Мультимодальный подход в лучевой диагностике к определению интрамедуллярной фазы острого гематогенного остеомиелита у детей: проспективное исследование

INTRODUCTION: Despite the fact that acute hematogenous osteomyelitis is classified as a sufficiently studied disease, the percentage of diagnostic errors is still quite high. Timely diagnosis is crucial for the successful outcome of the disease, therefore, visualization should be aimed at early diagnosis and, as a result, successful treatment of the disease.OBJECTIVE: To identify early patterns in the intramedullary phase of the course of acute hematogenous osteomyelitis (CSO) with a multimodal approach of radiation research methods.MATERIALS AND METHODS: Twenty patients underwent a comprehensive examination, including multispiral computed tomography (MSCT) using color mapping techniques.RESULTS: In the intramedullary phase of the course of CSF, no pathological changes were detected during X-ray examination of the affected limb. Ultrasound in 75% of observations revealed a thickening of the periosteum of more than 1 millimeter (mm) in the affected bone. When using MRI in 93% of cases, and with MSCT in 95% of patients, signs of bone marrow edema were detected.DISCUSSION: The role of computed tomography in the diagnosis of acute hematogenous osteomyelitis in children has received significant recognition in pediatric surgical practice in recent years, and the use of MSCT in the diagnosis of CSO has found application in domestic healthcare. At the same time, a fairly large number of researchers reported on the high informativeness of MSCT in the diagnosis of CSOs.CONCLUSION: MSCT using the color mapping technique has a higher specificity compared to MRI and can be used as an integral method of the first level in the diagnosis of the intramedullary phase of the CSF course.ВВЕДЕНИЕ: Несмотря на то, что острый гематогенный остеомиелит относят к достаточно изученным заболеваниям, процент диагностических ошибок все же достаточно высок. Своевременная диагностика имеет решающее значение для успешного исхода заболевания, поэтому визуализация должна быть направлена на раннее установление диагноза и как следствие — успешное лечение заболевания.ЦЕЛЬ: Выявить ранние паттерны в интрамедуллярную фазу течения острого гематогенного остеомиелита (ОГО) при мультимодальном подходе лучевых методов исследования.МАТЕРИАЛЫ И МЕТОДЫ: Двадцати пациентам было выполнено комплексное обследование, включавшее в том числе мультиспиральную компьютерную томографию (МСКТ) с применением методики цветового картирования.РЕЗУЛЬТАТЫ: В интрамедуллярную фазу течения ОГО при рентгенографическом исследовании пораженной конечности патологических изменений не выявлено. При УЗИ в 75% наблюдений выявлено утолщение надкостницы более 1 мм в пораженной кости. При применении МРТ в 93% наблюдений, а при МСКТ у 95% пациентов были выявлены признаки отека костного мозга.ОБСУЖДЕНИЕ: Роль компьютерной томографии в диагностике острого гематогенного остеомиелита у детей получила в последние годы значительное признание в детской хирургической практике, а использование МСКТ в диагностике ОГО нашло начало применения в отечественном здравоохранении. При этом о высокой информативности МСКТ в диагностике ОГО сообщил довольно большой ряд исследователей.ЗАКЛЮЧЕНИЕ: МСКТ с применением методики цветового картирования обладает более высокой специфичностью по сравнению с МРТ и может использоваться как интегральный метод первого уровня в диагностике интрамедуллярной фазы течения ОГО

Acute appendicitis in children in the context of the new coronavirus infection (COVID-19)

Introduction. The first publications about acute appendicitis in the conditions of the new COVID-19 coronavirus infection have appeared. Most authors point to the increased time of seeking medical help in such patients and an increase in the level of postoperative complications. Material and methods. A retrospective study of 192 case histories of patients aged 3 to 17 years with various forms of acute appendicitis who were treated in the surgical Department of the Republican children’s clinical hospital in the period from 2019 to November 2020 was conducted. Children operated on during 2019 before the start of the new coronavirus pandemic were included in the first group (n = 114). Children operated on in 2020 after the development of a new coronavirus pandemic were included in the second group (n = 78). Results. The age of patients in both groups compared did not differ significantly. The course of the disease was within the average accumulated indicators and the terms of hospitalization did not change significantly. According to our observations, the time of admission to the surgical hospital from the time of the disease in the pre-coronavirus period and during it also did not differ significantly, which indicates that the same availability of medical care remains even during the epidemic. Our study also showed that the number of requests for complicated appendicitis in children during the COVID-19 epidemic even decreased, which ultimately led to a decrease in the level of postoperative complications. The study did not establish a significant difference between the main results of treatment of children with acute appendicitis before and during the new COVID-19 coronavirus infection. Only the level of postoperative complications significantly decreased in patients operated during the COVID-19 epidemic, which is associated with a lower admission of children with complicated appendicitis. Conclusion. With the onset of the pandemic, the organization of medical care for the child population with acute pathology in the Komi Republic did not change and did not have any restrictions, which made it possible to maintain the timely provision of surgical care to children with acute appendicitis at the proper level

Rare case of urethral duplication in the boy

A non-typical variant of Y-type urethral duplication has been described in the article. In this case, the surgical treatment decision was not difficult. Y-type urethral duplication was exposed up to the sinus, and its dissection was performed, followed by urethroplasty. This variant of Y-type urethral duplication has not been described in the world literature available to us, and, in our opinion, it is important for gaining experience in treating rare variants of congenital anomalies of the urethra

Ureteral stump syndrome after ureteroureteroanastomosis, heminephrectomy and nephrectomy in children

Introduction. Nephrectomy (NE), heminephrectomy (HNE) and the formation of ipsilateral ureteroureteroanastomosis (UUA) do not exclude the possibility of preserving the distal ureter. The remaining ureteral stump can cause the formation of ureteral stump syndrome (USS) in the form of recurrent urinary tract infection (UTI), hematuria, pain syndrome, and stump empyema in some cases.Purpose of the study. To assess the incidence and treatment approach of USS in children after NE, HNE and UUA performed using open and laparoscopic access in different Russian clinics.Material and methods. The study is based on the results of treatment of 778 patients from 9 clinics in the Russian Federation and the Republic of Belarus in the period from 1998 to 2020. Patients underwent NE, HNE and UUA by open or laparoscopic access. The ureter was not removed completely, its stump was left. Open access was used in 313 (40.2%) children, laparoscopic in 465 (59.8%) cases. USS was detected in 27 (3.5%) patients. The ureteral stump was removed in 26 (96.3%) children. Open removal of the ureteral stump was performed in 11 (42.3%) patients, through laparoscopic access in 13 (50.0%) and vesicoscopically in 2 (7.7%) children.Results. There were 12 boys (44.4%) and 15 girls (55.6%) among the patients with USS. USS was detected on the right in 13 (48.1%) children, on the left - in 14 (51.9%). The median age of the patients was 25 [12; 42] months at the time of USS detection. Ureteral stump was sutured and ligated in 15 (55.6%) children during the primary operation, the stump was left open after excision in 4 (14.8%) children, it was not indicated how the stump was processed in 8 (29.6%) patients. Reflux to the stump was detected in 13 (48.1%) patients, USS against the background of obstruction was detected in 14 (51.9%) children. It was determined that the frequency of SCM is lower (9 (1.9%)) with the use of laparoscopic access than with open (18 (5.8%)) operations (p < 0.004). Clinical manifestations occurred in 85% of patients with USS within a year after surgery.Conclusion. USS is a rare complication (3.5% of cases) in patients who have undergone NE, HNE and UUA with the distal ureteric stump preserving. Performing these operations by laparoscopic access allows carrying out total ureterectomy and significantly reduces the likelihood of USS development