Ultrasound for management of pediatric nasal fractures.

BACKGROUND: Nasal bone fractures are common in children but can be challenging to diagnose accurately in the first days due to swelling and tenderness. While X-rays and computed tomography have limitations, ultrasound may be a radiation-free and cost-effective alternative for diagnosing and treating nasal fractures. METHODS: A prospective cohort study at a tertiary referral hospital between 2021-2023. Children who had sustained nasal trauma were included. A radiologist and a non-radiologist blindly reviewed ultrasound scans, and the results were compared to the physical examination performed by a senior otolaryngologist. If closed reduction was necessary, ultrasound was employed during the procedure. The primary outcome was the assessment of nasal fractures in children using ultrasound; Secondary outcomes included success rates for closed reduction and test reliability. RESULTS: Of the 50 children (mean age: 11 years, interquartile range: 6-15 years, 36 [72%] males), 22 (44%) were clinically diagnosed with a nasal fracture. Interobserver reliability for nasal fracture by ultrasound was 92%, with a Cohen's kappa coefficient of k=0.91. The sensitivity and specificity of ultrasound in detecting nasal fractures were 90% and 89%, respectively, with positive and negative predictive values of 86% and 93%, respectively. Closed reduction was performed on 18 children, with (n=11) or without (n=7) ultrasound, with the former showing better alignment results (82% vs. 71%). CONCLUSIONS: Ultrasound has a high negative predictive value in identifying nasal fractures in children with swollen noses during presentation. This enables to avoid further unnecessary referrals and interventions. Ultrasound-guided closed reduction of nasal fractures demonstrates improved outcomes; however, further large-scale randomized studies are required to validate our findings.

[The effect of age on the degree of strength restoration of the lower limb musles in the long-term period after surgical treatment of adult patients with spondylolisthesis.]

The purpose of the work was to study the effect of age on the degree of isometric strength restoration of the lower limb muscles in the long-term period after surgical treatment of adult patients with spondylolisthesis. 36 patients with spondylolisthesis of I and II displacement degree and 50 normal subjects at the age of 41-66 years were included in the study. Maximum moments of the femur and leg isometric strength were studied using dynamometric stands. The pain syndrome was evaluated in all the patients (VAS scale), as well as their functional condition (Oswestry scale). The investigations were performed before treatment and 75-99 months after surgical intervention. The presented reliable reverse correlation of the patient's age and the pattern and magnitude of changes in the strength of the lower limb muscles was identified in adult patients with spondylolisthesis in the long-term period after surgical treatment. At the younger age (41-59 years) positive dynamics of the muscle strength prevailed - an increase in 56,3% cases, conformity to the preoperative level was observed in 6,3% patients, a decrease in muscle function - in 37,4% cases. In the age-related group of 60-74 years the muscle strength growth was recorded only in 16,7% cases, there was no dynamics relative to the initial level in 8,3% patients, and a decrease in maximum moment of strength was observed in 75% cases. Thus, in case of large intervals of the follow-up period of the results of surgical treatment of adult patients with spondylolisthesis it is impossible to avoid evaluating the effect of age changes in muscles on the degree of restoring isometric strength of the lower limb muscles. As far as age increases, the reserves for muscle function improvement after surgical treatment are reduced significantly.

[Treatment of diabetic foot complications]. / Lechenie solozhnenii "diabeticheskoi stopy".

Of 3721 patients with diabetic lesions of the foot treated 2416 (65%) patients have been operated. The rise of urgent hospitalization rate (over 90%) unfavourably influenced the results of the treatment and contributed to increased frequency of high amputations of the extremity. The proposed system for evaluation of the condition and scope of the combined treatment resulted in decrease of mortality among operated patients from 14.7% to 9.8% and among not operated ones--from 20.5% to 5.5%. The suggested classifications of complicated forms of the "diabetic foot" syndrome provided proper evaluation of the prognosis and individual approach to the choice of treatment measures.

[The rapid diagnosis of the toxicity of biological media in surgical patients]. / Ekspress-diagnostika toksichnosti biologicheskikh sred u khirurgicheskikh bol'nykh.

A simple and objective rapid method for assessing serum and plasma toxicity is proposed, based on registration of the frog cardiac contractions. The method permits assessment of disease severity and monitoring the time course of pathological process after surgery and plasmapheresis. The level of toxemia and disease severity did not correlate in 20% of cases. Causes of this disagreement are discussed.

[New methods for assessing the severity of endogenous intoxication in surgical patients]. / Novye metody otsenki tiazhesti éndogennoi intoksikatsii u khirurgicheskikh bol'nykh.

New methods (a reticulocytic test, inhibition of erythrocyte sedimentation, registration of the frog's heart rate) were used in studying the toxicity of the serum, blood plasma and urine of surgical patients. The most informative methods for the assessment of the toxemia degree are thought to be the reticulocytic test and registration of the frog's heart rate. The maximum time for the determination of endotoxicity is 15 minutes. The pathological process severity can be estimated not only by the toxemia degree but also by its dynamics. The determination of endotoxicity is of value for choosing the methods for the individual detoxication therapy.

[Plasmapheresis in the treatment of critical stages of ischemia in diabetic angiopathy of the lower extremities]. / Plazmaferez v lechenii kriticheskikh stepenei ishemii pri diabeticheskoi angiopatii nizhnikh konechnostei.

The authors have used gravitation plasmapheresis in the treatment of 26 patients with diabetic angiopathies of lower extremities. It was established that continuous gravitation plasmapheresis facilitated the immediate correction of most of the altered biochemical and coagulation parameters of blood, in patients with diabetes mellitus. The use of rheopolyglucinum is followed by stable central hemodynamics and stabilization of the general state of the patients during continuous plasmapheresis which allows to recommend rheopolyglucinum as the main plasma-substituting solution for fractionation of blood in patients with diabetic angiopathies. The gravitation plasmapheresis used in the treatment of critical degrees of ischemia in patients with diabetic angiopathies of lower extremities is thought by the authors to allow to preserve the extremity or to make the level of its amputation lower in most patients.

[Clinico-anatomical types of deforming bronchitis in children]. / Klinike-anatomicheskie vidy deformiruiushchego bronkhita u detei

A complex clinico-roentgeno-morphological investigation was performed in 38 patients, aged from 4 to 15 years, with chronic deformative bronchitis. The analysis of the results obtained enabled to reveal three clinico-anatomical forms of deformative bronchitis: a. chronic infiltrative endobronchitis; b. chronic deformative bronchitis with cylindric enlargement of bronchi; c. chronic deformative bronchitis with marked angiobronchosclerosis. Broncho-angiopneumographic and morphological correlations contributed to further pinpointing differential indications to radical surgical procedures for such pulmonary pathology.