment tactics. The article provides a literature review on choosing the various methods for assessing the glomerular filtration rate in children with kidney injury. We identified the main limitations of creatinine as a marker for measuring GFR; the features of laboratory methods for creatinine determination were detected.

Catheterization of the central veins during intensive therapy is followed by a high risk of mechanical complications. Considering anatomical interrelation in the neurovascular bundle of the neck, it is highly probable that the vagus nerve is damaged in the puncture of the internal jugular vein (IJV). However, lacking awareness of medical personnel and knowledge of the clinical picture of damage of the valgus nerve don’t allow to prevent and register the complications. The purpose of the study is to use US when diagnosing location of the vagus nerve to prevent its damage during the puncture and catheterization of the IJV. IJV US examinations were performed in 100 children aged 2 weeks to 17 years with various emergencies in the process of intense therapy to reveal anatomical interrelations between the internal jugular vein, carotid artery and vagus nerve. In 30 children US was performed following catheterization of the IJV (static method) with the following selection of the safest vascular IJV approach. 26 patients underwent a dynamic method of US guiding control when performing catheterization of the IJV. A retrospective analysis of a number of case records is done for the patients at the resuscitation department with suspicion of the vagus nerve damage due to catheterization of the IJV. Results – preliminary US examinations of the vascular bundle in all children allowed to visualize the valgus nerve. Selection of an optimal and safe approach to the IJV using the data of US statistical method and catheterization under US guidance enabled successful catheterization of the IJV avoiding mechanical complications. Retrospective analysis of case records revealed the complications not registered in the medical records.

In the course of intensive therapy for central venous catheterization is a high risk of mechanical complications. The probability of damage to the nervus vagus in the catheterization internal jugular vein is very high, but the lack of vigilance of medical personnel and damage to the knowledge of the clinical picture does not allow prevent and register this type of complication. The purpose of research — the use of ultrasound in the diagnosis of the location of the n.vagus to prevent damage during puncture and catheterization IJV. In the process of intensive care at various emergencies in 100 children aged from 2 weeks to 17 years, conducted IJV ultrasound to identify anatomic relationships of the internal jugular vein, carotid artery and n.vagus . At 30 children ultrasound preceded IJV catheterization (static method) and then selecting the most safe vascular access to the IJV. Dynamic method of ultrasound guidance during IJV catheterization was performed аt 26 саses. We made a retrospective analysis of a series of stationary cards of patients in the intensive care ward with suspected damage to the vagus nerve as a result of catheterization (attempts) IJV. Results — when the preliminary ultrasoundneurovascular bundle all the children had rendered the vagus nerve. Selection of the optimal, secure access to the IJV on the basis of static methods and ultrasound assisted of catheterization allowed to successfully catheterize IJV and avoided mechanical complications, including damage of the nervus vagus. Retrospective analysis of stationary cards of patients allow to think about the presence of such complications are not recorded according to medical records.

О р и г и н а л ь н ы е с т а т ь и РАНЫ И РАНЕВЫЕ ИНФЕКЦИИ ЖУРНАЛ ИМ.ПРОФ.Б. М

О р и г и н а л ь н ы е с т а т ь и РАНЫ И РАНЕВЫЕ ИНФЕКЦИИ ЖУРНАЛ ИМ.ПРОФ.Б. М