Pediatric Urachal Anomalies: Monocentric Experience and Mini-Review of Literature

Background: Surgery is the current mainstay for the treatment of urachal anomalies (UA). Recent literature data support the theory of a spontaneous resolution within the first year of life. The aim of this study, comprising solely surgically treated children, was to identify age specific patterns regarding symptoms and outcomes that may support the non-surgical treatment of UA. Methods: Retrospective review on the clinico-laboratory characteristics of 52 children aged < 17 years undergoing resection of symptomatic UA at our pediatric surgical unit during 2006–2017. Data was dichotomized into age > 1 (n = 17) versus < 1 year (n = 35), and complicated (pre-/post-surgical abscess formation or peritonitis, n = 10) versus non-complicated course (n = 42). Results: Children aged < 1 year comprised majority (67%) of cohort and had lower complication rates (p = 0.062). Complicated course at surgery exclusively occurred in patients aged > 1 year (p = 0.003). Additionally, complicated group was older (p = 0.018), displayed leukocytosis (p < 0.001) and higher frequencies regarding presence of abdominal pain (p = 0.008) and abdominal mass (p = 0.034) on admission. Regression analysis identified present abdominal pain (OR (95% CI), 11.121 (1.152–107.337); p = 0.037) and leukocytosis (1.435 (1.070–1.925); p = 0.016) being associated with complicated course. Conclusions: This study provides evidence that symptomatic disease course follows an age-dependent complication pattern with lower complication rates at age < 1 year. Larger, studies have to clarify, if waiting for spontaneous urachal obliteration during the first year of life comprises a reasonable alternative to surgery.

No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area

In the Netherlands, the coronavirus disease 2019 (COVID‑19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID‑19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID‑19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID‑19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients.

Issues of safe correction of gastroduodenal symptoms during pregnancy

Extragenital diseases make a great effect on the complicated course of pregnancy and childbirth. The lack of pregravidar preparation and somatic diagnostics lead to miscarriage, preeclampsia, and placental disorders. Therefore, the development of various algorithms for the management of pregnant women suffering from diseases of the gastrointestinal tract and the safe correction of various gastroduodenal symptoms, which is sometimes characteristic of the gestation period, are relevant. The purpose of the study: evaluation and critical analysis of modern data in the field of diagnosis and safe correction of various gastroduodenal symptoms during pregnancy. Materials and methods. Collection of modern Russian and foreign literature sources on the correction of gastroduodenal pathology during pregnancy, generalization and critical analysis of this problem. Results. Heartburn, constipation, flatulence are the most common complaints during pregnancy. The causes of their occurrence are physiological features during gestation, aimed at the most favorable gestation of the fetus. The first-line preparations are alginates created on the basis of alginic acid of brown alga. Antacids have a number of disadvantages. Proton pump inhibitors are prescribed extremely rarely and cautiously during pregnancy. In case of constipation in pregnant women, it is recommended to prescribe lactulose preparations together with defoamers. Prebiotics perfectly regulate the work of the intestine. The etiology, mechanisms of occurrence, clinical symptoms, differential diagnosis and treatment of intrahepatic cholestasis of pregnant women were analyzed. Its possible prognoses and risks for the mother and fetus, the possibilities of diagnosis and correction are determined. Diseases of the gastrointestinal tract in pregnant women cause difficulties in diagnosis and treatment. For the most optimal course of pregnancy, there are sufficiently effective gastroenterological drugs recommended so that the effect of treatment is maximized and the side effect is minimized.

Dyshormonal dysplasias of the mammary gland in adolescent girls

436 juvenile girls were examined. The results received indicate that dyshormonal dysplasia of mammary glands takes an important place in gynecologic morbidity of juvenile girls (11% of those who consulted a gynecologist). Diffuse forms that can be treated conservatively are mostly diagnosed. The main diagnostic methods in teenagers are palpation and MESUSS. Considering polyethiology of the disease, conservative therapy ought to be complex. To avoid carcinogenic effect of oral contraceptives, they may be used in case of non-complicated heredity, intact liver, and non-complicated course of perinatal period of the girl.

Experience in the use of cognitive psychocorrection of the emotional state of women with complicated pregnancy in the third trimester

In the article the data of experimentalpsychological investigation of pregnant women with complicated course of gestation are drawn to determine the peculiarities of their psychological status. One hundred pregnant women in the third trimesterwere examined, 64 of them demonstrated symptoms of late gestosis. The investigation revealed high level of both reactive and personal anxiety in women with complicated course of pregnancy. All the women of this group were subjected to supporting psychotherapy, which was directed to the decreasing psychological troubles. The basic aim of cognitive psychocorrection was to overcome different systemic presuppositions, to help the pregnant women to elaborate an alternative behavioral pattern and to change their attitude to themselves, to form the sense of self-confidence. The results received testify to the expediency of including psychotherapy (supporting and cognitive psychocorrection) into the complex of treatment.

Results of chalazion cryosurgery with an increased risk of complications

Background. At an appointment with an ophthalmologist, patients with pathological conditions of the eyelids are often dissatisfi ed with the effectiveness of the traditional surgical treatment.The aim: assessment of the functional state of the eye adnexa after cryodestruction of the chalazion with an increased risk of complications using modern cryosurgical equipment.Material and methods. Clinical studies were carried out in 254 patients (277 eyes) with chalazion, including a complicated course of the disease, with cryodestruction of the chalazion using an autonomous cryoapplicator made of porous-permeable titanium nickelide.Results. Cryosystems of the new generation, in comparison with the well-known industrial cryoapparatus, diff er in new properties. They can signifi cantly improve the quality of cryotherapy in surgery due to a clearer localization of cryotherapy and a high rate of heat removal from the surface of altered tissues without damaging the surrounding tissues. Depending on the size of the pathological formation, the duration of the exposure, the frequency of repetitions of the applications during the session, the regression of the chalazion occurred within 1–1.5 months with the preservation of the integrity of the intermarginal space and the functional state of the eyelid.Conclusion. Analysis of the data obtained indicates a high clinical and cosmetic effi ciency of cryosurgery of the eyelid chalazion using an autonomous cryoapplicator made of porous-permeable titanium nickelide.

The Costs of Complications and Unplanned Readmissions after Pancreatoduodenectomy for Pancreatic and Periampullary Tumors: Results from a Single Academic Center

Background/Objectives: Complications after pancreatoduodenectomy (PD) lead to unplanned readmissions (UR), with a two- to threefold increase in admission costs. In this study, we aimed to create an understanding of the costs of complications and UR in this patient group. Furthermore, we aimed to generate a detailed cost overview that can be used to build a theoretical model to calculate the cost efficacy for prehabilitation. Methods: A retrospective cohort analysis was performed using the Dutch Pancreatic Cancer Audit (DPCA) database of patients who underwent a PD at our institute between 2013 and 2017. The total costs of the index hospital admission and UR related to the PD were collected. Results: Of the 160 patients; 35 patients (22%) had an uncomplicated course; 87 patients (54%) had minor complications, and 38 patients (24%) had severe complications. Median costs for an uncomplicated course were EUR 25.682, and for a complicated course, EUR 32.958 (p = 0.001). The median costs for minor complications were EUR 30.316, and for major complications, EUR 42.664 (p = 0.001). Costs were related to the Comprehensive Complication Index (CCI). The median costs of patients with one or more UR were EUR 41.199. Conclusions: Complications after PD led to a EUR 4.634–EUR 16.982 (18–66%) increase in hospital costs. A UR led to a cost increase of EUR 12.567 (44%). Since hospital costs are directly related to the CCI, reduction in complications will lead to cost-effectiveness.

ENDOSCOPIC TREATMENT OF HEREDITARY PANCREATITIS IN A CHILD WITH JUVENILE IDIOPATHIC ARTHRITIS: CLINICAL CASE REPORT AND LITERATURE REVIEW

The severe course of chronic pancreatitis (CP) in children is rare. More often it is caused by hereditary factors and abnormalities of the bile and pancreatic ducts. Cases of the development of pancreatitis against the background of systemic inflammatory diseases are described. Therapy of a systemic disease can aggravate the course of pancreatitis, and the general serious condition of the patient does not allow for the necessary surgical treatment. The article describes the clinical case report of a complicated course of CP against the background of juvenile idiopathic arthritis in a 17-year-old girl. The effectiveness of intraluminal endoscopic methods of treatment (wirsungotomy and stenting of the main pancreatic duct) for relieving exacerbation and complications of CP has been demonstrated.

Clinical and immunological features of the combined course of pertussis and rhinovirus infection in children

The association of pertussis with various respiratory infections in children is the leading factor determining the complicated course and unfavorable outcome of the disease.Objective. To analyze clinical and immunological features of the combined course of pertussis and rhinovirus infection.Children characteristics and research methods. The authors observed 20 patients: 10 (50%) children were under the age of 1 year, 5 (25%) children of 1–3 years old, 3 (15%) children of 4–6 years, 2 (10%) children of 7 -14 years old.Results. The rhinovirus infection developed mainly at 1-2 weeks of illness in 18 (90%) children. Bronchitis developed in 11 (55%) children, pneumonia – in 4 (20%). Special attention was drawn to the low content of NK cells in 82.4% of patients when assessing the subpopulation composition of lymphocytes. The cytokine profile was characterized by a low level of interferon-gamma and interferon-alpha production – in 94.4 and 61.1% of patients, respectively.Conclusion. The combination of pertussis and rhinovirus infection in children contributes to the uneven course of the disease, the frequent development of bronchopulmonary complications.

RARE COMPLICATION OF CROHN’S DISEASE WITH LOCALIZATION IN THE INFLAMMATORY INTESTINE IN THE F0ORM OF THE SPREAD OF INFLAMMATORY OF THE PROCESS ON THE ANTERIOR ABDOMINAL WALL WITH FORMATION ABSCESS AND ITS DISCLOSURE IN THE NAVEL

The purpose of the study. Show a rare variant of the clinical course of complications of Crohn’s disease (СD). To analyze the anamnestic data, symptoms, clinical manifestations, preoperative diagnosis, features of surgery, postoperative period and the results of histological examination in a patient with CD who had complications in the form of transition of inflammation from the ileal wall to the anterior abdominal wall with abscess formation, opening it in the navel and the formation of a fistula. Material and methods. An analysis of the case of a complicated course of CD, manifested by the transition of inflammation from the ileum to the anterior abdominal wall, the formation of an abscess, its breakthrough into the navel and the formation of a fistula in the umbilical region. This complication was detected only after urgent computed tomography of the abdominal cavity and small pelvis (CTACSP). Results. The patient, despite the history of complaints, performed appendectomy, in which the removed appendix did not fully correspond to the clinical manifestations and data of CTACSP, in which CD was suspected, did not complete the examination, was not consulted by gastroenterologists and proctologists. He was urgently hospitalized with a clinic similar to acute purulent omphalitis. Only careful collection of the anamnesis and performance of urgent CTACSP allowed to suspect existence at the patient of the complicated course of CD. This allowed us to predict the course of surgery, perform a right hemicolectomy with excision of the altered tissues of the anterior abdominal wall and suturing the wound in the form of a laparostomy. The patient’s condition improved, he was discharged from the hospital. Conclusions. Patients with suspected CD should be monitored and treated by gastroenterologists and proctologists. Careful collection of anamnesis in patients of this group and the implementation of emergency CTACSP allowed to establish a correct diagnosis in the preoperative period.