Surgical treatment of chronic colostasis in children: a ten-year experience.

OBJECTIVE: To analyze our ten year experience of surgical treatment of children with chronic colonostasis of different origin. MATERIAL AND METHODS: The study covers 353 children aged from 1 day to 17 years with colonic stasis who undergo treatment at the Department of Children's Surgery, Bukovinian State Medical University, Cernauti, Ukraine. Study design included case history, physical examination, routine clinical and biochemical laboratory tests, endoscopy (sigmoidoscopy, colonoscopy), X-ray (irrigoscopy, irrigography, other radiopaque techniques) methods, and sphincterometry. RESULTS: Non-surgical treatment was effective in 261 (73.94%) patients. The group of the operated patients consisted of 92 (26.06%) children. The outcome of surgical treatment of Hirschsprung's disease (49 children), dolichosigmoid (29 children), Payr's disease (12 children), and Chilaiditi syndrome in all cases is considered to be satisfactory. The optimal methods of surgical operations are offered according to pathology of colon. CONCLUSIONS: One-step Soave-Boley operation is considered to be the method of choice for rectal and rectosigmoid forms of Hirschprung's disease. Transversal colon resection and phrenico-colic ligament dissection in Payr's disease, hepatopexia and right colon fixation in Chilaiditi syndrome are effective treatment approaches.

[Peculiarities of a large bowel microstructure in children, suffering chronic constipation, caused by its inborn anomaly].

Layer-by-layer electron microscopy investigation of the large bowel microstructure in children, suffering chronic constipation (CHC), caused by inborn anomaly (dolichosigma), was conducted. There were investigated 20 intraoperative specimens of the sigmoid colon intestine. Essential changes in all layers of the large bowel were noted. For example, in CHC in decompensated stage there were characteristic features: changes in mucosal epithelium, inhibition of the goblet cells secretion activity, oedema of lamina propria and submucosal layer, the filamental structures disorders. The gut layers trophic function was disordered by the blood vessels and the hemocapillars wall damage. Destructive changes in the smooth myocytes in muscular layer reflects disorder of the organ contractile function. Destructive changes in the large bowel structure are accompanied by the lymph nodes hyperemia, diffuse leukocytic infiltration, witnessing reaction of lymphoid tissue on pathological changes in the organ. Peculiarities of the CHC clinical course, the dolichosigma staging in children were caused by morphological changes of the large bowel wall. The revealed structural reorganization of the gut wall may be considered as a "critical cusative agents", in which propulsive function of sigmoid colonic intestine is inhibited significantly and do not provide an adequate passage of a large bowel contents.

[The changes of general potential of hemocoagulation in children, suffering an acute hematogenic osteomyelitis].

Chronometric hypocoagulation was observed in children, suffering an acute hematogenic ostheomyelitis, witnessed by processes of thrombin formation according to internal (the prolonged time of the blood plasm recalcification and activated partial thromboplastin time) and external (the thrombin time enhancement) ways of the blood coagulation process, as well as changes in fibrinogenesis mechanisms (the thrombin time prolongation). The lowering of anticoagulant capacity of the blood (the antithrombin III activity inhibition by 18.5%) was combined with significant increase of the thrombocytes functional activity (the rising of their adhesive and aggregational properties) in more than two times, which have occurred on the background of constant content of fibrinogen in the blood. Changes in the system of the plasm fibrinolysis in an acute hematogenic ostheomyelitis was characterized by inhibition of cofermental and, mainly, fermental fibrinolytic activity of the blood plasm, in conjunction with Hageman-dependent fibrinolysis intensification and was accompanied by accumulation of soluble complexes of fibrin-monomer in the blood. So far, chronometric hypocoagulation is secondary process, caused by the influence of soluble complexes of fibrin-monomer, which blocks fibrinogenesis. That's why the general potential of the blood coagulation system in children with an acute hematogenic ostheomyelitis must be regarded as a structural hypercoagulation.

[Membrane plasmapheresis in complex treatment of endogenous intoxication in diffuse peritonitis of appendicular genesis in children]. / Membrannyi plazmaferez u kompleksnomu likuvanni endohennoï intoksykatsiï pry rozlytomu perytoniti apendykuliarnoho henezu u diteï.

With the aim to lower the degree of endogenous intoxication in 9 children with diffuse peritonitis of appendicular genesis the membrane plasmapheresis with the plasma exchange was used in complex of postoperative treatment. Depending on severity of clinical course of the disease there were conducted two procedures on the 2-3 and 5-7 postoperative day to every patient. Application of the membrane plasmapheresis in complex of treatment had promoted the reduction of the endogenous intoxication degree due to influence on its main pathogenetic chains and the immune systemic reactivity raising.

[Renal and tissue fibrinolysis dysfunction in secondary pyelonephritis in children before and after the surgery]. / Porushennia funktsiï nyrok ta tkanynnoho fibrynolizu pry vtorynnomu piieloneftyti u ditei do ta pislia operatsiï.

Indexes of fibrinolytic and proteolytic blood and urine activity in secondary pyelonephritis in children up to and after operative treatment for obstructive pyelonephritis were studied. The simulating method of hydronephrosis and secondary pyelonephritis was elaborated, changes of the tissues fibrinolytic activity of pyelourethral segment region in conditions of experiment and in operated children were studied. After the operation the conditions for urodynamics disorder occurrence are creating, in particular, lowering of activity of urine urokinase, disorder of tissues enzymatic fibrinolysis of pyelourethral segment with activation of general hemocoagulative potential, what promotes the urolythic disease and hydronephrosis occurrence and necessity for according correction.

[Diagnosis and results of treatment of congenital pyloric stenosis in children]. / Diahnostyka ta rezul'taty likuvannia vrodzhennoho pilorostenozu u ditei.

Results of treatment of congenital pylorostenosis in children during last 15 years were studied. There was established, that degree of hypotrophy increases proportionally to duration of vomitive period. Changes of clinical signs of illness due to depression of immune defence, observation by divisional pediatrician with administration of spasmolytic preparation constitute the causes of late hospitalization to unit of pediatric surgery. Late results of treatment witness, that timely performance of operation constitutes an effective method.

[The influence of intra-abdominal electrophoresis and enteral sorption on the immune indices in children with peri-appendicular abscess]. / Vplyv vnutrishn'oabdominal'noho elektroforezu ta enterosorbtsiï na imunni pokaznyky u ditei z periapendykuliarnym abstsesom.

Comparative characteristic of application of different methods of intratissue electrophoresis and their influence on immune indexes in children with perioappendicular abscess was presented. Application of complex treatment with usage of intraabdominal electrophoresis and enterosorption had guaranteed an effective correction of systemic and local immune disorders, the peritoneal macrophages activation, improvement of cytokines cooperation of cells in the immune answer.

[Influence of hyperbaric oxygenation on clinico-immunologic indices in children with acute diffuse peritonitis]. / Vplyv hiperbarychnoï oksyhenatsiï na kliniko-imunolohichni pokaznyky u ditei z hostrym rozlytym perytonitom.

The impact of hyperbaric oxygenation (HBO) on clinical-immunologic indexes in complex treatment of an acute diffuse peritonitis of appendicular genesis in children was studied up. Efficacy of the HBO application in moderate immunodepressive state, registered in this disease, was noted.

[Differences in differential diagnosis between acute mesenterial lymphadenitis and appendicitis in children]. / Dyferentsiino-diahnostychni vidminnosti mizh hostrym bryzhovym limfadenitom ta apendytsytom u ditei.

The thermal streams intensity (THSI) from definite points of anterior abdominal wall in children with an acute mesenterial lymphadenitis (AML) and an acute appendicitis (AA) were determined. It was established, that in right inguinal region THSI in AA was in 4.06 times higher than in AML, in paraumbilical region--THSI was in 2.78 times, in the left subcostal region--in 1.76 times higher in AML than in AA. In the right subcostal region THSI was higher in an AA. Differential algorithm for AML and AA was determined. In children with an AML the circulating immune complexes level in the blood plasma was by 26.4% higher than such in children with an AA, presenting possible additional differential-diagnostical criterion.

[The renal function disorders in children with peritonitis of appendicular genesis]. / Rozlady funktsiï nyrok u ditei z perytonitom apendykuliarnoho henezu.

In 36 children with the appendicular genesis peritonitis the changes of excretory, ionregulating and acidexcretorial renal functions were studied up, using clearance-method under the conditions of spontaneous nocturnal diuresis. The glomerular filtration rate, the endogenic creatinine concentrational and the sodium excretion indices were the most informative exponents.

[Empty follicle syndrome as cause of unsuccessful in vitro fertilization]. / "Ures" tüszö szindróma, mint a sikertelen in vitro fertilizáció egyik oka.

The authors report a case, where ultrasound guided transvaginal follicle aspiration was carried out for oocyte retrieval during the source of in vitro fertilization. Despite the favourable situation described by ultrasound and prognosed by serum hormone levels aspiration of oocytes proved unsuccessful even after lavage of follicules. The authors give an overview of the literature of "empty" follicle syndrome, its possible aetiology and methods of treatment.

[Effect of selenium on the functional state of white rat kidney in aluminum-cadmium poisoning]. / Vplyv selenu na funktsional'nyi stan nyrok bilykh shchuriv pry aliuminiievo-kadmiievii intoksykatsiï.

The breach of kidney's functional state and also the possibility of their selenite correction were researched after aluminium and cadmium intoxication. Aluminium chloride intensifies acid-secrete function of kidney. Cadmium chloride and its combination with aluminium chloride change the transport of sodium. Sodium selenite has aptitude for correction of the functional renal state in the case of aluminium and cadmium joint intoxication.

[Characteristics of peritoneal exudate microflora in children with appendicular peritonitis]. / Kharakterystyka mikroflory eksudatu cherevnoï porozhnyny u ditei z perytonitom apendykuliarnoho henezu.

Bacteriological investigation of peritoneal exudate was conducted in 131 children with peritonitis. The greatest quantity of pathogenic and conventionally pathogenic Escherichias and bacteroids was revealed in March, April and September. In summer peritonitis was caused by pathogenic and conventionally pathogenic Escherichias in association with enterobacterias, staphylococci and other microorganisms.

[Can the storage time be limited for cryopreserved pre-embryos?]. / Korlátozható-e a humán préembriók fagyasztva tárolásának idötartama?

The authors discuss about the questions connected with the time of the storage of the human cryopreserved preembryos. After approaching the different interest of the participants and giving the variable international statements the authors are preparing their suggestion for the limitation of the storage of the cryopreserved human preembryos.

[Functioning conditions of laboratories dealing with cryopreservation of human pre-embryos]. / A humán préembriók fagyasztásával foglalkozó laboratóriumok müködési feltételei.

The authors discuss about the functional conditions of the Human Reproductive Laboratories dealing with the cryopreservation of the human preembryos. They determine the safety specifications and recommend documentation of the cryopreservation based on their own practice. Finally they suggest the licensing-controlling system of the Human Reproductive Laboratories concerning cryopreservation of the human preembryos.

[Ethical questions of oocyte donation]. / A petesejt-adományozás etikai kérdései.

The authors discuss about the ethical questions connected with the human egg donation. After expounding the indications of the egg donation they analyse the age limits of the donors and the recipients and the consequences of these age limits by the point of ethics. The selection of the donors, the types of them and the ethical relations of the donation rise a lot of questions. After wording the possible answers the authors state their standpoints.

[Use of intraorganic electrophoresis in the treatment of peritonitis in children]. / Zastosuvannia vnutrishn'oorhannoho elektroforezu v likuvannni perytonitu u ditei.

There were examined 53 patients aged from 1 to 14 years. The galvanization of an abdomen method with the help of current while preliminary intravenous and intraperitoneal antibiotics injection was used in the treatment of 21 patient. It permitted to avoid the relaparotomy conduction, to reduce the postoperative complications appearance frequency, and also to shorten the duration of hospital stay.