Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance.

PURPOSE: To study the relationship between the angiographic pattern of extrahepatic portal vein obstruction (EHPVO) and its etiology and clinical manifestations. METHODS: Clinical, etiological, and angiographic findings in 155 children with EHPVO were reviewed. Anatomy of extrahepatic portal venous system (EPVS) was categorized into five imaging patterns. Assessment of the severity of esophageal and gastric varices (EV and GV) was performed by upper gastrointestinal endoscopy. RESULTS: Based on multislice CT angiography, most commonly observed pattern of EHPVO was type I (48.4%) and type II (29%). According to anamnesis, 68 (43.8%) children had pathological conditions in neonatal period. Of these, 35 (22.6%) had an umbilical vein catheterization, 11 (7.1%) had a history of omphalitis, and 9 (5.8%) had prolonged jaundice. Thirteen (8.4%) patients had various septic conditions in neonatal period and it was more common associated with widespread thrombosis throughout the EPVS (type 5)-28% of observations. Significantly lower risk of bleeding from EV (p = 0.01) was noted in children with type IV pattern, whereas children with type III and V patterns had higher grades of EV. CONCLUSION: Angiographic pattern of portomesenteric occlusion may provide a clue to its etiology, and clinical manifestation, especially in children with widespread thrombosis throughout the EPVS.

[Morphological criteria for surgical treatment of anorectal malformations in children]. / Morfologicheskie kriterii khirurgicheskogo lecheniya anorektal'nykh mal'formatsii u detei.

OBJECTIVE: To improve treatment outcomes in patients with anorectal malformations via research of morphological criteria and differentiated approach to surgical correction. MATERIAL AND METHODS: There were 37 children with various types of anorectal malformations for the period 2000-2019. We analyzed morphological features of atretic rectum wall, fistula, anastomosis with adjacent organs and skin of the perineum. RESULTS: Morphological research of anorectal malformations made it possible to differentiate treatment strategy and explain the causes of unsatisfactory results after perineal and abdominal-perineal proctoplasty. Incidence and severity of complications, as well as early disability were reduced that significantly improved postoperative quality of life. CONCLUSION: According to the morphological criteria, deeper mobilization of atretic rectum within at least 2.5-3 cm of the rectal «cone¼ with intact muscular wall is necessary. This approach was valuable to ensure adequate closure function of the rectum, prevent anal incontinence and restore normal appearance of the perineum. These achievements contributed to decrease in the incidence of admissions, redo surgeries and improvement of social adaptation in children.

Spleen stiffness measurement as a non-invasive test to evaluate and monitor portal hypertension in children with extrahepatic portal vein obstruction.

PURPOSE: The aim of the study was to test the feasibility of spleen stiffness measurement (SSM) by two-dimensional shear wave elastography (2D-SWE) and compare data on its diagnostic use with upper gastrointestinal endoscopy in children with extrahepatic portal hypertension (EHPH) before and after surgery. METHODS: A total of 44 children were included in this study [34 children with EHPH (main group)] and 10 controls (7.57 ± 1.22 years), who underwent ultrasonography including SSM by 2D-SWE. Patients in the main group also underwent upper gastrointestinal endoscopy (UGE) and CT angiography. The main group was divided into three subgroups: Group A: patients with EHPH without large spontaneous portosystemic shunts (n = 15); Group B: patients with EHPH with large spontaneous portosystemic shunts (n = 9); Group C: patients with EHPVO and after surgical portosystemic shunts (n = 10). RESULTS: According to UGE, children in group A had significantly higher grades of esophageal varices (EV) (2.3 ± 0.14; p < 0.001) compared to those in groups B and C. After surgical shunting procedures (in group C), the grade of EV declined to 0.37 ± 0.14. There was significant difference (p < 0.001) in the mean SS of children in group A (70 ± 4.64 kPa) compared to those in group B (37.04 ± 4.62 kPa) and group C (26.3 ± 2.9 kPa). After surgery, SS decreased but remained elevated compared with controls (26.3 ± 2.9 vs 17.85 ± 1.3 kPa; p = 0.016). The SS showed a small but significant correlation with grades of EV (r = 0.56, p = 0.002). CONCLUSIONS: The SS measured by 2D-SWE is feasible in children with EHPH and the results reflect the presence or degree of EV, thus elastography of spleen is useful in monitoring portal hypertension before and after shunt surgeries.

Advantages of abdominal ultrasound in the management of infants with necrotizing enterocolitis.

The purpose of this study was to assess the prognostic value of abdominal color Doppler ultrasound (US) in determining predictors of early complications of NEC. METHODS: Fifty-one consecutive infants with stage Ia to IIIa NEC were prospectively included in the study between 2013 and July 2016. At least one abdominal US examination was performed in each patient. RESULTS: According to abdominal color Doppler US, neonates with NEC Ia stage in most cases (80%) found increased bowel wall perfusion. For the stage IIa typical signs were intramural gas and decreased bowel peristalsis. Patients in IIb stage had bowel wall thinning (less than 1 mm), decreased or absence of bowel peristalsis and absence of perfusion. In stage IIIa 71% of the cases had absence of bowel peristalsis and intramural gas. Absence of perfusion and bowel wall thinning less than 1 mm was found in 86% of neonates. One patient had portal venous gas. Nine patients with IIb and seven neonates with IIIa stage of NEC had laparotomy. In all 16 cases, US signs of bowel wall necrosis were verified intraoperative. CONCLUSION: US provides an opportunity to image the bowel loops in cross section with dynamic evaluation of perfusion and peristalsis. Our study shows that abdominal US examination in neonates with NEC can highlight the presence of intestinal necrosis before the onset of intestinal perforation. Surgically intervening earlier in the clinical pathway of NEC may lead to improved outcomes.

[A method of surgical treatment of acute ischio-rectal and pelvio-rectal paraproctitis with a transsphincter and extrasphincter position of the primary pus meatus].

A one-moment radical method of surgical treatment was used in treatment of 36 patients with ischio-rectal and pelvio-rectal forms of acute paraproctitis. The method of surgical treatment of acute paraproctitis considerably shortened the period of hospital treatment, promoted the formation of a soft scar, excluded the development of the anal sphincter incompetence, and reduced the percentage of recurrent diseases.

[Tissue pressure in patients with phlebogenic edema]. / Tkanevoe davlenie pri flebogennykh otekakh.

This paper describes the results of tissue pressure measurement according to the Emmet technique in the subcutaneous fat at phlebogenic edema in 31 patients with lower extremity varicosity. The changes in the pressure were recorded over a length of 5-10 after needle impaction. The rate of tissue fluid resorption was measured. The indicators appeared normal in 16% of patients, absorption was accelerated in 39%, and deceleration of absorption was marked in 45% of patients. In the event of decelerated resorption, chronic edema was observed more frequently. The rate of saline resorption in health exceeded 4.8-fold the rate of tissue fluid absorption. In valvular insufficiency of the deep veins, this indicator is up to 4.8-fold as increased. Cessation of tissue fluid and/or saline resorption points to tissue swelling at the microcirculatory level. The given technique allows to diagnose latent edema, to objectively evaluate the patient tissue response to a specific drug and elastic appliance, to work out the well-founded indications for phlebectomy, especially in young people. Also, it enables the assessment of the results of surgical intervention and making the early diagnosis of disease recurrences.

[Prophylaxis of recurrent multiple echinococcosis of the liver in children]. / Profilaktika retsidiva mnozhestvennogo ékhinokokkoza pecheni u detei.

The article presents an experience with treatment of 47 children aged from 3 to 14 with multiple echinococcosis of the liver. The authors have made a comparative analysis of the antiparasitic remedies and of a wide spectrum bactericidal solution of Betadin. The results of microscopic, histological and electron microscopic investigations have shown Betadin to be highly effective and harmless for the intraoperative prophylactics of recurrent echinococcosis. It is expedient to use Betadin for multiple echinococcal lesion of the liver in children.

[The efficacy of organ-preserving operations on the spleen in portal hypertension in children]. / Effektivnost' organosokhraniaiushchikh operatsii na selezenke pri portal'noi gipertenzii u detei.

Under analysis are results of treatment of 38 children with liver cirrhosis. Operations were performed in 25 patients, in 13 children decompensating shunts were put between the vessels of the splenic and left renal veins. Based on the assessment of the clinical effect the authors made a conclusion that in children with portal hypertension and symptoms of hypersplenism the creation of a spleno-renal anastomosis with the retained spleen is an effective measure and considerably reduced risk of postoperative complications.

[Functional condition of the liver after surgical treatment of cirrhosis in children as revealed by hepatoscintigraphy]. / Funktsional'noe sostoianie pecheni posle khirurgicheskogo lechenia tsirroza pecheni u detei po dannym stsintigepatografii.

Scintigraphy with colloid 99mTc (56 cases) and the radiopharmaceutical preparation 99mTc--HIDA (43 cases) was performed in children with early and developed cirrhosis of the liver to study the functional condition of the hepatic Kupffer's and parenchymal cells in the long-term periods after surgical treatment. Increased activity of the parenchymal cells and inactivation of Kupffer's cells were revealed after splenectomy. The formation of a portocaval shunt and denervation of the hepatic artery promoted activation of hepatocyte functioning in these patients.

[The function of the liver mitochondria in rats with experimental cirrhosis undergoing an organ-preserving operation on the spleen]. / Funktsional'noe sostoianie mitokhondrii pecheni krys s éksperimental'nym tsirrozom pri organosokhraniaiushchei operatsii na selezenke.

The effect of splenectomy and of spleen-preserving operation with suture ligation of the left gastric artery on the functional status of liver mitochondria was studied by using 102 white male-rats of mixed population with experimental cirrhosis. The obtained data made it evident that in the immediate postoperative period (from 1 to 3 weeks after the procedure) in the animals of both the first and the second series, the disorder of energetic regulation of mitochondria hepatocytes respiration and the decrease in phosphorylation efficiency had the same tendency, which were seemingly caused by stress-action of the operative trauma. The data accumulated in the more distant postoperative period (8 weeks after the procedure) indicated that the resection of the lower splenic pole in combination with supplementary liver arterialization improved essentially the functional status of mitochondria hepatocytes and was more beneficial in contradistinction to splenectomy.

[Clinical aspects and surgery of fibrocholangiocytosis in children]. / Klinika i khirurgicheskoe lechenie fibrokholangiokistoza u detei.

Fifty one children with a diagnosis of fibrocholangiocystosis (FCC) were examined. A degree of circulatory blockade in the portal vein system in FCC was established to be one of the factors conditioning a severity of the course of the disease and its prognosis. With increase in duration of the disease and age of a child, the cirrhotic process in the liver and its complications are aggravating. The esophagogastric bleeding with the incidence as well depending on duration of the disease is the most severe and life-threatening complication. Our experience with operative treatment of FCC is indicative of the necessity to perform early interventions, and of a high effectiveness of creating the vascular anastomosis with preservation of the spleen.

[A 99mTc-colloid study of the intrahepatic blood flow in liver cirrhosis in children]. / Issledovanie vnutripechenochnogo krovotoka s 99mTc-kolloidom pri tsirroze pecheni u detei.

Hepatoscintigraphic investigations were conducted in 63 patients aged 3 to 15 to study the features of intrahepatic blood flow and degrees of its compensation in children with liver cirrhosis of different stages. 99mTc-colloid was employed as a radiopharmaceutical. Disproportions of scintigraphic liver images showed close correlation with clinico-biochemical and morphological signs of the severity of disease. Subcompensation and decompensation of the organ blood flow and reticuloendothelial system in children with developed and terminal stages of liver cirrhosis are characterized by prolonged blood RP inhibition, a decrease in the total clearance of radioactive colloid, a progressively reduced index of liver clearance, and an increase in a colloid uptake by the spleen.