Vaikų, sergančių limfangioma, gydymo preparatu OK-432 (picibaniliu) patirtis

Gintarė Breivienė,  Marytė Malevskienė, Andrius Čekuolis, Kęstutis Trainavičius Vilniaus universiteto Vaikų ligoninė, Vaikų chirurgijos centras, Vilniaus universiteto Vaikų ligoninės Chirurgijos centras, Santariškių g. 7, LT-08406 Vilnius El paštas: [email protected] Įvadas / tikslas Pagrindinis limfangiomos gydymo būdas – jos pašalinimas. Tačiau radikaliai limfangiomą pašalinti ne visada įmanoma. Todėl ieškoma alternatyvių gydymo būdų. Pastaruoju metu labai paplito limfangiomų gydymas preparatu OK-432 (picibaniliu). Tyrimo tikslas – įvertinti vaikų limfangiomų gydymo rezultatus preparatu OK-432 (picibaniliu).. Ligoniai ir metodai Per 12 metų (1995–2006) preparatu OK-432 buvo gydyti 26 ligoniai (nuo 6 mėn. iki 15 metų amžiaus), sergantys įvairios lokalizacijos limfangiomomis. Cistine (makrocistine) limfangiomos forma sirgo 14 ligonių, kavernine (mikrocistine) – 12 ligonių. Rezultatai Trylika iš 14 ligonių, kurie sirgo cistine limfangiomos forma, pasveiko. Viena ligonė, nepadėjus skleroterapijai, buvo operuota. Iš 12-os sirgusiųjų kavernine forma visai pasveiko trys, labai pagerėjo šešiems, truputį pagerėjo trims. Išvada Mūsų patirtis leidžia daryti išvadą, kad OK-432 yra veiksmingas vaistas gydant cistines limfangiomas, taip pat jis padeda ir daliai ligonių, sergančių kavernine ligos forma. Pagrindiniai žodžiai: cistinė limfangioma, kaverninė limfangioma OK-432 (Picibanil) therapy in children with lymphangioma Gintarė Breivienė,  Marytė Malevskienė, Andrius Čekuolis, Kęstutis Trainavičius Vilnius University Children’s Hospital, Center of Pediatric Surgery, Santariškių 7, LT-08406 Vilnius, Lithuania E-mail: [email protected] Background / objective The aim of this study was to evaluate the results of treatment with OK-432 of lymphangioma patients. Patients and methods During 12 years (1995–2006) we treated 26 children for lymphangiomas with OK-432. Their age ranged from 6 months to 15 years. Fourteen patients had cystic lymphangioma and 12 had cavernous lymphangioma. Results Thirteen patients with cystic lymphangioma recovered. One patient was operated on because of unsuccessful therapy, 3 patients from the 12 with cavernous lymphangiomas had a total shrinkage, 6 patients had a marked shrinkage and 3 a slight shrinkage. Conclusions Intralesional injection of OK-432 is an effective and safe treatment for lymphangiomas, especially for cystic lesions. Key words: cystic lymphangioma, cavernous lymphangiom

Diuretic enhanced ultrasonography in the diagnosis of pyeloureteral obstruction

Background and Objectives: To determine the value of diuretic ultrasonography for the diagnosis of obstructive hydronephrosis. Materials and Methods: Diuretic enhanced ultrasonography was used routinely as a part of examination of patients with hydronephrosis in our Department. There were 72 patients (42 males, 30 females; aged 2 months to 17 years; median age 7.07 years) with a sonoscopic diagnosis of hydronephrosis included from January 2006 until October 2011. The anteroposterior diameter (AD) of renal pelvis was measured sonoscopically before and at sixty minutes after furosemide injection. A weight-adjusted dose of 1 mg/kg of furosemide was administered intravenously. Results: Patients were operated on if pyeloureteral obstruction was suspected because of low or deteriorating differential renal function, increasing hydronephrosis or symptoms thereof. Hydronephrosis was unilateral in 61 (84.7%) and bilateral in 11 (15.3%) patients. The median AD of pelvis before furosemide injection was 22 mm in operated and 17 mm in non-operated patients (p = 0.005). Sixty minutes after furosemide injection, the AD of pelvis in operated patients was 35.5 mm and 25.8 mm in non-operated—25.8 mm (p < 0.001). Logistic regression model demonstrated that significant factors for surgery were: AD 60 minutes after furosemide infection and ultrasonographic parenchymal sclerosis. Conclusion: Ultrasound measurement of the AD of renal pelvis 1 hour after the injection of furosemide used as an additional investigation can help in predicting obstructive hydronephrosis

Vaikų uždaros pilvo traumos: diagnostika ir gydymas

Benjaminas Siaurusaitis, Kęstutis Trainavičius, Gintarė Breivienė, Andrius Čekuolis, Arūnas StrumilaVilniaus universiteto Vaikų ligoninė ir Vaikų ligų klinikaSantariškių g. 7, LT-08406 VilniusEl paštas: [email protected] Įvadas / tikslas Dauguma vaikų uždarų pilvo traumų pastaraisiais metais išgydoma konservatyviai. Darbo tikslas – apžvelgti šių traumų gydymo taktiką per 25 metus ir jo rezultatus. Ligoniai ir metodai Retrospektyviai analizuota 1979–2003 metais gydytų 1139 vaikų uždarų pilvo traumų priežastys, sužalojimų klinikiniai ir tyrimų duomenys, gydymo metodai ir rezultatai. Rezultatai Vaikų uždaros pilvo traumos dažniausiai įvyksta dėl buitinių traumų ir autoįvykių. Daugėja smurtinių traumų. Dažniausiai sužalojama blužnis (174 ligoniai, 15,3% visų traumų). Kepenų sužalojimai nustatyti 42 ligoniams (3,7%). Dėl tikslesnės diagnostikos per pastaruosius 5 metus šių pažeidimų gydymo taktika tapo konservatyvesnė: neoperuojant išgydyti 39 iš 47 blužnies traumą patyrusių vaikų (83,0%) ir 10 iš 12 kepenų traumą patyrusių vaikų (83,3%). Vaikų ertminių pilvo organų sužalojimai reti: 36 ligoniai (3,2%). Visi kasos, dvylikapirštės žarnos traumas patyrę ligoniai buvo operuoti. Jie pasveiko. 865 ligoniams (75,9%) diagnozuotas tik pilvo sumušimas. Mirė 3 ligoniai (0,3%). Išvados Nauji šiuolaikiniai tyrimo metodai – echoskopija, kompiuterinė tomografija – labai pakeitė vaikų uždarų pilvo traumų gydymo taktiką. Dėl tikslesnės diagnostikos daugumą blužnies, kepenų, kasos sužalojimų galima išgydyti konservatyviai. Operuojama besitęsiant ar atsinaujinus kraujavimui ir esant nestabiliai hemodinamikai. Reikšminiai žodžiai: vaikų uždaros pilvo traumos, pilvo organų sužalojimai, diagnostika, chirurginio gydymo taktika Blunt abdomen injury in children: diagnosis and treatment Benjaminas Siaurusaitis, Kęstutis Trainavičius, Gintarė Breivienė, Andrius Čekuolis, Arūnas Strumila Background / objective The large majority of children with blunt abdomen trauma are treated non-operatively. The aim of our study was to analyze the tactics of treatment of blunt abdomen trauma and the results of 25 years. Patients and methods The retrospective study of 1139 patients treated in our clinic between 1979 and 2003 has been undertaken. Causes of trauma, clinical and diagnostic data, methods of treatment and results were analyzed. Results The most common causes of injuries were conditions of life and motor vehicle accidents, but violent traumas were also frequent. Spleen injury was the most frequent blunt trauma (174 patients, 15.3%). Hepatic trauma was diagnosed in 42 patients (3.7%). The diagnosis was made clinically and confirmed by sonography. The background for non-operative treatment was the precise diagnostics including CT-scan: in the last 5 years 83% of spleen (39 patients) and liver (10 patients) injuries were treated non-operatively. All 36 patients (3.2%) with intestinal injuries were operated on. Injuries of the retroperitoneal organs (duodenum, pancreas) were rare. The diagnosis was confirmed by CT. All patients were operated on and recovered. The large majority of patients (865 patients, 75.9%) underwent only abdomen contusion. There were 3 deaths (0.3%). Conclusions New diagnostic modalities, sonography and CT-scan, changed the management of patients with blunt abdominal trauma. Most patients with liver and spleen blunt injuries are treated non-operatively. Operative treatment is indicated if there are signs of continuing bleeding and patients are hemodinamically unstable. Keywords: blunt abdomen injury in children, intraabdominal injuries, diagnosis, tactics of surgical treatmen

Kidney length normative values in children aged 0-19 years - a multicenter study

Abstract Background: Currently used pediatric kidney length normative values are based on small single-center studies, do not include kidney function assessment, and focus mostly on newborns and infants. We aimed to develop ultrasound-based kidney length normative values derived from a large group of European Caucasian children with normal kidney function. Methods: Out of 1,782 children aged 0-19 years, 1,758 individuals with no present or past kidney disease and normal estimated glomerular filtration rate had sonographic assessment of kidney length. The results were correlated with anthropometric parameters and estimated glomerular filtration rate. Kidney length was correlated with age, height, body surface area, and body mass index. Height-related kidney length curves and table were generated using the LMS method. Multivariate regression analysis with collinearity checks was used to evaluate kidney length predictors. Results: There was no significant difference in kidney size in relation to height between boys and girls. We found significant (p < 0.001), but clinically unimportant (Cohen's D effect size = 0.04 and 0.06) differences between prone vs. supine position (mean paired difference = 0.64 mm, 95% CI = 0.49-0.77) and left vs. right kidneys (mean paired difference = 1.03 mm, 95% CI = 0.83-1.21), respectively. For kidney length prediction, the highest coefficient correlation was observed with height (adjusted R2 = 0.87, p < 0.0001). Conclusions: We present height-related LMS-percentile curves and tables of kidney length which may serve as normative values for kidney length in children from birth to 19 years of age. The most significant predictor of kidney length was statural height