Торсійна патологія великого чепця у дітей: огляд літератури та власні клінічні спостереження 1 Вінницький національний медичний університет імені М.І. Пирогова, Україна 2 ВДНЗУ «Українська медична стоматологічна академія», м. ПолтаваПерекрут великого чепця є рідкісною причиною болів у животі у дітей. Здебільшого у пацієнтів виникають гострі болі в правому нижньому квадранті живота, які зазвичай симулюють гострий апендицит. Перекрут великого чепця рідко діагностується до операції, зазвичай діагноз встановлюється тільки під час операції, яка виконується з приводу підозри на гострий апендицит або іншу невідкладну патологію органів черевної порожнини. Причини перекрута великого чепця не встановлені, проте можливо диференціювати вторинний перекрут, що виникає за наявності органічної причини завороту, і первинний, коли такої причини немає. Лікування тільки хірургічне.У статті наведено огляд літератури за темою, а також аналіз власних клінічних спостережень перекруту чепця у дітей.Ключові слова: діти, перекрут чепця, гострий живіт.

Today septic wound treatment demands from a surgeon a multipurpose approach. For the reason of the microorganisms’ resistance to antibiotics, specialists have to use more often various dosage forms of antiseptics. According to the topical cement antibiotic form, which is used in traumatology and orthopedics, the new antimicrobial polymer compound was designed, that contains decametoxinum. Previous studies in vitro proved the sustained-release of the agent. The purpose of our experiment is to study the treatment effectiveness of the new polymer compound dosage form of the decametoxinum in comparison with other treatment methods of septic-necrotic processes of soft tissues. We estimated on laboratory animals the effectiveness of alternative treatment approaches of the septic wound management, which were caused by S.аureus and P.аeruginosa, in different groups, including those where the new antiseptics’ dosage form was used. Three groups of the septic experimental wounds were treated by the principles of monotherapy — with liquid solution of decametoxinum, depo-form of decametoxinum and with intramuscular (IM) injection of etiological antibiotic — amikacin. The animals in fourth group received multipurpose treatment — depo-form of the decametoxinum topically with amikacin IM. Fifth group — was the control one. Visual estimation, bacteriological investigations were held according to the stages of the wound healing process. Macroscopic assessment of the wounds showed the best treatment effect in groups with depo-form application, especially during the first stage of the healing process. Finally, it was revealed that in groups where different dosage forms of decametoxinum were used the effectiveness of decontamination process was almost the same. But the wounds’ redressing with depo-form of decametoxinum was carried out once in three – four days, in comparison with daily redressings of the wounds in the group where it’s liquid form was used. The sanitation effect was more vital against P.aeruginosa, then in relation to S.aureus. The best results were received in the multipurpose treatment group — the complete bactericidal effect against all microbe populations was achieved. That grants us an idea about possible potentiation of the system antibiotic by topical antiseptic.

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Annotation. Chronic colostases are characterized by the absence of independent bowel movements due to disturbance of intestinal contractility and evacuatory function of the large intestine which have a negative influence on the development of an organism. The purpose of the study is to evaluate a possibility of predictive diagnostics of motility disorders of the large intestine in children with chronic constipation due to organic causes. The study is based on the determination of serum cholinesterase level in 67 patients of both sexes (main group) which included 25 children suffering from pathology of aganglionic genesis and 42 patients with non-aganglionic congenital anomalies of the large intestine. The average age of the patients was 11.5±0.8 years. The control group included children without any pathologies of gastrointestinal tract and central nervous system. The quantitative determination of cholinesterase level was performed by the photometric method described by Molander and Friedman. The group of children suffering from large intestine anomalies of non-aganglionic origin showed an increase in serum cholinesterase level by 1.08 times. The group of children with anomalies of aganglionic origin showed an increase in cholinesterase level by 1.15 times. The increase in cholinesterase level in patients suffering from colostases of non-aganglionic origin can be regarded as a prognostic indicator having the signs of a factor of organic origin. The increase in cholinesterase level in patients suffering from disorders of aganglionic origin shows the presence of neurobiological changes which cannot be solved simply by surgical correction of a congenital anomaly of the intestine.

Summary. The aim of the study was to present an argument for treatment algorithm of patients with extremity gunshot injuries complicated by suppurative inflammation. Materials and research methods. Examination and treatment of 163 patients with gunshot wounds of the extremities were performed. All the wounded were divided into 3 study groups. The patients of group 1 underwent conventional treatment of gunshot wounds. In group 2, negative pressure wound therapy was used. Wounded patients of group 3 received vacuum-assisted therapy supplemented by the proposed scheme of counter-drainage and flow-through flushing irrigation of wounds with antiseptic solutions of 0.02 % decamethoxine and 3 % hydrogen peroxide. Bacteriological study of wound exudate was carried out, and sensitivity of microorganisms to antibiotics was determined. Results and its discussion. Wound microbiology analysis in victims of blast and mine-blast injuries demonstrated predominance of gram-negative bacteria in wound microbiocenosis — Acinetobacter spp. (53 % of cases) and Pseudomonas spp. (15 % of cases). Gram-positive cocci were isolated in 22.2 % of cases. Sensitivity study of nonfermentative gram-negative rods demonstrated them to have high level of resistance to most antibacterial agents. All strains of Acinetobacter and Pseudomonas spp. were sensitive to polymyxin B and colistin but resistant to inhibitor-protected and -unprotected amino penicillin. Beneficial effect of vacuum therapy in patients of groups 2 and 3 was evidenced by significantly reduced time of wound healing and hospital stay. The use of suggested mixture of antiseptics resulted in decrease of inflammation in 94.45 % and 88.89 % of patients in groups 3 and 2, respectively. Besides, in group 3, duration of hydration phase in wound healing process decreased to 5.7 days. The period of complete wound healing was shorter by 2.5 days, and hospital stay decreased from 14.97 to 10.8 days. Conclusions. Thus, predominance of gram-negative microorganisms in gunshot wounds as well as their high resistance to antibiotics should be considered when undertaking empirical antibiotic therapy in wounded patients. The proposed treatment algorithm involving negative pressure wound therapy supplemented with counter-drainage and flow-through flushing irrigation with a mixture of suggested antiseptics proved to be highly efficient in patients with extremity gunshot injuries complicated by suppurative inflammation.