INTRODUCTION: Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemia, lymphomas in children and is accompanied by a fatal outcome in 21.4 % of patients. The basis of ATLS is the decay of tumor cells, in which the volume of decay products exceeds the excretory capabilities of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100×109/L) and non-Hodgkin's lymphomas with a large tumor mass (III–IV stages of the disease). To date, the volume of thematic publications in the aggregator of the PubMed medical database is not so large: over the past 10 years, there have been 12 articles, which makes the task of systematizing previously accumulated and recently received information even more relevant for the practitioner. OBJECTIVE: Generalization of the modern scientific base for the diagnosis and treatment of ATLS in children. MATERIALS AND METHODS: To highlight the modern scientific base concerning the diagnosis and treatment of ATLS in children with oncohematological diseases, a search was conducted in PubMed, Research Gate, Web of Science Core Collection and Google Scholar systems for the period from 2000 to August 2022. RESULTS: In total, 94 articles were found, including 1 systematic review with meta-analysis and 16 review articles that meet the requirements. CONCLUSIONS: Conservative ATLS prophylaxis is effective in 93.4–93.6 % of patients. However, in 8.8–21.4 % of patients, ATLS acquires a rapid character, accompanied by the lack of the ability to conservatively correct the indicators of potassium, phosphorus, uric acid. Additional study of the pathogenetic mechanisms of the complication, identification of key targets of drug therapy and a multidisciplinary approach in the treatment of an extremely prognostically unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components of further improving the effectiveness of ATLS therapy.

АКТУАЛЬНОСТЬ: Синдром острого лизиса опухоли (СОЛО) осложняет лечение высокоагрессивных лейкозов, лимфом у детей и сопровождается летальным исходом у 21,4 % больных. В основе СОЛО лежит распад опухолевых клеток, при котором объем продуктов распада превышает экскреторные возможности почек. В группу риска СОЛО входят пациенты с острым лимфобластным лейкозом, сопровождающимся гиперлейкоцитозом (выше 100×109/л) и неходжкинскими лимфомами с большой опухолевой массой (III–IV стадии заболевания). К настоящему времени объем тематических публикаций в агрегаторе медицинской базы данных PubMed не столь велик: за последние 10 лет насчитывает 12 статей, что делает задачу систематизации ранее накопленной и полученной в последнее время информации для практикующего врача еще более актуальной. ЦЕЛЬ ИССЛЕДОВАНИЯ: Обобщение современной научной базы по диагностике и лечению СОЛО у детей. МАТЕРИАЛЫ И МЕТОДЫ: Для освещения современной научной базы, касающейся диагностики и лечения СОЛО у детей с онкогематологическими заболеваниями, был проведен поиск в системах PubMed, ResearchGate, Web of Science Core Collection и Google Scholar за период с 2000 г. по август 2022 г. РЕЗУЛЬТАТЫ: В целом было обнаружено 94 статьи, из них 1 систематический обзор с метаанализом и 16 обзорных статей, соответствующих предъявляемым требованиям. ВЫВОДЫ: Консервативная профилактика СОЛО (инфузионная терапия, применение аллопуринола и расбуриказы, начало противоопухолевого лечения с циторедуктивной префазы) оказывается эффективной у 93,4–93,6 % больных. Однако, по некоторым данным, у 8,8–21,4 % пациентов СОЛО приобретает стремительный характер, сопровождаясь отсутствием возможности консервативно корригировать показатели калия, фосфора, мочевой кислоты. Дополнительное изучение патогенетических механизмов осложнения, определение ключевых мишеней лекарственной терапии и мультидисциплинарный подход в лечении крайне прогностически неблагоприятной группы онкогематологических больных с распространенными стадиями опухолевого процесса — возможные составляющие дальнейшего повышения эффективности терапии СОЛО.

Aiml. Optimization of anesthesia during enucleation of the eyeball in pediatric oncosurgery with an emphasis on regional methods. Material and Methods. Eight anesthesias were performed in children, whose average age was 3 years, operated on for retinoblastoma from July 2021 to January 2022. All patients underwent combined endotracheal anesthesia. A triple block was used as a regional component: palatal anesthesia, infraorbital anesthesia and van Lint block. Results. The effectiveness and adequacy of the proposed method of anesthesia using regional anesthesia was assessed in terms of hemodynamics – heart rate, systolic and diastolic blood pressure, the level of oppression of consciousness (BIS-index). The assessment was made at five stages: the beginning of anesthesia, tracheal intubation, 10 minutes after the triple block, at the traumatic stage of surgery, and at the end of anesthesia before tracheal extubation. As a result, it was noted that the studied variant of anesthetic management is characterized by a stable hemodynamic profile, and also does not provoke the development of an oculocardial reflex. There was a decrease in the level of the BIS-index below 40 c.u. at the stage of maintenance of anesthesia, which indicated the possibility of using lower concentrations of sevoflurane. Conclusions. This option of anesthetic management has sufficient efficiency and safety, and also allows to ensure the comfort of the surgeon. Key words: retinoblastoma; combined anesthesia; regional anesthesia.

Background. Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemias and lymphomas in children and leads to death in 21.4 % of severe cases. ATLS is based on the death of tumor cells, so the volume of decay products exceeds the excretory capacity of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100 × 109/L) and non-Hodgkin’s lymphomas with a large tumor mass (stage III–Iv of the disease). The development of acute renal and then multiple organ failure require intensive monitoring of ATLS clinical and biochemical markers and the development of optimal patient management tactics jointly by an intensive care physician and a pediatric oncologist-hematologist.Aim. To summarize the literature and our own clinical experience in the diagnosis and treatment of ATLS in pediatric oncohematology.Materials and methods. The literature data on the diagnosis and treatment of ATLS in children with oncohematological diseases were analyzed. Summarized own clinical experience from January 2009 to January 2022.Results. Of 379 patients with acute lymphoblastic leukemia and non-Hodgkin’s lymphomas, who are at risk for developing ATLS, 350 (93.4 %) patients underwent conservative ATLS therapy, of which in 31 (8.8 %) cases, hemodiafiltration was required to eliminate tumor decay products. The average number of hemodiafiltration procedures is 3 (from 1 to 15). Nevertheless, despite the whole range of therapeutic measures, the addition of infectious and multiple organ complications caused death in 7 (22.6 %) of 31 patients. Most (5 out of 7) fatal cases occurred between 2009 and 2013, and the number of lethal cases because of ATLS from 2014 to 2022 years were only 2. In 24 (77.4 %) patients, the signs of ATLS were successfully managed, the patients continued antitumor treatment. when observing patients for 6 years (from 7 months to 13 years), there were no signs of disease relapse, as well as renal dysfunction.Conclusion. prevention and treatment of ATLS, including cytoreductive prephase, infusion therapy, allopurinol and rasburicase, and in case of ineffectiveness, hemodiafiltration is the basis of modern intensive therapy for hematological malignancies in children. Additional study of the pathogenetic mechanisms of ATLS development, identification of key targets of drug therapy, and a multidisciplinary approach in the treatment of an extremely unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components for further increasing the effectiveness of ATLS therapy.