Surgical aspects of the treatment of neonatal ovarian cysts in girls

Introduction. Neonatal ovarian cysts develop in case of hormonal imbalance in the mother-placenta-fetus system. Cystic transformation in the ovary may cause appendage torsion which leads to follicular necrosis and loss of ovarian reserve. Most often, torsion occurs in the utero, but in premature girls- due to the specific hormonal status - the risk of cyst growth and its torsion remains in the postnatal period. Currently, a unified approach to the surgical treatment of neonatal ovarian cysts is absent.Material and methods. In the department of pediatric surgery for malformations in the Perinatal Center of the Amazov National Medical Research Center, 34 girls with ovarian cysts were examined during 2012-2020; 9 of them (27%) were premature. In the presented observation, we faced an ovarian cyst in the fetus of 30 week gestation.Results. The cyst looked uncomplicated, but had the enormous size, so we discussed a possibility to perform an intrauterine puncture. However, due to severe hemolytic disease of the fetus and premature delivery, the intervention was not carried out. By the third week of life, torsion of the cystic-transformed ovary developed; necrosis and self-amputation of the right uterine appendage were revealed intraoperatively. By the age of three months, cystic transformation of the only ovary developed. Timely performed laparoscopic fenestration was organ-sparing. Further follow-up revealed preserved and normally growing single ovary what confirmed the right choice of surgical tactics.Conclusion. Dynamic ultrasound examination of the pelvic organs is indicated to all premature girls, at least once every two weeks (in case of revealed ovarian cyst - weekly). We consider it reasonable to make the laparoscopic fenestration of uncomplicated cysts that have size of 3 cm and more. Newborn girls with ovarian cysts should be under the joint control of pediatrician and pediatric gynecologist for developing an individual follow-up plan.

A comparative analysis of outcomes after surgical reconstruction of stenoses in the upper respiratory tract in children

Introduction. Definition " upper respiratory tract stenosis " (URTS) includes a large number of nosologies. The most common are cicatricial stenoses, in particular, post-intubation ones as well as bilateral paralysis of the larynx. An important issue for nowadays is choosing the curative modality for such patients.Purpose. To compare outcomes after treating children with URTS.Material and methods. The authors have assessed results of treatment of 110 patients who had reconstructive surgery in 2010-2019. Patients were divided into two groups depending on the nosology: stenosis of the upper respiratory tract (n = 71) and bilateral paralysis of the larynx (n-39). In each group, four types of surgeries were performed: costal cartilage plasty, plasty with T-tube (TT), a modified version of plasty with TT, plasty with a stent. The choice of treatment technique was determined mostly by the tendency to make this or that type of surgery in authors' departments, as well as by the nosology, severity of the disease and patient's age. Decannulation terms, surgical time, early and late postoperative complications as well as relapse-free period were assessed.Results. 66% patients were decannulated in Group 1; in Group 2 - 69%. Group 1 a statistically reliable comparison was possible between the following techniques: costal cartilage plasty and laryngeal stent plasty (p > 0.005) as well as plasty with TT implantation and the proposed modified technique (p > 0.005). While using Mann-Whitney test and Log Rank, the authors found out that in Group 1 there were no significant difference in surgical time, relapse-free period and stenosis degree (p > 0.005). However, decannulation terms after plastic surgery of the larynx with costal cartilage implantation are longer than after plastic surgery with stent implantation (p < 0.005). In Group 2, the authors compared three abovementioned curative modalities, excluding laryngeal plasty with TT implantation. Thus, surgical time for costal cartilage plasty is longer, if to compare to other two techniques (p < 0.005). There is also no significant difference in decannulation terms and relapse-free periods between all three techniques (p > 0.005).Conclusion. The results obtained have demonstrated the effectiveness of long-term stenting with TT placement in children, mainly with cicatricial stenoses, and in older children. The trial also revealed that laryngoplasty with costal cartilage in children with bilateral laryngeal paralysis is an effectiveness choice too.

Modern approaches to the diagnostics and potentials of endoscopic treatment of esophageal stenoses in children

Introduction. Esophageal stenosis in childhood is quite a common disease characterized by different etiology, specific clinical picture, wide range of differential diseases and a variety of approaches to its treatment.Material and methods. The review analyzes scientific literature presented in such search engines as Medline, PubMed, Cochrane Library, eLibrary, 20 years deep. The most significant works of the last century were included too. Keywords were used for search.Results. There were selected 60 literary sources which included the description of modern concepts of etiopathogenesis, classification, diagnostic and curative techniques for the treatment of esophageal stenosis in children. A particular attention is paid to the safety and effectiveness of minimally invasive endoscopic interventions (bougienage, balloon dilation) as well as to the topical application of Mitomycin C in the treatment of esophageal stenosis in children.Conclusion. Innovative endoscopic technologies applied for the restoration of the esophageal lumen seem to be promising, effective and safe. In the overwhelming majority of cases, they allow to reduce surgical aggression and avoid complex reconstructive surgeries.

Inflammatory myofibroblastic tumor in children

Introduction. Inflammatory myofibroblastic tumor (IMT) is a rare volumetric neoplasm in the childhood which originates from the mesodermal tissue , and by the classification of soft tissue tumors refers to the tumors with intermediate biological potential.Purpose. To present a case of rare volumetric formation in the lungs and mediastinum in children.Material and methods. The publication presents three clinical observations of children with IMT. In all three boys (aged 6, 8 and 15), tumors were localized in the right hemithorax: lower lobe of the lung (two children), upper anterior mediastinum (one) without a reliable organ accessory.Results. There were no specific clinical symptoms of the disease. In two children, the volumetric formation was found accidentally: in one child, a rounded tumor above the liver was found during an ultrasound examination of the abdomen; in the other one, during chest X-ray prophylactic examination. Only in one case, the lung tumor caused respiratory failure during exercise due to the complete atelectasis of the lower lobe and emphysema of the middle lobe which was caused by the growth of the tumor from the parenchyma of the lower lobe into the lumen of the lower lobe and intermediate bronchi. There were no significant shifts in clinical and biochemical blood tests. Cancer markers were negative. Surgery was indicated because of the volume formation topography which was confirmed by the multispiral computed tomography with vascular contrast and fibrobronchoscopy. Surgical volume – thoracotomy, lobtumorectomy (1 child); thoracotomy, pulmonotomy, tumorectomy (1 child); thoracoscopy, removal of the mediastinal tumor (1 child). The most technically difficult was mobilization and removal of the mediastinal tumor when it was separated from the superior vena cava and in the chest aperture where it was intimately fused with the brachiocephalic vein. The postoperative period was without complications. All children recovered.Conclusion. IMT of the thoracic organs is not a rare case. It is not possible to reliably verify the nature of the tumor process in the preoperative period. Surgical treatment is radical and, in some cases, endovideotechnologies may be applied.

Penile agenesis (afallia) in pueros

Introduction. Penile agenesis (aphallia) is an extremely rare congenital defect characterized by the complete absence of the penis in a child with a male karyotype 46XY.Material. The analysis of the literature on keywords in the Pubmed and Medline databases was carried out.Results. The incidence of aphallia is estimated 1 out of 10-40 million newborn boys. Aphallia, in spite of its rarity, is a congenital defect which is thoroughly described in the medical literature. The combination of agenesis of the penis with other congenital anomalies often leads to death in such children. Currently, it is believed that these patients should be left with their genetic male sex, therefore, there is a difficult dilemma of choosing the optimal method and age for creating the neophallus and neourethra.Conclusions. The rarity of the aphallia determines the lack of publications covering the long-term results of phalloplasty in both children and adults.

Congenital cystic-adenomatous malformations of the lower lobe of the left lung in combination with intralobar pulmonary sequestration

Introduction. A combination of two rare congenital lung diseases - congenital cystic-adenomatous malformation of the lower lobe of the left lung and intralobar sequestration of the lung- is an extremely rare pathology in medical practice.Material and methods. The article describes a case of successful treatment of an 8-year-old child with cystic-adenomatous transformation of the lower lobe of the left lung in combination with intralobar sequestration. A child with chronic pneumonia was prescribed CT of his chest organs with intravenous contrast enhancement. A combination of cystic adenomatous malformation with intralobar sequestration of the lung was revealed at this examination. The sequestration zone was supplied with blood via the artery from the thoracic aorta, and the wide vein went towards the opposite hemithorax and flowed into the azygos vein. The patient had a planned surgery: left-sided lateral thoracotomy, lower lobectomy with ligation of additional vessels.Results. The early postoperative period was uneventful. Next year, there were no exacerbations of pneumonia. The child considers himself healthy. The histological report No. 31568 - 31577 confirmed type II cystic adenomatous malformation with sequestration of the lung.Conclusion. Modern diagnostic tools allow to put a correct diagnosis at the preoperative stage. In the described case, possible intraoperative complications were avoided because surgeons knew specific blood supply in the diseased area before surgery.

Complications of surgical treatment of idiopathic scoliosis in adolescents

Introduction. In modern literature, there are still debates on causes of the most common complications after surgeries for idiopathic scoliosis in adolescents and their risk factors. Currently, there are growing potentials to reduce the length of patients’ postoperative stay in hospitals, but it arises the need for attending physicians to know better the main types of complications of juvenile idiopathic scoliosis after surgery, their risk factors so as to predict and avoid them, to develop an individual program for patient’s management in the postoperative period, especially for patients from the risk group.Material and methods. Literature search was done in databases Pubmed, Medline, Google Scholar, using key words, on complications of surgical correction of juvenile idiopathic scoliosis.Results. On analyzing the obtained literature data, two large groups of postoperative complications were described in details: somatic and neurological. In addition to most common complications, some rare ones are described too which include superior mesenteric artery syndrome and distant deep infections.Conclusion. Over the past twenty years, the incidence of postoperative complications after surgical correction of scoliotic deformities has significantly decreased. When analyzing findings of various trials, it can be concluded that the overall complication rate decreased in 2004-2007 from 5.7% (2000-2003) to 4.95% and then to 0.98% (2013-2016). Despite the general decrease in the incidence of complications, the latter still remain a problem for clinicians. The basic risk factors for such complications are: concomitant renal pathology, large volume of surgical blood loss, significant increase of exposure to anesthesia and surgical intervention, application of stainless steel constructions, anterior or combined surgical access, refusal of intraoperative neuromonitoring.

Endoscopic treatment of subglottic stenosis in children

Introduction. Subglottic stenosis is one of the most common causes of upper airway obstruction. The incidence of post-intubation stenosis ranges from 0.9% to 3% (Rodríguez H. et al.), or from 0.2% to 20% (Haranal M.Y. et al.). Currently, there is no consensus on the choice of surgical tactics due to a large number of modalities for surgical restoration of the laryngeal lumen.Material and methods. 44 patients with postintubation laryngeal stenosis were treated in the surgical thoracic department of the National Medical Research Center of Children’s Health subordinate to the Ministry of Health of the Russian Federation during 2019-2021. The average age of patients in this group was 4 years 8 months ± 3 years 8 months. Endoscopic treatment was done to 24 patients (54.5%). Laryngoscopy, fibrobronchoscopy, multispiral computed tomography and, if necessary, barium esophagogram were done for additional diagnostics.Results. The average number of endoscopic procedures per patient was 2.9 ± 1.5 (range from 1 to 7). Good results were seen in 20 patients (83.3%).Conclusions. Endoscopic techniques are alternative options to open reconstructive surgery. These techniques give good results in treating stenoses in the subglottic space and give a good chance to avoid tracheostomy in a certain group of patients, which, according to the results of our study, was as large as 79.1%.

Povidon-iodine applied for the treatment of chylothorax in children

Introduction. The aim of this study is to demonstrate the experience of non-surgical treatment of congenital and acquired chylothorax in children using povidone-iodine.Material and methods. The study presents results of treatment of 10 patients with chylothorax who had chemical pleurodesis with povidone-iodine. The study covered a time period from 2016 to 2020. The congenital character of the disease was registered in 2 patients, the acquired one - in 8 patients. The main indication for surgery was ineffective conservative therapy, including the withdrawal of feeding and the administration of preparation Octreotide. The procedure consisted of intrapleural injection of 4% povidone-iodine solution into the pleural cavity with the calculated dose of 1 ml/kg and solution exposure for 4 hours. Results. The interpleural administration of povidone-iodine was effective in all patients. Complications of chemical pleurodesis were observed in 2 patients and were associated with pulmonary edema on the injection side. Lymph outflow was stopped on average in 4 days. There was one adverse episode which developed because of the lung malformation incompatible with life. Conclusions. Intrapleural administration of povidone-iodine is an effective treatment of chylothorax in children.

Treatment of the hidden penis in boys

Introduction. “Hidden penis” (HP) is a developmental malformation of the penis characterized by normally developed, but abnormally located cavernous bodies in the surrounding tissues of the symphysis or scrotum, manifested by the visually shortened penis trunk. The most common type is «buried» penis (BP). This pathology requires, as a rule, surgical treatment.Purpose. To assess outcomes of BP treatment with an improved surgical technique.Material and methods. 40 boys, aged from 2 to 16 (average age 9 ± 1.59) and diagnosed with HP, were treated in 2014-2019. BP was diagnosed in 35 children (87.5%), webbed penis (WP) – in five (12.5%). Primary BP was in 18 children (51.4%) and BP in combination with the suprapubic obesity - in 17 patients (48.6%). Two children (5%) were operated after the previous circumcision. Indications for surgery were: congenital primary HP, secondary HP in adolescents with insufficient visualization of the penis, psychological discomfort of the patient and the absence of significant clinical effects after conservative care. The average age of children with primary HP was 3.9 ± 2.48; with secondary HP and pubic obesity - 12 ± 3.84 years. During surgery, circular or circular and ventral midline incisions to the middle of the scrotum were used; they were followed by mobilization of the penis from adhesions, excision of adipose tissue in the bosom, fixation of the pubopenile and penoscrotal angles with a non-absorbable surgical thread. The authors have proposed a new technique for foreskin fixation using 2 ventral and 2 dorsal incisions, through which the skin was sutured to the deep fascia of the penis to prevent its distal slipping.Results. All patients had good anatomical and functional results. The authors describe the developed surgical technique in details; they also make literature review on the discussed problem.Conclusion. In the treatment of HP an improved surgical technique with the additional use of incisions allows you to reliably fix the skin of the foreskin on the trunk of the penis, avoiding its distal displacement.