Birkitt lymphoma (BL) is one of the most studied and curable type of lymphoma in children. But inspite of lymphomagenesis deep understanding on immunologic, molecular and genetic levels, diagnosis of some rare clinical presentations of disease become challenging task for well-qualified clinicians. In the current issue we present rare case of skin involvement in pediatric 4 year old patient with disseminated BL. It is presented clinical and morphologic characteristic of specific skin presentation. Used multiagent chemotherapy with rituximab deliver the result of complete response. Skin site regression was found on 2d day of treatment. Parents give their agreement to use personal data, including fotos, in research and publications.

The article presents the results of prospective randomized study consisted of patients (n = 90) with malignant tumors of lungs and chest wall, undergoing surgeries for lung, pleura resections, lobectomy, one or several ribs resection under combined anesthesia. The choice of analgetic component of combined anesthesia for the first group (n = 50) was paravertebral block (PVB), for the second group (n = 40) — high thoracic epidural block (EB). Induction of anesthesia was performed with inhalational Sevoflurane for minors and with intravenous Diprivan for seniors. Fentanyl and myorelaxants (cysatracurium or rocuronium bromide) were administered before intubation. Anesthesia was maintained with inhalational Sevoflurane (1 MAC) in all the cases. Paravertebral and epidural blocks were performed according to current protocols. It was determined that analgesic effect of prolonged paravertebral block for operative pain control after thoracotomy was equal to the one of epidural block.

A case of anesthesia management for nephrectomy in 20-month-old patient with a giant Wilms tumor is reported. The complexity of anesthesia was determined by the size of tumor, increased intra-abdominal pressure, respiratory deficiency, hypercoagulation and tumor intoxication. However, intraoperative epidural analgesia: continuous infusion of mixture of local anesthetic, opioid analgesic and epinephrine, provided reliable protection against surgical stress response, granted hemodynamic stability and fast recovery in the earliest postoperative period. Pneumoprotective ventilation strategy excluded hypoxic disorders of organs and tissues in the intra- and postoperative period, with an eye to inflammatory changes and hypoventilation in lungs, and keeping in mind the huge size of the tumor. «Harvard standard» monitoring, bispectral index monitoring, capillary blood gas and coagulation intraoperative tests, as well as transesophageal doppler provided adequate infusion-transfusion therapy and rapid recovery in the postoperative period. ( For citation: Matinyan N.V., Saltanov A.I., Martynov L.A., Kazantsev A.P. Anesthesia Management of a 20-month-old Patient with Giant Unilateral Wilms Tumor: Case Report. Onkopediatria. 2015; 2 (1): 69 – 72).

22 monthsboy had beendiagnosed with rhabdomyosarcoma of the right hemithorax at the complex examination and received 2 courses of PCT (vincristine, cisplatin, cyclophosphan, doxorubicin, doses are unknown) domiciliary (Uzbekistan). Parents refused from subsequent treatment. To be noted: any other data on an.morbi is unknown. At the age of 32 months the child developedclinical signs of I-II grade respiratory failure that made parents to refer to the DOG SRI N.N. Blokhin RCRC. The child was diagnosed with a giant size ganglioneuroblastoma of the right hemithorax with spread to the left hemithorax. The patient received 2 courses of etiotropic PCT (carboplatine, doxorubicin, cyclophosphan, etoposide in conventional doses), stabilization, it was decided to perform a surgery.At the day +64 operation was performed: thoracotomy at the right, removal of the tumor of the posterior mediastinum. At the day +74 a residual tumor with an intracanal component was revealed at the control MRI. At the day +94 no disease progression and complications of surgical treatment were revealed.

Sugammadex is a new type agent for reversal of neuromuscular blockade in any stage. There are foreign and home sugammadex use studies; however the information of sugammadex use in Pediatric patients is not enough. The article deals with study results of sugammadex use in Pediatric surgical oncology for the reversal of neuromuscular blockade by the agent rocuronium. 42 Pediatric patients in age from 2 to 17 years after elective oncology surgeries were recruited in the study. The speed and entirety of myorelaxation shifting as an evidence of sugammadex effectiveness were assessed by the accelerometer.

216 patients age of 6 months to 18 years and referred to various categories of ASA classification (I class 5 %, II 47 %, III 43 %, IV 5 %) were enrolled in the study. Balanced conductive anesthesia was the option in the group of the 105 patients. Effectiveness of anesthesia was assessed in comparison with control group (n = 61) data. Opioids were epidurally administered in the 50 patients. Results of our study demonstrated that addition of epidural blockade to balanced anesthesia for major abdominal surgery improves quality of the anesthesia as well as leads to significant opioid-sparing effect (fentanyl), diminishing risk of opioid adverse effects in pediatric patients.

The paper presents the results of use of continuous epidural bupivacaine infusion for postoperative anesthesia in 88 children operated on for malignant tumors. Two groups of patients differing in the procedure of epidural bupivacaine infusion are compared. The use of bupivacaine at a higher concentration (0.25%) within the first 12 hours of the early postoperative period can provide a more effective anesthesia than that at a concentration of 0.125%. The efficacy and tolerability of the above procedures for injecting the local anesthetic are studied and their after-effects are analyzed.

Thirty-five patients (ASA II-III) aged 12 to 17 years, diagnosed as having osteogenic sarcoma and Ewing's sarcoma localizing in the femur and tibia, were examined. Surgery was performed as sectoral resection of the affected bone along with knee joint endoprosthesis. Surgical intervention was made under combined spinal and epidural anesthesia (CSEA) with sedation, by using the methods for exact dosing of propofol (6-4 mg/kg x h). During intervention, a child's respiration remains is kept spontaneous with oxygen insufflation through a nasal catheter. CSEA was performed in two-segmental fashion. The epidural space was first catheterized. After administration of a test dose, 0.5% marcaine spinal was injected into dermatomas below the subarachnoidal space, depending on body weight (3.0-4.0 ml). Sensory blockade developed following 3-5 min and lasted 90-120 min, thereafter a local anesthetic (bupivacaine) or its mixture plus promedole was epidurally administered. ??Anesthesia was effective in all cases, motor blockade. During surgery, there was a moderate arterial hypotension that did not require the use of vasopressors. The acid-alkali balance suggested the adequacy of spontaneous respiration. The only significant complication we observed was atony of the bladder that requires its catheterization till the following day. An epidural catheter makes it possible to effect adequate postoperative analgesia.