Особенности клинической картины, диагностики и лечения при перекруте придатков матки у детейРезюме Сохранение репродуктивного здоровья девочек является важной задачей демографического характера для любого региона.Одним из фертильно значимых заболеваний у девочек является перекрут придатков матки.Неспецифичность клинических проявлений данной патологии (приступообразная боль внизу живота, тошнота, рвота) приводит к позднему обращению пациенток за медицинской помощью.Согласно нашим наблюдениям, обращение задерживалось на 2,0 (1,0; 3,0) сут.Осмотр таких девочек врачом -акушером-гинекологом, проведение ультразвукового исследования (УЗИ) органов малого таза с обязательной регистрацией овариального кровотока позволяют заподозрить перекрут придатков матки у пациентки и выставить показания к оперативному лечению в экстренном порядке.Эндоскопическое лечение у девочек с перекрутом придатков матки предпочтительно, так как является малоинвазивным, высокоинформативным методом, позволяющим не только визуализировать патологию, но и эффективно ее устранить.Органоуносящие операции (удаление маточной трубы, яичника) выполняются только при объективных признаках некроза (отсутствие восстановления кровотока после деторсии).После оперативного лечения перекрута придатков матки в случае проведенного органосохраняющего лечения обязателен динамический ежемесячный УЗ-контроль за состоянием яичников в течение не менее 6 мес, проведение оценки антимюллерова гормона -не ранее чем через 6 мес после операции

Репродуктивное здоровье детей и подростков / Том 19

Introduction. Dirofilariasis of the scrotum is one of unusual manifestations of this zoonosis in children, especially in regions which are outside the distribution area of this helminth what causes certain difficulties in preoperative diagnostics. Purpose. To describe a clinical case so as to warn physicians about a possibility of meeting dirofilariasis infection in the scrotum outside the area of this helminth location. Clinical case. The authors present a clinical case of a child with a parasitic cyst simulating tumor in the scrotum for what an oncologist was invited for the consultation. At the examination, a rounded formation adjoining the left testicle, densely elastic in consistency, with smooth borders, motionless to the testicle, painless on palpation was revealed. The child did not leave the region. A parasitic cyst of the scrotum was removed in the clinic of pediatric surgery. Results. Histopathology confirmed cyst parasitic origin; the revealed parasite was identified as Dirofilaria repens because of characteristic morphological features. The child was found healthy at one-year follow up examination. Conclusion. Though the disease is rarely met, dirofilariasis should be included in the differential diagnostics in case of mass formations in the scrotum in children.

We report a case of plexiform neurofibroma of the external genitalia and perineum in a 11-year-old girl with no family history of this disease. The patient was diagnosed with neurofibromatosis type 1 upon admission to the clinic. Surgery was performed by a team of a pediatric surgeon and gynecologist after the examination. The postoperative period was uneventful. No signs of neurofibroma recurrence were observed 2 years postoperatively. The description of the diagnostic and treatment stages in this case resulting from a primary genetic mutation is of interest to pediatricians and pediatric surgeons. Key words: neurofibromatosis, perineum, child

Anomalies in the biliary tract development are a relatively rare pathology in the practice of a pediatric surgeon. A combination of two or more defects of the biliary tract is even less common. The article presents literature data and own clinical observation of a child with a combination of a cyst of the common bile, or hepatic, duct (common bile duct) and an additional bile duct. The anatomical structure of the biliary tract was identified before surgery using magnetic resonance cholangiography. Based on the analysis of literature data and our own observation, we propose an algorithm for diagnostic measures in children with malformations of the biliary tract, which helps to avoid intraoperative injuries.

Chronic pelvic pain syndrome (CPPS) in adolescent girls is a common pathology that reduces the quality of life and disrupts their social adaptation. Objective of the research: to study causative factors of CPPS in female adolescents to assess the vegetative status (VS) and autonomic reactivity (AR). Materials and methods: the examination results of 90 girls with CPPS are presented. The VS was investigated using Kerdo index and cardiointervalography. Results: рathology of the urinary system was detected in 12 patients, gynecological dysfunctions were determined in 24 girls, the adhesions of the pelvic organs were registered in 9 girls, and pathology of the gastrointestinal tract was the reason of CPPS in 45 female adolescents. Initial sympathicotonia was found in 63 patients. While AR assessing a predominance of the sympathetic part was recorded in all patients, where hypersympathicotonic AR was registered in 27 girls. Conclusions: CPPS in adolescent girls is combined with sympathicotonic reactivity, and in some cases with hypersymptotic, AR, which requires correction in order to increase the efficacy of treatment of the main disease.

A distinct tendency to an increased number of pregnancies and deliveries among young women has been observed lately. Pregnant teenagers with various types of traumas can be admitted to a non-profile pediatric surgical in-patient facility where no gynecologist is available. Purpose . The article describes a clinical case of an injury to the uterus and 33–34-week fetus in 17-year-old pregnant woman after an accidental fall on a kitchen knife. Materials and methods . The patient in a severe condition was admitted to the hospital with a knife in the anterior abdominal wall. Post-hemorrhagic anemia was diagnosed (Hb 95 g/L, RBC3.0 х1012/L). Based on urgent indications of an operating team consisting of a pediatric surgeon and an obstetrician-gynecologist, a midline laparotomy was performed. 2L of blood was removed from the cavity, the cutting edge of a knife was removed from the uterus body. No other damages were found during abdominoscopy. Cesarean section was done in the inferior segment of the uterus, an alive fetus was removed, bilateral ligation of uterine arteries was done and a hemostatic supraplacental suture was applied. A double balloon obstetric catheter was used. The uterine wound was sutured. Total blood loss was about 3 L. It was compensated with red blood cells (1385 ml) and fresh frozen plasma (2740 ml) transfusion. The removed boy had a weight of 2,300 g and 2 Apgar scores. Resuscitation activities were successful. The child was taken to the ICU and put on life support. 2 cm long injury was found in the right axillary region not penetrating into the chest. Its primary surgical debridement was done. Postoperative period in a child and mother who was taken to the maternity home went on without complications. The child was examined in a year. He developed according to the age. Conclusions . It can be possible that pediatric surgical departments are not ready for Cesarean section and elimination of possible complications when dealing with pregnant teenagers with various types of traumatic injuries requiring urgent obstetric intervention. That’s why it’s better when the patients are admitted to maternity homes where a pediatric surgeon is available.

Цель . В последние годы наблюдается отчётливая тенденция к увеличению числа беременностей и родов среди юных женщин. Беременные девочки-подростки с различными вариантами травматических повреждений могут оказаться в непрофильном детском хирургическом стационаре, где отсутствует врач акушер-гинеколог. Материалы и методы . В статье представлено описание клинического случая ранения матки и плода на 33–34 неделе беременности у девушки 17 лет после случайного падения на кухонный нож. Пациентка доставлена в тяжелом состоянии с ножом в передней брюшной стенке, диагностирована постгеморрагическая анемия (He 95 г/л, эритроциты 3,0×1012/л). По экстренным показаниям операционной бригадой, состоящей из детского хирурга и акушера-гинеколога, была выполнена срединная лапаратомия, при которой из брюшной полости удалено около 2 литров крови, а из тела матки извлечено лезвие ножа. При ревизии брюшной полости других повреждений не обнаружено. Выполнено кесарево сечение в нижнем сегменте матки, извлечён живой плод, произведена перевязка маточных артерий с обеих сторон и наложение гемостатического сборочного надплацентарного шва. Установлен двухбаллонный акушерский катетер. Рана матки ушита. Общая кровопотеря составила около 3 литров, которую восполняли трансфузией эритромассы (1385 мл) и свежезамороженной плазмы (2740 мл). Извлеченный мальчик весом 2 300 гр. имел оценку по Апгар 2 балла. Реанимационные мероприятия были успешны, ребенок переведен в ОРИТ и подключен к аппарату ИВЛ. В правой подмышечной области ребенка была обнаружена рана длиной около 2 см, не проникающая в грудную полость, произведена ее первичная хирургическая обработка. Послеоперационный период у ребенка и матери, переведенной в родильный дом, протекал без осложнений. Ребенок осмотрен через год, растет и развивается соответственно возрасту. Выводы . Персонал детских хирургических отделений при поступлении беременных девочек-подростков с различными вариантами травматических повреждений, требующих проведения неотложных акушерских вмешательств, может оказаться не готов к проведению кесаревого сечения и устранению возможных осложнений. Поэтому целесообразно, чтобы эти пациентки поступали в медицинские организации родовспоможения, куда можно экстренно вызвать и доставить детского хирурга.

Introduction. Tracheal and bronchial injuries in children are not at the last place in the trauma incidence structure . It is an urgent issue for both adult and pediatric surgeons. Purpose. To show ways for obtaining good outcomes in patients with trachea and bronchi rupture. Material and methods. The researchers analyzed outcomes of surgical treatment of 19 patients with trachea and bronchi ruptures. The patients had surgeries at various intervals after the injury: from few hours to 10 days. X-ray and tracheobronchoscopy examinations were made. On the first day after the injury, a radical surgery was performed to restore the airway patency. Late surgical interventions ended with pulmonectomy or lobectomy. At the final stage of the trial, early and long-term results were analyzed. Results. The radical surgical treatment consisting of thoracotomy and complete restoration of anatomical integrity and airway patency had 16 children of various age on the first day after their injury . Surgery lasted for 85 ± 15 min. There were no any complications during the surgery. At the early period of observation after the surgery, a ventilation failure of degree I was seen in 3 patients. Two years later, compensated stenosis of the bronchus without signs of ventilation failure was seen in one child. Three children were operated on in 10 days after their injury. Organ-sparing surgeries were performed in them (lobectomy and pulmonectomy). These surgeries lasted for 130 ± 15 min. At the early postoperative period, all three patients had ventilation failure of degree II. In 2 years, two children developed a persistent deformation of the chest, two children were disabled. Conclusion. A successful treatment of children with lower airways injury may be expected if the radical assistance is provided by a thoracic surgeon and shortly after the injury.

This is a case report of an elderly patient with urogenital tuberculosis and concurrent tuberculosis of peripheral inguinal lymph nodes. The disease manifested by a fistulous form of inguinal lymphadenitis for 10 years and spread to the kidneys and genitals, but the patient did not seek medical attention. Changes on the glans penis prompted him to consult dermatovenereologist. Due to ineffective treatment and uncovering the scar in the inguinal area the patient was send to an anti-tuberculosis institution, where he was diagnosed with tuberculosis involving the kidneys, prostate, epididymis, penis, inguinal lymph nodes. The patient had a history of a contact with the patient with respiratory tuberculosis. Treatment with antituberculosis drugs produced a positive effect.

Currently, questions of clinic, diagnosis and treatment of vesicoureteral reflux (VUR) are widely covered in literature, but there is no clear evidence whether the ureterovesical anastomosis (UVA) disorders are the sole and/or leading mechanism in VUR formation. Objective of the research - to evaluate correlation between UVA profilometry indicators, VUR degrees and lower urinary tract dysfunction (LURD). Ureter profilometry was performed in 22 patients with mono- and bilaterally VUR of II, III and IV degrees. Age of patients was from 11 months to 11 years (5,1±3,1 years). It was found that for healthy ureter UVA indicators do not depend on the child’s age and presence or absence of LURD. In formation of secondary reflux mechanism important role belongs not only to UVA obturator function disorder, but also to intravesical pressure high gradient. VUR degree is more dependent on constriction zone length, while the influence of intravesical maximum pressure on it is minimal.

One of the diseases that affect reproductive potential of girls is ovarian veins varicose. Objective of the research - to analyze the effectiveness of ovarian veins varicose surgical treatment in adolescent girls and the impact of surgical treatment proposed methods on ovarian reserve main indicators. The article presents results of surgical treatment of 40 adolescent girls with ovarian veins varicose. Girls with veins diameter up to 4 mm received conservative therapy, 20 girls with veins diameter more than 4 mm received surgical treatment. Treatment results showed almost complete disappearance of uterine bleeding after 6 months, a significant reduction of pelvic pain severity without reduction of ovarian reserve by the results of laboratory and instrumental examination, regardless of treatment method.

The study has established that during a progressive tuberculous process, immunological changes appear as significant increased proinflammatory cytokine production that leads to progressive destructive processes in the lung parenchymal lesion areas. Inclusion of lymphotrophic chemoimmunotherapy with roncoleukin into the complex therapy of patients with progressive pulmonary tuberculosis permits the optimization of the results of treatment in patients with progressive pulmonary tuberculosis due to the target delivery of antituberculous and immunoactive agents.

The study evaluated clinical efficiency of noopept used to prevent adverse side effects of antituberculous agents. It included 60 patients with newly diagnosed respiratory tuberculosis. Those in group 1 (n = 30) received 10 mg of noopept twice daily during the first month. The treatment promoted functional normalization of vegetative nervous system and antioxidative systems, reduced manifestations of anxiety, decreased frequency of adverse neuro- and cardiotoxic responses to antituberculous drugs.

To study the specific features of infiltrative pulmonary tuberculosis and its treatment efficiency in patients over 60 years, the authors analyzed case histories of 80 patients who were divided into 2 groups: 1) 40 patients aged 60 years or more and 2) 40 patients aged 18 to 50 years. The types of adaptive reactions (L. Kh. Garkavi et al., 1977) and those of the body's responsiveness (N. A. Brazhenko, 1987) were studied; the leukocytic shift index (N. I. Yabluchansky, et al., 1983) was calculated. The efficiency of treatment was evaluated from the results of control bacteriological and X-ray studies conducted after 2-, 5-, and 8-month drug therapy. The persons over 60 years of age were significantly more frequently (p < 0.05) diagnosed as having concomitant diseases (mainly coronary heart disease (65%), arterial hypertension (50%), chronic bronchitis (50%), atherosclerosis of central and peripheral arteries (35%), and adverse reactions caused by antituberculous drugs (75% versus 40%; among them there were prevalent neurotoxic and cardiotoxic reactions). Despite the fact that the results of treatment in this group of patients did not differ from those in young persons, which may be attributable to better compliance in patients above 60 years of age.