Vol 27, No 6 (2023)

BACKGROUND: For several decades, remote shock wave lithotripsy has been considered a universally recognized gold standard for the treatment of upper urinary tract concrements. Despite its noninvasiveness, each lithotripsy session causes acute kidney injury which cannot be reliably assessed with traditional indicators used in nephrourology. Currently, new modern indicators found in the urine and serum are thought to be more informative biomarkers. In this paper, we investigated the effectiveness of some of them for possible potentials in the diagnostics of acute kidney injury in remote lithotripsy.

AIM: To evaluate changes in acute kidney injury biomarkers during remote shock wave lithotripsy in children.

MATERIALS AND METHODS: 54 children with urolithiasis, who had a session of remote shock wave lithotripsy, were enrolled in the study. In all patients, samples of urine and blood serum were taken three times for assessing biomarkers concentration: before lithotripsy session, after 45 min and after 24 h.

RESULTS: Statistically significant changes in the concentration of all urine biomarkers (NGAL, L-FABP, TIMP-2, calbindin-D, KIM-1) were registered at the basal level and 45 min after the procedure. A number of markers studied by us in the blood serum showed more significant changes 24 h after the procedure (IL-18, TNF-α). Although IGFBP-1 concentration increased slightly after 45 min, this change was not statistically significant (p <0.781). The level of cystatin C did not increase after lithotripsy.

CONCLUSION: The performed analysis of changes in biomarkers concentration has revealed a sufficiently high informative value of biomarkers in assessing the degree of acute kidney injury during remote lithotripsy in children. It also allows to suggest that the studied biomarkers may be promising indicators characterizing such an injury.

BACKGROUND: Ultrasound is a method of choice which is recommended in patients with portal hypertension for diagnosing and monitoring the disease, since it is informative, non-invasive, available and can be performed at patient’s bedside. The problem of portal hypertension in adults, methods of its diagnostics and treatment are widely covered in the medical literature. In clinical practice, portal hypertension in adults in most cases has an intrahepatic form and is associated with cirrhosis as the consequence of chronic liver diseases. Unlike in adults, portal hypertension in children is more often extrahepatic and is associated with some block to the blood flow through the portal vein. Portal vein impaired patency may be caused by thrombosis due to catheterization of umbilical vessels, omphalitis, peritonitis, developmental malformation of the portal system. A considerable difference in the frequency of portal hypertension forms in children and adults impacts the strategy of ultrasound diagnostic examination.

CLINICAL CASE DESCRIPTION: The article presents two clinical observations of extrahepatic form of portal hypertension in children aged one year one month and seven years. The authors demonstrate potentials and main aspects of ultrasound diagnostics in this pathology. They also underline the priority of assessing the portal system patency so as to detect cavernous transformation in the portal vein. Echographic signs such as changes in echogenicity and liver structure, presence of uneven bumpy contour, dilation of portal vessels, recanalization of the umbilical vein, ascites are not typical for the extrahepatic form of portal hypertension in children.

CONCLUSION: In children with extrahepatic portal hypertension, clinical manifestations such as enlarged abdomen, changed blood tests and ecchymoses on the body may be unnoticed for a long time. Bleeding from varicose veins of the esophagus and stomach is met as a frequent sign in children. Therefore, it is of particular importance to allocate newborn children from the risk group (with umbilical vascular catheterization, omphalitis, etc. in the anamnesis) to the special diagnostic group with detailed ultrasound examination of the liver, Dopplerographic assessment of portal vein patency so as to identify possible signs of portal hypertension as early as possible.

BACKGROUND: To diagnose the torsion of the wandering spleen in infants is a challenging task. Torsion of the wandering spleen in such population is an extremely rare case. Among children under one year of age, the wandering spleen is more common in boys (2.5:1). A total of 26 cases of torsion of an accessory spleen were described in the literature. Asymptomatic course of the disease before the first episode of spleen torsion occurs in 70% cases. No case of asynchronous torsion of the main and accessory wandering spleens are described in the literature.

CLINICAL CASE DESCRIPTION: This article describes a very rare clinical case of asynchronous torsion of the main and accessory wandering spleens in an infant. In the described case, basic clinical manifestations of the spleen torsion in an 8-month-old girl were typical for acute enteric infection. The child had laparoscopic splenectomy.

CONCLUSION: The present article describes challenges associated with the diagnostics of this pathology, important role of spiral computed tomography, efficacy of diagnostic laparoscopy and relaparoscopy as well as the efficacy of laparoscopic spleen resection in case of spleen necrosis in an infant.

BACKGROUND: Intestinal intussusception is a common cause of acute intestinal pathology in children. Peitz–Jaegers syndrome is a rare disease with an autosomal dominant type of inheritance characterized by the development of hamartomic polyps in the gastrointestinal tract and pigmented spots on the skin and mucous membranes. It is a “precancerous” state which increases the risk of oncologic formations in the gastrointestinal tract and in genital glands. Peitz–Jaegers syndrome is associated with mutations in STK11 or LKB1 genes.

CLINICAL CASE DESCRIPTION: The article describes the authors’ experience in surgical resolution of the intestinal intussusception with atypical course in a 6-year-old child. Diagnostic laparoscopy detected intussusceptions in the small intestine, one of which was immediately desinvaginated with instruments and the other one required conversion. During the surgery, dense tumor-like formations were identified; therefore, jejunum loop with revealed formations was resected. Further histological and other testings showed that these formations were hamartomic polyps. The patient had been preliminary diagnosed with Peitz–Jaegers syndrome which further was confirmed by genetic and histological analyses and gastroscopic examination. The postoperative period was uneventful; the child was discharged in the satisfactory condition on day 7 after the surgery.

CONCLUSION: Consultations with a pediatric surgeon and gastroenterologist, examination of the upper and lower gastrointestinal tract, monitoring polyps’ onset or growth are stages of key importance in children with Peitz–Jaegers syndrome. Such an approach promotes minimization of risks associated with the course of this disease. To prevent emergency surgical situations, it is important to make genetic analyses for children with the family history of polypous syndrome in the gastrointestinal tract.

BACKGROUND: Treatment of patients with destructive pneumonia remains one of the most difficult problems in pediatric surgery. Modern possibilities of antibacterial and intensive care, minimally invasive endoscopic intraluminal technologies, as well as surgical techniques have reduced the number of adverse outcomes up to 4%. The type of surgical intervention and the time of its performance depend on the disease form, child’s general state, local changes in the bronchi and pleural cavity, as well as on technical capabilities of the clinic.

CLINICAL CASE DESCRIPTION: The article presents a clinical observation of the complex treatment of a 4-year-old patient with destructive pneumonia complicated by a bronchial fistula. Intensive and antibiotic therapy stabilized the child’s condition, eliminated manifestations of multiple organ failure, and drained the pleural cavity to resolve tension pyothorax. The programmed thoracoscopy provided an adequate sanation of the pleural cavity, assessed dynamics of the inflammatory process and allowed to position drains under visual control. The fistula of the lower lobe bronchus was closed with a valve bronchoblocker after elimination of the local erosive and ulcerative lesion. A clinical success of such management was manifested with inflammatory process remission, bronchopleural fistula closure, pleural empyema removal. Due to this, deblocking was done three months after discharge from the hospital. At the control examination, the patient had no fistula, most part of the affected lung was preserved, post-inflammatory changes in the pleural cavity were minimal.

CONCLUSION: The favorable outcome after treatment of children with destructive pneumonia depends on personalized and multidisciplinary approach. Minimally invasive endoscopic techniques do contribute to the effective elimination of complications, to effective functional restoration of the affected lung and to better recovery of patients.