BACKGROUND: In recent years, there has been marked a tendency to a sharp increase in the number of children with complaints of pectus carinatum. The literature describes only a few cases report of a combination of keeled chest deformity with a more serious pathology of the spine - Scheuermann-Mau disease.AIMS: The aim of the work is to study the frequency, clinical manifestations and methods of timely diagnosis of combined structural lesions of the thoracic spine in children with keeled chest deformity.MATERIALS AND METHODS: The observational single-center cross-sectional study included patients from 5 to 176 years old with pectus carinatum. Categorical values ​​were described by indicating absolute values ​​and percentages in the sample, quantitative indicators corresponding to the criteria of normal distribution were described by using arithmetic means (M) and standard deviations (SD), boundaries of the 95% confidence interval; quantitative indicators not meeting the criteria for a normal distribution were descrided by using the median and interquartile range (Me, Q1Q3).RESULTS: Scheuermann-Mau disease was detected in 11 (9.3%) of 118 children with pectus carinatum. Pterygoid scapulae noted in 97 (82.2%) children with pectus carinatum, increased cervical lordosis in 93 (79.7%) children, and sloping, anteriorly adducted shoulders in 99 (83.9%) children significantly hampered the clinical assessment of the magnitude of thoracic kyphosis. Rigid thoracic kyphosis at the time of examination was formed in 1 16-year-old boy. In children of the younger age group (514 years old), Scheuermann-Mau disease had no clinical manifestations and was detected only during screening X-ray examination, while in the older age group (1516 years old), 3 out of 4 adolescents complained on the back pain. CONCLUSIONS: The frequency of occurrence of Scheuermann-Mau disease in children with pectus carinatum exceeds the average prevalence in the population. In patients with keeled chest pterygoid scapulae, excess cervical lordosis, and rounded shoulders sloping shoulders are associated with the difficulty of assessment the magnitude of thoracic kyphosis. Asymptomatic progression of Scheuermann-Mau disease is typical for younger children with pectus carinatum, and the complaints of pain syndrome and clinical picture of the disease develop only by the age of 15-16.Thus, all patients with pectus carinatum and posture disturbance should undergo a screening X-ray examination of the thoracic and lumbar spine in order to detect Scheuermann-Mau disease and start treatment in time.

Background. Patients with clubfoot can have pain and functional disorders that lead to disability. Familiarity of obstetrician-gynecologists, general practitioners, surgeons with its early diagnosis and timely management may prevent disablement.Objective. The aim of the study is to analyze the opinion from parents of children with clubfoot on medical care via Ponseti method in outpatient center of surgery, traumatology and orthopedics.Methods. Cross-sectional study in the form of sociological survey (questionnaire) was carried out in N.F. Filatov Children’s City Hospital from March to December 2021 among parents of children with the following diagnoses: congenital bilateral clubfoot, congenital right clubfoot, congenital left clubfoot.Results. Respondents rated the quality of provided medical care and its availability, the hospital stay conditions by 10.0 points on the scale from 0 to 10. Territorial accessibility of medical care was estimated by 9.0 (7.0; 10.0) points, 30 out of 99 respondents (30.3%) required improvement in territorial accessibility (7 points out of 10 and below). Only 36.4% (36 out of 99) of children were sent to N.F. Filatov Children’s City Hospital for treatment by doctor of out-patient clinic. Others learned about this variant from the Internet, from acquaintances, etc. 10 out of 15 (15.2%) children with disabilities included in the study had difficulties in learning socially necessary skills. None of 10 children who have been diagnosed antenatally had any difficulties in learning socially necessary skills or disabilities. Mean age of disability was 10.6 ± 7.3 months. Children with disease diagnosed since birth had difficulties in learning socially necessary skills in 7.1% (2 out of 28) cases, and in 13.3% (8 out of 60) cases if diagnosed after birth (p = 0.356). Disability did not affect conditions in which children received treatment (14.6% and 20.0% of children under outpatient and inpatient treatment, respectively, had disabilities; p = 0.646). 26.7% of children with disabilities and only 11.9% of children without disabilities received treatment in hospital before the treatment (p = 0.218). 5.9% of children treated on outpatient basis had difficulties with learning socially necessary skills. Children treated on inpatient basis had difficulties with learning socially necessary skills in 35.7% cases (p = 0.005). The choice of outpatient or inpatient treatment did not depend on the presence of spina bifida (p = 0.276), children age (2.1 (0.7; 3.6) months vs 3.65 (0.6; 4.975) months, respectively; p = 0.309).Conclusion. Treatment can be delayed statistically significantly in case of late diagnosis, which is associated with the observed low awareness of doctors (working by the district principle) about specialized medical care. Ratio of children with disabilities and difficulties in learning socially necessary skills or disabilities is lower among patients with antenatal diagnosis. However, further studies are required for evaluation of these factors’ association.

Introduction. In the number of countries, the ambulatory direction in the domain of medical care has been created as an alternative one to hospitalization. This is a type of round-o’clock hospitalization which is a modern trend in medical care where a patient is in the center of progress and modernization of healthcare.Material and methods. The literature search was made in Scopus, MedLine, ELibrary, CyberLeninka, RSCI databases.Results. Over the past 30 years, the proportion of outpatient surgeries in children has significantly increased in developed countries. Such modality of medical care is provided in the overwhelming majority of cases. In Russia, in 2010-2018, the number of ambulatory surgical interventions increased by 15%, but this figure is still lower than in European countries. In pediatric surgical practice, there is no good evidence-based support yet for performing most of common surgical procedures outpatiently, due to the lack of well-planned randomized trials. However, the world’s widespread experience allows to suggest that routine surgical interventions could be recommended for outpatient care. Inpatient replacement technologies reduce health care costs because the inpatient care is a more expensive type of medical services.Conclusion. The outpatient medical care has to develop so as to transfer medical services from expensive hospital stay to much more economic and efficient one-day stay. At the same time, while developing the inpatient replacement technologies one must observe the basic principle – to ensure a high quality of medical care.