bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and functional outcome of metal backed versus all polyethylene post operated total knee replacement patients: a prospective study
Authors: Kriplani Suresh , Patil Tejas , Kulkarni Milind , Kulkarni G. S. , Kabra Krishna , Parikh Yash
Published: June 2020

Background: Osteoarthritis (OA) is most common chronic degenerative disease in orthopaedic practice. The literature pertaining to comparison of the clinical outcome and functional outcome between the metal backed and all polyethylene prosthesis for the total knee replacement are scant.   

Methods: A prospective study was undertaken in a tertiary hospital April 2018 to June 2019. The final sample size was 32 cases (40 knees) of newly diagnosed of primary OA knee cases treated with cemented TKR with Metal backed prosthesis and 29 cases (40 knees) with all polyethylene prosthesis. The patients were followed up at 1st, 3rd and 6th post-operative months.

Results: Knee clinical score pre-op was not statistically significant. But after 1 month, after 3 months after 6 months, knee clinical score was statistically significant. Knee functional score pre-op, after 1 month, after 3 months, after 6 months was not statistically significant. 87% patients of metal back total knee replacement and 85% of all poly total knee replacement had no pain or just mild pain.

Conclusions: Total knee arthroplasty resulted in excellent relief of pain, range of motion, restoration of function, and low prevalence of complications and continues to function well during the follow-up period. Improvement in clinical score in MB group is correlated significantly than all polyethylene group. Knee society scoring system is an effective in evaluating clinical, functional outcomes.
Evaluation of incorporation of bone allograft at the site of implantation in various clinical conditions along with its complications
Authors: Jajoriya Laxmi Narayan , Sural Sumit
Published: June 2020

Background: Bone transplants have been used routinely in the present century for diverse purposes to unite fractures, fuse joints, and repair skeletal defects.

Methods: Twelve patients with fracture, bone defect, deformity, difficulty in the fusion of bone, etc. were taken in the study for elective surgery with fresh frozen allograft in the orthopedics department with the incorporation of inclusion and exclusion criteria.

Results: Out of 12 cases in this study, 7 cases were related to spinal fusion, 3 cases were of fractures with bone defects, 1 case of non-union neck femur fracture and 1 case was of revision hip arthroplasty with the acetabular bone defect. Seventy-five percent (9 patients) and 25% (3 patients) were graded fair and poor respectively in the preoperative phase. At 6 months, excellent results were obtained in 50% (6 patients), good in 25% (3 patients), fair in 25% (3 patients), while none were graded as poor in terms of clinical evaluation.

Conclusions: Fresh frozen bone, a good source of abundant bone allograft, can be stored in -70° freezer for use in orthopedic surgery to fill any filling defect in the bone. Also, proper storage, better surgical technique, hospital infection control policy, antibiotic policy, preoperative use of antibiotics before surgery has a good clinical outcome.
A retrospective analysis of twenty two cases of floating knee
Authors: Yadav Umesh , Sheoran Ajay , Dutta Mayank , Devgan Ashish , Dahiya Amit , Dhupper Vasudha , Singh Abhishek
Published: June 2020

Background: With increase in road traffic accidents, incidence of floating knee injuries is increasing day by day. Along with bony injuries, multiorgan injuries are generally present which require urgent intervention. Despite advance in surgical management and implants, achieving a good functional knee still remains a challenge to the surgeons.

Methods: This retrospective study was conducted to assess management, functional outcome and complications of patient presenting with floating knee injury to a tertiary care centre. 22 patients with floating knee injury admitted in trauma centre from 2017 to 2019 were analysed and functional assessment was done.

Results: Males with mean age 33.5 years were exclusively victims of road traffic accident. 14 patients presented with multisystem injury. After stabilization fractures were fixed with nails/plates/screws. Knee stiffness was most common complication seen in 37% cases. Functional assessment was done using modified Karlstrom Olerud criteria which revealed excellent results in 22.7% cases while poor results in 18.2% cases.

Conclusions:Floating knee injury is not merely bony injury but a multisystem injury and should be managed on principles of Damage control Orthopaedics. Regarding bony injuries, achieving union and acceptable range of motion remains the prime target. 
Tennis elbow brace and wrist cock-up splint in the management of tennis elbow: a comparative study
Authors: Gavhale Sandeep , Dave Harshit , Rohra Hitesh , Shet Vipul D. , Aher Ganesh , Bansal Sagar
Published: June 2020

Background: The purpose of our study was to compare the efficacy of a wrist splint with a forearm counterforce strap brace in the management of tennis elbow.

Methods: This prospective study was conducted between January and December 2018 comprising of 75 patients suffering from lateral epicondylitis managed conservatively with splints. Patients were randomized into three treatment groups, group 1 received tennis elbow forearm brace, group 2 received wrist extension splint, group 3 received both tennis elbow forearm brace and wrist extension splint. The patient-rated tennis elbow evaluation (PRTEE) score and visual analogue scale (VAS) scores were calculated at 0, 3 and 6 weeks of the treatment.

Results: Mean difference of pre-treatment and post-treatment PRTEE score was significant in all three groups and was maximum for group 3 patients (32.42) followed by group 2 patients (27.04) followed by group 1 patients (20.06). Pre-treatment and post-treatment VAS score difference was maximum for group 3 patients.

Conclusions: Significant symptomatic relief can be achieved in patients with tennis elbow by using either tennis elbow forearm brace or wrist extension splint or both. Provided proper patient selection and compliance, wrist extension splint achieves better symptomatic relief and functional outcome as compared to tennis elbow brace.
COVID-19 lockdown induced fractures
Authors: Jampani Ravitheja , Chava Satya Prasad , Dutta Sravan Chandra
Published: June 2020

Tough times and tough measures taken by central government of India. India is under national lockdown due to COVID-19 pandemic.It was difficult for common man in many ways to deal with lockdown. The basics of life food, fuel, transport was handicapped during lockdown phase. People in major cities and towns have sources of food availability in terms of continuous grocery supply from supermarket chains, food delivery chains. It was rural population of India that was more effected due to lockdown rather than urban population.The rural population of India sustained on food that was available in around houses and in the fields. Most of them went to fields and bought vegetables for their lunch and dinner. During this process people climbed trees and fell down causing major limb injuries. We present few scenarios of injury that occurred during lockdown of COVID-19 pandemic causing major limb fractures. Tough times and tough measures to control pandemic COVID-19 caused new problems for people in search of food and daily needs. These are some of those injuries which were able to document in these tough times.
Bone grafting of the regenerate: a previously undescribed case and surgical technique
Authors: Abdalla Mazen` , Giannikas Konstantinos
Published: June 2020

Distraction osteogenesis can occasionally be complicated with poor-quality regenerated bone. Several factors have been identified in the literature in order to reinforce the maturation of the regenerate. We would like to present a case in a 40 years old patient who presented with shortening and uniplanar varus angulation at his proximal tibia. The patient was treated with distraction osteogenesis using a circular frame. He had significant delay in the maturation of the 4-5 cm gap, and it was decided to use a non-vascularized fibular graft that was introduced using the tibial intramedullary nailing instrumentation. The graft led to an impressive acceleration of the maturation of the regenerate, mostly posteriorly and laterally with poor progression at the anterior part of the tibia. As this is the first such case presented in the international literature it is difficult to speculate why the regenerate was stimulated only in specific areas. Further reporting is necessary to reach safe conclusions.
Providential non-union of the medial condyle of distal humerus: a case report
Authors: Mebouinz Ferdinand Nyankoue , Diouf Alioune Badara , Dembele Badara , Daffe Mohamed , Sarr Lamine , Dieme Charles , Coulibaly Ndeye Fatou
Published: June 2020

Non-union of the medial condyle of the humerus is a rare development of neglected fractures of the distal humerus. We report a case found in a 19 years old boy who consulted for relative functional impotence of the right elbow, with a functional score rated at 76 points out of 100 according to Broberg and Morrey. The elbow radiograph showed a pseudarthrosis of the medial condyle of the humerus and the computed tomography found in addition a partial filling of the olecranon and coronoid dimples. Also, a therapeutic abstention was retained this pseudarthrosis in view of its providential character.
Correlation of clinical and histopathological diagnoses of oral mucosal lesions at tertiary care centre: a retrospective study
Authors: Maheshwari Ankita M. , Kharkar Vidya D.
Published: June 2020

Background: The objective of the study was to study the correlation between clinical and histopathological diagnoses of oral lesions.

Methods: Data of all patients attending the department of Dermatology KEM Hospital, Mumbai with oral mucosal lesions who underwent biopsy for histopathological examination in a duration of one year was included in this retrospective study. Their clinical and histopathological diagnoses were correlated and data was analysed.

Results: A data of total of 164 patients was included in study. Out of the clinically diagnosed, histopathological correlation was found to be 66.66% for oral leucoplakia, 81.25% for lichen planus, 72% for squamous cell carcinoma, 88% for pemphigus vulgaris and 75% for submucosal fibrosis. Overall correlation found was 75.60%.

Conclusions: Histopathological examination of oral mucosal lesion is very important to arrive at the accurate diagnosis and to plan definitive treatment. Histopathological examination of oral mucosal lesions must be done routinely because wide variety of conditions present with similar morphologic features and can be the initial signs of many skin disorders.
A comparative study between micro needling with modified Kligman regimen versus micro needling with tranexamic acid in melasma patients
Authors: Momin Anjum M. , Mistry Ankita A. , Vaishnani Jignesh B.
Published: June 2020

Background: Melasma is common, acquired disorder of hyperpigmentation, with female predominance and occurrence of facial involvement mostly. Various modalities of treatment are available including topical, oral and procedural therapies.

Methods: Total 46 patients of melasma were studied. They were divided in two groups A and B. Micro needling with derma roller 1.5mm was done once in a month for 3 months. Group A patients received topical Modified Kligman regimen daily at night, while group B patients were advised topical tranexamic acid daily. Topical sunscreen was advised in both group patients. Patients were evaluated clinically and by Modified MASI score, and followed up for 3 more months after completion of treatment.

Results: Female predominance was noted with most common age group being 25-40 years. Epidermal type of melasma was common. Centro-facial type of distribution was found mostly in patients. Significant decrease was noted in modified MASI score (p<0.05) which was more and rapid in group A patients.

Conclusions: Modified Kligman regimen has better efficacy but tranexamic acid is safer with lesser side effects. Inspite of various treatment arms, melasma is still challenging.
Toxic epidermal necrolysis like acute cutaneous lupus erythematous or drug induced toxic epidermal necrolysis: case report of a diagnostic dilemma
Authors: Chavan R. B. , Belgaumkar V. A. , Deshmukh N. S. , Pawar A. M.
Published: June 2020

Systemic lupus erythematosus (SLE) is an autoimmune disorder causing microvascular inflammation with generation of antinuclear auto-antibodies. It can have varied presentations and its coexistence with other disorders makes diagnosis and management all the more challenging. We describe a young male, known case of SLE and pulmonary tuberculosis on anti-tubercular treatment presenting with sudden onset diffuse maculopapular dusky rash, oral lesions, fever, joint pain and photosensitivity. Positive Nikolsky’s sign on clinical examination, epidermal necrosis on histopathology, negative direct immunofluorescence and Naranjo’s causality assessment clinched the diagnosis of streptomycin-induced toxic epidermal necrolysis (TEN) in SLE. Rash responded rapidly to systemic steroids and discontinuation of anti-tubercular drugs. Rifampicin, ethambutol and isoniazid have been previously incriminated in TEN but streptomycin- induced toxic epidermal necrolysis remains an extremely rare event. TEN like rash of lupus is a rare entity clinically indistinguishable from drug induced TEN. Moreover, TEN is known to occur with increased frequency in connective tissue disorders.
A clinico-epidemiological study on various patterns of facial dermatoses in adolescents attending a rural tertiary centre: A cross-sectional study
Authors: Ravindranath Mithila , R Swaroop M , Ghosh Avik , Devaraj Yogesh , Shale K S Mouryabha
Published: June 2020

Adolescence is a critical phase of transition with a myriad of hormonal changes occurring in the body to which the skin reacts in various ways. Since adolescents constitute one fifth of the Indian population, dermatological disorders have an impact on their health- related quality of life, especially when it occurs on face leading to considerable physical and psychological morbidity.

1. To study the prevalence of various facial dermatoses among adolescents (10-19 years). 2. To study the clinical and epidemiological determinants of facial dermatoses among adolescent patients.

A total of 550 adolescents in the age group of 10-19 years presenting with facial dermatoses to the outpatient department of Dermatology, Adichunchunagiri Institute of Medical Sciences, B.G. Nagara, meeting the defined inclusion and exclusion criteria were enrolled in this observational cross-sectional study after taking an informed consent from the guardian (for patients <18 years) and approval of institutional ethical committee. A detailed history and thorough clinical examination was recorded in a structured proforma. The diagnosis was based on detailed history and thorough clinical examination, and relevant investigations were done when needed.

The prevalence of adolescent facial dermatoses in the study was 7.3%. The mean age of sample population was 15.79±2.6 years. There was a female preponderance in the study (M:F=1:1.4). Infections and eczema showed association with lower middle class. Acne vulgaris (34.8%) was the most common dermatoses followed by infections (15.3%) and eczema (12.9%).

Infections and eczema were common in lower middle class of socioeconomic status. Acne vulgaris was the most common dermatoses followed by infections and eczema.
DEPREDACIÓN DEL TUCÁN ANDINO PIQUILAMINADO Andigena laminirostris (RAMPHASTIDAE) A UNA SERPIENTE DEL GÉNERO Chironius (COLUBRIDAE)
Authors: Arteaga-Chávez William Andrés , Togán-Murillo Dayana Pamela
Published: June 2020

El Tucán Andino Piquiliaminado Andigena laminirostris es una especie principalmente frugívora que complementa su dieta con invertebrados, vertebrados pequeños, huevos y pichones de otras aves. En esta nota reportamos el primer evento de depredación de A. laminirostris a una serpiente del género Chironius (Colubridae). Este reporte presenta aspectos ecológicos anteriormente desconocidos de A. laminirostris.
EL CARACARA MONTAÑERO Phalcoboenus megalopterus (FALCONIFORMES: FALCONIDAE), REGISTRO DE UNA NUEVA LOCALIDAD AL OCCIDENTE DE LA PROVINCIA DEL AZUAY
Authors: Barros Santiago , Landázuri Boris , Astudillo Pedro X. , Barnuevo Eduardo A.
Published: June 2020

En Ecuador, el Caracara Montañero Phalcoboenus megalopterusse distribuye en los Andes del extremo sur. Los registros mayoritariamente se concentran en las provincias de Loja y Zamora Chinchipe. Sin embargo, al norte del límite conocido, en la provincia de Azuay, los registros de P. megalopterusson escasos y sin documentación. En esta nota se presenta el primer registro fotográfico en la provincia de Azuay. Un individuo adulto fue observado en agosto de 2018 en San Gerardo, cantón Girón, en los Andes occidentales de la provincia. Este registro representa una nueva localidad, las más septentrional, y sugiere que la especie podría distribuirse localmente hacia el norte del límite de su distribución conocido en Ecuador.
Experiencia en la utilización de hipolipemiantes en una cohorte de pacientes en 12 ciudades colombianas
Authors: Diaztagle Juan José , Castro Carlos Alberto , Buitrago Diana Carolina
Published: June 2020

Introducción: Los estudios de utilización de medicamentos sirven para evaluar la efectividad y seguridad de los fármacos en la práctica real, diferente al contexto del estudio clínico controlado. Los hipolipemiantes actúan sobre el perfil lipídico disminuyendo el riesgo de enfermedades cardiovasculares. Objetivo: Describir el desempeño clínico y seguridad de la utilización de medicamentos hipolipemiantes en la práctica médica real en una cohorte de pacientes con diagnóstico de dislipidemia. Metodología: Estudio observacional de cohorte. Se siguió una cohorte de pacientes con indicación de hipolipemiantes durante 6 meses, en 12 ciudades de Colombia pertenecientes a un registro biomédico de seguimiento de pacientes tratados con medicamentos del portafolio de Abbott. Se midieron variables demográficas y clínicas basales, de seguridad y de desempeño clínico de los medicamentos sobre el perfil lipídico a los 3 y 6 meses. Resultados: Se siguieron 501 pacientes en tratamiento con hipolipemiantes. Las estatinas solas disminuyeron el colesterol de baja densidad de 249 mg/dL (RIQ=226-268) en la medición basal a 190 (177.6-210) y 170 (108-170) en la segunda y tercera medición, respectivamente. Para estatina + ezetimibe, de 167 mg/dL (RIQ=139-184) a 132 (110-150) y 128.5 (101.5-128.5). El fenofibrato disminuyó los triglicéridos de 275 mg/dL (RIQ=219-346) a 201 (172-239) y 150.5 (140-150.5). Conclusiones: la administración de estatinas sola o en combinación disminuyó los niveles de LDL y colesterol total, mientras que el fenofibrato demostró su efectividad al disminuir los triglicéridos. No se reportaron efectos adversos. Hubo una adherencia parcial del médico tratante a la guía de práctica clínica para dislipidemias. MÉD.UIS.2019;32(1):13-20
Calidad de la atención médica y adherencia a la guía de manejo colombiana de neumonía adquirida en la comunidad en el Hospital Universitario de Santander: periodo 2014 – 2015
Authors: Tellez Luis Ernesto , Gómez-Ochoa Sergio Alejandro , García-Ruedaa Nicolás Andrés , Beleño-Payares Daniela , Osma Jose Luis
Published: June 2020

Introducción: la neumonía adquirida en la comunidad es una infección aguda del parénquima pulmonar que corresponde a una importante causa de morbi-mortalidad en Colombia. En esta entidad, se ha asociado la pobre calidad en la atención y la mala adherencia a las guías de manejo con un impacto negativo tanto en el desenlace clínico del paciente, como en la academia y solvencia económica de un Hospital Universitario. Objetivo: describir la calidad de la atención médica y adherencia a la guía colombiana de manejo de la neumonía adquirida en la comunidad en el Hospital Universitario de Santander durante el periodo 2014-2015. Materiales y métodos: estudio descriptivo de corte transversal; se seleccionaron 121 historias clínicas con diagnóstico de Neumonía Adquirida en la Comunidad en el Hospital Universitario de Santander durante el periodo 2014-2015. A partir de estas, se recolectaron variables respecto a la aproximación diagnóstica, asignación de tratamiento y recomendaciones generales, evaluando por cada ítem individual el porcentaje de adherencia a la guía de Neumonía adquirida en la comunidad de la Asociación Colombiana de Infectología y los criterios de calidad en la atención de la Community Acquired Pneumonia Organization. Resultados: los ítems con mayor cumplimiento fueron: el hemoleucograma (100%) y la toma de radiografía de tórax (98%). Por otra parte, la clasificación CURB-65 (15%), la indicación de radiografía de tórax en el control (12%) y las recomendaciones para cese de tabaquismo y vacunación (0%) fueron los parámetros con menor rendimiento. Conclusiones: se evidenció una falencia en el proceso de clasificación clínica del paciente, condición que, asociada al escaso uso de laboratorios de diagnóstico microbiológico y el excesivo uso de estudios de imagen no indicados como la tomografía computarizada, favorece un tratamiento ineficiente y el desarrollo de resistencia farmacológica. MÉD.UIS.2019;32(2):23-30
TYPOLOGICAL SIMILARITIES OF PAREMIOLOGICAL UNITS ABOUT "LABOUR" (ON THE BASIS OF ENGLISH, RUSSIAN AND KAZAKH LANGUAGES)
Authors: Rsaliyeva Zhulduz
Published: June 2020

Purpose of the study: The main task of the article is to represent the English, Russian and Kazakh proverbs and sayings’ equivalents about the labour. The semantic characteristics of the paremiological units’ on the thematic group "labour" in English, Russian and Kazakh languages are examined comparatively for the first time.
Methodology: The semantic components of paremiological units about labour were analyzed, considering their general and specific characteristics by using the qualitative method. Until now three genetically not related paremiological units in English, Russian and Kazakh languages were not fully investigated in linguistics contrastively and comparatively. Component analysis, descriptive analysis, contextual and comparative analysis were used as a tool for investigation of the following work.
Main findings: Paremiological units of three different people and from various group languages can have universal lexemes in their components. The similar paremiological units of several languages are considered as a typological phenomenon, because of having similar life stages and historical correlation. Studying the paremiological units, we have the opportunity to get acquainted with the peoples’ culture, the range of interests, worldview, and psychology of the people.
Applications of this study: The results and conclusions of the work can be used in the preparation of language textbooks and seminars, teaching textbooks, and special courses in comparative typology and general linguistics in the future.As well as, the following work can be the beginning of the composing the trilingual dictionary in English, Russian and Kazakh languages.
The novelty of the study: The proverbs and sayings about "labour" of unrelated languages in terms of comparative and contrastive study have so far been little studied, especially in linguistics, and such study of this field will reveal universal and nationally specific features between English, Russian and Kazakh proverbs, which will have practical and theoretical significance.
Statistical Disclosure Control Methods for Microdata from the Labour Force Survey
Authors: Pietrzak Michał
Published: June 2020

The aim of this article is to analyse the possibility of applying selected perturbative masking methods of Statistical Disclosure Control to microdata, i.e. unit‑level data from the Labour Force Survey. In the first step, the author assessed to what extent the confidentiality of information was protected in the original dataset. In the second step, after applying selected methods implemented in the sdcMicro package in the R programme, the impact of those methods on the disclosure risk, the loss of information and the quality of estimation of population quantities was assessed. The conclusion highlights some problematic aspects of the use of Statistical Disclosure Control methods which were observed during the conducted analysis.
A MODIFIED TECHNIQUE FOR SURGICAL REMOVAL OF THE CONGENITAL DUODENAL OBSTRUCTION
Authors: Chepurnoy M. G. , Chepurnoy G. I. , Katsupeev V. B. , Leyga A. V. , Chilibiyskiy Ya. I. , Rozin B. G.
Published: June 2020

Purpose. To improve the duodenum function after Kimura surgery which is performed for the congenital duodenal obstruction by restoring the horseshoe-shaped duodenum. Material and methods. A comparative analysis of two groups of patients was made: In Group 1 (n = 31) , patients were operated with the mobilization of lower horizontal duodenal branch and duodenoduodenal anastomosis by Kimura without restoring the horseshoe-shape of the duodenum. In Group 2 (n = 11), children had similar surgeries but the horseshoe-shaped configuration of the duodenum was restored by fixing the initial part of the jejunum to the Treitz ligament. After surgery, the researchers radiographically compared time of barium suspension passage through the duodenum in patients of both groups. Results. In children from Group 1, passage of the contrast suspension via duodenum lasted for 43.9 ± 3.9 sec., what is approximately 2 times faster than in the norm. In patients from Group 2, this indicator was 3-4 times larger than in patients from Group 1 and was 158.2 ± 18.2 sec. Such a slowdown in the chyme passage along the duodenum prolongs exposure of food masses to pancreatic juice, bile and intestinal juice and, consequently, improves the duodenal function. Conclusion. The authors recommend to end the surgical intervention for eliminating congenital duodenal obstruction by Kimura technique with the restoration of horseshoe-shaped duodenum by fixing the initial part of the jejunum to the Treitz ligament.
ERRORS IN THE DIAGNOSTICS OF TESTICLE TORSION IN CHILDREN
Authors: Grigorieva M. V. , Sarukhanyan O. O. , Gasanova E. N. , Teleshov N. V. , Batunina I. V.
Published: June 2020

Introduction. Testicular torsion is an emergency condition requiring emergency medical care. Polymorphism of symptoms in testicular torsion makes diagnostics not easy and leads to late treatment what can results in irreversible damages to the testicle. Early diagnostics is a key point to organ preservation. Material and methods. The authors describe two clinical cases of testicular torsion in adolescents with errors in diagnostics. Clinical, laboratory findings and instrumental examination (MRI, ultrasound) were used for diagnostics. Results. A diagnostic error resulted in orchectomy which was made to one patient. In the other patient - despite a diagnostic error- testiclular detorsion and urgent surgical intervention resulted in patient’s complete recovery. Discussion. These examples illustrate how important is to carefully study the patient’s case-history - onset and nature of pain, associated vegetative symptoms - nausea and vomiting - which are not characteristic for other acute testicular diseases. Conventional tactics of urgent surgical intervention for all acute testicular diseases in children does not insure against diagnostic errors in case of testicular torsion with atypical symptoms. Ultrasound examination is of irreplaceable value, but one cannot be guided only by its findings in excluding testicular torsion. Conclusion. Any of the symptoms of testicular torsion - whether it is acute onset or severe pain, or a combination with vomiting, or severe pain on palpation, or ultrasound findings - is a reason to suspect testicular torsion and, it is an absolute indication for urgent surgery. The protocol for diagnostics and treatment of acute testicular diseases developed by us includes these diagnostic peculiarities and allows to choose an effective treatment modality.
DIAGNOSTICS AND TREATMENT OF THE CLOACA POSTERIOR IN A 3-YEAR-OLD CHILD
Authors: Novozhilov V. A. , Stepanova N. М. , Petrov E. M.
Published: June 2020

The posterior cloaca (cloaca posterior) is the most rare type of cloacal anomaly representing one of the most complicated problems for the operative correction of the defect. A variety of options for the fusion of structures involved in the formation of urogenital sinus, vaginal and uterine anomalies cause the lack of a unified approach to surgical correction which would allow to obtain good anatomical and functional outcomes and a decent quality of life. The authors discuss a clinical case of successful treatment of a rare form of anorectal malformation - cloaca posterior in a 3-year old child.
EPISPADIAS IN GIRLS
Authors: Soloviev A. E.
Published: June 2020

Purpose. To study the clinical picture, diagnosis and treatment of epispadias in girls. Material and methods. 22 girls with epispadias of various forms were under supervision for 50 years. During diagnostics the following issues were used: anamnesis, examination, catheterization and uroflowmetry, cystoscopy of the bladder, ultrasound and X-ray examination. Results and discussion. Out of 22 girls with epispadias, clitoral epispadia (partial ) was in 10 patients; sub-symphisal (subtotal) - in 4; symphisal (total) - in 8 girls. In 10 girls with the clitoral form, urological examination was made because of changes in the urine. Girls with sub-symphisal epispadia complained of irritation and itching in the vulva. All had vulvitis, cystitis, chronic pyelonephritis. In 2 patients, renal doubling was diagnosed; in other 2 patients ureterohydronephrosis and kidney dystopia were diagnosed. Uroflowmetry revealed hyperactive bladder in all. 8 girls with the total (symphisial) form of epispadia and urinary incontinence were operated by the Derzhavin technique; after the surgery the function of bladder sphincter was restored and the patients could have a normal quality of life. Conclusion. Epispadia in girls is a rare case . There are clitoral, sub-symphisal and symphisal (total) forms of epispadias. Cluster and sub-symphisial forms do not require surgical treatment. While in the symphisial (total) form, plastic surgery on the bladder neck by the Derzhavin technique is recommended. It is a good option for recovery.
DYNAMICS OF PHENOTYPIC MANIFESTATIONS OF CONNECTIVE TISSUE DYSPLASIA IN CHILDREN WITH UROANDROLOGICAL PATHOLOGY IN THE AGE ASPECT
Authors: Vasilyeva I. G. , Sharkov S. M. , Safronov B. G. , Volkov I. E. , Burov I. S. , Dementyev A. P. , Mozhayev A. V.
Published: June 2020

Introduction. The article includes a comparative study of phenotypic manifestations of undifferentiated connective tissue dysplasia in children of different age groups with urological and andrological pathology. Material and methods. The trial performed included 214 children aged from 1 month to 17 years with clinical manifestations of undifferentiated connective tissue dysplasia who were treated in the children’s uroandrological department for congenital malformations of the urogenital system. The generally accepted table of external phenotypic markers in scores was used in establishing undifferentiated connective tissue dysplasia . Results. In infants, the most frequent disorders were in ears and skin. In the preschool age, in the majority of cases, craniocephalic abnormalities, pathology of osteo-articular system and ears were met. The trail has revealed that the rate of ocular abnormalities increases with age. Moreover, two or more ocular problems were most common in older children. Anomalies of the oral cavity were diagnosed only in a quarter of infants and were manifested in them by a single sign. In older age groups, oral cavity anomalies were in more than half of the patients, and often they were not isolated. During the survey of senior schoolchildren, it was noted that all children of this age group had this or that disorder in their osteo-articular system, and almost always they were multiple. Conclusion. Somatic manifestations of undifferentiated connective tissue dysplasia are often multiorganic and often have non-specific clinical symptoms. Identification of patterns of formation of uroandrological pathology in patients of different age groups with connective tissue insufficiency will ensure timely prevention and correction of visceral manifestations of dysplasia in children.
THE “THIRD MODE” OF BLOOD FLOW AND PARAMETERS OF CENTRAL HEMODYNAMICS IN CHILDREN WITH APPENDICULAR PERITONITIS AND DESTRUCTIVE PNEUMONIA
Authors: Vecherkin V. А. , Voronova O. K. , Toma D. A. , Koryashkin P. V.
Published: June 2020

Introduction. In modern world literature there are no data on changes in the central hemodynamics in children with purulent-septic pathologies. Purpose: to improve diagnostics of cardiovascular disorders in children with appendicular peritonitis and destructive pneumonia using device “Cardiocode”. Material and methods. The trial with “Cardiocode” was conducted in two regional medical centers in Voronezh and Belgorod. Hemodynamic parameters were studied in healthy children (n = 60), in children with destructive pneumonia (n = 83) and in children with appendicular peritonitis (n = 98). Parameters of the central hemodynamics were studied in pre- and postoperative period until recovery. Results. It has been found out that in children with appendicular peritonitis and destructive pneumonia the heart rate exceeds normal limits by 37-58%. The stroke volume in children with appendicular peritonitis did not differ of normal values, while in children with destructive pneumonia it declines by 10-15%. Early diastole was significantly reduced on admission, by 75-85% of normal limits. Reduction of parameters was recorded in the rapid expulsion of left ventricular systole from 80% to 70% of normal limits. In children with destructive pneumonia and appendicular peritonitis, tone of the ascending part of the aorta (Vt.a) was increased as well. conclusion. Apparatus "Cardiocode" is an effective non-invasive tool for early diagnostics and for controlling treatment of hemodynamic disorders in children with appendicular peritonitis and destructive pneumonia.
THE ETIOLOGY AND PATHOGENESIS OF HIP JOINT ARTHRITIS IN CHILDREN. A LITERATURE REVIEW
Authors: Yablonskaya K. P.
Published: June 2020

Arthritis in children is a group of diseases that are encountered by various specialists. It is a pediatrician, who starts the diagnostic search, in most cases. The definition “arthritis of the hip joint” implies a number of pathologies. In the article, the researcher discusses the basic aspects of epidemiology, etiology and pathogenesis of such forms of arthritis as septic, transient, reactive as well as the arthritis in orthopedic pathologies.
SURGICAL TREATMENT OF FOCAL FORMS OF CONGENITAL HYPERINSULINISM: IS ALL CLEAR?
Authors: Sukhotskaya A. A. , Bairov V. G. , Nikitina I. L. , Ryzhkova D. V. , Mitrofanova L. B. , Amidkhonova S. A.
Published: June 2020

Introduction. 30-60% of all patients with congenital hyperinsulinism have a delayed psychomotor development, and 15-25% of them have severe organic brain damage, including epilepsy. Timely diagnostics and intensive treatment can prevent severe neurological complications. With the ineffectiveness of conservative therapy, surgical treatment is a necessary alternative. Objective. To define indications for various options of surgical correction of focal forms of congenital hyperinsulinism. Material and Methods. In the Department of Pediatric Surgery of V.A. Almazova National Medical Research Centre, in 2017-03.2019, 14 children with focal forms of congenital hyperinsulinism were operated after analyzing their PET-CT findings; in 2 patients out of them they were doubtful. Results. 13 (93%) patients had a complete relief of hyperinsulinism and a significant improvement in their psycho-motor development. 10 (71%) of 14 children had a complete recovery; 1 (7%) - a significant positive trend. 3 (21%) patients needed insulin therapy with minimal dosages. They all were children with an atypical (mixed adenomatous-diffuse) form of hyperinsulinism. Conclusions. In case of focal lesions in the pancreas, partial pancreatectomy with maximal preservation of healthy tissue, defined by the express biopsy, and with any lesion localization is indicated. For atypical forms, the volume for pancreatectomy dissection is defined individually.
THE ROLE OF NEUROMUSCULAR DISORDERS IN CHILDREN WITH ENCOPRESIS OPERATED ON FOR ANORECTAL ABNORMALITIES
Authors: Mashkov A. E. , Nalivkin A. Е. , Khkir B. M. , Sigachev A. V. , Filjushkin Yu. N.
Published: June 2020

After clinical and neurophysiological examinations of 22 patients with developmental anomalies of the rectum and anus, who suffered of fecal incontinence of type III and who were operated in the Vladimirsky Moscow Region Clinical Institute, a modern approach to the diagnostics of neuromuscular disorders has been proposed. A particular attention was paid to the sacral plexus and its branches. A detailed examination of the sexual nerve and its functions was made using a St. Mark disposable rectal electrode. The optimal evaluation of motor potentials from the thigh muscles under transrectal stimulation of the sacral plexus was made; findings of EMG diagnostics were compared too. The researchers backgrounded an optimal modality for treating this pathology: not only surgical tactics, but also patient’s reserve capabilities in restoring lost functions using EMG biological feedback.
A RARE CLINICAL OBSERVATION OF A DERMOID CYST AND ISOLATED DOUBLING OF THE SMALL INTESTINE IN THE RETROPERITONEAL SPACE IN A 15-YEAR-OLD GIRL
Authors: Karaseva O. V. , Golikov D. Е. , Gorelik A. L. , Utkina K. E. , Achadov T. A. , Dmitrienko D. M. , Kisliakova A. N. , Kharitonova A. Yu.
Published: June 2020

Introduction. In the available literature, we could not find any description on the combined pathology consisting of a volumetric formation in the form of a dermoid cyst and malformation of the abdominal cavity in the form of an isolated duplication of small intestine with localization in the retroperitoneal space. Purpose. To present a curative and diagnostic algorithm for a rare pathology in the retroperitoneal space in a 15-year-old child. Material. A 15-year-old girl who was operated on for a dermoid cyst and an isolated doubling of small intestine localized in the retroperitoneal space and having no clinical manifestations. Results. When performing the spiral computed tomography (SKT) of the patient’s abdomen because of polytrauma, a cystic mass localized in the left half of the abdomen was accidentally revealed. Due to the critical state of the girl, it was decided to observe the child’s state and to make a decision on surgical treatment after her recovery. Later, at the preoperative thorough examination (ultrasound, CT, MRI), a retroperitoneal formation (dermoid cyst?) was suspected, and a part of small intestine isolated from the gastrointestinal tract but adjacent to this formation was visualized. Laparoscopy confirmed the diagnosis, and both formations were successfully removed from the retroperitoneal space. conclusion. Modern imaging techniques have the potential to make accurate diagnostics in rare surgical diseases before surgery, to determine surgical tactics and minimize surgical aggression due to minimally invasive technologies.
ECHOGRAPHY IN THE DIAGNOSTICS OF INFLAMMATORY BOWEL DISEASES IN CHILDREN
Authors: Pykov M. I. , Vrublevskaya A. M.
Published: June 2020

Crohn’s disease (CD) and ulcerative colitis (UC) are pathologies that have various clinical manifestations, which sometimes cause problems in putting a correct diagnosis by clinicians. The review of domestic and foreign literature highlighted the relevance in improving the diagnostics of inflammatory bowel disease (IBD). Modern diagnostic techniques (computed tomography, magnetic resonance imaging, various endoscopic and radiological methods) are widespread in clinical practice, but they have a number of limitations in pediatric practice and are associated with certain risks. Significant drawbacks are radiation loading at the child’s organism and general anesthesia. So, a diagnostic tool which provides sufficient information, widely available, safe and non-invasive is a need . The ultrasound examination meets all the above mentioned demands. Unfortunately, currently there are no explicit protocols to be used for ultrasound examination of children with CD and UC. Researches in this direction should be continued, so as to confirm the effectiveness of this technique in diagnosing the intestinal tube pathology and to develop algorithms for practical application of this imaging technique, particular in pediatric patients with IBD.
CHRONIC APPENDICITIS WITH APPENDIX PENETRATION INTO THE BACK BLADDER WALL
Authors: Sobolevsky A. B. , Elin L. M. , Filyushkin Yu. N. , Nalivkin A. E. , Sobolevsky A. A. , Denisova L. B. , Zakharova M. O.
Published: June 2020

Chronic appendicitis is a pathologic condition caused by a slowly developing, flaccid and long-lasting inflammatory process in the appendix of the cecum. A 7-year-old child with chronic appendicitis and appendix penetration into the posterior wall of the bladder was treated at the surgical department of Vladimirovsky Moscow Region Clinical Institute. Such a combined pathology caused some difficulties in diagnostics. Chronic appendicitis is considered as an independent nosological form and can be masked by various surgical conditions.
LAPAROSCOPIC CENTRAL RESECTION OF THE PANCREAS. THE FIRST EXPERIENCE AT THE MOROZOVSKAYA CITY CHILDREN’S CLINICAL HOSPITAL
Authors: Ryabov A. B. , Poddubniy I. B. , Trunov V. О. , Khizhnikov A. B. , Milashchenko T. A. , Kurkin A. P. , Kozlov M. Y. , Kubirov M. S. , Khamukova O. S.
Published: June 2020

The central pancreatic resection is a complex organ-preserving surgical intervention used in patients with tumors located in the area of gland body. The laparoscopic access minimizes surgical trauma and shortens patients’ rehabilitation. The publication describes the first experience of laparoscopic central resection of the pancreas in a 13-year-old girl at the Morozovskaya City Children’s Clinical Hospital, Moscow.
A TOTAL DESTRUCTION OF MEMBRANES IN A TRUE SPLENIC CYST IN CHILDREN - AN OBLIGATORY TECHNIQUE FOR ITS RADICAL REMOVAL
Authors: Katsupeev V. B. , Chepurnoy M. G. , Chepurnoy G. I. , Shamsiev Zh. A. , Leiga A. V. , Volovik K. G. , Rozin B. G. , Khoronko Yu. V. , Kivva A. N.
Published: June 2020

The authors describe a case when a recurrence of a true splenic cyst developed after non-radical excision of its membranes. During the second surgery, a combined surgical technique was applied for membranes destruction: diathermocoagulation, argon laser irradiation and taking a strand of the greater omentum closer to the surfaces of treated cyst membranes. Half a year later, there was no recurrence revealed at the follow-up examination. It indicates that the cyst was radically removed.
SURGICAL TREATMENT OF ATIPICAL FORMS OF CONGENITAL HYPERINSULINISM
Authors: Sukhotskaya A. A. , Bairov V. G. , Mitrofanova L. B. , Ryzhkova D. V. , Nikitina I. L. , Amidhonova S. A.
Published: June 2020

Introduction. 30-60% of all patients with congenital hyperinsulinism have a delayed psychomotor development, and 15-25% of them have a severe organic brain damage, including epilepsy. The timely diagnostics and intensive care can prevent severe neurological complications. If the conservative therapy is not effective, then the surgical treatment is a need. Objective: To demonstrate features of surgical correction of atypical forms of congenital hyperinsulinism. Material and methods. 11 children with atypical forms of congenital hyperinsulinism were operated on in the department of pediatric surgery in the V.A. Almazov National Medical Center in 2017-03.2019. Results. 2 children demonstrated a complete relief of hyperinsulinism in 9 months (1.5 years) of follow-up; one patient had a significant improvement of his psycho-motor development. Conclusion. Some children with presumably focal forms of hyperinsulinism, by PET-CT findings, may have histologically atypical forms. In the atypical lesion of the pancreas, an intraoperative biopsy dramatically changes the planned volume of pancreatectomy up to almost total removal of the gland.
SISTEMA COMUNITÁRIO PORTUÁRIO (SCP) E DESEMPENHO DO PORTO
Authors: Caldeirinha Vitor Manuel Dos Ramos , Felício José Augusto , Salvador Antônia Sena , Nabais João , Pinho Escola Tiago
Published: June 2020

Este estudo tem como propósito avaliar o efeito do sistema comunitário portuário (SCP) e a sua influência no desempenho do porto. Avalia-se, no caso português, a janela única portuária (JUP), com que se identifica. Recorre-se à análise das componentes principais e à metodologia structural equation modeling (SEM), aplicadas á amostra de 153 respostas válidas, obtidas na comunidade portuária portuguesa. Os resultados mostram diferentes factores que constituem  o sistema comunitário portuário e grandes diferenças entre o SCP genérico e o SCP português (JUP). Os factores de desempenho também apresentam fortes diferenças. Como principal contribuição verificam-se diferentes os factores do SCP com impacto em diferentes factores de desempenho no porto.
FATORES DE DECISÃO NA IMPLANTAÇÃO DE TERMINAL PORTUÁRIO PÚBLICO E PRIVADO NO CORREDOR LOGÍSTICO DE EXPORTAÇÃO ARCO NORTE
Authors: Gomes Pereira Felipe George , Carlos Botter Rui , Tadeu Robles Leo
Published: June 2020

Este artigo discute os fatores de decisão para a implementação de terminais portuários especializados na região conhecida como Arco Norte, portos localizados no Nordeste e Norte do país. O Analytic Hierarchy Process (AHP) ferramenta de decisão foi utilizado para aplicação de questionário com especialistas portuários e os gestores. Os resultados mostraram uma grande relevância para os critérios Porto Localização (54%), seguido por Económico e Financeiro (27,8%), Desempenho e Dimensionamento (11,2%) e Contrato e Legislação (6,9%). O estudo concluiu que a prioridade é para Terminais de Uso Privativo, considerando a situação atual do país e os investimentos nos terminais portuários privados em vigor nos últimos anos.
AS DIFERENTES PERSPECTIVAS DE ANÁLISE DA RELAÇÃO PORTO-CIDADE: UMA REVISÃO DA LITERATURA
Authors: Cordeiro Fabiano Nogueira , Castro Junior Osvaldo Agripino de , Luna Mônica Maria Mendes
Published: June 2020

Este estudo trata da relação porto-cidade, em especial da identificação das perspectivas de análise adotadas na literatura para abordar o tema.  A compreensão e harmonização das interações entre o porto e a cidade deve possibilitar que ambos cumpram o seu papel: o porto, com a primazia voltada ao transporte, colaborando com as cadeias de suprimentos globais; e a cidade, enquanto espaço onde ocorrem as relações e atividades sociais. Este estudo permitiu identificar, a partir da revisão da literatura, as principais perspectivas adotadas nos estudos e pesquisas realizadas na temática relação porto-cidade: econômico; infraestrutura de acesso, urbanidade, meio ambiente, histórico, social, político, gestão, governança e planejamento.
ANÁLISE QUALITATIVA DO USO DOS RECURSOS EMPREGADOS NO PROCESSO DE DESCARGA DE GRANEL SÓLIDO EM UM PORTO PÚBLICO DO NORDESTE (BR)
Authors: Silva Jonas Figuerêdo , Moreira Gabriella Gambarra , Leite Maria Silene Alexandre
Published: June 2020

O objetivo principal deste trabalho é levantar e discutir os recursos identificados em uma operação de descarga realizada em um porto público do Nordeste (BR). A pesquisa foi pautada em uma abordagem qualitativa e as análises foram realizadas a partir de observações e entrevistas com os principais gestores responsáveis pelas empresas que participam da operação de descarga ativamente, baseando-se os resultados em suas percepções. Com principais resultados, foi possível discutir as falhas e problemas presentes na operação com relação ao gerenciamento dos recursos, além da percepção incompleta dos gestores com relação à gestão destes recursos por suas empresas.