Main factors affecting natal injury of the cervical region of the newborn spine

Parturition is a complex biomechanical process that affects the entire body of a newborn baby. The traumatic process consists of the flexion-compression and distraction moments, as well as the rotation of the head. The purpose is to identify the main factors on the part of mothers and medical staff facilitating the trauma of the cervical spine segment. Over the past 3 years we have seen 87 newborns who were in the intensive care unit over natal trauma of the cervical spine. Boys counted 38, girls - 39. Average weight is 2800-3200 grams. Newborns were born during the period from 38 to 40 weeks. All the newborns had KISS-syndrome. Predisposing factors of the parturient woman are as follows: narrow pelvis - 5; rapid parturition - 9; anomaly of the fetus and placenta position - 6; others – 7. Predisposing medical factors are stimulation or suppression of labor - 13; cesarean section - 20; not shown or incorrect medical benefit - 16. Combined factors of mothers and medical personnel - 11. We considered only those factors that played a major role in the trauma of the cervical region. Of all 87 newborns, the cervical injury due to “maternal causes” occurred in 27 cases (31%); due to “medical staff” - 49 (56%), combined factors 11 (13%). Conclusions: considering predisposing factors, one can prevent or avoid natal trauma of newborn by changing tactics of childbirth. The main role in the formation of the natal injury of the cervical spine region in the newborn is devoted to unspecified or “active” medical benefits. Malformations in parturient women contribute least to the formation of the natal injury of the cervical spine region in newborns

Experience of using the metal plate in the treatment of Pectus Excavatum in children

Congenital deformities of the ribs and sternum are often encountered. Surgical treatment of hollowed chest in children is generally accepted. The purpose is to evaluate the efficacy of the metal plate in plastic surgery on the ribs and the sternum at the hollowed chest deformation. Over the past 10 years there were 23 patients with a hollowed chest under the supervision. Of all the patients (23), the parents noted the deformation of the anterior thoracic wall in the first year of life in 5 children. The remaining 18 children had deformity at an older age - these children often had colds. Indications for plastic surgery were cosmetic, orthopedic, and functional. Only 10 patients demonstrated a violation of posture, 8 had a round back, and 3 had kyphoscoliosis. Conducted electrocardiographic and spirometric studies found a violation of the cardiac activity function and external respiration in the majority of sick children (18, 67%). Operation in the deformation of the ribs and sternum consisted of subchondral resection of the ribs of the deformed zone and T-shaped osteotomy of the sternum with subsequent correction of its shape and retention in this position by means of a metal plate that was inserted behind the sternum, and its jaws rested against the ribs themselves. The metal plate was removed one year after the operative treatment. 22 of the 23 children with chest deformity treatment had a recover restore the chest form and improvement of the chest function, 3 patients had a flat shape. Significant improvement in the function of respiratory and cardiovascular systems was revealed. All children became more active, cheerful, and sociable. Inferiority syndrome disappeared

Percutaneous intramedullary fixation with the wires for fractures of the distal radius metaepiphysis in children

Fractures of the forearm bones in children are among the most common injuries and they occupy a leading place among limb fractures. The method of treatment of the fracture of the distal metaepiphysis of the radial bone in children determines the type and place of the fracture, the degree of displacement of the bone fragments and the method of repositioning the bone fragments. The purpose is to verify the effectiveness of percutaneous intramedullary Kirschner wires fixation in the treatment of fractures of the distal radius metaepiphysis in children. Over the past 10 years the surgery department provided treatment for 107 children of different age and sex with fractures of the distal radius metaepiphysis. There were 67 boys and 40 girls. Damages were as follows: epiphyseolysis distal epiphysis in 39 (36%); osteoepiphyseolysis of distal metaephysis in 43 (40%); fracture of the distal radius with displacement of bone fragments in 25 (23%) children. The tactics of treatment depended on the fracture line, the shape of the fracture, and the age of the patient. All children reposition and percutaneous fixation was performed under general anesthesia with X-Ray control. Wires as a retainer of bone fragments were applied for 30-35 days averagely. These patients were constantly observed by a traumatologist. From all observations (107), the complications were in 7 (5%) patients, out of which 5 had an inflammation of the soft tissues, one patient had a soft tissue abscess rear of the wrist and one had a wire on the 30th day after the repositioning was broken at the level of the wrist joint. All of these patients underwent treatment tactics correction that did not affect the final outcome

Coccygodynia in childhood and its treatment

Coccygodynia is the pain in the zone of the coccygeal bone. The cause is injury. The purpose is to determine the main clinical and X-ray signs of coccygodeny in childhood and to justify the effectiveness of her surgical treatment. Since 2005, 33 children have been observed with a clinical symptoms of coccygodynia - age from 8 to 17 years old. There were 5 boys and 28 girls. On examination, all patients were determined constant pain in the coccyx. Clinically - the coccygeal zone without pathological changes. Palpation in this area defined pain at all 33 patients, 24 patients have pain while sitting on a solid surface, pain during the act of defecation at 16 patients. Vicious position of coccygeal bone and pain determined in all patients with rectal examination and X-Ray. Anamnesis contains a fall on the buttocks. All patients underwent surgery - removal of coccyx bone. The pain syndrome disappeared on the second day after surgery at 27 patients, all children without pain syndrome were prescribed for outpatient observation. All patients treated with a surgical method had a persistent cure - the pain syndrome in the coccyx region disappeared. Long-term results were followed to a depth of 5 years, recurrence of pain wasn`t observed. Coccygodynia is a consequence of traumatic damage of the coccygeal bone followed by non-nonunion of the fracture, and the rapid development of scar tissue with involvement in the process of sensory nerve endings to the clinic constant pain in the coccyx. Diagnosis is simple - a constant pain in the area of the coccyx. Radiographically is a vicious position of the coccygeal bone. The removal of the coccygeal bone is an effective way to treat coccygodynia

Treatment of notta desease according to shastin method in our modification

Tenosynovitis stenosans is a dysplastic pathology of the anular ligament of the fingers that occurs in children most often between the ages of 1 to 3 years. The anular ligaments of the first finger are most often affected, although this is possible with the other fingers. Parents notice the difficult extension of the first finger or the inability to unbend the first finger completely. Also one can notice directly at the base of the first finger on the palmar side a thickening. The purpose is to prove the effectiveness of the mini-invasive method of treatment according to Shastin method in our modification. In recent years, we observed 67 children under the age of 3 years, in 51 cases the constrictive ligament was observed in the first finger, 16 were from other fingers. In 49 cases it was on both first fingers of brushes. Before surgery, ultrasound was also performed, which specified the area of the pathologically altered anular ligament and its extent. Operative access is performed on the palmar surface in the middle of the finger through a point incision (according to Shastin method) with a special pointed scalpel in the projection of the pathologically altered anular ligament, which was later dissected longitudinally. After all procedures a tendon of the long flexor gets the possibility of free sliding in its channel and the finger takes the usual position. The edges of the surgical wound approached by a thin strip of adhesive. After getting out of anesthetic sleep the child could move his finger freely. Traced long-term results up to 7 years in 45 patients. The functions of the fingers were restored completely in all 45 patients, there were no relapses. Operative treatment in our modification is low-traumatic, highly effective and extremely rarely leads to relapses

Mathematical substantiation of the main symptoms role in diagnostics of natal injury consequences of the cervical spine

Recently, according to the literature, the trauma of the cervical spine in newborns takes the leading place among thenewborn natal injuries. According to available information, out of every 3 births, two newborns are injured in the cervical spine segment during labor. We have studied 136 cases of children who were in the intensive care unit of newborns in Republican Mother and Child Center. As a result of systematization of complaints, disease anamnesis, objective examination, 52 factors related to this disease were collected. The task was to find out the most important factors determining the prognosis of the consequences of the natal trauma of the spine. Algorithm to solve this problem: - study of tables of initial experimental data and measures of tightness of linear regression between factors; - construction, analysis of correlation matrices, splitting of factors into pleiads; - application of expert methods - direct ranking and weighting factors of importance; - tabulation of weakly correlated factors. The mathematical analysis led to reduction of the factor space dimension from the original 49 to 4 units without changing the information capacity. Conclusions: 1. As a result of the calculations, we have established 4 factors containing the greatest information load in the natal trauma of the cervical spine. These factors are the symmetry of the shoulders, the sucking reflex, the weighed gynecological anamnesis, the caesarean section. 2. Based on these four factors, it is planned to construct a probabilistic model for the consequences prognosis of the natal injury of the spine

Beta-blockers in pharmacological treatment of infantile hemangioma

We conducted a retrospective analysis of pharmacological treatment of infantile hemangioma (IH, vascular hyperplasia) with beta-blockers (enteral use of Propranolol and topical use of Timolol) in our pediatric surgery department. This method performed from 2014 to 2017 at our center. The protocol of examination and treatment developed to provide rare but serious side effects of Propranolol administration including hypoglycemia, wheezing, hypotension, and bradycardia. 78 children were treated with propranolol at the dosage 2mg/kg/ day. In 17 cases we use topical 0,1% ointment of Timolol. The age of the children ranged from 10 days to 13 months, 51 female and 27 male. The treatment duration was from 5 to 13 months. Positive clinical effect it obtained at all patients. Side effects of propranolol administration were observed in 4 cases, after 5-6 month of treatment (bradycardia) which disappeared after the treatment withdrawal. In 3 cases after cancelling treatment, we determined the recurrent of hemangioma, but not to the initial size. Our experience confirms the efficacy and safety of treatment with beta-blockers in accurate compliance with protocol management

Mathematical substantiation of the main symptomschoice in diagnostics of natal injuryconsequences of the cervical spine

We have studied 217 charts of the children treated in the surgical department of the Republican Mother and ChildCenter that have a diagnosis of a chronic rotational subluxation of C1. All the sick children underwent x-ray examination of C1 through the open mouth, a rheoencephalographic procedure. As a result of systematization of complaints, diseaseanamnesis, objective examination and results of instrumental survey methods, 27 factors related to the disease were collected. The task was to find out the most important factors determining the severity of the disease. Algorithm for solving the task: • study of tables of initial experimental data and measures of tightness of linear regression between factors; • construction, analysis of correlation matrices, splitting of factors into pleiads; • application of expert methods - direct ranking and weighting factors of importance; • tabulation of weakly correlated factors. The mathematical analysis ledto reduction the dimension of the factor space from the initial 27 to 5 units without changing the information capacity. Conclusions: As a result of the calculations, we have identified 5 factors carrying the main information load in the case of a rotational subluxation of the C1 vertebra. These factors were: data from the rheoencephalographic study, perinatal encephalopathy in the anamnesis, the age of the child, visual impairment, the presence of complications such as vertebrobasilar insufficiency, syncope, tension headache. Based on these five factors, it is planned to build a probabilistic model for the severity of the disease