Background. The 40-year-old patient developed headache, dyscoordination, imbalance, memory problems, fever, and somnolence. Two days after manifestation, the patient was hospitalized with an altered mental state (GCS of 12). No previous history of atrial fibrillation, persistent headache, migraine, drug abuse, autoimmune, or systemic inflammatory disorders. Results. CSF analysis revealed 10 WBC/μL with normal glucose and protein levels, no atypical cells or culture growth. No antibodies to TORCH infections or Borrelia were identified. CRP was elevated at 11.5 mg/dL, as well as ESR at 39 mm/hr, IgE at 1120.2 mU/L, and CD16+ NK cells in the blood, indicating inflammation. The rheumatologic workup was negative. Duplex ultrasound revealed bilateral resistive vertebral artery Doppler waveforms with no evident signs of atherosclerosis. Echocardiography was normal without valvular or septal pathology. The combination of multifocal middle-small caliber vessel stenotic changes, inflammatory signs, and no specific autoimmune antibodies is suggestive of primary CNS vasculitis. The patient was initiated with a short-term course of corticosteroids, long-term therapy with immunosuppressive drug, pentoxifylline, and antiplatelet drugs. During the 1-year follow-up, he responded to the therapy with clinical improvement and a radiologically stable state. Conclusions. The uniqueness of this clinical case is the coexistence of two clinically challenging disorders. The occlusion of the artery of Percheron, a rare anatomical variant of posterior cerebral perforator arteries 2, was caused by no less rare inflammatory neurological disease - primary CNS vasculitis.

 Keywords. Artery of Percheron, artery of Percheron territory infarct, bithalamic lesions, brainstem stroke syndromes, central nervous system vasculitis, posterior circulation infarction, posterior inferior cerebellar artery (PICA) infarct, superior cerebellar artery

UDC:  616.833-009.7

Background. Up to 50–80 % of military service members suffer from postamputation pain. Residual limb pain significantly postpones prosthetic surgery, recovery, employability, negatively impacts rehabilitation and military duty performance. 

The purpose was to study residual limb pain types in military personnel after traumatic amputation and efficacy of methods for their treatment. 

Materials and methods. A randomized cross-sectional study was performed of 231 military service members with residual limb pain after combat traumatic amputation, who underwent surgical treatment in tertiary and quaternary level military medical center between 2022 and 2024 amid full-scale war. 

Results. Somatic residual limb pain was observed in 36.36 % of enrolled patients, which was mainly caused by heterotopic ossification (30.74 %). 41.13 % of amputees experienced neuropathic pain due to neuromas. Pain syndrome in 22.51 % of patients resulted from both somatic causes and neuromas. Prosthesis-associated pain as a type of somatic pain was observed in 17.32 % of individuals. This study found that the persistence or recurrence of neuropathic pain among patients from the group of lidocaine-alcohol injection for painful neuromas was significantly lower (Pα = 0.013) at 6-month follow-up compared to the simple neuroma resection group. During 3 months after regenerative peripheral nerve interface, which was performed for 25 terminal neuromas, no pain recurrence was observed. 

Conclusions. It is important to assume the presence of one or both pain types in a patient with residual limb pain: somatic and/or neuropathic. Simple neuroma resections lead to an undesirably high reoperation rate — 21.79 ± 4.86 % of persistent painful neuromas. Lidocaine-alcohol injections are sufficiently simple and effective (8.70 ± 3.26 % of reinjections) in the treatment of neuropathic pain caused by terminal neuromas. Regenerative peripheral nerve interface is promising in the treatment and prevention of symptomatic neuroma. 

Keywords: postamputation pain; residual limb pain; stump pain; symptomatic neuroma; heterotopic ossification; neuroma resection; lidocaine-alcohol injection; regenerative peripheral nerve interface; prosthesis-associated pain

UDC: 618.19-009.7-085

More than 82 % of women of reproductive age note pain in the mammary gland. Every fifth woman feels severe pain (mastalgia) and swelling (mastodynia) in the mammary gland. Cyclic mastalgia is combined with hyperprolactinemia. Hyperprolactinemia occurs when dopamine does not suppress pituitary function enough to reduce prolactin release. Agni casti fructus, known for its dopaminergic activity, relieves pain and discomfort in the mammary glands. 50 patients were under observation. Only 10 % of patients felt mild pain, 32 % experienced moderate pain, 50 % assessed it as severe, and 8 % experienced extreme pain. After the treatment, the complete absence of pain was noted by 76 % of patients. The results of the conducted studies indicate a high efficiency of 76 % and the safety of using Agni casti fructus in treating mastalgia and mastodynia. The high efficiency in the treatment of mastalgia and mastodynia with the herbal medicine Agni casti fructus without the additional use of hormonal drugs can be explained by the fact that this drug normalizes the hormonal balance of a woman

УДК: 617.541-007.24-089.5-031.83-089.85]:616.153.45

Періопераційна стрес-реакція є динамічним процесом, на який впливають пацієнт-специфічні, хірургічні та анестезіологічні фактори.

Мета – оцінити стрес-відповіді при корекції лійкоподібної деформації грудної клітки за Nuss в умовах комбінації загальної анестезії з різними реґіонарними блокадами.

Матеріали та методи. Обсерваційне проспективне дослідження включало 60 підлітків (хлопчики/дівчатка=47/13), які перенесли операцію Nuss для корекції лійкоподібної деформації грудної клітки в умовах комбінації загальної анестезії з різними реґіонарними блокадами. Пацієнти рандомізовані в три групи залежно від методу реґіонарного знеболювання (по 20 осіб у кожній групі): стандартна епідуральна анестезія (СЕА) на рівні Th5–Th8, висока епідуральна анестезія (ВЕА) на рівні Th2–Th3, білатеральна паравертебральна анестезія (ПВА) на рівні Th5–Th8. Рівні кортизолу та глюкози в сироватці крові визначені на трьох етапах: 1-й – вихідний рівень до операції, 2-й – під час травматичного моменту операції (повертання коригувальної пластини), 3-й – після операції.

Результати. Середнє значення кортизолу сироватки серед усіх пацієнтів перед операцією становило 342,4 [282,1–415,0] нмоль/л (медіана – 25–75% процентилі). Під час ротації пластини кортизол знизився до 223,1 [174,9–282,3] нмоль/л (p<0,000001). Після операції та прокидання від наркозу кортизол сироватки становив у середньому 279,6 [216,7–312,6] нмоль/л (p<0,000001 порівняно з вихідним рівнем до операції). На травматичному етапі операції кортизол сироватки був нижчим порівняно з вихідним рівнем до операції в групі СЕА на 41%, у групі ВЕА – на 30%, у групі ПВА – на 31%. Після операції та наркозу кортизол залишався нижчим за вихідний рівень у групі СЕА на 28%, у групі ВЕА – на 20%, у групі ПВА – на 26%. Середній рівень глікемії серед усіх пацієнтів до операції становив 4,62 [4,01–5,05] ммоль/л. Під час операції глікемія значно знизилась до 4,05 [3,86–4,62] ммоль/л (p=0,00018). Після операції глікемія повернулася до вихідного рівня 4,24 [4,09–4,99] ммоль/л (p=0,7). Під час операції глікемія знизилася порівняно з вихідним рівнем у групі СЕА на 11%, у групі ВЕА і ПВА – на 5%. Динаміка кортизолу та глюкози сироватки була схожою у всіх групах зі статистично незначною міжгруповою відмінністю на всіх етапах.

Висновки. Рівні кортизолу та глюкози в сироватці крові під час операції Nuss для корекції лійкоподібної грудної клітки у підлітків в умовах комбінації загальної анестезії з епідуральною та паравертебральною блокадами значно знизилися порівняно з вихідним рівнем до операції. Після закінчення операції глікемія повернулася до вихідного рівня, кортизол дещо підвищився, але залишався нижчим за вихідний рівень. Ці зміни стресмаркерів були більш виразними в групі СЕА на рівні Th5–Th8, ніж у групах ВЕА на рівні Th2–Th3 та ПВА.

Автор заявляє про відсутність конфлікту інтересів.

Results. The average serum cortisol level among all patients before surgery was 342.4 [282.1–415.0] nmol/L. At stage 2 the plasma cortisol decreased up to 223.1 [174.9–282.3] nmol/L (p<0.000001). After the surgery and anesthesia finished the average plasma cortisol was 279.6 [216.7–312.6] nmol/L (p<0.000001 vs baseline). During surgery serum cortisol decreased in group SEA by 41%, in group HEA – by 30%, and in group PVA – by 31% compared with baseline levels. After surgery, the serum cortisol was lower than baseline measurements in group SEA by 28%, in group HEA – by 20%, and in group PVA – by 26%. The average baseline glycemia among all patients before surgery was 4.62 [4.01–5.05] mmol/L. At stage 2 glycemia decreased significantly up to 4.05 [3.86–4.62] mmol/L (p=0.00018). After the surgery finished the average serum glucose among all patients was 4.24 [4.09–4.99] mmol/L (p=0.7). At stage 2 serum glucose decreased in group SEA by 11%, in groups HEA and PVA – by 5% compared with the baseline level. The dynamics of serum cortisol and glycemia were similar in all groups with statistically insignificant intergroup differences at all three stages.

Conclusions. Serum cortisol and glycemia during the Nuss procedure under the combination of general anesthesia with regional blocks decreased significantly. After surgery finished glycemia returned to baseline level, but serum cortisol was lower than baseline measurement. The changes in serum cortisol and glycemia were more pronounced in patients under standard epidural analgesia in Th5–Th8 compared with the high epidural in Th2–Th3 and paravertebral blocks.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study.

Since March 11, coronavirus infection has become an intercontinental problem - a pandemic has developed.Ukraine (until December 2019) ranks 17th in the world in the number of Covid-19 cases. Although according to statistics, the children are the least vulnerable group for coronavirus infection, unfortunately, severe and serious complications such as pneumonia, Kawasaki disease and Kawasaki-like syndrome, Multisystem inflammatory syndrome in children, toxic shock syndrome, myocarditis occur in children, too. As of the end of November, according to the Ministry of Health in Ukraine, 732,625 cases of coronavirus were laboratory- confirmed, including 13,720 children. According to the Lviv Regional Laboratory Center of the Ministry of Health, in the Lviv region since the beginning of the Covid-19 pandemic, among 46078 of all infected were about 5-6% of children. To analyze clinical, laboratory features of severe coronavirus infection complicated by bilateral pneumonia with acute respiratory distress syndrome (ARDS) in a three-year-old girl who was on V-V ECMO for one week and mechanical ventilation of the lungs for 28 days. The diagnosis was confirmed by detection of SARS-CoV-2 virus RNA by PCR, X-ray and ultrasound examination of the lungs. The disease had a dramatic course but a successful outcome. Life-threatening conditions associated with COVID-19 in children are much less common than in adult patients. However, in some cases, when critical hypoxemia is not eliminated by traditional methods of respiratory support, ECMO can become a life-saving technology and with its timely usage in pediatric patients.