[Glomus tumors of the middle ear in children].

Glomus tumor (GT) is a rare tumor of the middle ear in children. In spite of cytologically benign nature of this tumor, its course can be characterized as malignant because of GT infiltrative growth, destruction of the adjacent bone tissue, possible intracranial involvement. Because of scare symptoms, early GT diagnosis is problematic. At admission to hospital principal complaints of the children are poor hearing, discharge from the ear. These often underlie misdiagnosis -- acute otitis media. GT of the middle ear are detected with application of computed tomography which is able to show changes in the soft tissue and bone destruction, and angiography. Combination of the above two methods allows assessment of location and advance of the pathological process. GT treatment planning depends on the examination data and can include radiotherapy, endovascular occlusion of the vessels carrying blood to the tumor, surgical treatment and combination of the methods. Modern approaches to GT diagnosis and treatment are described. A case of GT of the temporal bone with involvement of the middle cranial fossa in a 4-year-old child is reported.

[Hemostatic provision of surgical treatment of juvenile angiofibromas of the skull base in children].

For three years we operated sixty two 7-16-year-old children for angiofibroma of the base of the skull. To reduce the risk of massive intra- and postoperative bleeding, we used preoperative endovascular occlusion of the vessels carrying blood to the tumor. In addition to preventive administration of vicasol, ethamsilate, dicinon and transamine, we used highly effective hemostatic drugs tahocomb and novo-seven intraoperatively in case of massive blood loss. Neither lethal outcomes nor complications occurred in children during removal of angiofibromas of the base of the skull.

[Lowering of nephropathy risk during angiography procedure. What are choice criteria for the radiocontrast media?]. / Problemy snizheniia riska nefropatii pri provedenii angiografii. Chto iavliaetsia kriteriem vybora naibolee bezopasnogo rentgenokontrastnogo sredstva?

The paper analyses current data of monomer and dimmer iodine-containing radiocontrast agents used for diagnosis of cardiovascular diseases and radiovascular interventions. Considering the risk factors of nephropathy as the most common and threatening complication of radiocontrast agents the authors conclude that non-ionic monomers are the most advisable as they demonstrate optimal balance of viscosity, water solubility, osmolality and diagnostic effectiveness.

[Evaluation of aqueous compartments of the body by integral bioimpedance spectrometry in x-ray surgical interventions in children]. / Otsenka vod'nykh sektorov organizma metodom integral'noi bioimpedansnoi spektrometrii pri rentgenokhirurgicheskikh vmeshatel'stvakh u detei.

There were studied 14 children (mean age 5.71 +/- 0.60 years, body weight 18.95 +/- 3.50 kg, height 101.0 +/- 4.03 cm) with initially normal osmotic and volumic status. Plasma osmolarity, blood aldosterone level, aqueous compartments balance were (evaluated by segmented bioimpedance spectrometry), urine osmolarity and diuresis were investigated after bolus injection of x-ray contrast agent (RCA) urografin-60% (mean volume 2 ml/kg for 2-4 sec). A statistically significant gradual decrease in the total volume of water (TVW) in the organism was observed, with 8.53% deficiency of TVW by the second hour after RCA injection in comparison with the initial level. TVW deficiency developed as the result of diuresis which increased 7-fold in the presence of increased plasma osmolarity after injection of RCA bolus. Correction of the volume of circulating blood and plasma was carried out mainly at the expense of intracellular liquid, whose deficiency was actually 4.5 times higher than of extracellular liquid. Bioimpedance spectrometry indicated centralized redistribution of water in the organism, as TVW deficiency was mainly due to water in the limbs. The results indicate the need in infusion therapy after RCA injection in order to correct the resultant water deficit.

[Use of diprivan in anesthesiology of angiographic studies and x-ray endovascular methods of treatment in children]. / Primenenie diprivana v anesteziologicheskom obespechenii angiograficheskikh issledovanii i rentgenoéndovaskuliarnykh metodov lecheniia u detei.

Diprivan was a component of anesthesia for angiographic studies and x-ray endovascular treatment in 30 patients aged 4 months to 16 years. Patients with diseases of the head and neck (hemangiomas and arteriovenous dysplasias), thoracic and abdominal cavities and kidneys (portal hypertension, pancreatic cysts, developmental defects, renal injuries, etc.), and limbs (angiodysplasias, traumatic injuries to the vessels, developmental defects of the vessels, etc.) were examined. Use of various methods of examination, including mathematical analysis of cardiac rhythm, demonstrated the stability of anesthesia and negligible fluctuations in the principal hemodynamic parameters. Hence, diprivan is an effective and perspective agent which may be included in anesthesiological protocols for children undergoing angiographic diagnosis and x-ray endovascular treatment.

[Use of ultra high-frequency electromagnetic fields in pediatric surgery]. / Primenenie sverkhvysokochastotnogo élektromagnitnogo polia v detskoi khirurgii.

The procedures associated with the application of a super-frequency electromagnetic field (SFEMF) are being introduced into a therapeutical process in their various modifications at the Pediatric Surgery Hospital of Russian State Medical University. This has been preceded by enormous experimental work aimed at evaluating the potentialities of SFEMF for potentiation of cryogenic exposure and for individual use for endovascular occlusion and local hyperthermia. A total of 947 patients were treated with SFEMF from 1979 to 1990. The largest group included children with hemangiomas of various site (n = 465) and those with cheloid scars (n = 395). Thirty-one patients underwent intravascular coagulation with SFEMF in the treatment of arterial and venous malformations and 31 patients were treated for pigmentary spots of various site with SFEMF + cryodestruction. Local hypothermia was performed in 25 children with extensive hemangiomas of the face and neck with SFEMF. The total therapeutical benefits reached 98%. For these purposes the authors used a Plot routine apparatus, 915 mHz, with a set of contact and special emitters. The experience with SFEMF in pediatric surgery suggests that it is highly effective and the trend is promising.

[Use of intra-arterial chemotherapy in the treatment of malignant tumors in children]. / Primenenie vnutriarterial'noi khimioterapii v lechenii zlokachestvennykh opukholei u detei.

Transcatheter arterial chemotherapy has been perfected in the treatment of 66 patients with various severe malignant tumors. A total of 75 arterial cytostatic injections were made, out of them 57 were given in primary tumors and 18 in tumor metastases. The children's age ranged from 1 to 14 years. High arterial therapeutic doses in combination with extracorporeal blood purification by hemosorption in the treatment of hepatic metastases yielded 100% efficiency. Prolonged arterial chemotherapy for pulmonary metastases provided an excellent therapeutic effect. Thus, 75 arterial injections of cytostatics gave rise to 32% of complete remissions, 48% of partial remissions. There was no benefit in 20% of cases. Adverse reactions were absent.

[Portal hypertension in children: venous shunting in the early childhood]. / Portalnaia gipertenziia u detei: opyt venoznogo shuntirovaniia v rannem detskom vozraste.

Operations were carried out on 98 children with extrahepatic portal hypertension and on 6 with intrahepatic block and no signs of hepatocellular insufficiency. Mesenterico-caval H-shunt was formed in 78 children with the use of the internal jugular vein as the insert. The remaining children underwent formation of mesocaval anastomosis (8), distal spleno-renal shunt (4), portocaval anastomosis (1), Sugiura's operation (7). Among the operations 68 were planned, 12 emergency, and 18 preventive. The average age of the children was 6.5 years; 31 were under the age of 5 years and 19 under 3 years of age. The youngest child was aged 10 months, the H-shunt was successful. The results of the operation: thrombosis of the shunt 0%, portosystem encephalopathy 0%, recurrent hemorrhage 0%, lethality 1%. This is evidence of the expediency of performing shunting operations in early childhood.