Background and Aims: Intraabdominal hypertension (IAH) is poorly diagnosed condition that cause splanchnic hypoperfusion
and abdominal organs ischemia and can lead to multiple organ failure. There are no scientific data regarding effect of intraabdominal pressure (IAP) on splanchnic circulation in children.
Material and Methods: Ninety‑four children after surgery for appendicular peritonitis were enrolled in the study. After IAP measurement children were included in one of two groups according IAP levels: “without IAH” (n = 51) and “with IAH” (n = 43). Superior mesenteric artery (SMA) and portal vein (PV) blood flows (BFSMA, BFPV, mL/min) were measured, and SMA and PV blood flow indexes (BFISMA, BFIPV, ml/min*m2) and abdominal perfusion pressure (APP) were calculated in both groups.
Results: Median BFISMA and BFIPV in group “with IAH” were lower by 54.38% (P ˂ 0.01) and 63.11% (P < 0.01) respectively compared to group “without IAH”. There were strong significant negative correlation between IAP and BFISMA (rs = –0.66; P ˂ 0.0001), weak significant negative correlation between IAP and BFIPV (rs = –0.36; P = 0.0001) in group “with IAH” and weak significant negative correlation between IAP and BFISMA (rs = –0.30; P = 0.0047) in group “without IAH”. There were no statistically significant correlations between IAP and BFIPV in group “without IAH”, between BFISMA and APP in both groups and between BFIPV and APP in both groups.
Conclusion: Elevated IAP significantly reduces splanchnic blood flow in children with appendicular peritonitis. BFISMA and BFIPV negatively correlate with IAP in these patients. There is no correlation between BFISMA/BFIPV and APP in children with IAH due to appendicular peritonitis.
УДК: 616.24-006-089-06[.001.36
The aim of the study was to identify factors that are associated with complications after surgery for lung cancer.
Materials and Methods. Retrospective analysis of the surgical treatment results in patients with lung cancer who were operated on in 2010-2014 at the department of thoracic surgery of the Lviv Oncological Regional Treatment and Diagnostic Center. The study included 461 patients. The data of each patient were divided into the following groups: general characteristics, tumor characteristics, treatment characteristics, and complications. The whole cohort of patients was analyzed and their separate subgroups were compared by age, type of complications, and type of surgery.
Results and Discussion. Elderly patients have three times higher levels of postoperative dyspnea and much higher levels of cardiac arrhythmias. Pulmonary complications are more common in men, after more aggressive surgeries with longer time of operative pulmonary ventilation; increase with age. This subgroup is also characterized by longer postoperative period and a higher in-hospital mortality rate. Postoperative complications such as dyspnea, fistula of the bronchial stump, and pleural empyema, higher levels of pleural punctures, and postoperative bed-day were more common in the group of patients who underwent pneumonectomy. A higher level of postoperative pneumonia and a longer drainage period were observed in the group of other operations. It is noteworthy that the level of dyspnea in elderly patients who underwent pneumonectomy is three times higher.
Conclusions. There are age-related features connected to the onset of postoperative complications in patients with lung tumors who have undergone surgery. Complications typical for the patients after different types of operations were found. It is established that the age of patients and the type of surgical treatment significantly change the palette of postoperative complications. An improved method for predicting complications is required.
УДК: 614.1:313.13:312.2:616.22-006.6(477)(477.83)"2010/2019"
Aim. Analysis of the epidemiological block of the model of early detection and prevention of laryngeal malignancies.
Material and Methods. A retrospective analysis of morbidity and mortality from malignant neoplasms of the larynx among the population of Ukraine and Lviv region for ten years (from 2010 to 2019). Statistical data of the National Cancer Registry of Ukraine were used. The following methods are used in the work: medical- statistical analysis, system approach, and structural- logical analysis.
Results and Discussion. The primary incidence of laryngeal cancer among the population of Ukraine decreased by 6% (from 5 cases per 100,000 population in 2010 to 4.7 cases per 100,000 population in 2019). In Lviv region, there was an increase in the level of primary morbidity by 12.3% (from 5.7 cases per 100,000 population in 2010 to 6.4 cases per 100,000 population in 2019). In 2010-2019, the mortality rates from laryngeal cancer in Ukraine and Lviv region were in the range of 2.7-3.1 and 2.8-4.6 cases per 100,000 population, respectively. The proportion of men with newly diagnosed
laryngeal cancer was 94.4-95.8%, and women - only 4.2-5.6%. Analysis of sex and age incidence of laryngeal cancer in Ukraine in 2019 showed that the highest rates among both men and women were in the age group of 60-74 years. The proportion of patients with stage IV laryngeal cancer in Ukraine in 2010 and 2019 was 10.2% and 15%, respectively. A similar indicator in the Lviv region in 2010 was 12.6%, and in 2019 - 20.8%. Mortality
up to one year from among newly diagnosed patients in 2019 in Ukraine was 25.1%, and in Lviv region - 23%. In Ukraine in 2019, the proportion of patients detected at professional examinations was 11.2%, in Lviv region -only 0.7%.
Conclusion. The incidence of malignant neoplasms of the larynx among the population of Lviv region during the study period was higher than the national. There was a tendency to reduce the death rate from laryngeal cancer in both Ukraine and Lviv region. In men, laryngeal cancer is more common than in women in Ukraine and the Lviv region. The incidence of malignant neoplasms of the larynx is highest among people 60 years and older. There
was a low proportion of patients identified during preventive examinations, as well as high mortality rates up to one year from diagnosis and neglect of the malignant process.
SARS-CoV-2 infection, in the vast majority, affects adult patients. The severity of COVID-19 and mortality are directly correlated with the increasing age of patients and the number of comorbidities. However, with the further development of the COVID-19 pandemic, severe cases of COVID-19 have been reported in children. About 0.8-1% of sick children require hospitalization in an intensive care unit. The main syndromes that cause disease severity and mortality in children are acute respiratory distress syndrome, multisystem inflammation syndrome and multiple organ failure. The rapid development of severe respiratory failure and hypoxemia in respiratory distress syndrome leads to the use of various methods of respiratory therapy, and in case of their ineffectiveness to extracorporeal membrane oxygenation (ECMO). In our report, we present two clinical cases of successful use of ECMO in children with COVID-19, who developed severe ARDS.
The measles epidemic was observed in Ukraine during 20172019. According to WHO, in Ukraine there was registered the highest number of measles cases in Europe during that period [8]. Measles is characterized by an acute course with fever, maculopapular rash, cough, conjunctivitis and can lead to central nervous system complications (encephalitis, encephalomyelitis) and bronchopulmonary system complications (laryngotracheobronchitis, bronchiolitis, pneumonia). In immunocompetent patients, viremia ends after the end of clinical signs, in contrast to immunosuppressed individuals, who could develop viremia from one month up to a year. We have described a case of measles inclusion body encephalitis (MIBE) or subacute measles encephalitis (SME) in an unvaccinated child with an acute lymphoblastic leukemia (ALL). The diagnosis was confirmed by the synthesis of IgG antibodies to the measles virus in the cerebrospinal fluid and by the MRI results. The disease had a dramatic course and ended in death.