Clinical case of SARS-CoV-2-associated multisystem inflammatory syndrome

The clinical course, features of diagnostic examinations and difficulties in verification of the new nosology of multisystem inflammatory syndrome associated with SARS-CoV-2 in 15-year-old girls are described. The girl was taken to the Kyiv Regional Children's Hospital No. 2 with complaints of fever, intoxication syndrome, general weakness, dizziness, vertigo, lack of urine during the day. The child was examined by a consilium of doctors, examined in the laboratory and instrumentally, after a carefully collected epidemiological history revealed possible contact with a patient with coronavirus infection at the place of study and identified a probable case of multisystem inflammatory syndrome associated with SARS-CoV-2. According to the results of our own observations during the pandemic, this nosology was found in patients who relapsed into coronavirus infection in clinical or subclinical form and for the period of hospitalization had a clinical symptom complex of Kawasaki with similar symptoms. This disease is new today, has a variety of clinical manifestations and pathological features that are a problem for clinicians. After all, at present there are no unified protocols for the diagnosis and treatment of MIS-C (multisystem inflammatory syndrome) and each doctor relies on their own experience and previously described cases. This case of multisystem inflammatory syndrome will help practicing clinicians in the early stages to diagnose the disease and provide qualified care to patients. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: multisystem used for setting fire syndrome, 15-year-old girl, kawasaky-like symptoms, SARS-CoV-2, intravenous immunoprotein, acetophene, glucocorticosteroids.

PATIENT SAFETY IN THE OPERATING ROOM: HELSINKI DECLARATION IMPLEMENTATION IN UKRAINE

Patient safety in the operative and perioperative period is critically important. The consequences of anesthesia complications have a significant impact on long-term surgical outcomes, quality of life of patients, morbidity and mortality. The purpose of the study was to assess the implementation of the components of the Helsinki Declaration in the practice of Ukrainian hospitals. Materials and methods. The survey was conducted in March-June 2021 by filling out a standard Google form. The link to the survey was distributed on the official page of the Association of Anesthesiologists of Ukraine, through social networks Facebook and Instagram on the official pages of the Department of Surgery, Anesthesiology and Intensive Care of the Institute of Postgraduate Education of the Bogomolets National Medical University. A total of 174 respondents took part in the survey. According to the results, 79.3% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology. Among the respondents, only 43% stated that the principles of the Helsinki Declaration had been implemented in their medical institutions, and 20.9% about plans to implement the principles in the near future. At the same time, in 36% of medical institutions the principles of the declaration are not used and their implementation is not planned. The Safe Surgery checklist is always used by 18.7% of respondents, sometimes by 18.7%, and 29.2% of respondents have never about a checklist. Only 47% of doctors have an airway table in the operating room, and only 30% document the inspection of equipment before anesthesia. Most physicians noted that they used protocols in their practice, but 10% said they mostly did not. Regarding the report of complications, only 46% of hospitals have a separate form (journal), most doctors only inform the head of complications orally. Measures to improve patient safety in medical institutions in 2012-2014 were implemented by 24.1% of respondents, in 2015-2017 by 19.1%, in 2018 – 10.6%, in 2019-2020 – 10,2% of respondents. Most of the respondents stated that the quality of the department’s work has improved and the level of patient safety has improved after the application of these principles in their work. The study showed that while significant positive steps are being taken to improve patient safety, there are still many challenges and opportunities for improvement.

Staged laparoscopic traction orchiopexy by Shehata: first experience, technical features, results

Purpose – to evaluate the results of proposed method of staged laparoscopic traction orchiopexy by Shehata on the basis of our own experience in the treatment of children with abdominal cryptorchidism. Materials and methods. During the period 2019–2021, 18 boys aged 9 months – 4 years were operated with staged laparoscopic traction orchiopexy procedure. Right unilateral abdominal cryptorchidism observed in 10 children, left – in 6, bilateral – in 2. Indications for the procedure were cases of intra-abdominal testicular retention with short vessels. Results. Pelvic and iliac retentions observed in 44% of cases. In 22% testicles were located close to the inner inguinal ring, in 33% the distance between testicle and inguinal canal opening reached 3–4 cm. The 2nd stage was carried out in 3 months. Successful orchiopexy was conducted then in 94% cases without any vascular tension. No cases of testicular dislocation or atrophy have been reported. The volume of operated testicles was smaller than the healthy ones in 78% cases objectively. Conclusions. The experience of Shehata operation showed good effect of the method for correction of abdominal cryptorchidism. Indications for staged laparoscopic traction orchiopexy are abdominal undescended testicles with insufficient length of vessels. The technique allows to achieve effective elongation of spermatic vessels in a short period of time and to minimize the risks of atrophy, compared with the 2-stage Fowler–Stephens operation. This study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed parental agreement was obtained for the research. No conflict of interests was declared by the authors. Key words: abdominal cryptorchidism, orchiopexy, staged treatment, Shehata procedure.

Cystoscopic features of the ureteral orifices in children with vesicoureteral reflux

Purpose – to establish cystoscopic prognostic criteria for vesicoureteral reflux (VUR) in children. Materials and methods. Clinical material covers 270 patients with VUR II–IV grades aged 9 months to 14 years and 22 healthy children. The study included patients with VUR in the period of clinical and laboratory remission without symptoms of neurogenic bladder. During cystoscopy, the condition of the bladder mucosa was assessed; location, shape, hydrodistention degree, and ureteral orifices contractility. Results. Patients with VUR were diagnosed ureteral orifices in the form of: horseshoes – 127 (47.04%) patients, stadium – 106 (39.26%) and golf holes – 37 (13.7%). They were in the zones: A – 13 (4.81%) children, B – 154 (57.04%), C – 67 (24.81%), D – 36 (13.33%), and were characterized by the hydrodistention degree: H0 – 7 (2.59%) patients, H1 – 173 (64.07%), H2 – 60 (22.22%) and H3 – 30 (11.11%). In children with VUR, sluggish peristalsis of the ureter orifices clearly prevailed – 252 (93.33%) cases, relative to active peristalsis in only 18 (6.67%) patients. Conclusions. For ureteral orifices in the form of a stadium and with more pronounced signs of deepening, which are shifted to zone B and laterally to the sidewall of the bladder, with a hydrodistention degree above H1 has a positive association with VUR at the highest specificity of tests. Unfavorable prognostic diagnostic markers for effective minimally invasive interventions in patients with VUR should be considered ureteral orifices, which combine such morpho-topographic characteristics as pronounced signs of deepening to the shape of a golf hole, lateralization to the sidewall of the bladder in zone D, and hydrodistention H3 degree. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: vesicoureteral reflux, ureteral orifice, cystoscopy, children.

Conservative (non-invasive) management of children with splenic cysts

Surgeons’ views on tactics for treatment of splenic cysts (SC) in children are widely discussed in the literature. Indications and methods of conservative (non-invasive) management (observation) of children with SC is different issue. Purpose – to develop rational tactical approache for conservative (non-invasive) management of children with SC. Materials and methods. A retrospective analysis of conservative (non-invasive) management of 90 (33.96%) of 265 patients with SC was performed. Children were not operated if the SC was less than 20 mm (n=61) in diameter. They were first monitored by ultrasound 2 times for 6 months, then – 2 times a year, until puberty. We did not observe the progression of cyst growth in these children. Also did not operate children in whom the size of SC was from 20 to 62 mm, had an asymptomatic course and parents did not consent to surgical treatment (n=29). This is the most difficult group of patients to analyze, as most of them lack information about the dynamic observation. According to the results of dynamic observation in 19 of 29 examined patients’ regression of SC was not observed, which later served as an indication for surgical treatment. Results and conclusions. In the presence of SC, a choice of surgical treatment or conservative (non-invasive) management is possible. Tactical approach for treatment of children with SC is strictly individual and depends on the size and location of the parenchymal lesion. In SC up to 20 mm diameter, conservative (non-invasive) management is rational, which is confirmed by the lack of progression of cyst growth in these children. Dynamic observation of patients with SC with a diameter of more than 20 mm without regression, serves as an indication for surgical treatment. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: spleen cyst, children, conservative, non-invasive, management, results.

Torticollis in a 7-year-old child: an alarming sign not to be turned away

Acquired torticollis is not a separate disease rather a warning sign of an underlying disorder. The etiology of torticollis in children is quite wide. Hematogenous osteomyelitis of the first cervical vertebra (the atlas) is an extremely rare and potentially dangerous pathology. The aim is to acquaint physicians of different specialties with an extremely rare condition – acute hematogenous osteomyelitis of the atlas. Case Report. A case of osteomyelitis of the first cervical vertebra in a 7-year-old boy is presented. An important sign of the disease is torticollis. Conclusions. Hematogenous osteomyelitis of the atlas is an extremely rare and potentially dangerous pathology. Regardless of its incidence, it must be considered when examining a child with acquired wryneck. All the ENT specialists must possess the knowledge of this disease, as they are most likely the first doctors to see such a child. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: torticollis, osteomyelitis of the atlas, C1 osteomyelitis, vertebral osteomyelitis, children.

Penetrating Abdominal Trauma in Children

Injury is the leading cause of death among children and adolescents, with about 10% of injuries being penetrating. Penetrating injuries that occur if a child falls or sits down on a long, sharp object are rare by their mechanism. So far we have experience in treating 5 children with penetrating injuries to the abdominal organs involving long sharp objects. 3 children were injured by falling on a metal fence, and the other 2 by sitting down on a metal pin and a scythe. The consequences of the injuries were damage to the small intestine (1), colon (4), stomach (1), kidney (1), urinary bladder (2). Clinical cases. Two brothers, aged 11 and 12, who fell out of a tree on a metal fence from a height of about 3 meters, were brought Pediatric Municipal Clinical Hospital of Poltava Municipal Council with metal rods in their bodies. After preoperative preparation, the children were operated on. Removal of the foreign objects was performed in the operating room. One of the boys was found to have damage to the stomach, transverse colon, kidney crushing. Suturing of wounds of hollow organs, and nephrectomy were performed. The second boy was found to have damage to the rectum, a colostomy was performed with its subsequent closure. A 16-year-old girl was injured when she sat down on a vertical scythe blade. During the operation, wounds of the ileum and mesentery of the hungry intestine were revealed, the wounds were sutured. All children were discharged after they recovered. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: penetrating abdominal trauma, children.