[Diagnostics and treatment of congenital malformations of the lung and mediastinum in newborn children and infants].

The article presents the experience of treatment of newborn children and infants with congenital malformations of the lung and mediastinum, which required a surgery. Children (138 cases) were treated during recent 18 years. There was a prevalence of full-term infants (73%). Fetal malformations were diagnosed in prenatal period in majority of cases. Computed tomography was the main method of diagnostics after delivery. Children (110 cases) were operated out of 138. Children with extrapulmonary sequestration didn't undergo surgery in case of absence of clinical manifestations. The authors made a conclusion that malformations of the lung and mediastinum should be included in number of differentiated diseases in case of respiratory distress syndrome in newborn children. The indications to early surgery should be the danger of contamination and malignant transformation, presence of intrathoracic tension syndrome in neonatal period.

[Differential diagnosis of persistent interstitial emphysema and other cystic lesions of the lung].

Neonatal interstitial emphysema (IE) may develop as a complication of the respiratory distress syndrome. IE is classified as acute and persistent and as diffuse and local forms. The differential diagnosis of persistent IE and congenital cystic malformations from clinical and imaging data may present problems. The histological pattern of persistent IE has specific features that permit the morphological diagnosis of this condition.

[Methods of surgical treatment of Hirschsprung's disease in newborns]. / Khirurgicheskaia taktika pri bolezni Girshprunga u novorozhdennykh.

Fifty-nine newborn infants with Hirschsprung's disease were treated at the Saint-Petersburg Center of Surgery of Developmental Anomalies from 1978 to 1991. The typical rectosigmoid form was found in 47.5% and a long zone of agangliosis in 35.6% of children. Mortality rate--16.7%. According to the development of enterocolitis, three variants of the course of the disease in the newborns were distinguished. It is shown that the informativeness of the diagnostic methods increases with the growth of the infants, and the final diagnosis of Hirschsprung's disease is best established at the age of over two weeks on the basis of repeated or initially postponed contrast study of the large intestine. Inefficacy of nonoperative treatment conducted for 2-3 days and recurrence of symptoms of intestinal obstruction are indications for operative decompression of the intestine. The performance of one-stage radical operation at the age of about one month is advisable in an uncomplicated course of the disease.

[Diagnosis and characteristics of the clinical course of necrotizing enterocolitis in children]. / Diagnostika i osobennosti klinicheskogo techeniia nekroticheskogo énterokolita u detei.

Necrotizing enterocolitis (NEC) is a disease of unknown etiology affecting mainly premature newborns and occurring in about 1 to 7% of all admissions to neonatal intensive care units. Among the greatest problems is the early diagnosis and adequate and timely treatment, surgery included. In the last quarter of the century the survival rate of premature infants was gradually increasing in national regions and worldwide and accordingly there is an increasing number of babies with NEC. To date, to treat patients with the diagnosed enterocolitis is a complicated problem. The mortality rate among the children remains high. In the period from 1978 to 2000 432 patients with NEC were admitted to the St. Petersburg Center of Neonatal Surgery in the Children Hospital N 1,300 of them requiring surgical interventions. The author's personal experience with the diagnosis and treatment of the disease allowed three main forms of the clinical course of the disease to be established: superacute, acute and subacute.

[Heterodelphus--a rare form of twin developmental defect]. / Geterodel'fus--redkaia forma dvoinikovogo poroka razvitiia.

The authors saw a rare developmental twin anomaly--heterodelphus. The parasite was an organism devoid of the head, fixed with its thoracic wall an epigastric area to the front wall and the epigastric area of the autosite. Respiration and palpitation of the parasite was not auscultated. The abnormal twins had a single umbilical cord. The surgical division of the conjoined twins was performed in 4 months. The operation and operative findings are described. The postoperative period was hard. At the present time the boy's state is good, he feels well and develops in accordance with his age.

[Relaparotomies following the creation of intestinal anastomoses in newborn infants]. / Relaparotomii posle nalozheniia kishechnykh anastomozov u novorozhdennykh.

An analysis of the immediate postoperative period in 295 newborns after putting intestinal anastomoses was made. Postoperative surgical complications were found in 38 children who required 47 relaparotomies. Surgical tactics was determined for the complications of the postoperative period as well as the indications for relaparotomy.

[First experience with the surgical treatment of young infants with congenital pathology of the locomotor system]. / Pervyi opyt khirurgicheskogo lecheniia detei rannego vozrasta s vrozhdennoi patologiei oporno-dvigatel'nogo apparata.

The authors have revised traditional principles of treatment of children with a congenital pathology of the locomotor system. Early treatment has been shown to be necessary beginning from infancy since the operations have a more favourable course. Normal anatomo-physiological correlations of the locomotor system are being formed from the early days and months of the infants. Good immediate results were obtained in 22 children. The authors recommend to establish terms of the operative interventions for orthopedic abnormalities immediately after birth in the maternity home.

[Diagnosis and treatment of gastroesophageal reflux in children]. / Diagnostika i lechenie gastroézofageal'nogo refliuksa u detei.

The work is based on an analysis of results of treatment of 643 children with gastroesophageal reflux (operations were performed on 69 of them). Methods of anesthesia are described. Conservative treatment was used in correlation with the degree of reflux-esophagitis. Indications to operations were considered to be as follows: hiatal hernias, reflux-esophagitis in children with cerebral paralysis, failure of conservative treatment in the group of children having no anatomical causes of the reflux. A method of surgical treatment is proposed including a combination of fundoplication with the posterior gastropexy and fixation of the esophagus to the diaphragm at a distance of 3 cm from the gastric cuff (43 cases, no recurrences). In patients with a combination of gastroesophageal reflux with the esophagus stenosis resection of the altered portion was made followed by plasty with a colonic transplant or local tissues (10 patients with the diagnosed Barrett esophagus).

[The history of the surgery of esophageal atresia (based on data from the Saint-Petersburg Center for Neonatal Surgery)]. / Istoriia khirurgii atrezii pishchevoda (po materialam Sankt-Peterburgskogo tsentra khirurgii novorozhdennykh).

The article presents 42-year experiences with surgical treatment of atresia of the esophagus in 814 neonatals in the St. Petersburg Center of surgery in neonatals. Under analysis are the consecutive periods of work in this field, development and introduction into practice of the methods of surgical interventions, the original Bairov's operation--double esophagostomy--included. Factors responsible for results of the treatment of esophageal atresia are described. Improvement of the methods of treatment has resulted in a possibility mainly to make anastomoses of the esophagus and reduce lethality of neonatals with esophageal atresia from 81 to 7.7%.