Vol 15, No 4 (2025)

BACKGROUND: Preservation of population reproductive health is one of the most pressing issues in healthcare and public policy.

AIM: To assess the incidence of conditions associated with impaired reproductive health in boys aged 0–17 years in the Russian Federation; to characterize surgical interventions on the reproductive organs in boys aged 0–17 years, including the use of high-technology treatment methods. To analyze the staffing resources ensuring the provision of surgical care to children with reproductive system disorders.

METHODS: The study was based on data on morbidity and staffing capacity obtained from federal statistical reporting forms (Form Nos. 12 and 30) covering all regions of Russia, as well as data from chief external pediatric surgical specialists covering 68 regions. These 68 regions account for approximately 80% of the pediatric population of the Russian Federation. Descriptive statistics and correlation analysis were used in present study.

RESULTS: The results revealed substantial interregional differences in disease prevalence and in the number of surgical interventions across constituent entities of the Russian Federation. These differences were associated, among other factors, with the level of availability of pediatric surgeons and pediatric urologists-andrologists. The findings highlight the need for a comprehensive multidisciplinary approach that includes prevention, early diagnosis of condition, development of specialized care systems, and continuous monitoring of reproductive health in children and adolescents, as well as continuity of care into adolescence and adulthood.

CONCLUSION: Timely and accurate diagnosis and surgical treatment of reproductive system disorders in boys are crucial for preserving reproductive health and for preventing complications and infertility.

BACKGROUND: A current priority in addressing multiple organ dysfunction syndrome in adults, children, and newborns is the identification of syndrome phenotypes and the development of individualized treatment and rehabilitation measures. The septic phenotype of multiple organ dysfunction syndrome is associated with high morbidity, mortality, and poor long-term health outcomes; however, in neonatal practice this phenotype remains insufficiently studied, which determined the aim of the present study.

AIM: This study aimed to conduct a comparative analysis of short-term in-hospital and long-term outcomes in newborns with septic versus hypoxic phenotypes of multiple organ dysfunction syndrome.

METHODS: A retrospective study was performed including 128 newborns with multiple organ dysfunction syndrome, that were divided into two groups: group A (n = 67) with the septic phenotype and group B (n = 61) with the hypoxic phenotype. Outcomes were assessed at 1 month and 1 year of life and included treatment duration, complications, and physical as well as neuropsychological development. Statistical analysis was performed using nonparametric tests.

RESULTS: Newborns with the septic phenotype of multiple organ dysfunction syndrome demonstrated a significantly more severe disease course, including longer duration of stay in the neonatal intensive care unit (22 vs 10 days, p = 0.001), longer duration (9 vs 5 days, p = 0.04), and a higher rate of progression to persistent multiple organ dysfunction syndrome (20.9% vs 3.3%, p = 0.001). At 1 month of age, lesions of the central nervous system, abdominal organs, cardiovascular system, and hearing disorders were remarkably more frequent in this group. By 1 year of age, the septic phenotype group continued to show a higher prevalence of neurological complications, including motor impairment syndrome (43.2% vs 19.7%, p = 0.008), hypertensive–hydrocephalic syndrome (26.9% vs 8.2%, p = 0.005), and cardiovascular system involvement. No significant differences were found between groups in physical or neuropsychological development indices.

CONCLUSION: The septic phenotype of multiple organ dysfunction syndrome in newborns is associated with more severe short- and long-term outcomes compared with the hypoxic phenotype, predominantly manifesting as involvement of the central nervous and cardiovascular systems. These findings indicate the need to develop individualized treatment and rehabilitation approaches for this patient population.

BACKGROUND: Tracheal surgery in children is an interdisciplinary challenge that requires a high level of professional collaboration among thoracic surgeons, anesthesiologists–intensivists, endoscopists, otorhinolaryngologists, rehabilitation specialists, and palliative care professionals, in the setting of appropriate diagnostic and technical resources. This issue is particularly acute in leading regional medical institutions of the Russian Federation, including regional, territorial, republican, and district pediatric hospitals.

AIM: To substantiate the need for and to assess the effectiveness of thoracic surgery services within the structure of multidisciplinary pediatric hospitals in the regions of Russia.

METHODS: Medical and statistical data from the Speransky Children’s City Clinical Hospital No. 9 of the Moscow Department of Health were used as a typological model, as this institution is comparable in bed capacity, number, and profile of structural units to most multidisciplinary pediatric hospitals in the Russian Federation. Between 2020 and 2025, a total of 201 tracheal surgeries were performed in 186 children ranging in age from infancy to 17 years. Infants predominated (86 children), accounting for 46.2% of clinical cases. The protocol of specialized examination methods included imaging, endoscopic, and laboratory techniques aimed at assessing respiratory failure, bacteriological studies of biological fluids, and verification of the level and extent of tracheal lesions.

RESULTS: Analysis of patients according to the type and frequency of surgical interventions showed that tracheostomy predominated (153 children, 82.2%); tracheal stenosis dilatation was performed in 27 children (14.5%), and tracheal reconstruction in 6 cases (3.2%). The incidence and profile of surgical complications following tracheal surgery, including in the long-term period, were comparable to those reported by leading specialized centers.

CONCLUSION: The functioning of thoracic surgery units (specialized beds) in multidisciplinary pediatric hospitals of the Russian regions represents a rational solution to a wide range of organizational and clinical challenges, including resource-intensive issues of medical evacuation to other institutions. Under current conditions of a significant shortage of physicians, the acquisition of competencies in thoracic surgery within the existing qualification of pediatric surgery falls within the remit of the Ministry of Health of the Russian Federation, as it necessitates improvement of the regulatory framework. In the medium term, concentration of specialized patients in interregional centers for specialized (surgical) pediatric care appears to be a rational approach.

BACKGROUND: In the presence of a penetrating or stricturing–penetrating phenotype of Crohn disease, the formation of a psoas abscess is possible. Ileocecal resection is the most common surgical procedure for complicated Crohn disease. The feasibility of performing an anastomosis in the presence of a psoas abscess remains controversial. The lack of clear management algorithms for Crohn disease with psoas abscess and the rarity of this condition in pediatric patients determine the relevance of the present study.

AIM: To evaluate treatment outcomes and the necessity of stoma formation in patients with complicated Crohn disease undergoing ileocecal resection in the setting of a psoas abscess.

METHODS: The study included data from 8 patients with complicated Crohn’s disease who underwent ileocecal resection in the setting of a psoas abscess. In 6 of 8 patients (75%), no stoma was formed, whereas the remaining patients underwent a two-stage procedure with stoma creation. Intestinal anastomosis was constructed manually using an end-to-end two-layer technique. Broad-spectrum antibacterial therapy was administered preoperatively in 7 of 8 patients (87.5%) for 7–14 days, with a positive clinical and laboratory response.

RESULTS: In half of the patients, the abscess size did not exceed 3 cm, and this group received conservative antibacterial therapy prior to surgery. In 2 patients, the abscess was detected intraoperatively and surgical sanitation was performed. Before ileocecal resection, 7 of 8 patients did not receive glucocorticosteroid therapy; only 1 patient received a minimal dose of prednisolone (5 mg). Partial parenteral nutrition and albumin transfusion for nutritional correction were required in 4 of 8 patients (50%) for 7–14 days. Infectious complications occurred in 4 of 8 patients (50%) and were superficial in nature, not exceeding Grade I on the Clavien–Dindo classification.

CONCLUSION: The presence of a psoas abscess is a potential risk factor for intestinal anastomotic failure but is not a reliable predictor of an unfavorable surgical outcome. When a psoas abscess is identified prior to planned ileocecal resection, conservative treatment or percutaneous drainage is recommended (depending on abscess size), with clinical response assessment over 5–7 days (resolution of fever and reduction in inflammatory laboratory markers). In such cases, we consider primary intestinal anastomosis feasible within 7–14 days.

The laparoscopic approach can be technically challenging in patients with a horseshoe kidney due to the specific anatomy, including caudal kidney position and rotation, aberrant vessels, and high ureteral origin. The use of robotic systems has facilitated the performance of this procedure. We conducted a retrospective review of the medical records of a 1-year-old child with ureteropelvic junction obstruction associated with a horseshoe kidney. Contrast-enhanced computed tomography was the primary diagnostic modality for identifying the cause of hydronephrosis and allowed accurate determination of the true source of obstruction, namely a high origin of the ureter from the renal pelvis. The patient underwent robot-assisted Anderson–Hynes pyeloplasty. The key differences from surgery in anatomically normal kidneys included caudal placement of robotic ports and meticulous assessment of the renal vascular anatomy. The procedure was successfully completed with robotic assistance without conversion to laparoscopy or open surgery. No intraoperative complications related to bleeding or injury to adjacent organs were observed. The total operative time, including robotic docking, was 165 minutes: docking time was 15 minutes, and total console time was 150 minutes. The hospital stay lasted 5 days. The pyelostomy tube was removed on postoperative day 7 in an outpatient setting. The anteroposterior diameter of the renal pelvis was measured preoperatively and 6 months after surgery. The renal pelvis diameter decreased from 37 mm to 8 mm. Radionuclide renal imaging showed no residual obstruction on diuretic renography. The results of this case confirm that robot-assisted laparoscopic pyeloplasty for horseshoe kidney is safe, feasible, and associated with favorable outcomes when performed by experienced surgeons.

The pioneering projects aimed at integrating automated devices into surgical practice date back to the late 1960s. However, the transition from concept to a mass-produced product took nearly three decades. Today, the da Vinci platform (Intuitive Surgical Inc., USA) dominates the global medical community as a system for performing minimally invasive procedures. Importantly, its success was preceded by the development of earlier prototypes, including ZEUS, AESOP, ROBODOC, and the Green Telepresence System. Notably, the original purpose of these technological innovations was not commercial medicine but rather the provision of surgical care under field conditions, including battlefield settings. The research groundwork established with the participation of SRI International and the Advanced Research Projects Agency was later transferred to the private sector. The subsequent consolidation of multiple market players ultimately led to the formation of Intuitive Surgical Inc. This article reconstructs the complete chronology of the development of surgical robots. The methodology includes a meticulous analysis of archival data and scientific publications, as well as direct interviews with leading experts in the field of minimally invasive techniques. Such work is essential, as robotic interventions are currently evolving from an experimental approach into a widely accepted clinical standard, which necessitates a comprehensive understanding of the path already taken.

This article is an adapted version of the federal clinical guidelines on sepsis in children, developed by the specialists of the Association of Pediatric Anesthesiologists and Intensivists of Russia and approved by the Ministry of Health of the Russian Federation on October 10, 2025. Definitions of sepsis and septic shock in pediatric patients are substantiated, including their criteria. Data on etiology and pathogenesis, epidemiology, clinical presentation, and diagnosis of shock are presented. Recommendations for intensive care management of sepsis and septic shock include sections on antimicrobial therapy in pediatric sepsis, hemodynamic, respiratory, and nutritional support, renal replacement therapy and extracorporeal blood purification, and adjuvant therapy. It also discusses controversial issues related to the use of immunomodulatory agents, corticosteroids, and vitamins. The work emphasizes that in children with septic shock, antimicrobial therapy should be initiated no later than 1 hour after diagnosis, whereas in the absence of shock it should be started no later than 3 hours after diagnosis. It is noted that infusion therapy in children with septic shock during the first hour after diagnosis should not exceed 40 mL/kg in order to prevent fluid overload, with balanced crystalloid electrolyte solutions recommended as first-line agents for volume resuscitation. In septic shock, norepinephrine and epinephrine are the drugs of choice for hemodynamic correction, whereas dopamine is not recommended. It is demonstrated that septic shock and severe acute respiratory distress syndrome are absolute indications for invasive mechanical ventilation using lung-protective strategies. The importance of early initiation of enteral nutrition in children with sepsis and septic shock is emphasized; it is considered justified even during infusion of inotropic agents provided that hemodynamic parameters are stable. Renal replacement therapy is indicated not only for substitution of renal function but also for correction of fluid overload when diuretic therapy is ineffective. Convincing evidence is presented that the use of plasma exchange and sorption techniques in children with sepsis and septic shock is currently not recommended. It is noted that hydrocortisone therapy in children with sepsis is justified only in refractory septic shock. Modern principles of metabolic management in sepsis are described, indicating that optimal blood glucose levels in children should not exceed 7.8 mmol/L; insulin therapy is justified when blood glucose levels exceed 10 mmol/L. Data on rehabilitation, prevention, and organization of medical care for pediatric sepsis are also provided.

A native of the Altai Territory and a graduate of the Altai State Medical Institute, Arsen A. Osipov devoted his entire professional life to pediatric surgery and orthopedic traumatology in his hometown of Barnaul. As a faculty member of the Department of Pediatric Surgery, he developed a sustained scientific interest in the treatment of children with hypertrophic scars. These investigations culminated in the successful defense of both his Candidate of Sciences and Doctoral dissertations. For many years, Osipov served as the Head of the Department of Traumatology and Orthopedics at the Altai Regional Children’s Hospital, where he performed hundreds of surgical procedures. For 16 years, he also held the position of Chief External Pediatric Orthopedic Traumatologist of the Altai Territory. Arsen A. Osipov left behind a large cohort of students and colleagues who continue his professional legacy in medical institutions throughout the Altai region and beyond.