Vessels In Children Research Articles

Assessment of hemodynamic disturbance in connective tissue dysplasia syndrome of extracerebral and cerebral vessels in children

Syndrome of dysplasia connective tissue are recorded as cerebrovascular structural abnormalities of the vascular system include (deformations of vessels) and they are predisposing factors of dyscirculatory hemodynamic cerebrovascular disturbances.The studying of clinical and ultrasonic data of extra cranial part of brachiocephalic vessels at children allows to reveal the structural peculiarities and direction of internal carotid artery (deformations), its interrelation with cerebrovascular hemodynamic infringements.Early revealing of vessels’ structural abnormalities allow to carry out in due time diagnostics and cerebrovascular pathology preventive maintenance at children’s age. The ultrasound methods are one of the key non-invasive methods in management algorithm of patients with cerebrovascular disturbances

Feasibility of epicardial implantation of medtronic 3830 lead in a pediatric patient : case report

BackgroundHigh-grade atrioventricular block is the primary reason for epicardial permanent pacemaker implantation during the perioperative period in patients with congenital heart disease. Due to the smaller diameter of venous vessels in children, epicardial permanent pacemaker implantation is usually a preferred choice, we report one pediatric patient who received epicardial permanent pacemaker implantation using a new approach.Case presentationWe present the case of a 2-year-old girl who underwent the modified Konno procedure and Pulmonary valvuloplasty surgery and presented after surgery with a High-grade atrioventricular block. At over 20 days after the patient underwent a redo-sternotomy which epicardial permanent pacemaker implantation. Medtronic Model 4965 Capsure Epi ® steroid-eluting unipolar epicardial pacing lead was immobilized on the surface of the right ear. The Medtronic 3830 pacing lead was screwed obliquely and clockwise under direct view from the surface of the right ventricle to the endocardium near the interventricular septum. The patient’s recovery was uneventful.ConclusionIn this case report, we demonstrate the feasibility and potential benefits of using the Medtronic 3830 lead for epicardial pacing in a pediatric patient with severe cardiac complications following surgery for congenital heart disease. This approach offers a viable alternative to traditional epicardial pacing methods, particularly in complex cases where conventional leads fail to provide stable pacing thresholds.

THE ROLE OF INTRAUTERINE ANTIGEN EXPOSURE IN THE MORPHOGENESIS OF CEREBRAL BLOOD VESSELS

Introduction. The state of cerebral vessels in children of the first year of life with congenital toxoplasmosis, both active and without signs of activity (as models of antenatal antigenic exposure), was considered. The patients were born to mothers whose pregnancy proceeded with mild preeclampsia and perinatal damage to the nervous system. The features of the morphogenesis of the brain vessels of rats after exposure to antigens in the antenatal period were experimentally investigated. Materials and Methods. 119 children of the first year of life were examined. 43 patients with toxoplasmosis, 25 children from women whose pregnancy was complicated by mild preeclampsia, and 28 children with perinatal lesions of the nervous system of hypoxic-ischemic genesis due to antenatal hypoxia of the fetus. The comparison group consisted of 23 healthy children with an uncomplicated antenatal history. Experimental study of the morphogenesis of brain vessels of Wistar rats after intrauterine administration of antigens according to the method of M.A. Voloshin. Results. At 1–2 and 7–8 months of life, in children with antigenic antenatal exposure and perinatal lesions of the nervous system of hypoxic-ischemic genesis, blood flow disorders in the anterior cerebral arteries, vessels of the nail bed, manifestations of endothelial dysfunction and impaired function of the sympathoadrenal system were detected. In the experiment, after the intrauterine introduction of antigens of various nature, an increase in the proportion of the connective tissue component in blood vessels was established, and a significant decrease in the ratio of muscle and connective tissue components from the 1st to the 60th day of postnatal development. Changes in indicators of carbohydrate metabolism and a decrease in glycogen in the anterior cerebral artery of rats 1–60 days of life with antigenic antenatal exposure indicate long-term changes in metabolic disorders of carbohydrate metabolism in the anterior cerebral arteries. By extrapolating the results obtained in the experiment on rats, it is possible to predict metabolic disorders in the vessels of people of the appropriate age, which to a certain extent explains the ultrasound and biomicroscopic changes in vessels, endothelial dysfunction detected in children with antigenic antenatal stimulation at 1–2 and 7–8 months of life. Conclusions. The identified features indicate a change in the morphogenesis of brain vessels after antenatal antigenic exposure and are the background for the formation of central nervous system pathology in children

The efficiency of laser treatment of familial exudative vitreoretinopathy in children

Familial exudative vitreoretinopathy (FEVR) is a hereditary disease characterized by abnormal angiogenesis and avascular zones (AZ) on the retinal periphery. The leading method of treatment of its early stages (1–3) is laser coagulation (LC) of AZ and pathological retinal vessels.Purpose. To study the efficiency of retinal laser coagulation in children with various stages of FEVR.Material and methods. 65 children with FEVR (82 eyes) were observed after retinal LC for 6 months to 10 years (on average, 3 years). The efficiency of laser treatment was evaluated after 2–3 months. We regarded the result as stabilization if no progression of the disease could be observed over the entire follow-up period (at least 12 months), either with or without an additional LC.Results. The efficiency of a single LC in children with FEVR in stage 1 was 100 %, in stage 2, 50 to 56 %, in stage 3, 10 to 50 %, in stage 4, 20 to 33 %. The proportion of cases with long-term (over 12 months) stabilization after additional LC sessions was diminishing according to the initial severity of clinical manifestations: from 75–100 % in stages 1–2 to 41–60 % in stage 3 and to 17–20 % in stage 4.Conclusion. LC efficiency of AZ and pathological retinal vessels in children with FEVR is inversely proportional to the stage of the disease. In more than half of the cases, repeated sessions of LC are required to achieve stabilization. The persistence of vascular activity after LC or the appearance of new vascular malformations are prognostic signs of further FEVR progression. The results obtained indicate the need for an early detection of the disease and an LC procedure to prevent the development of extensive retinal detachment, as well as regular dynamic observation of the patients and further study of the pathogenetic mechanisms of FEVR progression.

Clinical and immunological features of heart and vascular damage in children with juvenile arthritis with systemic onset

Objectives. To study the clinical and immunological features of cardiac and vascular damage in children with juvenile arthritis with systemic onset. Materials and methods. The study included 30 children with juvenile arthritis with systemic onset who were hospitalized in the cardio-rheumatology department of the Republican Specialized Scientific and Practical Medical Center of Pediatrics. All patients underwent clinical and anamnestic, functional, instrumental and laboratory research methods. Conclusion. Clinical and immunological features of lesions of the heart and blood vessels in children with JAWSO depend on the timing of the disease manifestation, the activity of the systemic inflammatory process and are characterized by impaired functional activity of the heart, overexpression of vascular endothelial growth factor - VEGF, which determines the degree of risk of cardiovascular complications in this pathology.

Стеклянные сосуды из детских погребений могильника «Александровские скалы 1» в Восточном Крыму

We publish a collection of glass vessels originating from a burial ground of the 1st—2nd centuries AD, excavated in the vicinity of Kerch. We discuss their assortment, chronology, and role in the funerary rite. A characteristic feature of the funerary rite is the predominance of perfume vessels in children’s burials, i. e. balsamaria of various sizes, and almost complete absence of tableware, characteristic mainly of male graves. The planigraphic distribution of burials with glass vessels in burial mound 2 allows us to identify, preliminarily, two stages of their circulation here: the early one, when all of them were probably still imported from afar, and the later one, reflecting the wider spread of glassware in the region — including, possibly, local production, by the late 1st century AD. The predominance of vessels, which spread widely on the Bosporus towards the late 1st — early 2nd century, suggests that the formation of some elements of the burial rite associated with the use of glass vessels as grave goods could be directly related to the beginning of their wide circulation in the region.

Magnetic resonance-enhanced high-resolution three-dimensional water-selective cartilage sequence visualization of hip vessels in children.

Hip vessel examination provides key information on many hip-related pediatric diseases, and it has an important role in the evaluation of femoral head (FH) blood supply and diagnosis of avascular necrosis (AVN). The aim of this study was to investigate the feasibility of MR-enhanced high-resolution three-dimensional water-selective cartilage (3D-WATSc) sequence in visualizing the vessels of the hip joint in children. Children with hip disease were randomly enrolled prospectively at our hospital from January 2021 to August 2022. We performed our institution's hip MRI protocol and enhanced high-resolution 3D-WATSc sequence. The 3D-WATSc images were reconstructed and analyzed, and images of the normal hip were categorized into grades 0-3. The abnormal hip images were compared with those of the normal side using the χ2 test. Twenty-four patients with unilateral hip abnormalities were included in this study. The cartilaginous vascular canal and ossification centre vessels of normal FHs were observed in 18 patients (75%) and met the grade 3 standard. An abnormal cartilaginous canal was observed in 16 patients (67%); meanwhile, 18 patients (75%) had abnormal extrachondral vessels. Comparison of high-resolution 3D-WATSc images with those of the normal side provided effective abnormal vascular information in 95.8% of patients. Enhanced high-resolution 3D-WATSc can visualize the blood vessels of the hip in children. This may provide a new method for the vascular study of various pediatric hip diseases.

Academician Vladimir Ivanovich Burakovsky (1922–1994) (on the 100<sup>th</sup> anniversary of his birth)

Professor Vladimir Ivanovich Burakovsky was born on August 20, 1922 in Tiflis (Tbilisi). In 1940, Vladimir entered the Tbilisi Medical Institute. In 1947, V. I. Burakovsky was enrolled in a clinical residency at the Department of Faculty Surgery № 2 (since 1955 – Department of Surgery for Advanced Doctors № 1) Military Medical Academy named after S. M. Kirov in Leningrad. In the spring of 1960, Vladimir Ivanovich was accepted as a senior researcher at this Institute and appointed the head of the Department of Surgery of the heart and blood vessels in children. Vladimir Ivanovich was the author and co-author of more than 500 scientific papers, including 15 monographs: on the issues of pathophysiology, clinic, diagnosis and surgical treatment of congenital and acquired heart defects and major vessels, heart diseases in young children, complications after open heart surgery, surgery of complex congenital defects and coronary heart disease, heart defects with pulmonary hypertension, the use of hyperbaric oxygenation in cardiac surgery, surgical treatment of coronary disease, heart transplantation in experiment, history and philosophy of cardiac surgery. In 1970, «for the best scientific work on thoracic surgery», Vladimir Ivanovich was awarded the title of laureate of the S. I. Spasokukotsky Prize of the USSR Academy of Medical Sciences (together with B. A. Konstantinov). Academician Vladimir Ivanovich Burakovsky died on September 22, 1994 in Moscow and was buried at the Kuntsevo cemetery. The Institute of cardiac Surgery of the Federal State Budgetary Institution «A.N. Bakulev National Medical Research center of cardiovascular Surgery» (A. N. Bakulev NMRcVS) of the Ministry of Health of the Russian Federation bears his name, in which a bust of his creator is installed.

Мікрохірургічна субінгвінальна варикоцелектомія в дітей та підлітків. Модифікована техніка з додаванням контрастування лімфатичних судин

A varicocele is one of the most common causes of spermatogenesis and infertility disorders, which can be corrected. With the advent of high-quality optical operating systems, subinguinal microsurgical varicocelectomy has been added to the pediatric urologist’s arsenal. One of the most unresolved problems of using this operation in children is postoperative hydrocele and possible damage to the testicular artery due to its small size, which leads to testicular atrophy. To solve this problem, lymphatic vessel contrast with 1% methylene blue was used to verify lymphatic vessels and indirectly visualize the testicular artery. Purpose - to develop a modified technique of microsurgical subinguinal varicocelectomy with intraoperative contrast of lymphatic vessels in children; to evaluate the results of surgical treatment of varicocele using this technique. Materials and methods. The study included 65 boys aged 11 to 17 years with a confirmed diagnosis of grade III varicocele and recurrent testicular pain or testicular hypotrophy. Patients were randomized into 2 clinical groups for classical or modified varicocelectomy. The success of treatment was evaluated after 6 months. The Group I included 34 patients who underwent classical subinguinal microsurgical varicocelectomy; the Group II included 31 patients who underwent modified surgery. Results. No cases of complications and recurrence of the disease in the late postoperative period were recorded in the group using the modified technique, while in the group with the standard technique, such cases were detected in 17.6% of patients. In addition, it was found that intraoperative contrasting of lymphatic vessels made it possible to clearly identify the testicular artery in all cases in the group with the modified technique, while in the group with the standard technique it was visualized only in half of the cases. No intraoperative complications, hypersensitivity, or allergies were noted during the operation. Conclusions. A modified varicocele treatment with intraoperative lymphatic vessel contrast may be more effective and safe for patients with this disease due to vein visualization, as the artery and ductus deferens remain the only unchanged structures due to the use of a compression test and lymphatic vessel contrast. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent was obtained from the patients for the research. No conflict of interests was declared by the authors.

Doppler-ultrasound reference values after pediatric liver transplantation: a consecutive cohort study

ObjectivesDoppler ultrasound (DUS) is the main imaging modality to evaluate vascular complications of pediatric liver transplants (LT). The current study aimed to determine reference values and their change over time.MethodsA consecutive cohort of pediatric patients undergoing an LT were retrospectively included between 2015 and 2020. Timepoints for standardized DUS were intra-operative and postoperative (day 0), days 1–7, months 1 and 3, and years 1 and 2. DUS measurements of the hepatic artery (HA), portal vein (PV), and hepatic vein(s) (HV) were included if there were no complications during 2 years follow-up. Measurements consisted of: peak systolic velocity (PSV) and resistive index (RI) for the HA, PSV for the PV, and venous pulsatility index (VPI) for the HV. Generalized estimating equations were used to analyze change over time.ResultsOne hundred twelve pediatric patients with 123 LTs were included (median age 3.3 years, interquartile range 0.7–10.1). Ninety-five HAs, 100 PVs, and 115 HVs without complications were included. Reference values for HA PSV and RI, PV PSV, and HV VPI were obtained for all timepoints (4043 included data points in total) and presented using 5th–95th percentiles and threshold values. All reference values changed significantly over time (p = 0.032 to p < 0.001).ConclusionsDUS reference values of hepatic vessels in children after LT are presented, reference values change over time with specific vessel-dependent patterns. Timepoint–specific reference values improve the interpretation of DUS values and may help to better weigh their clinical significance.Key Points• Doppler ultrasound reference values of pediatric liver transplantations are not static but change over time. Applying the correct reference values for the specific timepoint may further improve the interpretation of the measurements.• The pattern of change over time of Doppler ultrasound measurements differs between the hepatic vessel and measurement; knowledge of these patterns may help radiologists to better understand normal postoperative hemodynamic changes.

Dual phase multidetector computed tomography angiography in evaluation of pulmonary arteries and collateral vessels in children with cyanotic congenital heart diseases

BackgroundThe purpose of this paper is to compare the efficacy of dual-phase multidetector computed tomography angiography (CTA) with transthoracic echocardiogram (TTE) and cardiac catheterization angiography (CCA) in evaluation of pulmonary arteries and collateral vessels, major aortopulmonary collateral arteries (MAPCAs) in children with cyanotic congenital heart diseases. MethodsThe study was a prospective observational study where 32 pediatric patients (18 males, 14 females and age range 2–116 months) with cyanotic congenital heart diseases (CCHD) were included. All patients underwent TTE, CTA, and CCA. The findings of CTA in evaluation of pulmonary arteries and MAPCAs were compared with TTE and correlated with CCA findings. ResultsAll CTA studies were adequate except in one (3.1%) case in which main pulmonary artery and left pulmonary artery were not visualized on any of the three modalities. Right pulmonary artery anatomy was not clear or not demonstrated in four cases (12.6%) on CCA, whereas CTA was able to demonstrate pulmonary arteries in these cases. TTE was inadequate in 11 cases (34.3 %) in which one or more pulmonary artery was not clearly visualized. In cases with good pulmonary artery diameter (corresponding to Z score between 1 to 2) statistically significant (P < 0.001) correlation was found between pulmonary artery diameters, McGoon ratio, Nakata index, and Z-scores calculated for pulmonary arteries on all three modalities. There was concordance between CTA and CCA in assessment of MAPCAs and patent ductus arteriosus (PDA), whereas TTE failed to demonstrate MAPCAs in six cases (18.8%). ConclusionCTA was found to be superior to TTE and CCA for the assessment of pulmonary arteries and MAPCAs. CTA is also superior to TTE in the detection of extracardiac anomalies.

Аdverse events underlying antiretroviral therapy in children with HIV infection

Introduction. Human immunodeficiency virus infection can alter properties of blood vessels in children and increase the risk of development of cardiovascular diseases in the future. Today the actual contribution of the effects of both HIV infection and antiretroviral therapy into such changes remains unknown. Objective. We seek to assess adverse events, including metabolic disorders (dyslipidemias), underlying antiretroviral therapy, and to determine the relation between metabolic disorders and intima injury in children receiving antiretroviral therapy (ART).Materials and methods. The adverse events were investigated within the framework of a prospective and retrospective study. The study included evaluation of biochemical parameters in relation to the therapeutic regimen; calculation of atherogenic index of plasma; and determination of incidence of dyslipidemia in children. In addition to standard tests, children on ART were evaluated for insulin resistance (using HOMA-IR) and submitted to diagnostic imaging including Doppler ultrasonography of brachiocephalic arteries and veins.Results. Children on protease inhibitor-based ART have higher total cholesterol, LDL and triglyceride levels in comparison to both children on NNRTI-based ART and children who do not receive ART. LDL levels in children on long-term ART remained within the tolerance range and were clearly higher than those in children who did not receive ART. Carotid IMT was higher in children on NNRTI-based ART in comparison to those who received protease inhibitor-based therapy; and the correlation analysis conducted revealed positive correlation between the age and carotid IMT: The later ART was prescribed, the greater IMT was, which most likely was attributable to HIV effects.Conclusion. Prescription of antiretroviral therapy at an older age results in changes in the intima-media complex, which may give evidence to vasoprotective effects of the therapy. Since HIV is directly involved in causing injury to the intima, it is advisable to start managing HIV infection in children as soon as they are diagnosed with the infection; and children to whom ART is prescribed at an older age and who develop dyslipidemia should be additionally evaluated by medical imaging with Doppler ultrasonography with carotid IMT measurement.

The Possibilities of Color Duplex Scanning in the Assessment of Hemodynamic Eye Disorders in Children with Uveitis

Purpose: to study the hemodynamic parameters in the eye’s vessels in children with endogenous uveitis, depending on the localization and degree and activity of the inflammatory process.Patients and methods: 67 children aged 6 to 18 years were examined. Of these, 19 people (35 eyes) were diagnosed with anterior uveitis, 20 (38) — peripheral, 8 (14) — posterior, 10 (20) — panuveitis. There were subgroups according to the degree of inflammation activity in each group. There were 10 healthy children (20 eyes) in the control group. The maximum systolic (Vsyst), final diastolic (Vdiast) blood flow rate and resistance index (RI) in the ocular artery (GA), central retinal artery (CAC), posterior short ciliary arteries (ZCCA), central retinal vein (CVS) and superior ocular vein (VGV) were detected with the method of the Color Duplex Scanning (CDR).Results. The maximum systolic and final diastolic blood flow rates in GA decrease, and in panuveitis, on the contrary, increase in anterior uveitis on the location of active inflamation. In panuveitis, the blood flow rate in the HBV also increases. In peripheral uveitis, there is a decrease in systolic and diastolic blood flow rates and an increase in the resistance index in CAC and WCC. With posterior uveitis, the blood flow in the HBV slows down and the RI in the CAC and WCC increases.Conclusion. In children with active uveitis, according to the CDR, hemodynamic changes in the vessels of the eye are observed, it depends on the localization of the inflammatory process. They have multidirectional nature. In most cases, a decrease in blood flow rate and an increase in RI are detected. The study of the eye’s hemodynamics can be an additional criterion for assessing the activity of inflammation and the effectiveness of therapy, as well as differential diagnosis of various localization of the uveitis.

Combination of fecal calprotectin and initial coronary dimensions to predict coronary artery lesions persistence in Kawasaki disease

Kawasaki Disease (KD) is systemic vasculitis involving medium-sized vessels in children. The aim of our study is to determine if fecal calprotectin (FC) could be useful in predicting the development or persistence of coronary artery lesions (CALs) in KD. We conducted a prospective monocentric study including all consecutive diagnoses of. Clinical, laboratory, echocardiographic data were recorded during the acute and subacute phase, including FC. Correlations among laboratory values, FC, clinical manifestations, IVIG-responsiveness and CALs development were investigated. We enrolled 26 children (76.9% boys; median age 34.5 months). The combination of FC > 250 microg/g and z-score > 2 during the acute phase was associated with the persistence of CALs (p = 0.022). A z-score > 2 alone during the acute phase was not related to CALs during the subacute stage (p > 0.05). A neutrophil percentage > 70% and WBC > 15,000/mmc during the acute phase significantly correlated with the presence of CALs during the subacute phase (p = 0.008). C-reactive protein (CRP) > 13 mg/dL at KD onset was significantly associated with the presence of CALs during the acute (p = 0.017) and subacute phase (p = 0.001). The combination of FC > 250 microg/g and a z-score > 2 during the acute phase of KD may be used as a predictor of CALs persistence. It can be useful especially in children with an initial CRP < 13 mg/dl.

Preoperative MRI Evaluation of Hand Vessels in Children With Congenital Syndactyly Malformation by a Contrast-Enhanced Three-Dimensional Water-Selective Cartilage Scan.

BackgroundIt is crucial to preoperatively assess the arteries of the hands in congenital syndactyly malformation (CSM) patients because this information can affect the therapeutic outcome and prognosis.ObjectiveTo investigate the value of a contrast-enhanced three-dimensional water-selective cartilage scan for the preoperative evaluation of CSM in children.Materials and MethodsContrast-enhanced three-dimensional water-selective cartilage scan 3.0 T magnetic resonance imaging (MRI) performed in 16 clinically diagnosed CSM patients with 17 affected hands. The arteries of the hands were displayed with a focus on the bifurcation position of the common palmar digital arteries (CPDAs) and the maturity of the proper palmar digital arteries (PPDAs). The MRI results were interpreted by consensus between two experienced pediatric radiologists with 10 years of MRI experience each. The MRI findings were compared with the operation results.ResultsOf 51 CPDAs in the 17 affected hands, MRI showed that 30 had an abnormal bifurcation position and 20 had a normal position, and of the 102 PPDAs, 14 were shown to have an abnormal maturity and 85 a normal state, which were confirmed by surgery. The accuracy, sensitivity and specificity for determining the bifurcation position of the CPDAs based on MR maximum intensity projection reconstructed images were 98.04% (50/51), 96.77% (30/31) and 100% (20/20), respectively. The maturity of the PPDAs was judged by MR maximum intensity projection reconstructed images with an accuracy, sensitivity and specificity of 97.06% (99/102), 82.35% (14/17) and 100% (85/85), respectively.ConclusionContrast-enhanced three-dimensional water-selective cartilage scan has excellent performance in displaying the bifurcation position of the CPDAs and the maturity of the PPDAs and is of high value for the preoperative evaluation of CSM in children.

Comparison Between Open and Ultrasonography Guided Venous Access Ports in Children with Malignancy

Background: Long-term central venous access is used in children for various reasons specially for delivering chemotherapy. Since vessels in children have smaller diameters, they are more prone to injury and complications such as thrombosis. Different methods are used for implantation of port-a-cath in children. We aimed to compare the complications of insertion of central venous access ports between two methods of open and ultrasound (US) guided. Methods: All children who were referred to pediatric surgery department of a children hospital from April 2018 to March 2020 for implantation of port-a-cath were included. Right jugular vein was the target vein and patients were randomly divided between two methods of insertion of open lateral neck exploration and ultrasound real-time guided percutaneous insertion and the reservoir was fixed in subpectoral fascia pouch. All open cases in which jugular vein was ligated proximally were excluded. Patients were followed up for early and late complications two days and one week later by the surgical team, then monthly by a trained nurse and were referred to the surgeon if any complication or malfunction had occurred for at least 6 months. Results: We included 76 patients (21 girls and 55 boys) less than 18 years of age: 24 patients with ultrasound guided method (1-13 years, median 3 years) and 52 patients with open exploration method (4 months-17 years, median 6 years). We observed no statistically significant difference between two groups with respect to sex, underlying disease, and complications. Most patients had hematological malignancies including ALL (52.9%), AML (19.1%) and the rest had solid organ malignancies. Early complications were observed in 2 (3.8%) in the open and 1 (4.2%) in the US- guided group (P=1). Late complications were observed in 9 (17.3%) patients in the open group and 1 (4.2%) in the US guided group. Infection was observed in 9.6% and malfunction in 5.8% of the open group leading to earlier removal of the catheter. There was not any complication indicative of infection in the US-guided group. Conclusion: US-guided method can be suggested for routine use as a safe method of insertion of port venous access in children.

Cold-induced Vascular Changes in the Macula, Optic Disc and Choroid in Children with Raynaud’s Phenomena

ABSTRACT Aim To investigate changes in retinal and choroidal vessels in children with primary and secondary raynaud’s phenomena(RP). Methods Measurements were performed by optic coherence tomography angiography before as well as during and 10 minutes after the immersion of one hand in ice water. Results Primary RP patients exhibited enlargement of the foveal avascular region and decrease in vessel density in the parafoveal superficial capillary plexus (SCP) during cold exposure, but values returned to normal when the hands were removed from the cold water. In children with secondary RP, there were decreases in choroidal thickness and vessel density in the SCP and radial peripapillary capillary plexus (RPCP) during cold exposure. Changes in choroid and peripapillary RPCP were still significant 10 minutes after removal from cold water. Conclusion Ocular arteriolar vasospasm seems to be more pronounced in patients with secondary RP, particularly in the choroid and the peripapillary area of the RPCP. Clinical Trial Registration Number and Date: Decision number 76/1315 - 10.03.2021

Ileum Terminal and Mesenteric Vessels; Two Fundamental Gateways of Ultrasound Examination in Acute Abdomen of Children: Review Article

Introduction: Acute abdomen is among the most common causes of pediatric hospitalization and ultrasound is the first diagnostic method. We aim to describe the best method of sonography to find the accurate diagnosis in the least time as possible. Materials and Methods:Two independent researchers screened for the articles that were related with acute abdomen and method of sonography in childrens. The electronic databases that were searched including: PUBMED, SCOPUS,EMBASE and WEB OF SCIENCE up to January 2021. Results: We search about the common causes of acute abdomen in children that are admitted to the emergency room and we find that if we start the sonography in ileum terminal and mesenteric vessels in children, so we can diagnosis the etiology in less time and help to manage the critically ill patients in the best way .By identifying ileum terminal in RLQ, appendicitis can be find in posteroinferior of that and important diseases such as enterocolitis, tuberculosis, Crohn's disease, and lymphoma can be find easily. In epigastric area, diagnosing mal-rotation and mid-gut volvulus is crucial to save a baby's life. complete visualization of the pathway of the mesenteric vessels and visualization of other abnormalities in this area such as HPS, pancreatitis, bowel obstructions. Conclusion: systematic sonographic approach in children with acute abdomen can show the main causes، by focusing on the ileum terminal and the mesenteric vessels, and many lesions are seen while trying to find these two viscera. We suggested the main gateways to start the ultrasound examination are RLQ, the terminal ileum, and epigastrium such as mesenteric vessels.

Ultrasonography to detect cardiovascular damage in children with essential hypertension

BackgroundEssential hypertension in adults may begin in childhood. The damages to the heart and blood vessels in children with essential hypertension are hidden and difficult to detect. We noninvasively examined changes in cardiovascular structure and function in children with hypertension at early stage using ultrasonography.MethodsAll patients with essential hypertension admitted from March 2020 to May 2021 were classified into simple hypertension (group 1, n = 34) and hypertension co-existing with obesity (group 2, n = 11) isolation. Meanwhile 32 healthy children were detected as control heathly group (group 3). We used pulse-wave Doppler to measure carotid–femoral pulse wave velocity (cfPWV), intimal–medial thickness (cIMT) and distensibility of carotid artery (CD). Cardiac structure and function (left atrial diameter [LAD], left ventricular mass [LVM], LVM index [LVMI], relative wall thicknes [RWT], end-diastolic left ventricular internal diameter [LVIDd], diastolic interventricular septum thickness [IVSd], diastolic left ventricular posterior wall thickness [LVPWd], root diameter of aorta [AO], E peak, A peak, E' peak, A' peak, E/E' ratio, and E/A ratio) were measured by echocardiography.ResultsThe cfPWV of children in group 1 and group 2 were significantly higher than healthy children in group 3. Significant differences were observed in LVM, LVMI, RWT, LVIDd, IVSd, LVPWd, LAD, A peak, E' peak, A' peak, and E/E’ among three groups.ConclusionChildren and adolescents with essential hypertension demonstrate target organ damages in the heart and blood vessels.

Capabilities of cardiac magnetic resonance imaging and magnetic resonance angiography of the great vessels in children with transposition of the great vessels

Aim. To demonstrate the capabilities of magnetic resonance imaging (MRI) and magnetic resonance (MR) angiography in the complex examination of patients with various types of transposition of great arteries (TGA) at the pre- and postoperative stages.Material and Methods. A total of 38 MRI studies of the heart and blood vessels were performed in 33 patients with various forms of transposition of great vessels.Results. The main purpose of MRI was to identify postoperative complications after arterial switch operation for simple TGA. Cicatricial changes in the wall of the left ventricle were revealed in two patients, which was the basis for coronary angiography. Coronary angiography revealed no significant coronary artery stenosis requiring surgical intervention. The aortic root was dilated to an average of + 2.85 Z-score in six patients after arterial switch operation, which required further dynamic observation. Stenosis of the branches of the pulmonary artery due to the use of the Lecompte maneuver was revealed in one patient. Heart catheterization was performed according to the results of MRI. Invasive pressure measurement revealed neither significant stenosis nor indications for surgical treatment. MRI data were used as one of the criteria for anatomical correction readiness in group of patients with congenitally corrected transposition of the great vessels, along with data of echocardiography and heart catheterization.Conclusion. MRI and MR angiography are the “gold standard” in the pre- and postoperative examination of patients with various forms of TGA . Using MR angiography, it is possible to carry out morphometry and clarify the spatial arrangement of vessels including that after correction of TGA. In most cases, MRI allows to correctly differentiate the morphology of the heart chambers and their relative position. It also allows to perform volumetry and to assess the parameters of local and global contractile function of the ventricles, which is essential for preoperative assessment and dynamic observation at all stages of correction.