Intestinal anastomoses in newborns and children of early age in complicated clinical cases

The application of intestinal anastomoses in newborns and young children under circumstances of multiple atresia, thrombohemorrhagic processes and infection of the abdominal cavity can be complicated by the development of inconsistency of the anastomoses. In the study, the analysis of the results of treatment of 385 children with intestinal anastomoses due to diverse intestinal pathology in newborns and young children over the last 5 years have been performed. All the patients have been on treatment at the Children’s Clinical Hospital of Kharkov National Medical University. We have gained the experience of application of the original anastomosis in 64 children, namely: with complex intestinal malformations (29), necrotizing enterocolitis (25), ulcerative necrotic enterocolitis (6), and other pathology of the abdominal cavity organs. Indications for use of the developed technique of intestinal anastomosis have been pathological processes complicating the course of the wound process and predicted long-term disorders of the digestive tract evacuation. The characteristic property of the anastomosis technique is a preliminarily semi-enclosed demucosation of the proximal intestinal loop with the excessively reserved seromuscular sheath, which allows to define clearly the limits of viability and isolate reliably the suture line long the whole length using the sutural or glue fixation by the demucosated part. The method does not prolong practically the time for application of the intestinal anastomosis in comparison with standard techniqies. One of the patients have undergone 7 anastomoses, five children - 3, and ten children - 2. In none of the cases of the “muff-shaped” anastomosis application has the dehiscence occured. The study of the autopsies has showed preserved viability of demucosated flaps. The analysis of long-term results using the developed method of intestinal anastomosis, taking into account a growing organism, has demonstrated absence of stenotic phenomena and passage problems in the connected segments of the intestine. Thus, the experience of application of muff-shaped anastomosis allows to make a conclusion about its high reliability in newborns and children of early age with complex surgical situations

Treatmet of infantile hemangiomas

During last year in the Regional pediatric clinical hospital of Kharkov 53 children with volume, noninvoluting and complicated hemangiomas were treated. There were 39 children under1 year old, 10 children from 1 to 3 years old and 4 children over 3 years old. Before treatmet, patients were scheduled lab tests, USG of internal organs and brain, CT, MRI, and histological analysis of biopsy materials. Indications to different methods of treatment were determined by type, localization, size, intensity of growth and stage of tumor`s development. Surgery was performed on 19 children. Conservative treatment was assigned for 34 children. Systemic therapy with propranolol was conducted for 19 children. In 15 cases we used permanent compressive therapy with additional applications of timolol 0,5 % three times a day. Children under 1 year old with fast growing hemangiomas were administered with propranolol in therapeutic dose of 2 mg/kg a day. Complete cure was observed in 12 cases. In 7 cases stabilization of growth was achieved but there remained significant residual changes such as excessive tissues which required surgical interventions. Surgery was perfomed on 19 patients; for 3 of them cytoreductive surgery. During the interventions we used high-frequency electric coagulator in “overlap” regime. After cytoreductive surgery volume of tumor decreased and partial devasculation led to discontinuance of growth. Plastic material for further reconstructive surgery was preserved. Basic criteria for prescribing therapy which combined compression and local timolol 0,5% were moderate growth intensity, with localization on the extremities, head, chest where it is possible to perform effective compression. Within one month significant regression was observed. It was manifested as decrease of volume and area of tumor, paleness and absence of volume restoration after removal of compression. Usage of high-frequency electric coagulator, significantly improves conditions and results of surgical treatment. Combining local treatment of β-adrenoblockers and permanent compression is very effective in treatment of hemangiomas in children

Formation of biofilms by clinical strains of microorganisms responsible for surgical pyoinflammatory diseases in children

The ability of microorganisms to exist in the form of biofilms creates considerable difficulties for medical practice, since in this case the resistance of bacteria to antimicrobial agents is greatly increased. Therefore, the purpose of this study was to scrutinize the ability to form biofilms by microorganisms isolated from children with pyoinflammatory processes. The identification of microorganisms was carried out according to the generally accepted microbiological protocols of their isolation and cultivation. Testing of isolates for the ability to form biofilms was realized by measurement of optical density in standard units (absorbance units - AU) on the spectrophotometer «Multiskan EX 355». The statistical processing of the results was performed using the programs «Statistica 6» and «Biostat». In the course of the study, S. aureus, S.epidermidis, P. aeruginosa, E. coli, Klebsiella, Proteus spp., and C.albicans were isolated. In most cases, microbial associations comprising from two to three types of microorganisms were detected, namely E. coli, K.pneumoniae, S. aureus in 26,8 %; P.vulgaris, Enterobacter, S.epidermidis – 7,9 %; P.mirabilis, K.pneumoniae, C.albicans – 13,4 %; S.aureus, K.pneumoniae, C.albicans – 23,7 %; E.coli, K.pneumoniae, C.albicans – 16,5 %; S. aureus, P. aeruginosa, C.albicans - 3,4 %; E.coli, S.epidermidis, C.albicans – 2,9 %; P. vulgaris, P. aeruginosa, S.epidermidis – 2,8 %; S. aureus, P.mirabilis – 2,6 % of cases. The obtained results indicated the prevalence of microorganisms of the Enterobacteriaceae in children with pyoinflammatory processes in the material examined. The studies of the ability of clinical strains of microorganisms to form daily compound biofilms, as well as plankton cells and new biofilms, made it possible to establish that the maximum daily biofilms density and the highest plankton cell formation were registered in microbial associations of S. aureus, K.pneumoniae, C .albicans (4,56 ± 0,19 AU) and S. aureus, P. aeruginosa, C. albicans (4,87 ± 0,14 AU). Plankton cells of all investigated microorganisms formed secondary biofilms actively with the highest density in C. albicans (3,62 ± 0,16 AU), K.pneumoniae (2,96 ± 0,14 units), S. aureus (3,09 ± 0,18AU) and P. aeruginosa (3,11 ± 0,12 AU). Thus, as a result of the division of bacterial cells, biofilm-forming microorganisms produce plankton cells capable of attaching themselves to the mucous membranes, wounds, catheters, and IV-lines with following formation of the new colonies, subsequently transforming into dense secondary biofilms, which makes for the spread and formation of multiresistant clinical strains of microorganisms. These properties of virulent microorganisms prompt to the development of methods for destruction of biofilms and intensification of micriflora inactivation in the focus of inflammation. Our studies showed that the above mentioned requirements relating to the effective influence on biofilms corresponded to the joint effect of ultrasound and ozone, which significantly increased the efficiency of the treatment complex