[The choice of surgical access in the treatment of lung hydatidosis in children].

Thoracoscopic and traditional access for the treatment of lung hydatidosis in children was compared. 56 children, who composed the 1st (control) group, were operated on with the open access. The 2nd (main) group, consisted of 22 patients, operated on thoracoscopically. The issue holds the thorough description of the operative technique. The mean operative time was 61.2±7.4 min for the thoracoscopic operation, the mean pleural drainig time was 2.5±0.7 days. The mean postoperative hospital stay was 12±3.5 days. For the patients of the control group, the operative time was 86.4±25.2 min, draining time was 4±1.2 days and hospital stay was 18.4±8.2 days. There were no conversion cases. 3 patients of the "thoracoscopic" group developed postoperative pneumonia and bronchial fistula. Considering the strict following the principles of antiparasitic treatment, the endoscopic treatment of lung hydatidosis proved to be a method of choice for the surgical treatment of lung hydatidosis in children.

[Early results of thoracoscopic treatment of inborn and acquired lung diseases in children].

Thoracoscopic and traditional methods of treatment of the inborn and acquired lung diseases in children were comparatively analyzed. The main group, operated on thoracoscopically, consisted of 30 patients. The control group, operated on thoracotomically, consisted of the same number of children. Both groups were comparable to the age, gender, diagnostic algorithm, risk and preoperative prepare. Traumaticity of the operation and postoperative period were assessed. Thoracoscopic method proved to have indisputable advantages.

[Treatment of bronchiectasis in children].

The thoracoscopic and traditional thoracotomic surgical access for bronchiectesis treatment in children were compared. The first (thoracoscopic) group included 18 children. The control (thoracotomic) group included 26 patients. The mean operative time in the 1st group was 78.3±31 min; pleural draining lasted for 1.3 days and postoperative hospital stay was 9.93±2.08 days. The mean operative time in the 2nd group was 81.7±35.1 min; pleural draining lasted for 3.3 days and postoperative hospital stay was 14.4±3.4 days. Conversion was needed in 4 cases. Therefor, the thoracoscopic surgery proved to be much more preferable in children because of its' minimal invasiveness.

[Bronchial fistulae closure by hydatid lung cysts in children].

The comparative analysis by bronchial fistulae closure by hydatid lung cysts in children using two surgical techniques was conducted. All patients were divided in two groups: the first group (n = 98) included cases of fistula closure using the traditional solitary Z-suture; the second group (n = 54) had fistula closure with the use of the original method. The least was thoroughly described in the paper. The were no cases of postoperative complications among patients of the 2nd group, whereas 6 patients of the 1st group had bronchial fistula recurrence after the operation.

[The surgical treatment of the inborn lobar emphysema in children: the comparative analysis].

Results of surgical treatment were comparatively analyzed in children with congenital lobar emphysema operated using traditional technique (1 group, 10 patients) and operated using thoracoscopic technique (2 group, 10 patients). In the first group average time of operation amounted 68 +/- 5,8 min., average time of plural drainage--3,3 days, average time of postoperative hospitalization--13,6 days and in the second group--62 +/- 15,6 min., 1,3 days and 7,4 days respectively. In the second group postoperative complications were not observed. In postoperative period one patient from the first group developed pneumothorax eliminated on the 5-th day after operation. Results of investigation indicate the advantages of thoracoscopic technique in treatment of children with lobar emphysema compared with traditional methods of treatment. Application of thoracoscopic technique in children with lobar emphysema is a serious alternative to traditional method due to slight postoperative period, lesser amount of complications and good cosmetic and functional results.

[Current aspects of transformation of morphological changes in children with nephrotic syndrome depending on the treatment regimen].

Despite existence of broad spectrum of medicine for treatment of childhood nephrotic syndrome, treatment efficiency of childhood nephrotic syndrome is not satisfactory yet. The aim of the study was investigation of clinical and histological changes during treatment of childhood nephrotic syndrome. Patients from the control group were treated with steroids according to ISKDC regimen and those of the study group-- with "long alternate day" regimen of steroids. Efficacy of the treatment was assessed by the relapse rate, rate of ESKD, glomerular filtration rate, proteinuria severity. The results showed a low relapse rate, ESKD, FSGS and proteinuria in the study group. Thus, long alternate day steroid regimen can reduce the number of relapses and improve outcomes in children with nephrotic syndrome by reducing transformation of histological pattern of NS to FSGS.

[Modes of intensive therapy for arterial hypertension in children with terminal chronic kidney failure]. / Rezhimy intensivnoi terapii arterlial'noi gipertenzii u detei s terminal'noi khronicheskoi pochechnoi nedostatochnost'iu.

In spite of considerable progress in development of pediatric science, intensive therapy of kidney diseases remains the pressing issue because of high lethality among patients with renal failure (RF). Cardiovascular diseases, especially malignant hypertension syndrome with development of left ventricular insufficiency, are leading among the causes of late deaths of postdialysis patients. We studied hemodynamics in 18 children with terminal chronic renal failure running with marked arterial hypertension and left ventricular hypertrophy. We have found that high blood pressure was initially caused by hyperhydration and hypernatriemia. After hemodialysis, children with KT/V > 1 developed hypertension due to hyperkinetic hemodynamics. Establishment of "dry weight" of the child on programmed dialysis was followed by renin-dependent arterial hypertension which was treated by inhibitors of angiotensin-converting enzyme and calcium antagonists, in one case by nephrectomy. In hemodialysis regimen KT/V < 1, dry weight was not achieved and hyperhydration-caused hypertension remained. Moderate arterial hypertension due to cukinetic hemodynamics was achieved only after 4 weeks of hemodialysis in administration of calcium antagonists, beta-blockers and central sympatholytics.

[Diagnosis of acute renal failure in pediatric nephrology]. / Diagnostika ostroi pochechnoi nedostatochnosti v pediatricheskoi nefrologii.

Acute renal insufficiency (ARI) complicated the course of the underlying process, including primary and secondary glomerulonephritis, interstitial nephritis, pyelonephritis, dysmetabolic nephropathies, urolithiasis, tubulopathies, renal congenitae defects and injuries in 136 of 1695 children with nephrological diseases hospitalized at Republican Pediatric Renal Center during the last decade. In 69.1% cases ARI developed by the renal type, in 23.5% cases was caused by prerenal factors, and rarely (in 7.4% cases) by postrenal factors. Renal ARI in children was caused by 5 causes, including glomerulonephritis (47%), acute tubular necrosis (19%), interstitial nephritis (14%), vascular disorders (11%) resultant from vasculitis, renal vein thrombosis, and acute crystalluria (9%) which developed in the presence of grave dysmetabolic nephropathy. Among three clinical variants of ARI the most severe was observed in renal ARI leading to grave endogenous intoxication and pronounced decompensation of renal function. More benign course of renal ARI caused by acute tubular necrosis or acute crystalluria differed significantly from prerenal ARI by a more pronounced endogenous intoxication, increased fractionated sodium excretion, and renal insufficiency index higher than 1.

[Nephrotic crisis in children]. / Nefroticheskii kriz u detei.

The aim of the study was elucidation of diagnostic criteria of the nephrotic crisis in children with primary and secondary nephrosonephritis. 44 children with nephrotic crisis (59% of them had primary glomerulonephritis, 41% - secondary one) and 62 control patients with activity of nephrotic syndrome of the third degree were examined. The tested criteria were the following: the activity of the pathological process, intensity of proteinuria, level of proteinemia, albuminemia and total pool of medium mass molecules in the serum, presence of acute renal failure, diffuse cavitary edema, abdominal syndrome, migrating erycepalas-like erythemas, severe hypovolemia, thrombotic complications. The analysis of the findings show that a nephrotic crisis reflects highly active nephrosonephritis provoked by different factors including primarily hormone resistance and discontinuation of basic medication. The crisis in children is characterized by variability of the clinical picture including abdominal, hypovolemic, thrombotic, kinin and mixed variants. Early diagnostic criteria of the nephrotic crisis include the level of hypoalbuminemia, hypoproteinemia, low rate ofglomerular filtration, small volume of circulating blood and cardiac output.