[Influence of connective tissue differentiation on scar tissue formation in children]. / Vliyanie differentsiatsii soedinitel'noi tkani na formirovanie rubtsovoi tkani v detskom vozraste.

OBJECTIVE: To study the immunohistochemical features of various scar tissues in children without connective tissue pathology and with undifferentiated connective tissue dysplasia syndrome. MATERIAL AND METHODS: Tissue biopsy was performed in 217 children who underwent surgical treatment for various lesions, such as injuries, burns, as well as other procedures. There were 127 boys (58.5%) and 90 (41.5%) girls. The main group consisted of 98 (48.2%) children with scar tissue; group of UCTD syndrome - 65 (30.0%) children; control group - 43 (24.8%) patients without pathological scars. Histological examination of scar tissue and intact skin was carried out during primary or redo reconstructive surgery. Immunohistochemical study of antibodies against CD34, CD105, CD140b, PDGFs, COL types I, III and IV was performed. RESULTS: The study showed a quantitative characteristic of expression of COL type I in hypertrophic scar with predominance in the main group (77.5±5.4%; p<0.05), and decrease in COL type IV. Keloid form was associated with predominance of granulation tissue in all layers of dermis and high levels of all types of collagen. In the group of UCTD, COL type III prevailed in all pathological forms of the scar. We determined quantitative indicators of expression of vascularization factors (CD34; CD105) and fibroblastic activity (CD140b; PDGFs). CONCLUSION: Understanding the process of fibrinogenesis and analysis of stages of triggering mechanisms are essential for development of preventive algorithms. Individualized approach should be considered in the treatment. These studies are especially important in children with UCTD syndrome as high-risk group for pathological scarring. Thus, further research is required.

[Multicenter study of the effectiveness of antiscar therapy in patients at different age periods]. / Mul'titsentrovoe issledovanie effektivnosti protivorubtsovoi terapii u patsientov razlichnykh vozrastnykh grupp.

OBJECTIVE: Was to evaluate the effectiveness of anti-scar treatment with Contractubex gel in children and adults. MATERIAL AND METHODS: A group of researchers based on clinical hospitals and university medical clinics carry out the multicenter study to evaluate the effectiveness of anti-scar treatment with Contractubex gel containing cepalin, allantoin and heparin, with its early appointment in groups of children from 12 to 18 years old and adults from 21 to 35 years old. The study included data from 216 patients. Patients of both age groups were initially divided into two: the main and control ones with an equal distribution according to the type of surgical intervention (hernia repair and appendectomy), age, gender, and anamnestic data. The dynamic observation was carried out using two rating scales - filled out by a doctor (Vancouver scale) and a patient (author's rating scale in the Scar Diary mobile application). RESULTS: Based on the results of the analysis of the data obtained, a high efficiency of the use of Contractubex gel at the early stages of scar formation among patients of the main group in comparison with the control was revealed. By 90 days, the treatment result according to the Vancouver scale was 0,16±0,1 points in the main group and 0,39±0,2 points in the control group. At the same time, with a dynamic scale for assessing the cicatricial process, there was a significant (p<0.05) improvement in the main group (0,2±0,06 points) compared with the control group (0,6±0,17 points). In addition, was noticed the strong commitment to anti-scar treatment in pediatric patients. CONCLUSIONS: The work confirms the undoubted need for anti-scar treatment in the early stages of scar formation after surgical interventions, which accelerates the psychophysical rehabilitation of patients after surgery and improves the quality of life.

[3d-technologies in hepatobiliary surgery]. / 3D-tekhnologii v gepatobiliarnoi khirurgii.

The authors describe modern 3D technologies in hepatobiliary surgery. These approaches reduce the risk of intra- and postoperative complications. Virtual 3D reconstruction with clear visualization of parasitic cyst, adjacent vessels and bile ducts is valuable to create 3D-model of liver. This model may be applied for personalized laparoscopic approach and precise surgical intervention.

[Multi- and single-port laparoscopic surgery in the treatment of hydatid liver disease]. / Mnogoportovaya i odnoportovaya laparoskopiya v lechenii ekhinokokkoza pecheni.

OBJECTIVE: To compare the effectiveness of multi-port and single-port laparoscopic surgery in the treatment of hydatid cyst of the liver. MATERIAL AND METHODS: There were 25 children with solitary hydatid cyst of the liver (CL-CE2) who underwent surgery in 2013-2017. Mean age was 10.1±2.05 years. There were 17 boys and 8 girls. Patients were divided into 2 groups: group 1 (multi-port laparoscopy) - 19 patients, group 2 (single-port laparoscopic surgery) - 6 patients. RESULTS: Duration of ultrasound-assisted laparoscopy (G11 generator) was significantly shorter in the group 1 compared with group 2 (62.2±5.4 vs. 85.3±9.7 min, p<0.05). Intraoperative complications were absent. Biliary fistula in postoperative period was observed in 1 (5.3%) patient of the group 1. External drainage was effective. Residual cavity in 6 months after laparoscopic resection was observed in 1 (16.7%) patient of the group 2. Recurrent liver echinococcosis was not recorded. CONCLUSION: Hydatid cyst (CL-CE2) of the liver is an indication for laparoscopic echinococcectomy. Multi-port laparoscopy is characterized by reduced duration of surgery and postoperative morbidity compared with single-port procedures.

[Results of a clinical study of a new anxiolytic, a blocker of central cholecystokinin receptors]. / Rezul'taty klinicheskogo issledovaniia novogo anksiolitika, blokatora tsentral'nykh kholetsistokininovykh retseptorov.

AIM: To evaluate anxiolytic action of GB-115, a low-affinity blocker of central cholecystokinin receptors, used in tablets in a dose of 1 mg for the treatment of patients with anxiety disorders in order to determine effective dose, safety, tolerability and efficacy in clinical settings. MATERIAL AND METHODS: The study included 31 patients (22 women, 9 men) diagnosed with generalized anxiety disorder (GAD, F41.1 according to ICD-10), aged from 22 to 53 years. The duration of treatment was 21 days. The Hamilton Anxiety Rating scale, Psychopathologic symptoms severity evaluation scale (PSSES), Spilberger State-Anxiety Inventory, Multidimensional Fatigue Inventory (MFI), Clinical Global Impression scale (CGI), computerized battery for evaluation of cognitive functions ('NS-Psychotest') were used. RESULTS AND CONCLUSION: The effective dose of GB-115 was determined at 6 mg per day. Drug action is characterized by fast onset of anxiolytic effect with stimulating properties and beneficial effect on sleep disturbances and autonomic symptoms. GB-115 treatment was associated with favorable changes in attention parameters, reaction time and overall performance. In contrast to first-line drugs for GAD treatment (SSRIs and SNRIs), GB-115 does not induce initial overactivation, anxiety and sleep disturbances. GB-115 is safe and has a good tolerability.

[Comparison of different methos of compression of scars with prolonged release plate]. / Sravnenie razlichnykh metodik kompressii rubtsov plastyrem prolongirovannogo deistviia.

The purpose of the study was to compare the effectiveness of various compression techniques with a prolonged-action patch on postoperative scars. MATERIAL AND METHODS: The study included 21 patients aged 3.6±1.7 years who had scars after surgery. The patients were divided into two groups: group No 1 (n=11), in which they applied longitudinal patch of prolonged-action Contractubex according to the standard technique; group No 2 (n=10) - transverse imposition of the patch on the postoperative scar (according to the author's method). RESULTS: In 20 (95.5%) patients, good compliance was noted. By the 90th day after surgery, the width of the scar in the group No. 1 was significantly larger than in the group No. 2, being 2.5±0.15 and 2.0±0.1 (p<0.05). CONCLUSION: Thus, the effectiveness of the proposed technique of transverse imposition of the patch Contractubex on the postoperative scar after surgical intervention was confirmed by a good cosmetic and functional result of scar formation.

[A new approach in the compression therapy of postoperative scars]. / Novyi podkhod v kompressionnoi terapii posleoperatsionnykh rubtsov.

The aim of the study was to evaluate the effectiveness of compression therapy with a prolonged plaster of Contractubex in the formation of skin scarring in children after surgery. MATERIAL AND METHODS: In a prospective open-label randomized trial, 109 patients aged 5.3±2.1 years after surgery: boys - 73, girls - 36. Patients were divided into 2 groups: in the main group (54 children) the application of the prolonged plaster Contractubex was performed; in the control group (55 patients) - dynamic observation. The scar deformation was assessed according to the Vancouver scale for 10, 30 and 90 postoperative days. RESULTS: 94.4% patients had good compliance; in 2 (3.7%) - satisfactory; in 1 (1.9%) - unsatisfactory compliance. In our study, the formation of hypertrophic scars in the main group was significantly less frequent than in the control group (1 and 8 patients, respectively, χ2=4.241, p=0.042). CONCLUSION: Thus, the use of the prolonged plaster Contractubex in the near and distant period a good cosmetic and functional result in the formation of a postoperative scar was provided.

[The complications of intestinal stoma in children]. / Oslozhneniia kishechnykh stom u detei.

AIM: To investigate the complications of intestinal stoma in children and to develop measures for decrease of their incidence. MATERIAL AND METHODS: The study included 152 children with congenital and acquired gastrointestinal pathology requiring surgical treatment with the imposition of intestinal stoma. Atresia of intestinal tube was observed in 28 (18.4%) children, meconium ileus - in 10 (6.6%) cases, Hirschsprung's disease - in 11 (7.2%)cases, anorectal malformations - in 39 (25.7%) cases, multiple malformations - in 11 (7.2%) patients, necrotic enterocolitis - in 56 (36.8%) patients, other reasons - in 7 (4.6%) cases. The average age of patients was 12,3±7,2 days. There were 93 (61.2%) boys and 59 (38.8%) girls. Ileostomy, ileocolostomy and colostomy were made in 37 (24.3%), 46 (30.3%) and 69 (45.4%) cases respectively. Time of intestinal stoma function was 18-217 days. RESULTS: Early complications were dehiscence in the area of stoma in 4 (2.6%) children, evagination in 7 (4.6%) patients, marginal necrosis of stoma in 2 (1.3%) cases, retraction of stomy into abdominal cavity in 1 (0.6%) child and abdominal skin maceration in 8 (5.2%) patients. Remote complications included dermatitis around stomy in 35 (23.1%) children, stenosis of stoma in 9 (5.9%) cases, evagination of stoma in 12 (7.9%) patients. Also, 5 patients were unable to use the colostomy bag due to vicious overlaying of intestinal stoma. Using the colostomy bags «Coloplast¼ and skin care products around the stoma significantly reduced (p<0.01) the number of complications at inpatient stage of treatment. CONCLUSION: Successful function of stoma depends on not only technical aspects but also obligatory care performance with timely correction of complications.

[Recombinant granulocyte-colony stimulating factor (filgrastim): optimization of conditions of isolation and purification from inclusion body].

We developed a unified process platform for two recombinant human GCSF medicines--one with the non-prolonged and the other with prolonged action. This unified technology led to a simpler and cheaper production while introduction of the additional pegylation stage to the technological line eased obtaining of the medicines with different action and allowed to standardize technological process documenting according to GMP requirements.

[Meta-analysis: the possibility of atrophy of testicle in acute testicular appendage problems in children].

A meta-analysis of extensive statistical data of "acute scrotal" syndrome in children was made. The two databases were considered. The first consisted of 1342 observations and described the nosologic structure of "acute scrotal" syndrome in children. The second included 440 patients and showed the long-term results of conservative treatment in children with acute scrotal problems. When a mathematical analysis of initial data was carried out, the authors determined, that the possibility of atrophy of stricken gonad in conservative treatment of acute hydatid problems belonged to the segment from 0.303 till 0.684.

[Up-to-date approaches in treatment of hydatid disease of the liver in childhood].

Sixty children (age 3-15 years) with hydatid disease of the liver were treated. The patients were divided into 2 equal groups (control and main groups).The hydatid disease of the liver was revealed in 22 (33.6%) patients, combined hydatid disease of the liver and lung were noted in 38 (66.4%) patients. The "capitonnage" of the residual cavity was applied in the control group and omentoplasty--in the main group. Chemotherapy with Nemazol (dose 10-15 mg/kg/day) was carried out. In order to reduce the negative influence of Nemazol on patients and to accelerate reparation processes of liver parenchyma Vobenzyme (2-3 pills/3 times/day) was applied. The number of complications was 23.2 % in the control group. The adhesive bowel obstruction was noted in 6.6% of patients, bleeding and jaundice in 3.3%, the residual cavity suppuration in 10%. Complications were registered in the main group in 6.6% of children (the adhesive bowel obstruction in 3.3%, preservation of the residual cavity after a year in 3.3%). The number of relapses in the control group was 6 (12%), there were no relapses in the main group. Thus the procedure of preoperative and postoperative chemotherapy allowed avoidance of the development of relapses of hydatid disease of the liver. Omentoplasty is the most rational method of treatment of residual cavity in surgery of hydatid disease of the liver in children.

[The surgical treatment of varicocele in children and adolescents in the outpatient setting].

The first group included 45 patients with varicocele stage I--II; the second group included 20 patients with varicocele stage III. The ambulatory treatment complex permitted the inmprovement of of ultrasound indexes in scrotal veins in 29 (64%) patients of the 1st group, whereas nobody of the 2nd group showed any isignificant improvement. The proper use of the worked out complex allows the pathogenetic and correct treatment of varicocele in adolescents.

[The surface anesthesia in outpatient pediatric department].

The combination of even parts lidocaine and prilocaine in crème substance was used for surface anesthesia in 73 children, aged 1,5-16 years. Such surgical interventions as molluscum contagiosum eradication, laser wart resection and prepuce synechia dissection were performed. The described anesthetic was highly effective in all areas, but the nasolabial triangle. Resection of warts larger then 0,5 sm required either additional infiltrative anesthesia or step-wise resection. Local allergic reaction was registered in one case, no systemic reactions were noticed. Generally, the used method of surface anesthesia proved to be highly appropriate in pediatric practice.

The influence of enzymes on adhesive processes in the abdominal cavity.

INTRODUCTION: Intraperitoneal adhesions remain a common problem after abdominal surgery. However, the advent of targeted, specific agents as a directed therapy against inflammatory and neoangiogenesis raises the prospect of a new approach for anti-adhesion strategies. METHODS: 70 adult rats were divided into two groups: an enzyme group (35 rats) and a control group (35 rats). Following laparotomy the visceral peritoneum of the cecum and inner layer the abdominal cavity were abraded. In the enzyme group the preparation Wobenzym (a combination of animal and vegetable proteases plus rutoside) dissolved in 2 ml of sterile 0.9% NaCl was administered to the rats through a gastric probe over a period of 21 days. The control animals received the same quantity of saline without the preparation. On the 1st, 3rd, 7th and 21st postoperative days 8 animals from each group were sacrificed. VEGF, bFGF and laminin were detected in the visceral and parietal peritoneum by immunohistochemistry. RESULTS: The mean adhesion grades of the enzyme group were significantly lower than in the control group. A comparison of the two groups showed that the expression of VEGF, bFGF and laminin in the enzyme group was lower than in the control group. Moreover, in the enzyme group the concentration of bFGF and laminin peaked on the 7th day, while in the control group the maximum concentrations peaked on day 21. CONCLUSIONS: Our study found that oral poly-enzyme therapy following laparotomy and abrasion of the visceral and parietal peritoneum reduces the extent of postoperative intestinal adhesions. This favorable effect can be explained by the lower levels of angiogenic agents (VEGF, bFGF) and laminin after the administration of hydrolytic enzymes.

[Complex treatment of acute hematogenous osteomyelitis in children].

The acute hematogenous osteomyelitis continues to remain at present one of the actual problems to pediatric surgery, being characterized by severe course, difficulty of the early diagnostics and frequency of unfavourable outcomes, becoming chronic and complications. We investigated the levels of CRP, IL-1beta, TNF-alpha in 74 children with acute hematogenous osteomyelitis. In the first (control) group children had standart therapy, in the second (main) group children had standart therapy with Licopid. The level of TNF-alpha in the main group on 7 days after operation was 91,8 + or - 4,1 pcg/ml, on 14 days -- 44,3 + or - 8,3 pcg/ml. The level of TNF-alpha in the control group on 14 days was 92,0 + or - 2,0 pcg/ml (p<0,01). The level of IL-1beta in the main group on 7 days -- 120,0 + or - 30,8 pcg/ml, on 14 days -- 80,0 + or - 15,3 pcg/ml. The level of IL-1beta in the control group on 14 days -- 100,5 + or - 2,4 pcg/ml. The level of CRP in the main group on 14 days -- 22,9 + or - 4,1 mg/ml. The level of CRP in the control group on 14 days -- 12,9 + or - 0,4 mg/ml (p<0,05). The use the complex treatment of acute hematogenous osteomyelitis in children has allowed to obtain a good results of the treatment.

[Modern approach to the rehabilitation of children with fractured long tubular bones].

An optimized therapeutic rehabilitation program involved 393 patients with fractured long bones (humeral, radial/ulnar, femoral, crural) admitted to the Orthopedic Department of the Stavropol Regional Children's Clinical Hospital and the Rehabilitation Centre for Handicapped Children and Adolescents. Rehabilitation was performed in three consecutive stages, viz. immobilization, functional recovery and training. The proposed approach ensured rather fast functional recovery of the affected extremity even in cases with compound fractures. The rehabilitation program included polyenzyme therapy with wobenzym during 3-4 weeks after injury or surgical repositioning of bone fragments. Pain and oedema syndromes resolved twice as fast as after traditional treatment. The use of this program permitted to avoid development of contracture and disturbances of locomotary activity; moreover, it improved the quality of life in children with fractures of long tubular bones.

[New aspects of pathogenesis of adhesive process in the abdominal cavity].

Adhesive process in the abdominal cavity is the leading cause of morbidity and mortality in abdominal surgery. The clinical investigation included 126 children with acute adhesive intestinal obstruction. All patients were divided into two groups: polyenzyme and monoenzyme groups. In the polyenzyme group there was one case of intestinal obstruction. In the monoenzyme group there were 4 children with intestinal obstruction. The experiment included 70 adult rats divided in two equal groups: the main and control groups. The main group animals were given a polyenzyme preparation. The control group had a high incidence of cecal adhesions, which was significantly higher than the number of adhesions in the main group (Chi-square test = 23.1, df=2, p = 0.001). Proteolytic enzymes induce cells to express, de novo, the vascular endothelial growth factor, fibroblast growth factor and Laminin. As a consequence of these effects, activation of T-lymphocytes and macrophages mediating the inflammatory response will be down-regulated. It was found that the levels of VEGF, FGF and Laminin in the abdominal cavity, detected by immunohistochemistry, were different in the rats having high level and having no postoperative abdominal adhesion. The level of angiogenesis factors was also rapidly normalized by means of polyenzyme therapy.

[The use of ultrasonography in the acute scrotum edema in children].

Ultrasound dopplerography of testicles and high-frequency ultrasonography of the spermatic cord were used to increase the efficiency of diagnostics at the acute scrotum edema in children. The signs of testicular torsion are the thickening of the spermatic cord from 7 to 33 mm, its helical structure (like cochlea), decrease or the termination of a blood flow in the spermatic cord. The combination of sonographic signs testifies about testicular torsion without dependence from prescription of clinical manifestation of the disease. Not always it was possible to visualize the sessile hydatid separately from epididymis during procedure. But such indirect signs as expansion of the epididymis twice and its heterogeneity specified the sessile hydatid involvement. False-negative results of ultrasonography were received in third of all cases of testicular torsion. The given phenomenon was marked when intraorganic blood flow in testicles was defined with ultrasound at the beginning of disease. The further introduction of ultrasound dopplerography and high-frequency ultrasonography into clinical practice will allow to improve results of treatment of children with acute testicular diseases.