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Introduction. Lyme borreliosis is the most frequent tick-borne disease in Europe and North America. It is a chronic, multi-organ disease, with phasic course. The diagnosis is based on clinical symptoms and serologic findings at the patient bitten by the tick. Aim. Aim of this study was to analyze the recommendations for the tests towards the Lyme disease at patients of the Pediatric Hospital of Medical University of Warsaw. Material and methods. We conducted a retrospective analysis of medical data of children hospitalized at the Pediatric Hospital in the period from January 2013 to the end of February 2015, who had performed diagnostic tests for Borrelia burgdorferi infection. Results. In the period from 1st January 2013 to 28th February 2015 tests forantibodies to Borrelia burgdorferi were ordered in 226 patients, including 119 girls and 107 boys. The ELISA test was performed in 219 patients, Western blot test was performed in 25 patients, and the presence of antibodies in the cerebrospinal fluid was examined in 2 patients. Diagnosed patients presented various symptoms. Patients from the two largest groups reported with articular complaints and heart symptoms. The group of patients diagnosed with fever, headache and facial nerve paralysis was less numerous. A small group of patients had a history of tick bite and presented with erythema. Conclusions. Patients of the Pediatric Hospital of the Medical University of Warsaw, who were ordered to perform tests for Lyme disease, presented symptoms from various organs and systems. These symptoms overlap with ailments and symptoms described in people who have been diagnosed with Lyme disease in both the early and late stages of the disease. The serological tests in connection with the medical history and physical examination are an important element in the diagnostics of Lyme disease in children.

Introduction. Foreign bodies in the oesophagus are one of the more frequent non-infectious reasons for a child’s visit to the hospital emergency room. Most often, children swallow items accidentally while having fun, learning about the world with the help of their senses, as well as when eating meals. It is coins, plastic or metal fragments of objects that are usually swallowed. Also, hard pieces of food may stick to the oesophagus. Aim. The aim of the study was to analyse clinical symptoms as well as diagnostic and therapeutic procedures in patients with suspicion of the presence of a foreign body in the oesophagus. Material and methods. The authors analysed clinical data of 49 patients hospitalized in the Department of Paediatric Otolaryngology at the Medical University of Warsaw due to the suspicion or presence of a foreign body in the oesophagus. What was also analysed, was the diagnostic and therapeutic process during which the initial diagnosis was confirmed or excluded. Results. The authors analysed the symptoms with which patients came to the hospital, the diagnostic and therapeutic procedures used and the results of treatment. Attention was paid to diagnostic difficulties that may be encountered by a physician in the Admission Room, and then an otolaryngologist qualifying the patient for interventional treatment or deciding on conservative procedures. Possible complications that may occur during ezophagoscopy are described. Conclusions. Foreign bodies in the oesophagus are a common problem in the paediatric population. The most common foreign objects are coins, metal or plastic items or food. The most dangerous foreign objects are disc batteries and sharp, large objects. Diagnostic imaging includes chest and neck X-ray, and in the case of non-contrasting bodies – X-ray with barium or a cotton ball soaked in contrast. The presence of clinical symptoms and/or imaging results suggesting the presence of a foreign body in the oesophagus is an indication for oesophageal endoscopy under general anaesthesia. Both rigid esophagoscopy and the use of a flexible fiberscope are burdened with a certain degree of risk, of which the parents should be informed before those are performer.

Mediastinal emphysema is a pathological condition in which air is present in the mediastinum. Mediastinal emphysema may occur spontaneously or as a result of disease or trauma, including iatrogenic injury. Air into the mediastinum may pass from the lungs, trachea, bronchi, esophagus, peritoneal cavity, or come from outside the patient's body. It can also pass from the mediastinum into the neck or abdominal cavity. The mediastinum communicates with the submandibular space, the retropharyngeal space, and the vascular sheaths in the neck. Predisposing factors for mediastinal emphysema include the Valsalva test, physical exertion, increased respiratory effort, coughing, asthma, respiratory infections, vomiting, and drug use. A patient with mediastinal emphysema may present with no symptoms or may present with symptoms of respiratory distress. The most common symptoms observed are retrosternal pain radiating to the shoulder or back and increasing with changes in body position, dyspnea, cough, neck pain or discomfort, dysphagia, tachycardia, and subcutaneous emphysema. The diagnosis is made on the basis of clinical features including the underlying cause and radiological findings. A case of a patient with mediastinal emphysema due to trauma to the posterior pharyngeal wall is presented.

Introduction. Lymphatic malformations (LMs) are benign lesions thought to be caused by the abnormal development of the lymphatic system in utero. Most commonly, LMs affect the head and neck. Because of LM morphology and location close to important vascular and nervous structures, surgical treatment is difficult, associated with a high risk of complications, and often incomplete. Aim. Bleomycin sclerotherapy is a recognised minimally invasive technique used in the treatment of LMs. We present the outcomes of bleomycin therapy of LMs located in the head and neck area in children receiving therapy in our centre. Material and methods. Between September 2017 and October 2019, treatment with bleomycin was provided to a total of 6 patients with LMs of the head and neck, aged from 3 weeks to 10 years. The procedures were performed under ultrasound and/or fluoroscopy guidance. The aspects analysed included the number of procedures applied in patients, drug doses, treatment response and complications. Results. In 4 patients, the LM was located on the neck, in 1 patient ? on the neck and in the mediastinum, and in 1 patient in the cheek region. Three patients underwent 2 procedures, 1 patient ? 3 procedures, and 2 patients ? 1 procedure. The treatment outcome was excellent and good in 4 patients and 1 patient, respectively. However, in 1 patient, the therapeutic effect was unsatisfactory, and a decision was made to administer another course of treatment. The maximum single dose of bleomycin was 10,000 IU; the dose of 700 IU/kg BW was not exceeded. No complications were observed after the procedures. Conclusions. Preliminary results suggest that bleomycin sclerotherapy of LMs in the head and neck region in children is an effective and safe treatment modality.