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Biomedical subjects

E A Stepanov

Publications and source records attributed to E A Stepanov.

At least 19 recordsLinked to original sources
PubMed2003

[Preoperative care and surgical treatment of small-intestinal fistulas in children].

Experience in using complex treatment in 42 children with unformed small-intestinal fistulas, generalized defects of the anterior abdominal wall and severe disorders of alimentary status is presented. Their preoperative preparation included parenteral alimentation, enteral probe feeding with special elementary milk formulas, correction of metabolic disorders. Intestinoplication during surgery was carried out with the medicinal glue MK-7 to prevent intestinal obstruction and formation of interloop abscesses. The use of portions of the tendinous part of the musculus tensor fasciale late was one the simple and effective methods for plasty of anterior abdominal wall defects.

Adolescent↗
PubMed2003

[Thoracoscopic and video-assisted surgeries on thoracic organs of children].

Forty-seven video-surgical thoracic operations performed in children are analyzed. Age of children ranged from 4 days to 14.5 years, body weight--from 700 g to 54 kg. Two types of surgeries are singled out--thoracoscopic and video-assisted (when minithoracotomy was performed in addition to thoracoscopic technique). There were no severe complications during surgery. One child died due to non-diagnosed penumothorax on the 4th day after surgery. Problems of anesthesia and surgical technique in children are considered.

Adolescent↗
PubMed2003

[Artificial esophagus in children].

The aims of the study were: 1) to formulate up-to-date principles of coloesophagoplasty (CEP) and to compare methods of CEP; 2) to determine the optimal age for esophagoplasty in children with esophageal atresia; 3) to evaluate quality of life and long term results after esophagoplasty performed in childhood; 4) to present results of surgical treatment of pharynx stenosis in children. Over the last 50 years more than 2 thousand surgeries on the esophagus in children were performed including more than 600 operations of artificial esophagus creation. From 1995 in some patients we carried out extirpation of the esophagus with one-stage plastic operation coloesophagoplasty taken the transplant in the posterior mediastinum. From 1992 on the pharynx with free revascularized intestinal segment was performed in isolated stenosis of the pharynx. Case histories of 54 children aged from 3 months to 15 years were analyzed to compare methods of esophagoplasty when the esophagus was taken behind the sternum and in posterior mediastinum. Case histories of 27 children with atresia of the esophagus were analyzed for determination of optimal age for coloesophagoplasty. Responses to questionnaires were analyzed to evaluate quality of life. From 1980 ive hase operated 28 patients with scarry stenosis of the pharynx (isolated or in combination with esophageal stenosis). Current policy of surgical treatment of pharyngeal stenosis which is considered as surgery of choice-pharyngoplasty with a free intestinal transplant--is described. Development and clinical appliance of up-to-date principles of CEP permitted to reduce the number of complications and to decrease lethality from 3 to 0.5%. After introduction of antireflux cologastroanastomosis the number of complications due to reflux reduced. Extirpation of the esophagus may be valid in peptic stenosis, Barrett's metaplasia, tumors, portal hypertension or angiodisplasia, and in the majority of cases of scarry stenosis of the esophagus.

Adolescent↗
PubMed2003

[Laparoscopic surgery in children--current possibilities and perspectives].

Experience in use of different laparoscopic methods in 6046 children who needed urgent and elective surgeries are analyzed. Urgent surgeries were performed in 3292 children for acute appendicitis and it complications, acute adhesive intestinal obstruction, invagination, trauma of abdominal organs, pathological changes of Meckel diverticulum, urgent inflammatory and non-inflammatory gynecological diseases. In this group endosurgery was successful in 3120 (94.8%) patients, conversion to open surgery was necessary in 5.2% cases (172 patients). Laparoscopic cholecystectomy, splenectomy, nephrectomy, surgeries for cysts of parenchymatous organs, benign cysts and tumors of abdominal cavity and retroperitoneal space, varicocele, syndrome of unpalpable testes and abdominal cryptorchism were performed as elective surgeries in 2754 patients. Endosurgical methods to minimized number of complications (1.1% or 29 patients in the whole group), conversion to open surgery was necessary in 10 (0.4%) cases. Laparoscopic methods in many cases are the "gold standard" in elective and urgent surgery in children.

Adolescent↗
PubMed2002

[Quality of life in patients after coloesophagoplasty, performed in childhood].

Based on questionnaire, the authors analyze long-term results of coloesophagoplasty in 32 patients operated from 1990 to 2000. At the moment of operation age of the children ranged from 3 months to 14 years (5 years, on the average). 1 (3.1%) patient died at the age of 15 years, 9 years after esophageal plasty. Long-term results were evaluated in 31 respondents. Most respondents (81.3%) evaluate their state late after coloesophagoplasty as good and satisfactory. All the respondents take meal without assistance 74% patients don't keep a diet. Respondents with severe concomitant diseases (VACNERL--syndrome, bullous epidermolisis, CNS disorders) evaluate their state as unsatisfactory. In children after coloesophagoplasty falling behind growth (48%) and weight (62%) was revealed due to disease and low living standard. 89.5% respondents evaluate their quality of life as satisfactory.

Adolescent↗
PubMed2002

[Treatment policy for children with gastroesophageal reflux complicated by Barrett esophagus].

Barret's esophagus (BE) is a rare disease in children. It is caused by gastroesophageal reflux (GER). From 1996 to 1999 seventy-eighth children with GER were treated. Twenty-four-hour pH-metry and manometry of the esophagus, scintigraphy and contrast roentgenoscopy of the esophagus were used for diagnosis of GER. All the children underwent biopsy of mucosa membrane of distal esophagus. Morphologic examinations revealed BE in 16 (20.5%) children. Metaplasia of esophageal epithelium by intestinal type (IT) in combination with one by gastric type (GT) were revealed in 8 children, metaplasia by gastric type alone (epithelium of gastric and fundal parts of the stomach)--in 8 children. Six children with IT metaplasia of the esophagus with long strictures underwent extirpation of the esophagus with one-stage esophagoplasty. It esophageal stenosis is not long or is absent, fundoplication by Nissen (4 children) and drug therapy (6 children) are performed. It is concluded that in IT metaplasia of the esophagus with long peptic esophageal strictures resistant to bouginage extirpation of the esophagus with one-stage coloesophagoplasty is desirable. Other methods of treatment do not exclude probability of esophageal adenocarcinoma. These children should be followed up with esophageal biopsy each 6-12 months.

Adolescent↗
PubMed2000

[Surgical treatment of fecal incontinence in children].

The experience of the faeces incontinence treatment in 295 children (age ranged from 1 to 15 years) is presented. Several original operations for surgical correction of the sphincter ani asthenia are proposed. The authors think that radical correction of faeces incontinence in children is necessary as early as at the age 6 to 7 years that is at the beginning of social activity. Efficient use of the above methods of the rectum closing apparatus creation allowed to achieve good results in 77.3-85.7% of the children.

Adolescent↗
PubMed1996

[Treatment of chemical burns of the esophagus in children].

On the basis of experience in the treatment of 2339 patients with chemical burns of the esophagus the authors hold that, despite its traumatic character, early prophylactic bougienage is the method of choice in the prevention of cicatricial esophageal strictures. The method has become more effective today because the aggressive properties of cauterizing agents have been significantly reduced in the recent decades. The use of modern fiberoptics has greatly widened the diagnostic possibilities of endoscopy. The above circumstances have made it possible to develop and introduce into clinical practice a new differential approach to the diagnosis and treatment of chemical burns of the esophagus in children. This complex method allows, with much probability, to differentiate Degrees II and III burns in the early periods and thus free a large group of patients with Degree II esophageal burn from needless bougienage. The method leads practically to 100% prevention of stenoses and complete restoration of the organ function, reduces markedly the period of hospitalization of the patients, and allows outpatients treatment in 42% cases.

Burns, Chemical↗
PubMed1995

[Plastic surgery of the pharynx and cervical esophagus using a revascularized intestinal segment in children].

Three children with isolated cicatricial stenosis of the pharynx and cervical esophagus were subjected to operation for segmental plasty with a free intestinal segment (2 jejunal and one sigmoid). In all cases the segment was anastomosed with the side of the carotid and internal jugular vein on the neck under 3.2 magnification. No complications occurred. The results of the operation showed a high effectiveness of segmental plasty in stenosis of the cervical esophagus. In cicatricial stenosis of the pharynx, in addition to restoration of normal deglutition, breathing through the pharynx must be fully restored, which makes segmental reconstruction of the pharynx in children more difficult.

Burns, Chemical↗
PubMed1995

[Late complications after surgery for high congenital intestinal obstruction in children].

The work analyses the experience in examination and treatment of 31 patients with late-term complications after operations for various types of acute and chronic high congenital ileus. Five groups of children were set apart according to the character and anatomical cause of the complication. The characteristics of late-term complications, their clinical manifestations, and methods of repeated surgical interventions are given. The most difficult for treatment were complications which had developed after creation during the primary operation of gastroentero-anastomoses for an annular pancreas (5 patients) and membranous atresia of the duodenum (one patient). It is concluded that the performance of this operation is not advisable.

Adolescent↗
PubMed1994

[Sacral proctoplasty in the treatment of anorectal malformations in children].

The paper describes novel procedures for sacroperineal, sacroabdominoperineal and posterosagittal proctoplasties during radical correction of various types of anorectal malformations and their sequelae in children of all age groups, including neonates. Some technical features of their performance are considered and the outcomes of treating 84 children are analyzed. The proposed scheme for surgical treatment allows one to achieve good and satisfactory late functional results in 80 per cent of patients with anorectal atresias and incontinence of feces.

Anal Canal↗
PubMed1994

[Hirschsprung's disease in newborns].

The authors examined and treated 52 newborn babies and infants with Hirschsprung's disease. The total form was encountered in 25%, the subtotal in 23.1%, the rectosigmoid in 36.5%, the rectal in 9.6%, and the supraanal in 5.8% of cases. The clinical picture was characterized by retention of meconium (94.2%), regurgitation or vomiting (75%), abdominal distention (100%). Irrigography with calculation of the rectosigmoid ratio was conducted in 35 children, histochemical examination in 46, and histological examination in 38 children. Twenty-four (68.5%) children had the third phase of disturbed proportion of the intestinal bacteria with clinical manifestations of enterocolitis. Emergency decompression of the intestine for low acute intestinal obstruction was carried out in 27 newborn babies. Twenty children were subjected to radical surgery in the first 2-4 months of life. The choice of the operative method was guided by the form of the disease and the length of the aganglionic zone.

Biopsy↗
PubMed1994

[Development of methods of esophagoplasty in children].

In the Clinic of Pediatric Surgery of the Russian State Medical University 310 operations for esophagoplasty were performed using segments of the small and large intestine. The 50-year progress in the creation of an artificial esophagus is characterized by gradual advancement from prethoracic plasty after Roux-Herzen-Yudin to the refined method of retrosternal coloesophagoplasty. The incidence of the characteristic postoperative complications reduced by 3 to 10 times, necrosis of the transplant was practically not encountered, the mortality reduced to 1.2%, and the functional results improved significantly.

Anastomosis, Surgical↗
PubMed1993

[Portal hypertension in children: venous shunting in the early childhood].

Operations were carried out on 98 children with extrahepatic portal hypertension and on 6 with intrahepatic block and no signs of hepatocellular insufficiency. Mesenterico-caval H-shunt was formed in 78 children with the use of the internal jugular vein as the insert. The remaining children underwent formation of mesocaval anastomosis (8), distal spleno-renal shunt (4), portocaval anastomosis (1), Sugiura's operation (7). Among the operations 68 were planned, 12 emergency, and 18 preventive. The average age of the children was 6.5 years; 31 were under the age of 5 years and 19 under 3 years of age. The youngest child was aged 10 months, the H-shunt was successful. The results of the operation: thrombosis of the shunt 0%, portosystem encephalopathy 0%, recurrent hemorrhage 0%, lethality 1%. This is evidence of the expediency of performing shunting operations in early childhood.

Child↗
PubMed1993

[Kidney autotransplantation in ureter injuries and diseases children].

Six operations for kidney autotransplantation into the ipsilateral iliac fossa were conducted on children aged from 2 to 14 years. In 2 children the operation was performed for a posttraumatic defect in the ureter of a considerable length. Severe neuromuscular dysplasia of the ureter in maintained function of the kidney was the indication for operating on 4 children. No complications occurred in 5 operations. One transplanted kidney had to be removed because of renal artery thrombosis resulting from damage inflicted to the endothelium during washing of the kidney. Operation for autotransplantation of the kidney is a permissible alternative of the traditional methods of replacement or plastics in long posttraumatic strictures and congenital developmental anomalies of the ureter.

Adolescent↗
PubMed1991

[Formation of a urinary reservoir from a small intestinal graft in children with exstrophy of the urinary bladder].

The authors suggest a new approach to the treatment of patients with exstrophy of the urinary bladder-the formation of an urinary reservoir from a detubulerized intestinal graft after II Kocks' method. This method, as well as its analogues, is mainly used in adults after radical cystectomy. Improved surgical techniques have been suggested on the basis of experimental works which allow the age features and the peculiarities of the functional condition of the formed reservoir to be taken into account. Analysis of the results of clinical use of the suggested method showed it to be effective in solving the problem of rehabilitation of patients with exstrophy of the urinary bladder, which allows it to be recommended as the operation of choice in the management of this developmental anomaly.

Bladder Exstrophy↗
PubMed1991

[Cysts of the common bile duct in children].

From 1975 to 1989 operations were carried out in the clinic by various methods on 30 children with cysts of the common bile duct. Hepaticoor choledochojejunostomy after Roux is the operation of choice in cysts of the choledochus. However, recurrent cholangitis caused by jejunobiliary reflux was encountered in some patients in the postoperative period. The accumulated clinical experience has also shown that the Roux type operation does not guarantee a successful functional result. To prevent reflux of the intestinal contents into the biliary tract after Roux's anastomosis, the authors used an antireflux valve on the excluded loop of the jejunum. Experimental study was undertaken of the theoretically substantiated antireflux valve on an excluded loop of the type of a "nonspilling inkpot" with a shortened loop. The creation of an antireflux valve in the form of an invaginated segment prevents jejunobiliary reflux and therefore provides the possibility for reducing significantly the length of the excluded loop in Roux's biliodigestive anastomoses. The obtained positive results confirm the rationality of this construction which does not need additional time for the operation. Since 1987 four children have been operated on by this method in the clinic. The length of the excluded loop was reduced from 30 to 15 cm. Postoperative complications linked with reflux into the biliary system were not encountered.

Adolescent↗