Introduction. Foreign bodies in the gastrointestinal tract are various objects of organic and inorganic origin, which are swallowed - not as food - either accidentally or intentionally. The article describes a clinical case of a 13-year-old child with multiple foreign bodies in his gastrointestinal tract which could cause serious complications, such as: perforation of hollow organs, peritonitis, intestinal obstruction, internal bleeding. By statistics, every fourth patient of the conscious age with foreign bodies in the gastrointestinal tract can potentially have problems in the neuropsychic sphere.Material and methods. A 13-year-old boy was admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) with nausea, repeated vomiting after each meal and water drinking. The careful anamnesis revealed that before the boy’s state deteriorated, he had swallowed a large number of magnets and metal objects within a short period of time. X-rays examination found multiple foreign bodies in his gastrointestinal tract. They were removed during esophagogastroduodenoscopy (EGDS) and surgical intervention.Results. The plain-film X-ray examination of the abdomen in the projection of the stomach revealed a radiopaque group of foreign bodies of a rounded shape as a conglomerate. At FEGDS, 54 objects were removed: 4 metal balls up to 0.5 cm in diameter, 47 round magnets up to 1.5 cm in diameter, a metal chain and two screws. During laparotomy and gastrotomy 99 foreign bodies were removed: 82 magnet balls 0.5 cm in size, 16 metal balls 1.5 cm in size, 1 bolt. The postoperative period was uneventful. The child was discharged on the 12 th day after surgery in the satisfactory state.Conclusion. Due to timely diagnostics and proper curative tactics, multiple foreign bodies were revealed and removed from the child’s stomach endoscopically and surgically within a short period of time. A correctly chosen curative tactics resulted in a complete recovery of the patient without complications on the 12th hospitalization day.

Introduction. In the present trial, the authors studied anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe traumas. Purpose. To study anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe injuries. Material and methods. 10 children, aged 13 ± 3 years, with severe trauma were taken into the study: 6 girls with mine-explosive injuries ( a terrorist attack in Kerch in 2018), 3 boys with multiple dog bites and one patient after a traffic accident. To treat them, 20-30% Xe with O2 was used. A session lasted for 20 minutes; the course included from 5 to 12 sessions. Device KTK-01 (LLC “KseMed”, Russia) was used. Pain intensity was assessed with the numerical rating scale (NRS) , sedative effect - with BIS index and Ramsey sedation scale. Patients’ blood was also examined for the level of somatotropic hormone (STH), cortisol (Co) and insulin. Results. Indications for Xe therapy in children were: persistent pain syndrome (PS) and acute stress disorder (ASD). Patients fell asleep (drug-induced sleep) under 20-30% Xe concentration in the respiratory mixture. The average values of BIS index decreased from 95.5 ± 2.5 U to 86.5 ± 5.0 U (p <0.05), and of Ramsay scale - from 5.5 ± 0.5 to 2.7 ± 1.2 points (p <0.05). Pain intensity by NRS decreased from 4.1 ± 1.8 to 1.1 ± 0.4 points (p <0.05). The level of stress hormones during Xe session went down: STH- from 4.8 ± 0.9 ng / ml to 1.9 ± 0.5 ng / ml (p <0.001); Ko - from 375.5 ± 23.6 nmol / L to 303.2 ± 20.7 nmol / L (p <0.0001); insulin - from 19.9 ± 3.6 pmol / L to 11.7 ± 2.7 pmol / L (p <0.001). To restore sleep, 2 - 3 sessions were needed; to relief PS - 5 sessions, to refuse of painkillers in phantom pains - 12 sessions. Conclusion. 20-30% Xe with oxygen therapy has a pronounced analgesic, sedative and anti-stress effect in children with severe injuries.

Introduction. Polytrauma (PT) in children is an important medical and social issue because it leads to a high percentage of disability and mortality in pediatric population. Destruction of the muscle mass in patients with PT causes traumatic rhabdomyolysis (TR) in 85% of cases. Such patients develop endogenous intoxication called “toxic-resorbtive state” (TRS) which is caused by the absorption of tissue degradation products into the systemic circulation.Purpose. The aim of the present study was to analyze publications on the diagnostics and treatment of “toxic-resorbtive state”, including extracorporeal techniques.Material and methods. We searched PubMed, Web of Science, Scopus, MEDLINE, eLibrary, and RSCI databases and found about 1800 references and 268 articles. We selected 38 articles for reviewing in traumatology, intensive care and extracorporeal methods.Results. In the acute period of injury, TRS is complicated by the acute kidney injury (AKI) in 5–25% of cases. Mortality in TRS is up to 20%; the leading cause of death is multiple organ failure. TRS markers are myoglobin, creatine phosphokinase lactate, LDH, AST and others. TRS therapy is aimed to prevent and to treat AKI. Continous renal replacement therapy (CRRT) for treating TRS allows to remove myoglobin, CPK and LDH from the circulation and to reduce mortality by half.Conclusion. In TRS management, there are no unified approaches to CRRT indications, regimens, session duration, and choice of optimal filters. In the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, a trial is planned aiming to assess CRRT effectiveness and safety of TRS treatment in children with polytrauma injuries.

Introduction. A comparative study on the effects of osmotic diuretics (OD) at parameters of water-electrolyte metabolism in children with brain injury was conducted. The researchers analyzed these effects depending on the treatment algorithm whether it was done by the Protocol or by generally accepted indications.   Material and methods. 51 case-histories of children with severe, combined TBI were taken for the analysis. The patients were treated with osmotic diuretics (OD) to relieve intracranial hypertension (ICH). All patients were divided into two groups: Group 1 ( studied group) – 25 children enrolled prospectively. In this group, OD were administered according to the Protocol. Group 2 (control group) – 26 children (retrospective group). In this group, OD was administered according to the accepted clinical recommendations.   Results. As it has been revealed, OD in the control group (Group 2) were used 8.7 % more often than in patients from Group 1 at Step 3 of the Protocol. In patients from Group 2, hypernatremia and hyperosmolarity had more persistent and pronounced type; such tendency persisted for the next 5–7 days of the study. However, there were no statistically significant differences between the groups in average values of sodium levels and osmolarity of blood plasma under ICH therapy. The conducted statistical analysis has shown that the lack of reliable differences is associated with a significant variance of analyzed indicators in Group 2. At the same time, we registered a statistically significant increase (p < 0.05) of unfavorable outcomes in Group 2 by 24.9 %.   Conclusion. Regular and rationally frequent administration of osmotic diuretics leads to less persistent violations of water-electrolyte metabolism. A prerequisite for the effective management of traumatic ICP in children is monitoring the intracranial pressure (ICP) and cerebral perfusion pressure (CPP).

Author affiliation:Bykov Mikhail Viktorovich, MD, anesthesiologist and resuscitation specialist at the department of anesthesiology and resuscitation of the research institute of emergency pediatric surgery and traumatology Address