Background. Retinoblastoma is the most common intraocular malignant tumor in children. Substantial advances have been made in field of local treatment, in particular, through the development of selective intraarterial chemotherapy (SIAC). Life-threatening cardio-respiratory disorders were reported during the course of SIAC at the moment of a.ophthalmica catheterization. Objective. Our aim was to improve the safety and effectiveness of anesthetic management in children with retinoblastoma. Methods. The retrospective study included patients (n=203) who underwent SIAC (517) under general anesthesia in 2013–2018. Results. Hemodynamic parameters in patients who underwent SIAC procedure for the first time (211) were analyzed, in 186 (88%) cases, smooth anesthesia was observed, the deviations of blood pressure and heart rate did not exceed 20% of the baseline values. In 25 (12%) cases, patients who underwent the first SIAC procedure developed bronchospasm with a decrease in respiratory volume of up to 30% from the initial values 10–20 seconds after catheterization of a.ophthalmica with microcatheter. When analyzing hemodynamic parameters in patients who underwent repeated SIAC procedures (2nd, 3rd sessions, etc.) (306), in 177 (58%) cases, a clinical picture of the trigemino-pulmonary reflex of varying severity manifested. Conclusion. Severe cardio-respiratory complications are often observed during SIAC in children with retinoblastoma. These reactions occur predominantly during the second or subsequent procedures and can be potentially life-threatening. All patients with retinoblastoma who undergo SIAC should be considered at high risk.
Вопросы анестезиологии w w w . r e a n i m a t o l o g y . c o m Цель исследования -повышение эффективности и безопасности анестезии при проведении торакальных оператив ных вмешательств в детской онкохирургии путем применения общей анестезии в сочетании с торакальной паравер тебральной аналгезией. Материалы и методы. Проведено проспективное, рандомизированное исследование. Ана лизировали интра и послеоперационные данные у 90 пациентов, оперированных по поводу злокачественных опухолей легких и грудной клетки. Выделены 2 группы пациентов: 1 группа -дети, которым в составе сочетанной сбалансированной анестезии использовалась продленная торакальная паравертебральная блокада (ПВБ) ропивака ином 0,3% (n=50) и 2 группа -дети, получавшие в качестве анальгетического компонента сочетанной анестезии эпи дуральную блокаду ропивакаином 0,2% (n=40). Всем пациентам проводили мониторинг гемодинамики, в послеопе рационном периоде применяли тесты оценки боли: у детей старше 3 лет -по визуально -аналоговой шкале (ВАШ) и у детей до 3 лет -по модифицированной шкале Douleur Aigue du Nouveau ne (DAN). Результаты. Исследование показало, что анальгетический эффект при продленной паравертебральной блокаде в интра и послеоперационном периоде сопоставим с анальгетическим эффектом эпидуральной блокады 0,2% ропивакаином, однако обладает большей гемодинамической стабильностью. Выполнение паравертебральной блокады в условиях УЗИ контроля имеет достаточную безопасность. Возникшие в послеоперационном периоде осложнения: пневмония в группе с па равертебральной блокадой -у 2 (4%) пациентов, в группе с эпидуральной аналгезией -у 5 (12,5%) были связанны с исходным состоянием пациентов. Синдром послеоперационной тошноты у пациентов в группе с паравертебраль ной блокадой выявлен лишь у 6% пациентов. Заключение. Предложенная модификация введения ропивакаина 0,3% в паравертебральное пространство под УЗИ контролем позволяет увеличить площадь распространения местного анестетика, тем самым повышая эффективность ПВБ. Эффективность блока составляет 98,1% по сравнению с 86%, приводимых зарубежными авторами. Ключевые слова: паравертебральная блокада, ропивакаин, детская онкология, послеоперационный период. Objective: to enhance the efficiency and safety of anesthesia during thoracic surgical interventions in pediatric can cer surgery, by using general anesthesia in combination with thoracic paravertebral analgesia. Subjects and methods. A prospective, randomized trial was conducted. Intra and postoperative data were analyzed in 90 patients who had been operated on for lung and thoracic malignancies. There were two patient groups: 1) 50 children who used contin uous thoracic paravertebral block (PVB) with ropivacaine 0.3% as part of combined balanced anesthesia and 2) 40 children who received epidural block with ropivacaine 0.2% as an analgesic component of combined anesthesia. All the patients underwent hemodynamic monitoring; postoperative pain assessment were carried out by a visual ana logue scale (VAS) in children above 3 years of age and by the modified Do...
204ОБМЕН ОПЫТОМ ВВЕДЕНИЕ Удаление опухолей и коррекция пороков раз-вития эндоскопическим эндоназальным методом у детей активно развивается. Метод является малотравматичным и хорошо переносится больны-
Infantile fibrosarcoma (IF) is a rare soft tissue sarcoma that occurs with a frequency of 1% of all cases of malignant neoplasms in children in the first year of life. IF most often affects the soft tissues of the upper and lower extremities. Rare localizations include the trunk, the head and neck, and the gastrointestinal tract. The article describes a rare clinical case of congenital IF of soft tissues of the chest wall in a newborn, as well as a literature review.
Introduction. Retinoblastoma (RB) is a malignant tumor of the retina, the survival rate for the intraocular form reaches 99 %. According to the researchers, the risk factors for the occurrence of refractory or recurrent forms of RB are the size of the tumor at primary diagnosis (more than 15 mm), the child's age at the onset of the disease (up to one year), bilateral RB, and the presence of subretinal and vitreal screenings. If methods of local destruction of the tumor are not applicable for the successful treatment of intraocular refractory or recurrent RB, then they resort to the second line of polychemotherapy as an alternative to enucleation. New versions of local chemotherapy and radiation therapy (gamma knife) are being developed and applied. Nowadays, researchers have a negative attitude towards traditional radiation therapy (EBRT) as a method of organ-preserving treatment due to serious consequences (asymmetry of the facial skeleton and second radio-induced tumors).Aim of the study — to increase the effectiveness of organ-preserving treatment in patients with refractory or recurrent intraocular RB.Materials and methods. In the period from 10.2018 to 12.2019 at the N.N. Blokhin National Medical Research Centre of Oncology it was received three-component selective intra-arterial chemotherapy (SIAC) in 15 patients (15 eyes) aged 11 to 52 months. Eyes initially affected by RB (n = 15), according to the IIRC (Murphree) classification, had the following groups: group B in 1 case, group C in 3, group D in 7, and group E in 4 eyes. It should be noted that all patients initially received intensive combined conservative therapy: in 11 (73 %) of 15 cases — systemic chemotherapy VEC; in 13 (86 %) of 15 — SIAC with melphalan, in all cases, additionally, two-component SIAC was used in combination with melphalan with topotecan. In some cases, local therapy in the form of intravitreal chemotherapy (IVIC) was added to the treatment of 6 (40 %) of 15 patients in the form of melphalan monotherapy and in one case (6 %) a doublet was used in combination with melphalan and topotecan. Also, in some patients, additional local ophthalmic therapy was used: transpupillary thermotherapy (TTT) in 6 out of 15 patients, including in combination with cryotherapy (CT) in 1 patient and in combination with brachytherapy (BT) in one case. At the same time, incomplete tumor regression (refractory form of the disease) was noted in 7 out of 15, and a recurrent course of the disease — in 8 out of 15 patients. Incomplete tumor regression and recurrent RB were the reasons for the appointment of a three-component SIAC using carboplatin, melphalan and topotecan, in combination with IVIC with pronounced endophytic growth of RB, as an alternative to irradiation and enucleation of the eye.Results. The average number of three-component SIAC courses was 1.46 ± 0.63 (rang 1—3). The combination of SIAHT with IVHT was performed in 3 out of 15 patients. All children (n = 15) are alive with a median period of follow-up of23.92 ± 15.68 (10—64) months. One in 15 patients was lost from observation due to their parents’ desire to be treated abroad. It is known that the child is alive, but there is no data on the condition of his eyes. 9 out of 14 patients needed additional treatment after SIAC intensification. To consolidate the resulting effect as a full regression in 2 cases, the final IVIC courses were conducted (n = 2). In connection with the presence of residual tumor and/or intraocular progression and/or appearance of new lesions in 1 of 9 patients were IVIC and TTT, 2 of 9 — IVIC, SIAC, CT, TTT. In 4 out of 9 cases, enucleation was performed, and in 2 out of 4 — the operation was performed after continuing the attempt of organ-preserving treatment: after CT and TTT (n = 1) and IVIC, CT, TTT and BT (n = 1). No child was given ERBT. There were no cases of stroke after SIAC. We managed to save 10 (71.4 %) of 14 eyes with visual acuity: object vision in 4 (40 %) out of 10, eye fixation in 3 (30 %) out of 10, and light perception in 3 (30 %) out of 10 cases. The average follow-up period from the end of three-component SIAC in 14 patients was 13.57 ± 5.27 (6—22) months.Conclusion. Thus, the three-component SIAC is effective and safe for patients with refractory and recurrent retinoblastoma, as evidenced by a high percentage of retained eyes and the presence of visual functions from light perception to object vision.
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