Pediatrics. Consilium Medicum

Plastic surgery to change breast size, both enlargement and reduction, are becoming more and more popular. At the same time, breastfeeding is recognized as an ideal food for a child and an important factor in the health and development of a child. Therefore, the issue of the impact of these operations on the possibility and effectiveness of breastfeeding is relevant and requires careful consideration. The article provides information on the influence of various factors on breastfeeding, such as the types of implants, the time elapsed after surgery, surgical access during surgery, the location of implants, the presence of complications during breast enlargement, the preservation of sensitivity of the nipple-alveolar complex, blood supply. Therefore, when making a decision to perform plastic surgery on the breast, it is necessary to be aware of all the associated risks, both short-term and long-term.

The influence of the age of parents at the time of conception and pregnancy of the mother on the development of children is the subject of constant debate and research. Although modern medicine has made significant advances in reproductive health, age limitations for conception and pregnancy are still relevant. Having children from one or two middle-aged parents carries certain benefits and potential risks for both parents and their offspring. The literature review addresses some potential risks of an “unequal” marriage.

Teething in children is a normal physiological process consisting of the intraosseous movement of a tooth in the jaw until it appears in the oral cavity. This process may be accompanied by local and systemic symptoms. Currently, local medicinal and non-medicinal treatments for teething syndrome are recommended. As part of an integrated approach, it is rational to use Cholisal® dental gel, which has the necessary levels of safety for infants and effectiveness when used according to the instructions.

Introduction. Myelodysplasia is a collective term that combines a large group of spinal cord malformations with typical localization (most often within the L_I-S_V segments). If myelodysplasia manifests as a myelocele, it requires urgent surgical intervention in the first hours after the child’s birth to excise the myelocyte. Treatment and rehabilitation of such children include using technical means of rehabilitation (TMR): orthoses, mobile vehicles, compression garments, etc. Success in the treatment and socialization of the patient depends on an individual approach for selecting TMRs and their maximum fit to the child’s body. In many cases, mature deforming scars of the lumbosacral region in a child challenge achieving the goal of rehabilitation and socialization of a disabled child.

Aim. To evaluate the effectiveness of the local therapy regimen, including laser phoresis of the drug with proteolytic activity, Contractubex gel, and its subsequent application to the scar tissue area without laser phoresis in disabled children after surgical excision of a myelocele. The therapy’s effectiveness criteria include softening and flattening old hypertrophic scars, increasing range of motion, decreasing tissue tension in the lumbosacral region, and improving the scar’s aesthetic condition.

Materials and methods. The main group included 20 children, 8 females and 12 males. The children were 5–17 years old, with a mean age of 11 years. The control group included 20 children (7 females, 13 males) aged 2–16, with a mean age of 11. Contractubex gel, manufactured by Merz Pharma LLC, was used to treat mature postoperative scars of the lumbosacral region in 20 main group patients. Proposed method and treatment regimen: 7 daily procedures of laser phoresis of the gel on the scar area, followed by switching to daily topical gel application without laser phoresis for 3 months. Evaluated indicators included scar width, size, color, pigmentation, vascularization, density, itching in the scar area, pain, feeling of skin tension, limited mobility, defects on the scar (cracks, wounds, ulcers), aesthetic discomfort, and quality of life. Each indicator was evaluated with 0 to 4 points, where 0 is the absence of a sign, and 4 is the most pronounced dissatisfaction with the sign. Statistical analysis was performed using the Page test.

Results. As a result of the therapy using the proposed regimen, in the main group, there was an improvement in the quality of life of children of 24±3 points and the achievement of positive results in several criteria at once, such as a decrease in pigmentation and vascularization of the scar, a decrease in the density of the scar and a decrease in the feeling of tension in the soft tissues surrounding the scar. According to the study findings in the main group, the average score before the start of treatment was 21 points vs. 16 points after the treatment. In the comparison group, the average baseline score was 18 vs. 17 at the end of the study. Improvements in the main group of patients led to increased quality of life and the possibility of more comfortable use of various TMRs that affect the scar area (locomats, exercise machines, corsets, etc.).

Conclusion. Correction of mature postoperative scars in the lumbosacral region in children operated for myelocele with a Contractubex containing onion extract (Cepalin), heparin, and allantoin according to the regimen with sequential use of laser phoresis and application of the drug without laser phoresis to the scar area has shown its effectiveness and is quite promising. The proposed therapy method helps to solve such problems as increasing the range of motion, the possibility of using TMRs, reducing the tension of the surrounding tissues, and improving the esthetics of the scar.

Tuberculosis of peripheral lymph nodes is extremely rare, so when patients first contact a pediatrician due to enlargement of lymph nodes, it may be challenging to establish the correct diagnosis. To conduct a differential diagnosis between tuberculosis and nonspecific diseases, it is necessary to consider the medical history, paying special attention to the presence of contact with a patient with tuberculosis, and conducting a set of tests available to pediatricians and surgeons in general polyclinics and hospitals. The presented clinical case demonstrates the missed opportunities for timely diagnosis of tuberculosis in an adolescent, which led to the generalization of the specific process with involvement of peripheral lymph nodes and required several surgical interventions.

Introduction. Impaired immune status is common in children with burns, which contributes to the reactivation of persistent herpes infections (HI). The clinical presentation of a viral infection does not always fall within the scope of the classical manifestations of an infectious disease. Therefore, pediatricians and surgeons must work closely to ensure adequate treatment and diagnostic approaches in this category of patients.

Aim. A brief review of the literature on this topic and a summary of the results of the retrospective study on the features of the course, diagnosis, and treatment of HI in children with thermal injury.

Materials and methods. We conducted a retrospective review of the medical records of children with burns treated in the specialized department of the Speransky Children’s City Clinical Hospital No. 9, from 2022 to 2024 with a hospital stay of 3 or more days. The study included 718 patients [522 (73%) males and 196 (27%) females] aged 1 to 165 months [median (Me) 16 months]. Of these, 110 (15%) were tested for HI. The indications for the test included fever (>38°C) for two or more days during antibacterial therapy for burn wounds and the absence of any signs of acute respiratory viral infection. The type of viral infection, the need for surgery, and the duration of inpatient treatment were evaluated.

Results. Sixty-seven (9.3%) of 718 patients had laboratory-confirmed HI. The median age of children with burns and confirmed HI was 16 months [interquartile range (ICR): 13–21]. Most children with confirmed HI were males (45 [67.2%]). The average burn area was 6% of the body surface (ICR 5-9). Baseline fever reached 38.7°C (ICR 38.3–39). In patients with thermal injury, the most common were herpes virus type 6 (28 [41.8%] patients) and cytomegalovirus (15 [22.4%] patients). The overall duration of hospital stay of patients was 7 days (ICR 5–9) and 8 days (ICR 6–10) in patients with a confirmed HI, suggesting an extension of the treatment duration (p<0.05). Surgery was performed in 25.9% of patients in the overall group and 31.3% of children with HI activation (p>0.05). Thus, the infection was not associated with a higher rate of surgical interventions for deep skin lesions.

Conclusion. HI in children presented with fever and was detected only during differential diagnosis with other infectious complications. Activation of the infection leads to longer treatment due to slower regeneration; however, it is not considered a risk factor for surgical intervention. The choice of a topical treatment is based on many factors. When managing wounds with a suspected viral and bacterial association, it is recommended to avoid the use of occlusive dressings. Our experience shows that dressings based on an aqueous iodine solution are preferable in such situations.