Method For Treatment Of Children Research Articles

Evolution of Pediatric Home Mechanical Ventilation Program in Serbia-What Has Changed in the Last Decade.

Home mechanical ventilation (HMV) is a method of treatment in children with sleep-disordered breathing (SDB) and alveolar hypoventilation regardless of primary disease. The goal of the study was to describe the changes in the HMV program in Serbia during the last two decades. Cross-sectional retrospective study included data from the national HMV database from 2001 until 2019. HMV was initiated in clinically stable patients after the failure to wean from mechanical ventilation succeeded acute respiratory deterioration or electively after the confirmation of SDB and alveolar hypoventilation by sleep study or continuous transcutaneous capnometry and oximetry. The study included 105 patients (50 ventilated noninvasively and 55 ventilated invasively via tracheostomy). The median age at the time of HMV initiation was 6.2 years (range: 0.3–18 years). Invasive ventilation had been initiated significantly earlier than noninvasive ventilation (NIV) (p < 0.01), without difference in duration of ventilatory support (p = 0.95). Patients on NIV were significantly older (p < 0.01) than those ventilated invasively (13 and 1.5 years, respectively). Average waiting time on equipment had been shortened significantly—from 6.3 months until 2010 to 1 month at the end of the study (p < 0.01). Only 6.6% of patients had obstructive sleep apnea syndrome (OSAS) requiring HMV. During the study period, 24% patients died, mostly due to uncontrolled infection or progression of underlying disease. Availability and shortened waiting time for the equipment accompanied by advanced overall health care led to substantial improvements in the national HMV program. However, future improvements should be directed to systematic evaluation of SDB in patients with OSAS, early diagnosis of nocturnal hypoventilation, and subsequent timely initiation of chronic ventilation.

Compression fractures of the spine in children: isn’t it time to change something?

Objective . To analyze the efficacy of various methods for treatment of children with compression fractures of the thoracic and lumbar spine on the basis of literature data. Material and Methods. A systematic review of the literature on methods for the diagnosis and treatment of compression fractures of the spine in children was carried out. PubMed, Science Direct, and Google Scholar databases were searched for literature sources for analysis. Results. A significant number of discrepancies between the approaches used in the treatment of compression fractures in children and the available literature data were noted. In particular, not any diagnostic protocol includes MRI as a tool to confirm the presence of a fracture, due to the high cost of the method and its low influence on the treatment tactic choice. The data of biomechanical studies cast doubt on the feasibility of long-term bed rest compliance and restrictions on sitting. As for bracing of patients with compression fractures, it has been demonstrated that wearing of rigid brace does not allow achieving better results in comparison with its absence. The child’s ability to remodel residual deformations of vertebral bodies ensures the restoration of their height and shape in the vast majority of cases. Currently, there is no data confirming the fact of earlier development of degenerative diseases and back pain in children who sustained compression vertebral fractures. Conclusion. The review results allow to analyze the efficacy of various treatment methods and can be the basis for reviewing the existing treatment tactics for children with compression fractures of the vertebral bodies.

Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation.

Studies reporting outcomes of endoscopic treatment methods in children who underwent liver transplantation (LT) is very limited. We present our outcomes, as a high-volume transplant center where endoscopic methods are preferred as the first choice in the treatment of biliary complications in children. Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) as the first treatment approach for biliary complications after LT between 2005 and 2017 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical intervention. ERCP was performed in 49 patients who had a duct-to-duct anastomosis (38 living donor liver transplantation (LDLT), 11 deceased donor liver transplantation (DDLT)). The most common biliary complication was stricture. Our endoscopic success rate was 66.7% (18/27) and 75% (6/8) in LDLT and DDLT patients with stricture (p > 0.05), respectively. While our endoscopic success rate was 75% (3/4) in patients with leak alone after LDLT, it was 25% (1/4) in patients with leak and stricture in this group. The endoscopic success rate was 50% in two patients who had leak alone after DDLT. ERCP should be considered as a preferential treatment option for the management of biliary complications in pediatric liver transplant patients with duct-to-duct anastomosis, as in adults.

APPLICATION OF RADIO-WAVES COAGULATION TECHNIQUE FOR THE TREATMENT OF HEMANGIOMAS OF THE MAXILLOFACIAL AREA

Statistics of the last years indicates the significant incidence of vascular neoplasms, the most of which are located at the maxillofacial area – 68–80 %, multi sites simultaneously – 20%. According to histological signs the capillary tumors are 51%, cavernous – 42%, combined – 4%, mixed – 3% of cases.&#x0D; Currently, in surgical dentistry, the problematic choice of new technical means and technologies that can increase the effectiveness of surgical treatment for the most common types of pathologies remains relevant.&#x0D; Despite numerous methods of treatment for benign vascular tumors (surgical, radiation, cryosurgical, electrosurgical, laser, sclerotherapy), the results leave much to be desired, as many authors note a significant percentage of tumor recurrence, as well as complications during the operation. As a rule, they are characterized by multiple procedures and are not accompanied by a more radical removal of hemangiomatous tissues, in this connection constant seek for new methods of hemangiomas treatment for children and adults is provided.&#x0D; At the same time, the expediency and effectiveness of radio wave coagulation remains an open question, as one of the latest among the high-tech methods of tissue dissection.&#x0D; This publication presents the results of cavernous hemangiomas treatment for the maxillofacial area by radio-wave coagulation.&#x0D; In all clinical cases, operations were performed practically with noninvasive technique. In the early postoperative period, there was a slight swelling of the tissues without the infiltration in the area of the wound. Healing process of the wound in all patients occurred below the crust, which persisted on average 7-10 days after the procedure, with the formation of the hardly noticeable scar, the shape, size and elasticity of which did not change during the first year of observation. The state of the scar in 52 cases (91%) was estimated as good (7-9 points according to the scale), in 5 (9%) – satisfactory (10-11 points according to the scale). A review in dynamics after 6 months allowed detecting recurrent disease in 4 patients (7%) with localization of hemangiomas in the scalp area, upper and lower lip. Recurrence cases of hemangiomas were noticed as small-spotted hemangiomatous lesions of the skin at the border of the tumor or in the area of the postoperative scarring, which were re-operated with a needle-shaped electrode of 0.02 mm in diameter.&#x0D; The application of radiosurgical technique allows us to conclude that this is a tool to minimize the risk of intra- and postoperative complications and reduce the period of rehabilitation of patients.&#x0D; Thus, the application of radio-wave coagulation for the treatment of maxillofacial hemangiomas is promising and allows us to discover the following advantages: greatly facilitates the work of the surgeon, reduces the traumatism and duration of surgical intervention; minimizes blood loss; reduces the percentage of postoperative complications; contributes to the formation of aesthetic scar.&#x0D; The obtained data indicate the expediency of using the method of radio-wave coagulation in the treatment of cavernous hemangiomas of the maxillofacial area.

Isolated chemoperfusion of the lung and pleura as a method of treatment in children with common forms of solid bone tumors

Introduction. Therapy of malignant tumors is one of the most important problems of modern pediatric oncology. The presence of distant metastases is considered as the main sign of generalization of the tumor process. In order to improve the results of treatment of these patients, we proposed to supplement cytoreductive surgery with intraoperative isolated chemoperfusion of the lung and/or pleura with cytostatic. The purpose of the study is to determine the effectiveness of metastasectomy combined with isolated lung/pleura chemoperfusion (ILCP/PCP) under conditions of hyperoxia in children. Materials and methods. For 10 years of research (2008–2018) on the basis of the N.N. Petrov National Medical Research Center of Oncology produced 45 ILCP and PCP in 30 patients with intrapulmonary and intrapleural metastases of various malignant bone tumors. The ILCP method is a surgical procedure, during which the lung is temporarily switched off from the circulation and perfused with modified saline containing high concentrations of an antitumor drug (melphalan or cisplatin), which allows delivery of high doses of cytostatics while avoiding systemic exposure to the drug. In cases of detection of metastatic lesions of the parietal pleura after metastasectomy, PCP was performed, consisting in drainage of the pleural cavity and intraoperatively conducting, after suturing the surgical wound, hyperthermic (42 o С) chemoperfusion of the pleural cavity with a cisplatin solution for 2 hours. Results. In children with malignant bone tumors, 37 isolated chemoperfusions with cisplatin and 8 with melphalan were performed. In 27 patients, 36 ILCP were performed, in 7 patients – 9 PCP. Nine (20 %) patients underwent bilateral perfusion with an interval from 1.5 to 31 months. There were no lethal outcomes during operations and in the postoperative period. The average duration of surgical interventions was 270 ± 90 (120–520) minutes. The number of remote foci – from 1 to 56 (average value – 9). The average blood loss was 300 ± 200 (150–1000) ml. The mean follow-up was 45 months; median overall survival – 38 months; 3-year overall survival – 65.5 ± 9.4 %. Survival without progression – 40.5 ± 10.5 % (n = 30). Conclusions. ILCP/PCP with cytostatics is a method of complex therapy that can improve the quality and increase the life expectancy of patients, especially with the exhausted possibility of other treatment options.

Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients

IntroductionFemoral shaft fractures are the commonest major pediatric fractures. For generations, traction and casting were the standard method of treatment for children. However, over the past two decades there has been growing recognition of the advantages of fixation and rapid mobilization. MethodsA prospective multicenter study was conducted at four Italian centers of reference for pediatric fractures (January 2005 to December 2014). The study involved 62 patients of both sexes, between 6 and 14 years of age, with closed femoral shaft fractures. The aim was to find out more about the short-term complications of titanium elastic nailing in diaphyseal femur fractures in children in order to reduce them. ResultsThe commonest complication observed in our study was pain at the nail entry point (24.19%) due to a local inflammatory reaction. After 1 year, 3.22% had limbs of different lengths. Proximal migration occurred in 1.61% of cases. DiscussionOver the last two decades, the treatment of femoral shaft fractures in pediatric patients has developed to include internal fixation using Titanium Elastic Nails (TEN). We only observed a few complications in our study, most of which were minor and associated with the surgical technique employed, particularly during the initial phase of the surgeon’s learning curve. ConclusionsTEN are an excellent internal fixation system if used by an expert surgeon and have a very low rate of complications. None of them produced permanent damage in the patients. In older children weighing more than 50 kg, alternative techniques such as subtrochanteric nailing, plates, or external fixation are advisable.

CHOLELITHIASIS IN INFANTS – CONSERVATIVE OR SURGICAL TREATMENT?

The aim of the research: to optimize the treatment strategy of cholelithiasis in infants by studying the conservative therapy and surgical treatment effectiveness.Children with cholelithiasis were divided into three groups: 60 children received conservative treatment; 14 children were not treated; 22 children underwent cholecystectomy. Conservative treatment was carried out by administration of Ursofalk suspension (Dr. Falk Farma, Germany) on the daily dose basis – 20 mg/kg of body weight per day once a day – at bedtime. Duration of litholysis ranged from 6 to 24 months. The therapeutic effect was controlled every 3 months by ultrasound examination of the bile ducts and biochemical analysis of blood serum.Results. Contractile function of the gallbladder normalized after 6 months, biochemical markers of cholestasis after 3 weeks, lipidogram by the end of the second year of conservative treatment. All children tolerated therapy well. No side effects were found. No spontaneous dissolution of gallstones was observed in 14 children who did not receive litholytic therapy. In 22 children, who underwent surgery, morphological changes in the gallbladder wall were reversible, but most of them formed post-cholecystectomy syndrome. In view of the aforesaid, conservative therapy should be considered the priority method of cholelithiasis treatment in children under 3 years of age. Surgical treatment should be performed only according to vital indications.

Prediction Model for Determination of Indications for Laser or Surgical Treatment for Aggressive Posterior Retinopathy of Prematurity at the Manifestation Stage

The purpose: to analyze anthropometric and diagnostic parameters in children with aggressive posterior ROP at the manifestation stage on its basis to build a predictive model, which allows to determine the indications for laser or surgical treatment.Patients and methods. The study included 111 children (190 eyes) with aggressive posterior ROP at the manifestation stage. 67 children (134 eyes) underwent transpupillary retinal laser photocoagulation (LPC) in the period from 2008 to 2013. In 46 children (82 eyes) the disease regression was archived (group 1), in 31 children (52 eyes) the progression continued (group 2), so at the second stage early lens-sparing vitrectomy was performed (2–4 weeks after LPC). In 34 children (56 eyes) primary lens-sparing vitrectomy was performed in the period from 2013 to 2017 (group 3). Anthropometric and diagnostic data for all patients were subjected to statistical analysis for building a predictive model.Results. The predictive model was based on logistic regression that determines the probability of separation of children with aggressive posterior ROP to the manifestation stage on treatment methods: transpupillary LPC or primary vitrectomy. The following parameters were selected: the diameter of the central arteries and tortuosity index (TI). All groups were joined into a single array to create the model, which allowed to differentiate the patients according to the treatment types based on the input data processing. It was obtained the equation of the logistic regression: Z = exp(55,2726 – 0,1584X – 35,3911Y) / (1 + exp(55,2726 – 0,1584X – 35,3911Y)), where Z has the value from 0 to 1.0; X value is the diameter of the central artery of the patient; Y — the value of the TI arteries of the patient. If Z &lt; 0.5, then the patient has indications for surgical treatment, if Z &gt; 0.5 — for laser treatment.Conclusion. The predictive model was obtained that with a probability of 96% allows to determine objectively the optimal treatment method for children with aggressive posterior ROP at the manifestation stage of the disease: transpupillary LPC or primary vitrectomy. This will increase the effectiveness of treatment of the severe and prognostically unfavourable forms of ROP. This model can be a “working” tool for ophthalmologists involved in the treatment of ROP, its introduction into the clinical practice is advisable.

Application of suction assisted closure to repair refractory ulcers of leukemia in children

Objective To investigate the effect of suction assisted closure (SAC) in treatment of children′s leukemia with refractory ulcers. Methods The clinical data of 15 children who had leukemia associated with refractory ulcers from January 2013 to April 2017 in Department of Orthopedics, Wuhan Children′s Hospital, Tongji Medical College of Huazhong University of Science & Technology were retrospectively analyzed.There were 8 males and 7 females, among whom 9 cases were acute non-lymphocytic leukemia and 6 cases were acute lymphoblastic leukemia.Patient′s ages ranged from 2 to 9 years old with the mean age of 6.2 years.There were 5 cases of refractory ulcers located in the medial side of thigh and 4 cases in the perineum and around anus, 3 cases in the ankle, 2 cases in the crus and 1 case in the lateral side of thigh.The refractory ulceration area varied from 2 cm×3 cm-7 cm×5 cm, and the depth varied from 0.6-1.8 cm.All the 15 cases were cultured with secretions, including 7 cases of Staphylococcus aureus, 4 cases of Escherichia coli, 2 cases of Klebsiella pneumoniae, 1 case of Pseudomonas aeruginosa, and 1 case with no bacteria detected.These children were transferred from Department of Hematology to Department of Orthopedics when there was no improvement in conventional therapy with the average treatment of 26 d (11-36 d). All of these children underwent SAC after thorough debridement.Secondary suturing of ulcers closure was performed or skin transplantation according to the recovery condition of ulcers. Results All the 15 patients of refractory ulcers achieved fresh granulation tissue after SAC treatment.Ten of them who had refractory ulcers could be sutured directly after once SAC treatment, and 5 cases who had refractory ulcers underwent SAC treatment again, in which 3 cases could be sutured directly, and the other 2 cases needed to reduce the wound area and autologous skin graft.All of these patients had refractory ulcers healed after SAC treatment, without any local or systemic complications. Conclusions SAC can bring the deep refractory ulcers into full drainage, protect the refractory ulcers against contamination, stimulate the growth of granulation tissue.SAC is a simple and effective method in treatment of children′s leukemia with refractory ulcers. Key words: Child; Leukemia; Suction assisted closure; Debridement

Efficiency of Multisensoric Therapy in Autism Spectrum Disorder Patients

Abstract The aim of this study was to investigate the role of various treatment methods for children with autistic spectrum disorders (ASD). The prospective study was conducted in 2013–2015 at the Children’s University Hospital and Social Pediatric Centre of the University of Latvia. The data analysis included 72 children (2 to 5 year old) with ASD, of whom 38 had infantile autism, 16 had atypical autism, and 18 had other diffuse developmental disorder). 86.1% patients received therapy. The most common treatment was by Montessori method and special pedagogue. Other treatments were dance-movement therapy, animal, sand and one patient received spa treatments. Univariate OR analysis showed that Montessori therapy had a decreasing trend on three health disorders (visual, hearing, and fine motor skills disorders) compared with other types of therapy, but the effect was not statistically significant. Special pedagogue therapy for autism patients showed similar results. A significant effect was observed for fine motor skills (p &lt; 0.05) and speech development (p &lt; 0.05), and Montessori method and special education were shown to be the most effective tools for promoting developmental progress and reducing developmental delay. Special pedagogue method showed statistically significant efficiency in fine motor skills and speech development. However, significant differences were not found for the Montessori method due to a limited number of patients.

The effectiveness of ankle foot orthosis on gait in children with spastic diplegic cerebral palsy

Introduction: Cerebral palsy is a life lasting disability and is one of the most expensive diseases. CP is defined as a non-progressive, chronic, involuntary movement disorder secondary to an injury or lesion of the immature brain. The lesion usually occurs prenatally on prenatally: only about 10 per cent of the lesions are of postnatal origin. In most patients, a specific cause is not identified. Orthotic management is a widely utilized method of treatment in children with CP due to its conservative nature. Orthosis continue to have an important role in many therapeutic regimens for children with CP. However; there have been differences in design variants of Orthosis prescribed for the common problem of Spastic Cerebral Palsy. Three AFO configurations frequently prescribed for children with spastic cerebral palsy they are Hinged AFO (HAFO), the Posterior leaf spring (PLS AFO), and the Solid AFO (SAFO). Methods: Thirty subjects with Spasticdieplegic Cerebral palsy aged from 5-15 years with (male=20 and female=16) chosen through randomized sampling and taken in this study. The Selected subjects underwent indicated AFOs (SAFO, PLSAFO, HAFO,). Each intervention was given up to three months with wearing schedule 6-12 hours per day. Results: Results shows a significant improvement in Gait Parameters and i.e. Step length (p&lt;0.020), stride length (p&lt;0.003), cadence (p&lt;0.005), Velocity (p&lt;0.002), but not significant difference in comparison between SAFO, PLSAFO and HAFO. Conclusion: The findings of the study support the hypothesis that there were significant differences between the three design variants of AFO in improving gait parameters in subject with spasticdieplegic Cerebral Palsy.

Efficacy of probiotic administration in the complex treatment of chronic catarrhal gingivitis in children

One of the leading pathogenic mechanisms of chronic catarrhal gingivitis development in children is disorders in the system of child macroorganism and oral cavity microorganisms interrelation as a result of normal microflora inhibition against the background of general amount of opportunistic and pathogenic microorganisms. The oral cavity protective mechanisms condition plays an important role in this process. Due to this fact a perspective direction is to study the methods of mentioned pathology treatment using probiotics containing strains of normal microflora with high antagonistic, enzymatic and immune-modeling properties able to inhibit growth of pathogenic bacteria. Objective : to improve the common method of catarrhal gingivitis treatment in children by means of oral microbiocenosis correction on the local level. Materials and methods . The method of catarrhal gingivitis treatment in children with administration of the probiotic “BioGaia Prodentis” has been developed. 30 children at the age of 12 with clinical signs of chronic catarrhal gingivitis were treated and dynamically observed. The children were divided into two groups: the main (with application of the improved method) and the group of comparison (the common method was applied). The periodontal tissue condition in children was assessed on the basis of OHI-S, PMA, CPI indices, and Schiller-Pisaref test. The oral cavity local immunity was assessed by means of lysozyme activity, the level of secretory immunoglobulin A, the degree of dysbiosis by urease activity detection in the oral fluid of children. Results . Administration of the drug “BioGaia Prodentis” in the complex of chronic catarrhal gingivitis treatment in children resulted in a quick reverse development of clinical signs. Among the children of the main group on the 3–4 th day of treatment a tendency to subsidence of inflammatory signs was observed. In the group of comparison the signs such as hyperemia, swelling and bleeding regressed at the beginning of the 4–5 th day. An average duration of local treatment in the main group was 4.46 ± 0.27 days against 8.00 ± 0.36 days in the group of comparison (P < 0.05). The results of paraclinical examination of children oral cavity after treatment have become the evidence of the clinical changes found. Significant difference by all the indices in children of the main group was detected. Catamnestic examination demonstrated that in half a year in children who were treated with the medicine “BioGaia Prodentis” better clinical-paraclinical indices were registered twice as less than those in children from the comparison group. Conclusions . Treatment of chronic catarrhal gingivitis in children with administration of the medicine “BioGaia Prodentis” in a complex therapy contributes to oral cavity microbiocenosis normalization. Clinical efficacy of the proposed method is evidenced by the local treatment periods reduction almost twice as large and approximately 2/3 decreased of the disease signs relapse as compared to the initial indices.

Is combined CBT therapy more effective than drug therapy alone for ADHD in children? A meta-analysis

Based on published research on the combined cognitive behavioral therapy (CBT) versus drug therapy alone in children with attention deficit/hyperactivity disorder (ADHD), we systematically reviewed and analyzed the efficacy of two treatment methods in children with ADHD. The literature as at the end of 10 July 2017 in multiple databases was systematically searched. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated. The results indicated that combined CBT therapy was efficacious in reducing symptoms of ADHD (SDM [Formula: see text]0.48, 95% CI [Formula: see text]0.80 to [Formula: see text]0.17). The executive function scores were not improved more in the combined CBT (SMD [Formula: see text]0.34; 95% CI [Formula: see text]0.71 to 0.03). This study suggests that combined CBT seems more efficacious in some domains affecting children with ADHD, but further evaluation is needed.

The effectiveness of non-surgical intervention (Foot Orthoses) for paediatric flexible pes planus: A systematic review: Update

BackgroundFlexible pes planus (flat feet) in children is a common presenting condition in clinical practice due to concerns amongst parents and caregivers. While Foot Orthoses (FOs) are a popular intervention, their effectiveness remains unclear. Thus, the aim of this systematic review was to update the current evidence base for the effectiveness of FOs for paediatric flexible pes planus.MethodsA systematic search of electronic databases (Cochrane, Medline, AMED, EMBASE, CINHAL, SportDiscus, Scopus and PEDro) was conducted from January 2011 to July 2017. Studies of children (0–18 years) diagnosed with flexible pes planus and intervention to be any type of Foot Orthoses (FOs) were included. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. McMaster critical review form for quantitative studies, was used to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken.ResultsOut of 606 articles identified, 11 studies (three RCTs; two case-controls; five case-series and one single case study) met the inclusion criteria. A diverse range of pre-fabricated and customised FOs were utilised and effectiveness measured through a plethora of outcomes. Summarised findings from the heterogeneous evidence base indicated that FOs may have a positive impact across a range of outcomes including pain, foot posture, gait, function and structural and kinetic measures. Despite these consistent positive outcomes reported in several studies, the current evidence base lacks clarity and uniformity in terms of diagnostic criteria, interventions delivered and outcomes measured for paediatric flexible pes planus.ConclusionThere continues to remain uncertainty on the effectiveness of FOs for paediatric flexible pes planus. Despite a number of methodological limitations, FOs show potential as a treatment method for children with flexible pes planus.PROSPERO registration numberCRD42017057310.

Traditional Method of Initial Diarrhea Treatment in Children

ABSTRACTDiarrhea is the most common cause of death in children. For diarrhea, home treatment should be administered by parents to prevent diarrheal complications. The purpose of this research was to investigate the traditional method of diarrhea treatment in Tegal regency, Central Java, Indonesia. A descriptive study was conducted with the aim of describing the traditional method of home treatment for diarrhea in children. The study sample included families with children who were experiencing or had experienced diarrhea and had received traditional medicine. The participants were randomly selected based on cluster random sampling, and the results showed that traditional diarrheal treatment involved the use of Psidium guajava leaves, curcumic (turmeric), and tea. P. guajava leaves and curcumic were processed by pounding or shredding and then squeezing to obtain the extracts. Some of the respondents also added salt to the mixture. Most traditional medicine could be found in the garden or by purchase, and friends and family were the most common information resources. Most respondents assumed that traditional medicine was effective to treat diarrhea. It is expected that this research can provide information about diarrheal management by traditional method in the community.

Potential of colonoscopy as a treatment for intussusception in children.

Background and study aims Invagination, which can occur in any part of the intestine, usually affects children and is the second most common cause of intestinal obstruction after pyloric stenosis. The cause of these intussusceptions in children is usually unknown and they typically occur within the ileocolic region. Management of pediatric patients with the condition often consists of surgical intervention. However, this retrospective study from the University Hospital of the University of São Paulo, Brazil, reports a series of cases of intussusception in children in whom a colonoscopy was used to reverse the intussusception. Patients and methods From April 2010 to January 2015, 30 pediatric patients underwent a colonoscopy as an noninvasive method for treatment of children’s intestinal intussusception. Results Overall, treatment with colonoscopy was successful in reversing invagination in 66.7 % of the patients. However, 33.3 % of patients required surgery to resolve the intussusception. Conclusion Noninvasive colonoscopy is a potential treatment for intussusception in children.

Intramedullary elastic nailing of the displaced radial neck fractures in children

ObjectiveThe aim of this study was to report the clinical and radiological results of 11 patients with Judet type 3 severely displaced radial neck fractures, who were treated with intramedullary elastic nail fixation with the help of percutaneous K-wire reduction maneuver (Métaizeau technique). MethodsA total of 11 children (4 boys and 7 girls with a mean age of 7.7 (6–10) years) with Judet type 3 radial neck fractures were treated in our clinic between February 2013 and August 2015. The fractures were evaluated according to Judet classification system modified by Métaizeau. Reduction and fixation was performed within the first 24 h after injury in all patients. All fractures were treated by closed reduction using distal elastic intramedullary nail. Clinical evaluation was performed by measuring elbow range of motion (ROM) with goniometer, radiological evaluation by assessing fracture healing and functional evaluation by using Mayo Elbow Performance Score (MEPS). ResultsThe mean MEPS score increased from 15 points preoperatively to 88 points postoperatively (range, 12–95 points). Radiological evaluation revealed that all fractures healed with excellent or good alignment. The mean flexion was 150° (range, 145–154°), extension 1° (range, 0–2°), supination 82° (range, 80–86°), and pronation 83° (range, 80–85°). ConclusionReduction and osteosynthesis of radial neck fractures by intramedullary nailing with the help of percutaneous K-wire manipulation appears to be a simple, safe and effective treatment method in children. Level of evidenceLevel IV, Therapeutic study.

First Polish analysis of the treatment of advanced heart failure in children with the use of BerlinHeart EXCOR mechanical circulatory support.

The treatment of advanced heart failure (HF) in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital aetiology. The treatment schedules for paediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the paediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance of surviving the period of waiting for a heart donor. The aim of the study was to analyse the outcomes of circulatory support in Poland and to assess the advisability of this method for treatment of children with severe HF. This treatment of paediatric patients is currently used in three Polish centres. From December 28, 2009 to August 1, 2015, 27 implantations of BerlinHeart EXCOR® mechanical circulatory support system were performed in children aged from one month to 16 years (10 patients below one year of age; 37%). Left ventricular assist devices were implanted to 21 patients, whereas the remaining children received biventricular support. The most common reason for using this method was HF developed in the course of cardiomyopathy. In one case, HF after Fontan operation was the indication. The duration of the circulatory support period ranged from six to 1215 days. It was followed by successful heart transplantations in 10 (37%) patients, in five (18.1%) it resulted in regeneration of the heart, enabling explantation of the device, whereas three children are still waiting for transplantations. Nine (33%) children died during the therapy because of thromboembolic complications. As follows from our data, circulatory support utilising the BerlinHeart EXCOR® system is an effective and promising method used as a bridge to cardiac transplantation, or for regeneration of the myocardium in paediatric patients. In the group of the youngest and the most difficult patients, the method requires close cooperation of the medical and nursing personnel.

Pathogenetic substantiation of minimally invasive methods of urinary system heterochrony correction

Heterochrony – is the timing of the formation and the rate of organs development in descendants of humans, animals and plants in comparison with their ancestors. Relevance. Anomalies of the urinary system organs development make up more than 40% of congenital childhood diseases. Violation of urodynamics and associated changes of intraorganic blood and lymph circulation create conditions for the nonspecific inflammation occurrence. Using of the standard treatment methods in a large percentage of cases leads to unsatisfactory outcomes and as a result to surgical removal of an organ. Objective: Pathogenetic justification of the low-invasive techniques using for the urinary system organs heterostructure correction. Differential diagnosis between dysplasia and heterochroism of the urinary system organs. Development and implementation of methods aimed at minimally invasive elimination of urodynamic disturbances and reduction of the possible complications level. Materials and methods. Based on the heterochrony theory in the clinic of pediatric surgery at the PI «ZCMCH» № 5 it has been developed and implemented in practice since 2008 year the method of obstructive uropathy endoscopic treatment, which resolves urinary retention with the help of endoscopic technology. Technique for megaureter surgery: urinary bladder was filled via catheter by 0.9 % sodium chloride solution. The state of both ureters mouths was estimated. Into stenotic mouth with some effort a plastic conduit with a diameter of 1mm was entered. Balloon dilatator or Fogarty catheter 4,5 Fr was conducted through stenotic area of the ureter via conduit. The high-stenting was increasingly used. Area of stenosis was determined by ultrasound scanning. The same methodology was used in cases of hydronephrosis. Results. The proposed tactics of treatment have been used in the clinic of pediatric surgery since 2008. The results have been obtained: 72 children from 3 months up to 7 years were treated. The evaluation of results was made according to four-point scale in a year after the start of treatment: excellent – 25 (34.7%) good – 22 (30.5%), satisfactorily – 11 (15.3%); unsatisfactorily – 14 (19.4%). A positive result was achieved in 59 (81.9%) patients. Further diagnostic and therapeutic programs are being practiced. Conclusions. Endoscopic restoration of urodynamics helps to make a differential diagnosis between heterochronia and dysplasia of tissue using the time factor. The advantages of proposed method of obstructive uropathies treatment in children are: technical simplicity, low invasiveness, maximal physiological and reducing the postoperative complications rate.

Posterior cervical screw fixation in children: the treatment experience

Objective. To prove the safety and technical and mechanical validity of posterior screw fixation of the cervical spine in children and to compare different types of the cervical spine fixation based on our own treatment experience and literature data. Material and Methods . A retrospective analysis of 47 patients under the age of 18 years who underwent various types of posterior instrumental fixation of the cervical spine was performed. Level of Evidence – III. Results . The duration of postoperative follow-up varied from 2 months to 6.6 years (mean, 2.1 ± 1.6 years). A total of 186 screws were placed, the number of screws inserted in one patient reached 10 (mean, 3.9 ± 2.4). Postoperative complications were observed in 5 (10.6 %) patients. Conclusion . Posterior screw fixation of the cervical spine provides biomechanically reliable stabilization of the segment, helps to achieve good correction of deformity and reduction of dislocations, shortens the period of rehabilitation, and is a safe method of surgical treatment in children.