Vol 3, No 1 (2021)

Background. Fractures of the distal leg bones in children, due to the peculiarities of localization, the presence of a growth zone, the proximity of the joint and the involvement of the ligamentous apparatus in the pathological process, present a difficult problem in the choice of treatment and rehabilitation. Aims: In order to our aims we create the diagnostic and treatment algorithm in the system of early rehabilitation after fractures in the distal part of the shin bone in adolescence. Methods. Our clinical investigation based on the treatment of 56 patients in the age 8–17 years. Cohort of patients consist from three age groups: 8–11 years (n=13), 12–14 years (n=28) and 15–17 years (n=15). Examination was done with X-rays, CT and Ultrasound, specialy in the cases where the damage of ligamentous apparatus was suspicious. The main method of treatment was surgical — osteosynthesis by pins, plates and screws. In the rehabilitation period the legs were immobilized by Plaster of Paris for 4–6 weeks. Results. In majority of cases the outcomes in the period of 6–8 weeks after trauma were good and satisfactory. The method of laser Doppler fluometry was performed in 16 cases in follow up period after trauma for examination of the regional blood circulation as a argumentation of regeneration process. Conclusion. The different choice in treatment of compound fractures of the distal part of the shin bones according to morphological changes in adolescence permits to aid good results in majority of caces.

The number of victims with difficult defects of the skull bones, which should restore the integrity of the skull is growing annually, both in connection with the increase in severe traumatic brain injury (TBI), and in connection with the expansion of indications for decompressive craniotomy not only in traumatic brain injury, but also vascular disease, neuro-Oncology for the relief of hypertension-dislocation syndrome. Cranioplasty at the stage of early rehabilitation of patients after decopressive craniotomy is an important condition for effective rehabilitation measures. Currently, titanium, polyether ethyl ketone (PEEK), polymethyl methacrylate (PMMA) and hydroxyapatite are actively used as the material for the implant. Unfortunately, none of the synthetic materials used meet the conditions of the «perfect implant» by 100%. CAD/CAM 3D printing technologies are used to achieve absolute accuracy of the implant that replicates the missing part of the patient’s skull bone, which is especially important in the presence of extensive and complex defects. The use of this technology at the preoperative stage directly in the medical institution where the cranioplasty will be performed avoids additional logistics, reduces the time from the patient’s admission to the hospital before the operation and reduces the cost of manufacturing implants, making them more accessible to healthcare institutions. also, the absence of the need for intraoperative implant adjustment significantly reduces the operation time, reduces the risk of infectious complications and complications associated with prolonged general anesthesia. The favorable course of the postoperative period allows you to resume rehabilitation activities on the third or fourth day after cranioplasty.

The need for respiratory therapy can reach 90% depending on the category of the intensive care unit and intensive care unit (ICU). Currently is a wide selection of respiratory therapy methods, including fully controlled mechanical ventilation and assist ventilation. The widespread use of mechanical ventilation and its varieties significantly reduced the mortality of ICU patients. However, the mortality of patients from acute respiratory distress syndrome, nosocomial pneumonia, and newborns with respiratory disorders remains high. High-frequency mechanical ventilation (HFMV) is an alternative treatment for severe respiratory failure, but the frequency of use is not yet sufficient. Three main types of HF ventilation is currently available: high-frequency positive pressure ventilation (HFPPV), high-frequency jet ventilation (HFJV) and high-frequency oscillatory ventilation (HFOV). There is an opportunity to choose a specific mode which will be most applicable for a particular patient. The use of the HFOV method allows the successful treatment of newborns with severe respiratory failure due to primary surfactant deficiency, meconial aspiration or multiple organ failure. Recently high amount of publications appeared on the possibilities of non-invasive HFMV in both adult patients and in pediatrics. This mini-review is devoted to this problem.

The Russian statistics demonstrate that in Russia, brain injuries are increasing every year what is particularly tragic if to speak about children. After traumatic brain injury (TBI), the process of consciousness restoration develops in stages. In Russian science, stages of mental recovery in adults are described by the neuropsychiatric group of researchers from Burdenko Institute of Neurosurgery. The authors have introduced the term «amnestic confusion» to designate the stage at which there is a possibility to have the verbal contact with amnestic defects and disorders of orientation in time and space. In foreign literature, this stage is defined as «post-traumatic state of confused consciousness» (PTCS). In children (adolescents), the state of confused consciousness after traumatic brain injury is met in about 80%. The aim of the study was to make a detailed description and phenomenological analysis of some psychological characteristics of the confused state in adolescents after brain injury what will add to the overall picture of medical and neuropsychological examinations. 62 teenagers in the confused consciousness state after TBI were taken into the study. The authors present their observations and analysis of such psychological phenomena as behavioral and emotional characteristics, social intelligence, gender and age identification.

Background. The wide and rapid spread of the new coronavirus infection, unfortunately, makes its own adjustments in clinical practice, including in the promotion of specialized care for oncological patients. Clinical case description. The authors demonstrated an example of a successful radical treatment of adenocarcinoma of the esophageal-gastric junction, complicated by dysphagia and recurrent bleeding from the tumor. Аn integrated approach, gastrostomy, adequate correction of concomitant diseases and timely vaccination against COVID-19 made it possible to carry out a full-fledged intervention in a timely manner. Conclusions. Radical treatment of patients with gastrointestinal toncological diseases in a severe viral pandemic is possible. Emergency vaccination significantly reduces the risk of developing severe respiratory and other disorders.

The most common cause of neurological disability in childhood is cerebral palsy. The objectives of the treatment of children with cerebral palsy are the acquisition and maintenance of new motor skills; prevention of the development of contractures and other secondary orthopedic complications; decrease in the level of pain; improving the level of childcare. At the same time, the provision of treatment and rehabilitation assistance to children with cerebral palsy requires an integrated, systematic approach. The article describes the route of rehabilitation of children with cerebral palsy in the Chuvash Republic from the moment of diagnosis until reaching the age of 18. The study was carried out on the basis of an analysis of data from the regional register of children with cerebral palsy at all stages of treatment and rehabilitation (habilitation). The first stage includes the identification of risk groups for cerebral palsy, conservative, surgical specialized medical care. The register of children with cerebral palsy made it possible to keep records of patients at the stages of treatment and rehabilitation with an assessment of the results. At the second stage, high-tech conservative and surgical treatment is carried out. After operations, patients are sent for rehabilitation to a 24-hour hospital or to a Rehabilitation Center for Children (over 3 years, 1.5 thousand children were treated, 25.7% — after operations). The third stage is organized at the outpatient clinic level and in specialized sanatoriums. For 2014–2018 the coverage of children with cerebral palsy with conservative treatment increased 1.9 times, with botulinum therapy — 2.6 times, the proportion of those who received surgery decreased to 22.4%. 92.7% of patients of the Register are covered by conservative treatment. 33.3% of operated children were referred for sanatorium-resort treatment. The control section of the rehabilitation results showed an increase in the proportion of children with improved gait quality, the ability to stand independently, walk (with support), and an increase in the average level of physical activity. A multi-level system of interagency interaction in the provision of treatment and rehabilitation assistance to children with cerebral palsy in Chuvash Republic made it possible to ensure a sufficient amount of basic and availability of highly qualified medical care, effective management and control of the stages of rehabilitation.

The first experience of organizing specialized care for patients with the novel coronavirus infection COVID-19 on the basis of the leading multidisciplinary hospital of the Ministry of Defense of Russia — FSBI «3rd Central Military Clinical Hospital named after A. A. Vishnevsky». Aims: to scientifically substantiate and develop organizational and methodological recommendations for re-profiling a multidisciplinary hospital to create a multifunctional medical center for the treatment of the new coronavirus infection COVID-19. Based on the regulatory and organizational and methodological documents (Orders and Resolutions of the Government of the Russian Federation, orders of the Ministry of Health of the Russian Federation, directives and orders of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation), a set of measures was taken to create a multifunctional medical center for the treatment of the new coronavirus infection COVID-19. Algorithms for organizational, diagnostic and therapeutic resource-saving technologies, as well as standard operating procedures for assisting patients with the novel coronavirus infection COVID-19, have been developed and tested. Within the framework of the «medical association» of the Federal State Budgetary Institution «3 CVKG im. A. A. Vishnevsky», the Ministry of Defense of Russia created a system for the provision of specialized medical care to patients with the new coronavirus infection COVID-19 with the established routing and provision of specialized medical care with elements of high-tech medical care, including extracorporeal membrane oxygenation, biological anti-cytokine therapy. Conclusion. The accumulated experience in the work of the newly created center for the treatment of patients with the new coronavirus infection COVID-19 can be used for further medical activities of medical organizations of military and civilian health care.