Method For Treatment Of Children Research Articles

Lumbosacral transitional vertebrae in children and adolescents (literature review, illustrated with clinical observations)

Introduction An analysis of the medical literature devoted to various aspects of transitional lumbosacral vertebrae shows that there are very few publications covering the course of this disease in the pediatric and adolescent population.Aim To study the issues of epidemiology, diagnosis, treatment and prevention of transitional lumbosacral vertebrae in paediatric and adolescent patients based on the analysis of current medical literature and illustrate the material with our own clinical observations.Material and methods To analyze the literature on the topic, 75 papers published between 1984 and 2023 were selected. Among them, there were 7 (9.3 %) domestic literary sources, 68 (90.7 %) were foreign. In the process of searching for scientific articles, the resources of the electronic databases of current medical information PubMed and CyberLeninka were used.Results and discussion The incidence of transitional vertebrae in children and adolescents is 16.8 % of clinical observations, as reported. In the structure of the transitional vertebrae in children, type II of the disease predominates according to the classification Castellvi et al (1984), 43.2 % of cases. The main clinical symptom of the pathology is pain of lumbosacral location, the intensity of which on the visual analog scale in children corresponds to an average of 3.0 points. In adult patients with similar pathology, the average pain intensity measured with the same scale is 7.5 points. The most informative method for diagnosing the disease is computed tomography, which allows obtaining both 3D images and sections at the level of pseudarthrosis between the enlarged transverse process (or processes) of the suprasacral vertebra and the wing of the sacrum. To relieve pain in children with transitional vertebrae, both conservative and surgical methods are used. The most commonly used procedure is pseudarthrectomy. The study of long-term results one year after the intervention allowed us to record the absence of pain in children who underwent surgery. Prevention measures for transitional lumbosacral vertebrae have not been developed.Conclusion The analysis of the published literature shows that transitional vertebrae are a frequently diagnosed pathology in children and adolescents. Current methods of imaging are able to accurately detect not only the presence of the disease, but also to differentiate its type. The main clinical symptom of transitional vertebrae is pain in the lumbosacral spine which is difficult to relieve with conservative therapy. Pseudarthrectomy is the most frequent surgical method of treatment in children and adolescents that provides stable relief of vertebrogenic pain syndrome. Measures for specific prevention of the disease have not been developed.

Эффективность различных терапевтических подходов в лечении детей с эозинофильным эзофагитом

Eosinophilic esophagitis (EoE) is a multifactorial disease characterized by variable clinical manifestations and varying responses to therapy, especially in pediatric patients. The purpose of this research was to analyze the results of EoE various treatment methods in children. Materials and methods used: a single-center retrospective cohort study conducted in 2020-2023 that included patients from 6 y/o to 17 years and 11 months old whose condition was assessed when verifying the EoE diagnosis and after prescribing therapy at least once. Symptoms of dysphagia were assessed using the Dysphagia Symptom Questionnaire, the endoscopic signs of EoE were recorded using the EREFS scoring system, and the number of eosinophils in biopsy samples of the mucous membrane (MM) of the esophagus was counted (at a magnification of 400) as well. Physical development was assessed using the WHO AnthroPlus application. Results: 18 patients were divided into 3 groups: G1 (n=5) of those who received monotherapy with topical glucocorticosteroids (tGCS), G2 (n=10) of those who received combination therapy with proton pump inhibitors (PPIs) and tGCS, and G3 (n=3) of those receiving dupilumab therapy. The three patients from G2 were prescribed with amino acid mixture as nutritional support. Statistically significant decrease in symptoms of dysphagia (p<0.001), decrease in the total score on the EREFS as well as decrease in the peak number of eosinophils in biopsy specimens of the esophagus were detected after 8 to 12 weeks after the start of treatment in all patients. However, statistically insignificant deterioration in clinical and histological parameters (p=0.06 and 0.2, respectively) coupled with statistically significant increase in EREFS scores (p=0.02) were revealed during the second control esophagogastroduodenoscopies in patients from Groups 1 and 2. Dupilumab therapy was effective in all considered parameters. In addition to the regression in clinical symptoms, endoscopic and histological signs, there was a significant improvement in nutritional status detected on the background of the amino acid mixture in all patients. Signs of esophageal candidiasis were recorded during the long-term therapy with corticosteroids in a singles patient. Conclusion: the too early reduction of therapy in children with EoE happening on the background of signs of clinical and histological remission could lead to the disease relapse. Management of children with EoE requires regular monitoring of the disease activity and dietary therapy taking into consideration the individual characteristics of each patient with EoE.

A critical review on kasa (cough) in children

In the Ayurvedic classics, Kasa (cough) is considered as an independent disease. It may also occur as Lakshana (symptom) or Upadarava (complication) in other diseases. It is an example of Pranavaha Srotas Dushti Kasa is common signs and symptom in the childhood, when mother and father see a doctor. It suggests that even after improvements in modern scientific science, coughs in children are not always treated effectively. According to Acharya Charaka, the Moola of Pranavaha Srotas is Hridya (brain, heart) and Mahasrotas. Acharyas have described definition, etiological factors, prodromal symptoms, types of Kasa along with all Pathya (wholesome) and Apathya (unwholesome) and therapeutic measures. Kasa is manifested with the vitiation of Vata and Kapha. Understanding and differentiating Kasa is important for its effective treatment. The study of Kasa is necessary as it can be associated with many complications if left untreated. In this context different Lakshanas (symptoms) of Kasa in children are explained by Acharyas which can be used for diagnosis as well as prognosis of the disease. Thus, with help of this study alternate safe methods of treatment in children can be employed. So, its identification as Kasa can be a ray of hope for the diagnosis.

Treatment methods for children with severe asthma in and abroad

Asthma is one of the common chronic diseases in children, and so far there is no cure for asthma. Asthma sufferers are estimated to be more than 300 million people worldwide, and the number of asthma treatments is growing every year. In recent years, thanks to advances in therapeutic medicines, asthma symptoms can now be successfully controlled with inhaled corticosteroids and, if necessary, in combination with bronchodilators. However, even with maximum use of these drugs, the effect may be insufficient, and there are still some patients with refractory asthma that are not adequately controlled with general treatment. Drugs called biologics may become a drug that works well for previously poorly treated asthma and is recently available in children with severe asthma. Three biologics are currently available for use in children: omalizumab, mepolizumab (6 years and older), and dupilumab (12 years and older). However, there is still a lack of clinical research evidence for the specific clinical improvement rate. Therefore, in this study, this paper conducted a literature review on the latest clinical trials of biological agents at home and abroad, summarized the clinical trials of common biological agents, and introduced the latest treatment methods. The differences and deficiencies between each other achieve the effect of enhancing the prevention and cognition of asthma.

Clinical observation of bow-tie adjustable suture technique for overcorrection in intermittent exotropia

Objective: To investigate the clinical effects of the bow-tie adjustable suture technique in managing overcorrection in patients with intermittent exotropia after surgery. Methods: This was a retrospective case series study. Clinical data were collected from children with intermittent exotropia who underwent strabismus correction surgery, including the bow-tie adjustable suture technique and conventional techniques, at the Department of Strabismus and Pediatric Ophthalmology, Shanxi Eye Hospital, from January 2020 to September 2021. Children with postoperative esodeviation≥15 prism diopters (PD) within the first 6 days were treated differently based on the surgical technique and their individual conditions, including suture adjustment and conservative treatment. The overcorrection rate and its changes among different surgical groups, the recovery of ocular alignment and binocular visual function after different treatment methods in children with overcorrection on the sixth postoperative day, and the postoperative complications in different surgical groups were observed. Statistical analysis was performed using independent samples t-test, Wilcoxon rank-sum test, repeated-measures analysis of variance, Bonferroni test, chi-square test, or Fisher's exact probability test, as appropriate. Results: A total of 643 children who underwent intermittent exotropia correction surgery were included in the study. Among them, 325 children underwent the bow-tie adjustable suture technique, with 185 males and 140 females, and the mean age was (9.50±2.69) years. The remaining 318 children underwent conventional techniques, with 176 males and 142 females, and the mean age was (9.90±2.67) years. There were no statistically significant differences in age and gender distribution between the two surgical groups (all P>0.05). On the first postoperative day, among children who underwent the bow-tie adjustable suture technique, 40 had an esodeviation of≥10 PD, resulting in an overcorrection rate of 12.3% (40/325), while among children who underwent conventional techniques, 32 had an esodeviation of≥10 PD, resulting in an overcorrection rate of 10.1% (32/318). On the sixth postoperative day, these rates decreased to 5.5% (18/325) and 3.1% (10/318) in the two groups, respectively. At 1, 6, and 12 months postoperatively, the overcorrection rate in children who underwent the bow-tie adjustable suture technique was 0, while in children who underwent conventional techniques, the overcorrection rate did not show a significant decrease compared to before surgery. The differences between the two surgical groups were statistically significant (all P<0.05). On the sixth postoperative day, among children with an esodeviation of≥15 PD, 13 underwent suture adjustment and 7 received conservative treatment. The results of repeated-measures analysis of variance showed statistically significant differences in near and distance esodeviation angles among children who received different treatment methods (F=145.20, 106.87, both P<0.001), as well as statistically significant differences in near and distance esodeviation angles at different time points within each group of children (F=81.67, 35.09, both P<0.001). There were also significant differences in the trends of change in near and distance esodeviation angles at different time points among children who received different treatment methods (F=79.90, 36.73, both P<0.001). Further pairwise comparisons showed significant differences in near and distance esodeviation angles between the sixth postoperative day and 1, 6, and 12 months postoperatively in children who underwent suture adjustment (all P<0.05), while no statistically significant differences were observed in children who received conservative treatment (all P>0.05). At 12 months postoperatively, among the 13 children who underwent suture adjustment, 12 achieved stereopsis, while among the 7 children who received conservative treatment, all became stereo-blind after removing the prismatic correction. No serious complications occurred in any of the children postoperatively. Conclusion: The proportion of children with intermittent exotropia who achieved orthotropic alignment one year after surgery was relatively low among those who had an overcorrection of≥15 PD on the sixth postoperative day. The bow-tie adjustable suture technique is a simple and effective approach for managing overcorrection in patients with intermittent exotropia. Adjusting the sutures on the sixth postoperative day can reduce the overcorrection rate and is considered a safe and effective method.

Minimally invasive methods for the treatment of obstructive ureterohydronephrosis in children

Purpose of the study . To evaluate the effectiveness of minimally invasive methods of treatment in children with congenital obstructive ureterohydronephrosis. Material and research methods . We performed ureteral stenting in 78 (70.9%) children with congenital obstructive ureterohydronephrosis: I degree of ureterohydronephrosis -18 (23.0%), II degree -34 (43.6%) and III degree. -19 (24.3%), IV degree -7(9.0%). Children under the age of 16. Children with impaired urodynamics in the distal ureters underwent a complete clinical-biochemical laboratory and X-ray study. Results of the study and their discussion . Stenting of the ureters was carried out in order to dynamically monitor the contraction of the urinary system. In children, stenting is performed under general anesthesia by performing cystoscopy. After assessing the topographic location of the orifice from the side of the pathology of the vesicoureteral segment, the ureteral orifice is expanded by balloon dilatation, followed by stenting of the ureter. It turned out to be effective in 26 (23.6%) children. Conclusions . With neuromuscular dysplasia of the ureters in children of the first year of life, bougienage, balloon dilation of the ureterovesical fistula, followed by stenting of the ureter and pyelocaliceal system in 34.0% of patients lead to a significant improvement in urodynamics.

Comparison of the use of intramedullary telescopic system and titanium elastic rods in children with osteogenesis imperfecta I and III types

Comparison of the use of intramedullary telescopic system and titanium elastic rods in children with osteogenesis imperfecta I and III types

Management of Children with Speech Disorders via Transcranial Magnetic Stimulation: Non-Randomized Controlled Study

Background. Speech development impairment is urgent and common problem in pediatric neurology. Transcranial magnetic stimulation (TMS) is one of the promising treatment variants for children with speech disorders. Objective. The aim of the study is to evaluate efficacy and safety of the developed approaches to TMS usage in the management of children with speech disorders. Methods. It was non-randomized controlled study. It included 46 children with speech disorders aged from 3 to 6.5 years. All children were divided into two groups comparable by gender and age: 26 children of the treatment group received TMS course, 20 children of the control group received treatment with hopantenic acid. All patients with speech disorders underwent psychological and pedagogical evaluation of speech and cognitive development, electroencephalography (EEG) before and after treatment. Moreover, comparative analysis of TMS and nootropic therapy efficacy was carried out. Specialized examination of speech and cognitive development was also performed via E.A. Strebeleva method for psychological and pedagogical diagnosis of children development. Furthermore, we carried out side reactions / adverse events registration according to patients and/or their parents complaints confirmed by physical examination, patient’s behavior observation, data from specially developed questionnaire for assessing child’s behavior and well-being (filled up by parents). Finally, we evaluated brain bioelectric activity recorded by EEG. Results. The study results have shown that it is possible to achieve significant positive dynamics in cognitive and speech development in preschool children with speech disorders in both groups (TMS course and medical treatment). But hereby, TMS treatment has demonstrated significantly higher positive dynamics in two out of the three evaluated parameters. There were no cases of adverse events in TMS group leading to early course discontinuation. Conclusion. TMS is non-invasive and safe method for treatment of children with speech disorders. This study has demonstrated the efficacy of the method in the field of personalized management of children with impaired speech and cognitive development.

Effectiveness of urethral endosphincteroplasty in children with urinary incontinence, myelodysplasia, and epispadias

BACKGROUND: Periurethral injections of various materials in the treatment of stress urinary incontinence have been known since 1938. In the literature, we could not find reports of endosurgical correction of urinary incontinence as the main method of treatment in children with myelodysplasia and epispadias and a pathogenetically based examination algorithm to predict the result of the injection, taking into account the endoscopic technique and volume of the injected drug.&#x0D; AIM: To present an assessment of long-term results, i.e., correction of stress urinary incontinence in children with myelodysplasia and epispadias, after endoimplantation of a stable synthetic volume-forming polymer.&#x0D; MATERIALS AND METHODS: The study analyzed 38 patients (517 years old) with urinary incontinence with myelodysplasia and epispadias: boys and girls with epispadias (n = 9 and n = 3, respectively) and with myelodysplasia (n = 10 and n = 16), respectively. For diagnostic purposes, clinical and instrumental (excretory urography, cystography, cystoscopy, uroflowmetry, electrophysiological, and urodynamic) examination methods were used. To correct incontinence, intra- and paraurethral endoinjections of a stable polyacrylamide mesh polymer with silver ions were performed.&#x0D; RESULTS: According to the literature, the effectiveness of the intraurethral administration of stable implants with urinary incontinence in catamnesis for up to 12 months reached 50%; with longer follow-up, positive results did not exceed 40% of observations. In this study, complete retention of urine was achieved in 25 (66%) children. Satisfactory result (incontinence in the afternoon up to 40 mL) was observed in 8 (21%) children, and unsatisfactory in 5 (13%) children.&#x0D; DISCUSSION: Indications for endosphincteroplasty in children with stress incontinence having myelodysplasia and epispadias with a stable implant should be determined considering urodynamics, blood circulation, innervation, and functional (urethral profilometry) parameters in the detrusor-sphincters-pelvic floor system.&#x0D; CONCLUSIONS: In patients with myelodysplasia and epispadias with isolated insufficiency of urethral sphincters, surgical treatments can be performed independently, and their effectiveness can reach 70%.

Оптимізація методики хірургічної корекції прихованого статевого члена в дітей

The purpose - to optimize the buried penis surgical treatment method in children for the most adequate functional and cosmetic results. Materials and methods. The clinical material includes 28 boys with a buried penis between the ages of 11 months to 7 years. Among them 9 (32.14%) children were admitted for repeated surgical interventions with unsatisfactory cosmetic results after previous surgical interventions in other medical institutions. Results. The method of surgical correction of the buried penis in children was offered. In patients whose penis glans could not be exposed, the foreskin stenotic ring was dissected on both sides on the lateral surfaces, or scar-altered tissues were partially excised circularly. During the maximum vertical traction per the ligature on the penis head, the skin at the base of the penis was circularly dissected. The dissection of the skin was extended to the inguinal folds on both sides. The penis spongy and cavernous bodies were skeletonized from the coronal sulcus to the pubic joint with careful excision of inelastic embryonic cords and scars. The skin of the anterior abdominal wall was lifted up with the help of traction ligatures or hooks and mobilized in an acute way. Maximum excision of subcutaneous fat in the suprapubic and inguinal areas was performed. The penis was moved into the hole formed in the lower part of the demobilized skin flap in the suprapubic area. For stable fixation of the penis, the deep fascia at the base of the corpora cavernosa was sutured to the pubic tubercle at maximum traction per the head, and the skin flap of the anterior abdominal wall was sutured with internal sutures to the crest of the upper pubic bone. The penis trunk was closed due to a sufficiently mobile foreskin, shifting the skin to the penoscrotal angle in the area of the formed hole in the abdomen skin flap. The postoperative wound was sutured in layers. Conclusions. Clinical differentiation of different types for penis size «visual» reduction in boys will allow a balanced approach to adequate correction of the defect. The proposed method of buried penis surgical correction in boys eliminates all the preconditions of the defect and demonstrates good anatomical, functional and cosmetic results. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the listed institution. Informed consent of children and their parents was obtained for the research. No conflict of interests was declared by the authors.

Complications of Ponseti Technique in Treatment of Idiopathic Club Foot

Background: Clubfoot, or talipes equinovarus, is a congenital deformity that consist of; supination and adduction of the forefoot and midfoot; equinus of hindfoot and varus. It was found that more than 100,000 babies are born each year with congenital clubfoot Objectives: The purpose of this study was to investigate the complications of ponseti method for treatment of children with idiopathic club foot. Subjects and Methods: 50 children with 74 clubfeet were managed by Ponseti method from May 2019 to July 2020 in Al-Wasity teaching hospital with primary correction of the deformity followed sometimes by elongation of Achilles tendon then the patients were followed up till June 2021 and the complications were calculated. Results: complications were 10.8% incomplete correction (mostly equinus) and it was corrected by surgery, 6.7% ulcer on the medial surface of head of 1st metatarsal , 9.4% cast falling and 18.9% relapse. Conclusions: Ponseti technique is a safe and effective method for correction of clubfoot and decreases the need for corrective surgery with minimal complications that can be easily managed.

의사소통 장애아동 특성을 고려한 언어 중심 심리 운동 실재와 중재 이론을 위한 제언

Even if there are various treatment methods for children with communication disorders and achieve results, but there is a limit that the child must belong to a specific treatment method system while controlling the children's free thoughts and actions to some extend and this study found close relationship in that children can improve their language skill in the course of communicating for thought and behavior required for play. So, the purpose of this study is to develop Language-oriented psychomotor and language-centered psychomotor intervention theory to promote its effectiveness.&#x0D; Therefore, this study presented the practical application of speech therapy method in physical experience, speech therapy method in material experience, and speech therapy method in social experience, as follows. First, in the case of speech therapy in body experience, a positive situation must be created at first then, by using play centered on the body, autonomous verbal behavior can be enhanced in that situation. Second, in the case of speech therapy method in material experience, we suggested a way to expand voluntary language acquisition in various play situations through the principle of generalization, using materials from very small to large. Third, in the case of speech therapy method in social experience, it is possible to achieve the process of integration with the outside world by forming a group of 3-4 people and performing role play while changing the role.&#x0D; In addition, this study presented the conclusion that the following should be considered in the development of an intervention theory to increase the effectiveness of process above. First, since the degree of disability of children with communication disorders is different, these differences should be fully taken into account in the Language-oriented psychomotor. Second, the children involved are lack of activeness, a warm-up process is necessary, it is necessary to establish an additional psychological exercise pre-step to promote their activeness. Third, because children with communication disorders become somewhat distracted while performing the above activities, effective intervention of the therapist must be followed and a gradual approach should be used with an emphasis on overcoming their frustration, which is the biggest wound of children with communication disabilities. Fourth, In order for Language-oriented psychomotor to be differentiated from other methods, the physical experience that maximizes autonomy, the material experience customized to each child's disposition and taste, and social experience that is sometimes goes against each child's disposition and preference through the setting of a cooperative play theme to achieve holistic development through maximization of internalization, Fifth, when the Language-oriented psychomotor is completed to some extent, it is proposed to move to a general psychomotor in to pursue the formation of a complete holistic development.

A new method of amblyopia treatment in children with unstable central and eccentric fixation using biofeedback

Purpose. To develop a new method of amblyopia treatment in children with unstable central and eccentric fixation by centralizing visual fixation and increasing retinal photosensitivity in the macular region using biofeedback. Material and methods. The study included 27 patients (27 eyes) with amblyopia of various origins, aged 5 to 17 (averagely 9.15 ± 3.19 years), who were able to perform training sessions on the MP-3 Nidek microperimeter (Japan). In addition to standard examination, all patients underwent binocular status assessment using a four-point test, macular electroretinography, microperimetry, optical coherence tomography (OCT). The treatment, carried out on the microperimeter using visual (flickering checkerboard pattern) and sound signal biofeedback, consisted of 10—15 sessions, 10—12 minutes each. All patients were examined before treatment cycle, immediately upon the end of the cycle, and also 1 and 3 months after it. Results. Preliminary results showed an increase in best corrected visual acuity (BCVA) from 0.41 ± 0.24 to 0.68 ± 0.27 (33.9 %), the photosensitivity of the retina in the fovea increased from 27.07 ± 3.90 to 29.8 ± 3.3 dB (10 %), fixation density in the central region from 59.80 ± 31.08 to 72.05 ± 34.5 %(20.4 %) with its amplitude decreased by more than two times. After treatment, unstable central fixation changed to stable central fixation in all cases. With eccentric fixation, the fixation point shifted closer to the central region, and fixation characteristics improved in 75 % of cases. The obtained results retained throughout the observation period which lasted up to 3 months. Conclusion. The proposed new treatment method of amblyopia with impaired fixation of various degrees proved to be effective and safe and can be recommended for use in pediatric patients.

Evaluation of the Cause of Dental Treatment in Children under General Anesthesia from the Perspective of Pediatric Dentists and Postgraduate Students and Parents of Children under General Anesthesia at the Dentistry School of Tehran University of Medical Science

Background. Nowadays, dental treatment under general anesthesia is accepted as a treatment method in children in which other common methods do not allow to achieve acceptable results. The benefits of general anesthesia in pediatric dental treatment are that the treatment is completed in one session, the person is relieved of pain, and most importantly, the child does not need to cooperate. However, it is important to determine the exact dental reasons for children under general anesthesia. Objective. In this study, the cause of dental treatment under general anesthesia in children was examined from the perspective of specialists, assistants, and parents of children under general anesthesia. Methods. In this descriptive-analytical cross-sectional study, participants were selected from among the parents of children under general anesthesia for dental treatment and pediatric dentists and assistants in a purposeful manner. After the items were prepared by the professors, the prepared checklist was read to the people. After completing the checklist, the data were entered into SPSS software version 20 and analyzed using descriptive statistics such as frequency determination, mean, and statistical rests. Results. According to the consensus of parents and experts, the main reasons for general anesthesia for children to perform their dental operations were: young age, lack of cooperation during previous dental treatment, a large number of dental treatments, systemic disease of the child, unwillingness of parents to perform behavioral control procedures, higher quality work under anesthesia, mental and physical behavioral problems, and reduced number of treatment sessions. Conclusion. Therefore, reasons such as young age, lack of cooperation, and a large number of dentist’s work are among the most important factors that lead to the decision to perform general anesthesia in children. In light of this decision, the consequences and disadvantages/advantages of this method are important and therefore more research should be done on this issue.

Temporary Epiphysiodesis Using the Eight-Plate in the Management of Children with Leg Length Discrepancy: A Retrospective Case Series.

Although eight-plates have been shown to be effective in correcting angular deformities of the knee, the literature is scarce regarding the efficiency of this method in treatment of children with LLD. The aim of this study was to determine the efficiency, rates of correction and complications of epiphysiodesis using eight-plate in the management of children with leg length discrepancy (LLD). Eleven consecutive patients with LLD (7 boys, median age = 9, age range 6-11years) who were treated by temporary epiphysiodesis using eight-plates were retrospectively reviewed and included in the study. The main indication for temporary epiphysiodesis was an LLD between 2 and 5cm in all patients. LLD and lower limb alignment were examined on lower extremity weight-bearing radiography preoperatively and at skeletal maturity. Longitudinal correction rate was calculated. The final LLD was categorized as ''good result'' (final LLD < 1.5cm), ''fair result'' (1.5-2cm), and ''poor result'' (> 2cm). The mean treatment period with the eight-plate was 44 (min to max = 32-72) months, and the mean follow-up from the index surgery to the final follow-up was 62 (min to max = 39-106) months. The mean LLD was significantly reduced from 39 (range 25-50) mm preoperatively to 22.40 (range 6-55) mm postoperatively (p = 0.006). The mean longitudinal correction rate was found to be 0.48mm/mo. Radiographic evidence of lower limb deformity in frontal and sagittal planes was determined in neither preoperative nor postoperative deformity analysis. No major complications were recorded. For the management of children with LLD of 2-5cm, temporary hemiepiphysiodesis using the eight-plate seems to be an effective treatment with low complication rates.

Вибір методу лікування новонароджених із гіпертрофічним пілоростенозом

Hypertrophic pyloric stenosis (HPS) remains the main cause of projectile vomiting in newborns. During many decades the open pyloromyotomy was the main method of treatment in children with HPS due to the excellent results and low frequency of complications. After applying the laparoscopic pyloromyotomy, this approach gradually became accepted by pediatric surgeons. Regarding advantages and disadvantages of laparoscopic pyloromyotomy compared to conventional pyloromyotomy the literature data had a contradictory character. The aim is to analyze our own experience in the treatment of children with HPS using traditional and minimally invasive techniques. Materials and methods. This study based on the results of the treatment of 98 children, which were operated with pyloric stenosis during 2009–2020 years. Diagnosis was established on the results of clinical, laboratory investigation, and ultrasonographic data. Surgery was applied after correction of electrolytes disturbances, but a type of approach (open or laparoscopic) was chosen by surgeon. With the aim to evaluate the results the methods of variative statistic, parametric and nonparametric evaluation were applied. Results. Open pyloromyotomy was applied in 76 (77.6%) and laparoscopic – in 22 (22.4%) of children. Complications developed in 10 children, including 8 (10.5%) patients after open and 2 (9.1%) – after laparoscopic pyloromyotomy (p=0.842). Perforation of mucosa was in one (4.55%) child during laparoscopic pyloromyotomy, but in case of open approach this complication was absent. Independence of the approach, the cases of incomplete myotomy were absent. The surgical site infection (3.95%), postoperative hernia (2.63%), and adhesive bowel obstruction (2.63%) were more often observed after open pyloromyotomy. Laparoscopic pyloromyotomy characterized by the decrease of terms of starting enteral feeding (p&lt;0.001) and length of hospital stay (p=0.031) compared with open pyloromyotomy. Conclusions. Pyloromyotomy remains the main method of treatment of newborns with pyloric stenosis, but a type of approach was chosen by surgeon. Open and laparoscopic pyloromyotomy equally effective and safe for the treatment of children with the hypertrophic pyloric stenosis. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: hypertrophic pyloric stenosis, newborns, treatment, pyloromyotomy, laparoscopy.

Порівняльна характеристика способів хірургічного лікування пілонідального синусу в дітей

Pilonidal sinus (PS) is a common pathology of the coccygeal area, which occurs with a frequency of 26 per 100000 people. Operative methods of treatment of PS are accompanied by a high frequency of complications and recurrences. Finding ways to treat PS in children, which will help to reduce frequency of complications and the duration of postoperative wound healing remains relevant. Purpose – to make a comparative analysis of the pilonidal sinus treatment methods in children: skin-fascial plastics, suturing to the bottom of the wound and suturing the wound tightly. Materials and methods. An analysis of 90 cases of PS in children operated at the City Children’s Clinical Hospital was provided. Methods of skin and fascial plastics in our own modification, sinus removal with sewing to the fascia and primer closure were compared. The duration of surgery, time of postoperative wounds healing, intensity of pain in the postoperative period, duration of hospitalization and the frequency of complications were analyzed. Results. The rate of pain intensity was on 60% lower on the first day and on 70% on the second and third days in cases of using skin-fascial plastics in comparison with the methods of sewing to the fascia and primer closure. Healing time was the shortest in cases of using skin-fascial plastics. The frequency of postoperative complications was by three times lower in operations with the method of skin-fascial plastics in comparison to other methods. Conclusions. Skin-fascial plastics method reduces the intensity of pain more than 60% in comparison to other methods and reduces wound healing time more than 26% and 65% in comparison of the groups of sewing to the fascia and primer closure, respectively. The technique of removing of PS with skinfascial plastics in children usage reduces the number of complications by three times. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pilonidal cyst, skin-fascial plastics, children.

The experimental rationale for new bleomycin-polidocanol mini-foam administration in the treatment of children with head and neck venous malformations

Relevance. Venous malformation (VM) is an abnormal development of the collecting blood vessels based on the vascular wall formation disorder, which occurs during the peripheral vascular network differentiation. According to various sources, VM prevalence ranges from 1 to 2 in 10 000 newborns. Head and neck VMs significantly reduce patients’ quality of life, causing severe functional and aesthetic impairments. Sclerotherapy is an effective treatment method for children with venous malformations. In recent years, bleomycin has been the most commonly used sclerosant. It is a glycopeptide antibiotic synthesized by Streptomyces verticillus and belongs to cytostatic medications. They successfully use it for venous malformations sclerotherapy, also in children. Purpose – the study aimed to improve the sclerotherapy method by combining the advantages of foam sclerotherapy and bleomycin.Materials and methods. 48 samples of rats’ external femoral veins were morphologically examined. We divided the rats into 2 groups depending on the administrated agent: the first group – 3% polidocanol (lauromacrogol 400), the second group – bleomycin-polidocanol mini-foam composition. The histological assessment identified the changes in the vein endothelium, necrosis of tissue structures, cell dystrophy characteristics.Results. The first group, which used the bleomycin-polidocanol mini-foam composition, demonstrated more pronounced irreversible changes in the venous vessel endothelium compared to the second group.Conclusions. The experimental study revealed that the proposed method of VM sclerotherapy using new bleomycin-polidocanol mini-foam composition is more effective than the polidocanol foam sclerotherapy. The new method is highly effective, minimally invasive, safe and can be considered an independent treatment method in children with head and neck VM.

Effects of Dynamic Suit Orthoses on the Spatio-Temporal Gait Parameters in Children with Cerebral Palsy: A Systematic Review.

Dynamic suit orthoses (DSO) are currently used as a complementary treatment method in children with Cerebral Palsy (cwCP). The aim of this review was to assess the effects of interventions with DSO on the altered spatio-temporal gait parameters (STGPs) in cwCP. An electronic search was conducted in the Web of Science, Scopus, PEDro, Cochrane Library, MEDLINE/PubMed, and CINAHL databases up to July 2021. We included a total of 12 studies, which showed great heterogeneity in terms of design type, sample size, and intervention performed (two employed a Therasuit, three employed the Adeli suit, three employed Theratogs, one employed elastomeric tissue dynamic orthosis, one employed a full-body suit, one employed external belt orthosis, and one employed dynamic orthosis composed of trousers and T-shirt). The Cochrane collaboration’s tool and the Checklist for Measuring Study Quality were used to assess the risk of bias and the methodological quality of the studies. It was variable according to the Checklist for Measuring Study Quality, and it oscillated between eight and 23. The studies of higher methodological quality showed significant post-intervention changes in walking speed (which is the most widely evaluated parameter), cadence, stride length, and step length symmetry. Although the evidence is limited, the intervention with DSO combined with a programme of training/physical therapy seems to have positive effects on the STGPs in cwCP, with the functional improvements that it entails. Despite the immediate effect after one session, a number of sessions between 18 and 60 is recommended to obtain optimum results. Future studies should measure all STGPs, and not only the main ones, such as gait speed, in order to draw more accurate conclusions on the functional improvement of gait after the use of this type of intervention.

Surgical treatment of children with extensive bone defects (Literature review)

BACKGROUND: Reconstruction of extensive defects to bone tissue is one of the important problems of orthopedics and traumatology. Especially in acuteis, the problem is associated with the restoration of bone tissue in conditions of its deficiency in pediatric patients.&#x0D; AIM: The aim of the study is to analyze modern methods of surgical treatment in children with extensive bone tissue injuries based on the published literature.&#x0D; MATERIALS AND METHODS: Our report presents a review of the literature of methods of surgical treatment of extensive bone defects. The literature search was carried out in several databases such as PubMed, ScienceDirect, E-library, GoogleScholar for the period from 2005 to 2020, using the keywords given below. As a result of the search, 105 foreign and 37 domestic sources were found. After exclusion, 56 articles were analyzed, all presented works were published in the last 15 years.&#x0D; RESULTS: The gold standard for replacing bone defects is still the use of autografts, including the use of technologies on a vascular pedicle. Various types of xenografts and allografts of bone tissue are increasingly being replaced by various kinds of synthetic implants.&#x0D; CONCLUSIONS: To date, there is no single generally accepted standard for the surgical treatment of extensive bone defects. The option of surgical treatment of extensive bone tissue defects using tissue-engineered bone implants with axial blood supply seems to be extremely interesting and promising.