Inguinálna hernia je jedným z najčastejších chirurgických diagnóz v detskom veku. Často sa diagnostikuje už počas prvého roku života. Klinicky sa inguinálny pruh manifestuje vyklenutím v oblasti slabiny a predstavuje vysunutie orgánov peritoneálnej dutiny cez preformovaný alebo sekundárne vzniknutý otvor. Inguinálna hernia sa môže prejaviť aj ako tuhá, výrazne bolestivá rezistencia v oblasti slabiny alebo miešku, ktorá sa nedá voľne reponovať, vtedy sa jedná o tzv. inkarcerovanú alebo zaškrtenú inguinálnu herniu. Inkarcerovaná hernia u dieťaťa patrí medzi náhle príhody brušné. Liečba inguinálnej hernie je iba operačná. Operácia neinkarcerovanej inguinálnej hernie patrí medzi plánované výkony. Cieľom článku je ponúknuť prehľad o aktuálnych operačných metódach pri liečbe inguinálnej hernie u detí. Okrem klasickej operácie inguinálnej hernie je možno zvoliť aj minimálne invazívny prístup, a to metódou PIRS (percutaneous internal ring suturing) alebo laparoskopicky purse-string, prípadne inými laparoskopickými prístupmi. Operácie inguinálnej hernie u detí sa vykonávajú v celkovej anestézii a možno ich vykonávať aj formou jednodňovej zdravotnej starostlivosti.
Inguinal hernia is one of the most common surgical diagnoses in childhood and is often diagnosed during the first year of life. Clinically, the inguinal hernia usually manifests as a bulge in the groin area and represents the protrusion of the organs of the peritoneal cavity through a preformed or secondary made aperture. An inguinal hernia can also manifest as a stiff, significantly painful resistance in the groin or scrotum area, which cannot be freely reponed, it is a so-called „incarcerated“ or strangulated inguinal hernia. An incarcerated hernia in a child is one of the acute abdominal events. Treatment of inguinal hernia is only surgical. Non-incarcerated inguinal hernia surgery is a planned procedure. The aim of the article is to offer an overview of current surgical methods in the treatment of inguinal hernia in children. The operations of inguinal hernia in children can be performed in several ways. In addition to open inguinal surgery, a minimal invasive approach can also be chosen, using the PIRS (Percutaneous Internal Ring Suturing) method, or the laparoscopic purse-string method, or other laparoscopic approaches. Inguinal hernia is operated under general anaesthesia. Inguinal hernia operations in children can also be performed in the form of one-day surgery.
- Klíčová slova
- purse-string,
- MeSH
- dítě MeSH
- inguinální hernie * chirurgie MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- operace kýly metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
Purpose: Various manifestations of coronavirus (SARS-CoV-2) have been reported since the pandemic began. Some articles have reported acute pancreatitis in adult patients due to COVID-19 infection. To our knowledge this is the first report of acute hemorrhagic necrotizing pancreatitis in children associated with SARS-CoV-2 infection. Case presentation: A 7-year-old girl with congenital immunodeficiency was referred to the intensive care (ICU) unit with acute respiratory distress syndrome. She required mechanical ventilation (MV) due to pulmonary involvement of COVID-19 (chest CT with lower lung ground-glass opacities). SARS-CoV-2 infection was laboratory confirmed. Following a 49-day stay in the ICU, due to the clinical and radiological signs of acute abdomen and to the rapid deterioration in the clinical status, an indication to proceed an urgent surgerical intervention was made. Intra-operatively an adhesiolysis with blunt dissection of the of gastrocolic ligament was performed, then followed by debridement of the necrotic pancreas (more than 1⁄2 of the pancreas was damaged). Continuous lavage and drainage were placed. During the post-operative period, patient required aggressive MV and insulin therapy for persistent hyperglycemia. The CT scans reported a necrosis of the pancreas and we observed amylase and lipase elevation in the peritoneal lavage sample. Despite active intensive therapy, the patient's condition did not improve and she died 38 days after laparotomy as a result of multi-organ failure. Conclusion: The mechanism for the development of acute haemorrhagic necrotizing pancreatitis in the COVID-19 positive patients is unclear; perhaps it is due to a direct cytopathic effect from the COVID-19 virus, or due to the ACE2 expression in pancreas.
- Publikační typ
- kazuistiky MeSH
Úvod: Operácie štítnej žľazy (ŠŽ) u detí patria medzi zriedkavé operačné výkony. Cieľom našej práce je poukázať na špecifiká chirurgie štítnej žľazy u detí. Metóda: Retrospektívna analýza pacientov hospitalizovaných na Klinike detskej chirurgie LFUK a NÚDCH Bratislava za 10 ročné obdobie (2007–2016), ktorí boli operovaní pre ochorenia štítnej žľazy. Výsledky: V retrospektívnej analýze bolo zaradených 81 pacientov: 66 (81 %) dievčat a 15 (19 %) chlapcov. Priemerný vek pacientov bol 14 rokov ±8 mesiacov (rozsah 4–18 rokov). Najčastejšou indikáciou na operáciu štítnej žľazy bol uzol u 36 (44,4 %) pacientov, Graves Basedowova tyreotoxikóza u 19 (23,5 %) pacientov a suspektný karcinóm štítnej žľazy u 11 (13,6 %) pacientov. Metastázy (mts) v krčných lymfatických uzlinách boli diagnostikované u 9 (11,1 %) pacientov, vzdialené pľúcne mts u 5 (6,17 %) pacientov. Totálna tyroidektómia (TTE) bola vykonaná u 43 (53 %) pacientov, totálna lobektómia (TL) u 20 (24,7 %) pacientov. Rozšírený výkon na regionálnych lymfatických uzlinách bol robený u 9 (11,1 %) pacientov. Reoperáciu postúpili 8 (9,9 %) pacienti. Celkovo u 12 (14,8 %) pacientov sa vyskytli pooperačné komplikácie. Jednostranná prechodná paréza nervus laryngeus recurrens (NLR) sa vyskytla u 2 pacientov, trvalá paréza NLR bola u jedného pacienta. Prechodná pooperačná hypoparatyreóza s hypokalcémiou bola zaznamenaná u 8 (9,9 %) pacientov, trvalú sme nezaznamenali. Záver: Multidisciplinárna spolupráca prináša pacientom optimálne chirurgické výsledky. Kľúčovou zostáva skúsenosť chirurga vykonávajúceho operácie štítnej žľazy u detí.
Introduction: Thyroid surgery in children is a rare operation. The aim of our paper is to point out the specifics of thyroid surgery in children. Methods: Retrospective analysis of patients hospitalized at the Department of Paediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases in Bratislava during a 10-year period (2007−2016) who underwent thyroid surgeries. Results: The retrospective analysis included 81 patients: 66 (81%) girls and 15 (19%) boys. The mean age of the patients was 14 years ±8 months (range 4−18 years). The most common indications for thyroid surgery were: a nodule in 36 (44.4%) patients, Graves Basedow thyrotoxicosis in 19 (23.5%) patients, and suspected thyroid carcinoma in 11 (13.6%) patients. Cervical lymph node metastases (mts) were diagnosed in 9 (11.1%) patients, and distant pulmonary metastases in 5 (6.17%) patients. Total thyroidectomy (TTE) was performed in 43 (53%) patients, total lobectomy (TL) in 20 (24.7%) patients. Extended surgery on regional lymph nodes was performed in 9 (11.1%) patients. Eight (9.9%) patients underwent reoperation. A total of 12 (14.8%) patients experienced postoperative complications. Unilateral transient recurrent laryngeal nerve (RLN) paralysis occurred in 2 patients, and permanent in one patient. Transient postoperative hypoparathyroidism with hypocalcaemia was reported in 8 (9.9%) patients; no permanent condition of this type was observed. Conclusion: Multidisciplinary collaboration ensures that optimal surgical results are achieved in the patients. Experience of the surgeon performing thyroid surgery in children remains crucial.
- MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- nádory štítné žlázy * chirurgie diagnóza MeSH
- nemoci štítné žlázy * chirurgie diagnóza MeSH
- pooperační komplikace MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- tyreoidektomie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Monocyte-derived dendritic cell (DC)-based vaccines loaded with tumor self-antigens represent a novel approach in anticancer therapy. We evaluated DC-based anticancer immunotherapy (ITx) in an academic Phase I/II clinical trial for children, adolescent, and young adults with progressive, recurrent, or primarily metastatic high-risk tumors. The primary endpoint was safety of intradermal administration of manufactured DCs. Here, we focused on relapsing high-risk sarcoma subgroup representing a major diagnosis in DC clinical trial. As a part of peripheral blood immunomonitoring, we evaluated quantitative association between basic cell-based immune parameters. Furthermore, we describe the pattern of these parameters and their time-dependent variations during the DC vaccination in the peripheral blood immunograms. The peripheral blood immunograms revealed distinct patterns in particular patients in the study group. As a functional testing, we evaluated immune response of patient T-cells to the tumor antigens presented by DCs in the autoMLR proliferation assay. This analysis was performed with T-cells obtained prior to DC ITx initiation and with T-cells collected after the fifth dose of DCs, demonstrating that the anticancer DC-based vaccine stimulates a preexisting immune response against self-tumor antigens. Finally, we present clinical and immunological findings in a Ewing's sarcoma patient with an interesting clinical course. Prior to DC therapy, we observed prevailing CD8+ T-cell stimulation and low immunosuppressive monocytic myeloid-derived suppressor cells (M-MDSC) and regulatory T-cells (Tregs). This patient was subsequently treated with 19 doses of DCs and experienced substantial regression of metastatic lesions after second disease relapse and was further rechallenged with DCs. In this patient, functional ex vivo testing of autologous T-cell activation by manufactured DC medicinal product during the course of DC ITx revealed that personalized anticancer DC-based vaccine stimulates a preexisting immune response against self-tumor antigens and that the T-cell reactivity persisted for the period without DC treatment and was further boosted by DC rechallenge. Trial Registration Number: EudraCT 2014-003388-39.
- Publikační typ
- časopisecké články MeSH
Despite efforts to develop novel treatment strategies, refractory and relapsing sarcoma, and high-risk neuroblastoma continue to have poor prognoses and limited overall survival. Monocyte-derived dendritic cell (DC)-based anti-cancer immunotherapy represents a promising treatment modality in these neoplasias. A DC-based anti-cancer vaccine was evaluated for safety in an academic phase-I/II clinical trial for children, adolescents, and young adults with progressive, recurrent, or primarily metastatic high-risk tumors, mainly sarcomas and neuroblastomas. The DC vaccine was loaded with self-tumor antigens obtained from patient tumor tissue. DC vaccine quality was assessed in terms of DC yield, viability, immunophenotype, production of IL-12 and IL-10, and stimulation of allogenic donor T-cells and autologous T-cells in allo-MLR and auto-MLR, respectively. Here, we show that the outcome of the manufacture of DC-based vaccine is highly variable in terms of both DC yield and DC immunostimulatory properties. In 30% of cases, manufacturing resulted in a product that failed to meet medicinal product specifications and therefore was not released for administration to a patient. Focusing on the isolation of monocytes and the pharmacotherapy preceding monocyte harvest, we show that isolation of monocytes by elutriation is not superior to adherence on plastic in terms of DC yield, viability, or immunostimulatory capacity. Trial patients having undergone monocyte-interfering pharmacotherapy prior to monocyte harvest was associated with an impaired DC-based immunotherapy product outcome. Certain combinations of anti-cancer treatment resulted in a similar pattern of inadequate DC parameters, namely, a combination of temozolomide with irinotecan was associated with DCs showing poor maturation and decreased immunostimulatory features, and a combination of pazopanib, topotecan, and MTD-based cyclophosphamide was associated with poor monocyte differentiation and decreased DC immunostimulatory parameters. Searching for a surrogate marker predicting an adverse outcome of DC manufacture in the peripheral blood complete blood count prior to monocyte harvest, we observed an association between an increased number of immature granulocytes in peripheral blood and decreased potency of the DC-based product as quantified by allo-MLR. We conclude that the DC-manufacturing yield and the immunostimulatory quality of anti-cancer DC-based vaccines generated from the monocytes of patients were not influenced by the monocyte isolation modality but were detrimentally affected by the specific combination of anti-cancer agents used prior to monocyte harvest.
- Publikační typ
- časopisecké články MeSH
