Vol 37, No 2 (2020)

The review presents the data of actual publications for 2019-2020 regarding the course of a new coronavirus infection COVID-19 in children and adults. The features of a new coronavirus SARS-CoV-2, the causes of its tropism to human respiratory system are discussed. The questions of clinical and roentgenological manifestations of lung affection in COVID-19 among children and adults are described in details. The adult COVID-19 is characterized by the presence of clinical symptoms of acute respiratory viral infection: elevation of temperature (> 90 %), cough (dry or with small amount of sputum) in 80% of cases, dyspnea (55 %), fatigability (44 %), sense of stiffness in chest (> 20 %). The most severe dyspnea is being developed by the days 68 from the moment of falling ill. Separately, the peculiar features of computed tomography of the lungs in children and adults with COVID-19 are discussed. The typical signs for CT-picture of the lungs in children with COVID-19 infection and pneumonia are bilateral affection, infiltration with a typical surrounding aureole – the sign of “halo”, the symptom of “opal glass” with predominantly peripheral localization and often in combination with elevated procalcitonin level. The cases of pneumonias in newborns and children of the first year of life with COVID-19 infection are considered in the paper. A clinical case with roentgenograms of thoracic organs and results of computed tomography accompanying is presented as an illustration. The high-risk groups of complicated COVID-19 course can include children with chronic bronchopulmonary diseases, patients with immune deficiencies, hemodynamically significant heart failures and chronic renal disease.

Objective. To study the clinically significant differential diagnostic signs of mumps.

Materials and methods. Medical records of hospital patients (form № 003/у) with mumps (n = 12) and extraordinary report of epidemiological detection of epidemic mumps focus over the period 27.11.2017 to 02.02.2018 among the members of Hockey Club “MP” were used. Quantitative data are presented as M ± α, where M – mean value, α – standard deviation; indices characterizing qualitative signs were determined in percent (%).

Results. Clinical-laboratory features of mumps during outbreak in conditions of multiyear practice of vaccine prevention are presented. Among the hospitalized patients, inflammation of parotid gland was observed in 100 %, pancreatitis – in 83 %, orchitis – in 25 %. These cases of disease in Russia are interesting in connection with a single registration of clinical cases of infection for the recent years – sporadic level of disease. The cases of disease are presented by clinical and laboratory manifestations of the same type in an organized group of subjects going in for sports, who came from North China.

Conclusions. During mumps outbreak in Perm, the clinical picture was characterized by a unilateral inflammation of the parotid salivary glands followed by bilateral damage and involvement of other glandular organs (pancreas, ovaries). The cause of mumps ictus in the studied territory was the infection, brought to an organized team of the hockey club “MP” against the background of reduced with age concentration of the level of protective antibodies to mumps.

Objective. To analyze the most frequent diagnostic, tactical and technical errors of young doctors, leading to postcholecystectomy syndrome.

Materials and methods. The analysis was based on the clinical material of 87 patients from the Surgical Department of Regional Clinical Hospital №1 and City Clinical Hospital №2 of Izhevsk regarding reconstructive and restorative surgeries on the biliary tract for the last 40 years (1978–2018).

Results. The reasons, causing iatrogenic injuries of the bile ducts during cholecystectomy, are diagnostic, tactical, technical. Diagnostic errors are more often associated with inadequate diagnosis of cholelithiasis and cholecystitis (underestimation of history, complaints, clinical picture of the disease and its complications; failure or impossibility of FGDS; insufficient topical diagnosis while ultrasound investigation of the biliary tract and abdominal organs). Tactical errors in surgeries on the gallbladder include: overly expectant tactics, incorrect choice of surgical approach and method of anesthesia, lack of experience of the surgeon, inadequate revision of the biliary tract during surgery, refusal from surgical cholangiography and external drainage of the choledoch in case of doubtful patency of the bile duct. Technical reasons are specific features of the anatomy of the extrahepatic biliary tract, factors complicating the surgery, violation of surgical technique when performing an operation on the bile duct.

Conclusions. Correct and timely diagnosis of bile diseases as well as qualified technique of surgical intervention will minimize the development of post-cholecystectomy syndrome and other iatrogenic complications.

Objective. To study the functional state of the musculoskeletal system in patients with Legg – Calve – Perthes disease after surgical treatment.

Material and methods. The study of 31 patients at the age of 8 to 13 years with unilateral Legg – Calve – Perthes disease (LCPD) was performed in the period from 2 to 5 years after surgical treatment. In the control group (15 children), correcting (varus) osteotomy (VO) was fulfilled, in the main group (16 children) – triple pelvic osteotomy (TPO), and the group of healthy children (18 persons) was examined as well. Walking biomechanics was studied using of the STEDIS complex (Neurosoft LLC, Ivanovo, Russia). The vertical balance of the body was evaluated on a stabilometric platform MBN "Biomechanics" (LLC NMF MBN, Moscow).

Results. After surgical treatment, the indicators of vertical balance and biometry of the step phases in both groups of children with LCPD did not reach the same level as in healthy individuals at the indicated follow-up dates. The least significant indicators of step phase asymmetry were found in patients after TPO compared with patients after VO. In patients after VO, the destabilization of the center of pressure significantly exceeded that in patients after TPO.

Conclusions. Biomechanical studies allow us to compare the functional results of various techniques of surgical treatment of children with unilateral LCPD. After TPO operation, patients have a more complete restoration of the supportability of the affected lower limb compared to VO operation.

Objective. To evaluate the effectiveness and improve treatment outcomes for patients with acute abdominal pathologies using video laparoscopy. Materials and methods. The paper is based upon a ten-year experience of using video laparoscopy in emergency abdominal surgery. Within a decade (2008 – 2018), 23127 patients had been admitted to the surgical department of City Emergency Hospital in the city of Rostov-on-Don; among them 19748 patients were operated on. Video laparoscopic surgeries for acute appendicitis, acute cholecystitis, acute intestinal obstruction, perforated gastric and duodenal ulcers, and other acute abdominal surgical pathologies were performed in 15124 patients; the share of these interventions was 76.6 % of all cases.

Results. Initially, when laparoscopy was introduced in emergency abdominal surgery, diagnostic laparoscopy was used in more than a half of the performed surgeries, mainly for acute appendicitis and abdominal injuries. Today, video endoscopic surgery is widely used for acute cholecystitis, acute pancreatitis, perforated ulcers, strangulated hernias, torsions of epiploic appendages of the colon and of the greater omentum. An effective use of video laparoscopy for therapeutic purposes allows increasing the number of laparoscopic operations performed in patients with emergency surgical pathology of abdominal organs.

Conclusions. Video laparoscopy in urgent surgery allows establishing a diagnosis in time, performing dynamic video laparoscopy, eliminating concomitant pathology, diagnosing and, in some cases, preventing postoperative complications. Video laparoscopic surgery is easier for patients to tolerate; it reduces the number of complications, the period of staying at the hospital and the rehabilitation period, and opens up new possibilities for helping patients with emergency surgical conditions.

Objective. To study and estimate the quality of life in patients with nodular and multinodular forms of euthyroid goiter prior to the surgery and in different postoperative periods.

Materials and methods. The method of random study was used to examine 100 patients with nodular and multinodular forms of euthyroid goiter, who were treated at Perm Regional Treatment and Diagnostic Center “Center of Hepatic and Endocrine Surgery” in 2009–2017. To study patients’ quality of life, SF-36 survey was used. The quality of life indices were assessed prior to the surgery, 1 and 6 days after the surgery as well as 3 and 6 postoperative months.

Results. The quality of life in patients with nodular and multinodular forms of euthyroid goiter is subjected to the influence of not only preoperative factors but also factors, occurring in both early and long-term postoperative periods. Special attention is to be paid to psychological factors of the preoperative period. Three and six months after the surgery, patients with initial compression of cicatricial deformity of the neck organs had improved psychoemotional indices.

Conclusions. Studying of the quality of life permits to estimate the efficiency of surgical treatment in patients with thyroid diseases. Relative decrease in the quality of life indices among patients with nodular and multinodular forms of euthyroid goiter are most evidently manifested in the early postoperative period. In case of favorable course of the postoperative period, improvement of physical activity is observed in 5 days, psychological – in six months. Six months later, the quality of life indices in patients with both forms of goiter did not differ from those in the comparison group.

March 23, 2020 marks the 120th anniversary of the birth of the famous scientist who left a bright trace in Russian science, A.V. Pshenychnova. Alexey Vasilievich - creator of the Perm School of Microbiologists, Honored Scientist of the RSFSR, State Prize Laureate, Doctor of Medical Sciences, Professor.