The case of ileocecal intussusception due to Burkitt’s lymphoma in a child

In the practice of a doctor, rare, casuistic diseases occur, accounting for less than 5% of all lesions of an organ. Single cases of intussusception in a child owing to Burkitt’s lymphoma have been described. The child Dmitry S., 12 years old, complained of abdominal pain, repeated vomiting, loose stools, and anorexia. He was sick for 3 days. The father accidentally discovered a tumor in in the right half of the child’s abdomen. At admission, the condition is grave due to intoxication. Pronounced asymmetry of the abdomen due to the formation was revealed. Examinations: CT of the abdominal cavity - abdominal mass in the right half of 120´70´90 mm in size, enlarged mesenteric and retroperitoneal lymph nodes, ultrasound of the abdominal cavity - intussusception of 72´60´50 mm, consisting of intestinal loops and lymph nodes. Preliminary diagnosis - tumour of the abdominal cavity? Intussusception. At laparotomy, tumor biopsy, omentum resection, terminal ileostomy and peritoneal drainage were made. The large omentum was totally affected having multiple nodular elements. The ileocecal zone was affected by the total tumorous process. Intussusception was found in the ascending colon. Disinvagination was determined to be not possible. The extensive tumor spread to the entire mesentery and walls of the small intestine. The parietal peritoneum was involved in the neoplastic process up to the diaphragm. Thrombohemorrhagic changes in the mesenteric vessels in the basin of a.ileocolica and the transitional phenomenon of the necrobiosis in the segments forming the invagination were revealed. Taking into consideration the foregoing, removal of the tumor and intussusception had been considered to be impossible. Biopsy was taken and the large omentum resected. The distal ileum was resected for examination and the terminal ileostomy applied in the proximal part. A «second look» re-exploration was planned in 48 hours. Aspiration biopsy of the bone marrow was performed. At relaparotomy in 2 days necrosis of the intestinal loops composing the intussusception was revealed due to thrombosis of the mesentery vessels. Right-sided hemicolectomy was performed. The results of histological study: lymphoblastic lymphoma with total large omentum infiltration, lesion of the walls of the removed intestinal fragments. Atypical cells were not found in the bone marrow. The child wss consulted in the Institute of Oncology. There was established the clinical diagnosis - Burkitt’s lymphoma, stage IV, therapeutic group 2, subgroup R3, total infiltration of the omentum, lesion of the wall and mesentery of the small intestine and ileocecal angle, retroperitoneal space, parietal peritoneum. Ileo-colonic intussusception with necrosis, terminal ileostoma. For further treatment, the child was sent to the hematology department

Intestinal anastomoses in newborns and children of early age in complicated clinical cases

The application of intestinal anastomoses in newborns and young children under circumstances of multiple atresia, thrombohemorrhagic processes and infection of the abdominal cavity can be complicated by the development of inconsistency of the anastomoses. In the study, the analysis of the results of treatment of 385 children with intestinal anastomoses due to diverse intestinal pathology in newborns and young children over the last 5 years have been performed. All the patients have been on treatment at the Children’s Clinical Hospital of Kharkov National Medical University. We have gained the experience of application of the original anastomosis in 64 children, namely: with complex intestinal malformations (29), necrotizing enterocolitis (25), ulcerative necrotic enterocolitis (6), and other pathology of the abdominal cavity organs. Indications for use of the developed technique of intestinal anastomosis have been pathological processes complicating the course of the wound process and predicted long-term disorders of the digestive tract evacuation. The characteristic property of the anastomosis technique is a preliminarily semi-enclosed demucosation of the proximal intestinal loop with the excessively reserved seromuscular sheath, which allows to define clearly the limits of viability and isolate reliably the suture line long the whole length using the sutural or glue fixation by the demucosated part. The method does not prolong practically the time for application of the intestinal anastomosis in comparison with standard techniqies. One of the patients have undergone 7 anastomoses, five children - 3, and ten children - 2. In none of the cases of the “muff-shaped” anastomosis application has the dehiscence occured. The study of the autopsies has showed preserved viability of demucosated flaps. The analysis of long-term results using the developed method of intestinal anastomosis, taking into account a growing organism, has demonstrated absence of stenotic phenomena and passage problems in the connected segments of the intestine. Thus, the experience of application of muff-shaped anastomosis allows to make a conclusion about its high reliability in newborns and children of early age with complex surgical situations

Formation of biofilms by clinical strains of microorganisms responsible for surgical pyoinflammatory diseases in children

The ability of microorganisms to exist in the form of biofilms creates considerable difficulties for medical practice, since in this case the resistance of bacteria to antimicrobial agents is greatly increased. Therefore, the purpose of this study was to scrutinize the ability to form biofilms by microorganisms isolated from children with pyoinflammatory processes. The identification of microorganisms was carried out according to the generally accepted microbiological protocols of their isolation and cultivation. Testing of isolates for the ability to form biofilms was realized by measurement of optical density in standard units (absorbance units - AU) on the spectrophotometer «Multiskan EX 355». The statistical processing of the results was performed using the programs «Statistica 6» and «Biostat». In the course of the study, S. aureus, S.epidermidis, P. aeruginosa, E. coli, Klebsiella, Proteus spp., and C.albicans were isolated. In most cases, microbial associations comprising from two to three types of microorganisms were detected, namely E. coli, K.pneumoniae, S. aureus in 26,8 %; P.vulgaris, Enterobacter, S.epidermidis – 7,9 %; P.mirabilis, K.pneumoniae, C.albicans – 13,4 %; S.aureus, K.pneumoniae, C.albicans – 23,7 %; E.coli, K.pneumoniae, C.albicans – 16,5 %; S. aureus, P. aeruginosa, C.albicans - 3,4 %; E.coli, S.epidermidis, C.albicans – 2,9 %; P. vulgaris, P. aeruginosa, S.epidermidis – 2,8 %; S. aureus, P.mirabilis – 2,6 % of cases. The obtained results indicated the prevalence of microorganisms of the Enterobacteriaceae in children with pyoinflammatory processes in the material examined. The studies of the ability of clinical strains of microorganisms to form daily compound biofilms, as well as plankton cells and new biofilms, made it possible to establish that the maximum daily biofilms density and the highest plankton cell formation were registered in microbial associations of S. aureus, K.pneumoniae, C .albicans (4,56 ± 0,19 AU) and S. aureus, P. aeruginosa, C. albicans (4,87 ± 0,14 AU). Plankton cells of all investigated microorganisms formed secondary biofilms actively with the highest density in C. albicans (3,62 ± 0,16 AU), K.pneumoniae (2,96 ± 0,14 units), S. aureus (3,09 ± 0,18AU) and P. aeruginosa (3,11 ± 0,12 AU). Thus, as a result of the division of bacterial cells, biofilm-forming microorganisms produce plankton cells capable of attaching themselves to the mucous membranes, wounds, catheters, and IV-lines with following formation of the new colonies, subsequently transforming into dense secondary biofilms, which makes for the spread and formation of multiresistant clinical strains of microorganisms. These properties of virulent microorganisms prompt to the development of methods for destruction of biofilms and intensification of micriflora inactivation in the focus of inflammation. Our studies showed that the above mentioned requirements relating to the effective influence on biofilms corresponded to the joint effect of ultrasound and ozone, which significantly increased the efficiency of the treatment complex