Treatment of splenic cysts (SC) in children is variable and controversial. Depending on the size and location of these formations in the spleen, surgical correction is possible in open or laparoscopic surgery, or conservative (non-invasive) management. The result of SC treatment should be the complete elimination of the cyst cavity.

Purpose - to evaluate the results of surgical correction or conservative management of CS in children according to remote monitoring changes.

Materials and methods. We conducted the study on 265 children aged 0-17 years (mean age 11.25±4.21 years), who were examined and treated for SC. One hundred seventy-five (66.04±2.91%) children underwent surgery, and 90 (33.96±2.91%) patients received conservative treatment. We subjected all the information recorded in the medical records to statistical processing. The mentioned information could characterize the situation with the treatment process and with dynamic monitoring of this pathology to some extent.

Results. The most common localizations of cysts were the upper (33.21±2.89%) or middle segments of the spleen (29.81±2.81%). Almost every fourth patient (27.92±2.76%) with SC had pathology of other organs or systems, and every tenth (9.81±1.83%) had other diseases of the spleen. We detected residual cyst in 46.42±3.06% of patients; it underwent complete regression within 1-3 years. Residual cyst of small size (which persisted after surgical correction) regressed much faster after surgery compared with regression of cystic formation of small size in the spleen with conservative management (p<0.05).

Conclusions. Therapeutic tactics for SC in children involve different options for individual surgical correction or conservative management, depending on the location, size, relationship to the architecture of the main vessels and the variant of damage to the parenchyma of the spleen. The outcome of treatment of children with SC depends on the volume, location, etiology of the lesion, the method of correction and compliance with all recommendations in the postoperative period against the background of comorbidities.

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 institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Aim: To determine the prevalence and to estimate factors associated with food hypersensitivity in young children of the Lviv region in Ukraine.

Methods: A prospective cross-sectional survey study was conducted between 2016 and 2017 in the Lviv region of Ukraine. A specially designed questionnaire about food hypersensitivity of young children developed and validated by M. J. Flokstra-de Blok was used after translation into the Ukrainian language. The questionnaire included 34 questions, grouped into general and detailed information. Parents of children aged 0–3 years were asked to complete the questionnaire at pre-schools and medical institutions.

Results: Among 4,500 distributed questionnaires, 3,214 (71%) were completed and processed. Parents reported that 25% of their young children had food hypersensitivity. According to the survey the most common agents involved in food hypersensitivity in young children were cow's milk (34%), egg (28%), and wheat (24%). Hypersensitivity to milk occurred in 50% of children in the age group of 1–2 years. Regional differences associated with food hypersensitivity were also found. Namely, in the Carpathians, there was more hypersensitivity to fish (27%) and honey (22%) than in other regions, while hypersensitivity to soy was detected mostly in Lviv City residents (8.5%). Unknown causes of food hypersensitivity were highly reported (34%) in the Carpathians.

Conclusion: Prevalence and some distinctiveness of food hypersensitivity revealed in four geographic and climate zones as well as in Lviv City have a considerable practical use for formulation of recommendations for children with food hypersensitivity.

УДК 616.411-006.2-036.8-08-089-053.2

Лікування кіст селезінки (КС) у дітей є варіабельним і дискусійним. Залежно від розмірів та локалізації
цих утворень у селезінці можлива хірургічна корекція при відкритій чи лапароскопічній операції або консервативне (неінвазивне) ведення. Результатом лікування КС має бути повна ліквідація порожнини кісти.
Мета – оцінити результати хірургічної корекції або консервативного ведення КС у дітей за даними віддалених моніторингових змін.
Матеріали таметоди. Проведено дослідження 265 дітей віком 0–17 років (середній вік – 11,25±4,21 року), які проходили обстеження та лікування з приводу КС. Прооперовано 175 (66,04±2,91%) дітей, а 90 (33,96±2,91%) пацієнтів проліковано консервативно. Статистичній обробці піддано всю інформацію, фіксовану в медичній документації, яка певною мірою могла б характеризувати ситуацію з процесом лікування та з динамічним спостереженням при цій патології.
Результати. Найбільш поширеними локалізаціями кіст були верхній (33,21±2,89%) або середній (29,81±2,81%) сегменти селезінки. Практично кожний четвертий (27,92±2,76%) пацієнт із КС мав патологію інших органів чи систем, а кожний десятий (9,81±1,83%) – інші захворювання селезінки. Залишкова кіста виявлена у 46,42±3,06% пацієнтів, яка протягом 1–3 років піддалася повній регресії. Залишкова кіста малих
розмірів (яка зберігалася після хірургічної корекції) значно швидше регресувала після хірургічного втручання, ніж кістозне утворення малих розмірів у селезінці при консервативному веденні (р<0,05).
Висновки. Лікувальна тактика при КС у дітей передбачає різні варіанти індивідуальної хірургічної корекції або консервативного ведення, що залежить від локалізації, розмірів, співвідношення до архітектоніки магістральних судин і варіанта ураження паренхіми селезінки. Результат лікування дітей КС залежить від об’єму, локалізації, етіології ураження, методу корекції та дотримання всіх рекомендацій у післяопераційному періоді на тлі супутніх захворювань.
Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом усіх зазначених у роботі установ. На проведення досліджень отримано
інформовану згоду батьків, дітей.

УДК: 614.25

Aim. The research aims at improving the quality of rendering medical care in the urology departments of health care facilities by conducting the clinical audit with advanced study of causes of dissatisfaction of patients with the medical service provided.

Material and Methods. Sociological research included the questioning of 405 patients who were treated in the urology departments of the municipal nonprofit enterprise of the Lviv Regional Council "Clinical Emergency Hospital". The respondents estimated the quality of providing health care in the sphere of medical service, informational content, financing, the quality of diagnosis and treatment. Methods of structural-logical analysis, systemic approach and analysis, calculation of mean and relative values, calculation of satisfaction index with services provided are used in this work.

Results and Discussion. The determination of the level of respondents' satisfaction with inpatient treatment showed that, in total, that the number of dissatisfied among the interviewed were 7.16±1.28 % persons. The focus-group of such persons was singled out: patients of active working age, financially - able, mainly with higher education, most often with diagnosis of urolithiasis, who suffered from pain syndrome, with late appealing for medical care (more than 24 hours), they were operated on and waited for the quick results of treatment, even despite the positive final result of treatment. These patients demanded more attention of a doctor, were dissatisfied with the work of paramedical personnel, conflicted with ward neighbors, had claims to availability and quality of medical equipment, sanitary state of premises of the department.

Conclusions. The results of the clinical audit targeting the satisfaction of patients with medical services provided as one of the forms of receiving the patient feedback concerning the quality of medical aid, point out, on one hand, the appropriate level of availability of services, interpersonal attitudes, infrastructure, execution of technical demands as to quality and standard compliance by the staff of department. While, on the other hand, the audit results indicate the presence of dissatisfied with some certain services in the department. The focus-groups of dissatisfied make it possible to take into account the personal approaches in rendering medical aid to such categories of population, that in total will improve and increase the quality of providing medical services. Basing on the results of clinical audit, the recommendations as to the perfection of medical care management in the urology departments of health care facilities.