Dear friends,
The entire staff of the Department of Oncohematology and Chemotherapy
(Oncohematology-16) asks you for a great favor. One of our patients,
Vitalik Sotnikov, a boy of five, needs your help for treatment.
The boy was admitted to the RCCH on April 18, 2006. His condition
was so serious that he was immediately taken to the intensive care
ward. Now his condition has somewhat stabilized, and he was transferred
to our Department of Oncohematology and Chemotherapy on April 25,
2006.
The story of his disease is so tragic and so unique that it is even
hard to write about it. I'll try to describe it as coolly as possible,
although I have never seen such situations before... and I am still
shocked.
The boy fell ill with acute lymphocytic leukemia. His treatment
was started at the hematology department of the local hospital (city
of Voronezh). The course of the disease seemed standard, and the
response to induction therapy was good. In other words, the boy
has reached remission, which still continues. However, the boy is
in terrible condition owing to complications that have developed
during the induction therapy at the local hospital. At the very
end of induction therapy, the boy had an infiltrate on his right
cheek. Then it quickly spread over both lips, almost entire right
cheek, and part of left cheek. In spite of the surgical drainage
of the soft-tissue facial phlegmon and anti-infection therapy affordable
in Voronezh, the phlegmon developed further, and the child had necrosis
of facial soft tissues. In a month, the boy experienced almost total
rejection of his upper and lower lips, about one-half of soft tissues
in his right cheek and one-fifth of his left cheek. The infectious
process also affected the upper and lower jaws, with development
of osteomyelitis and with several teeth falling out. At the same
time, all bacteriological examinations available in Voronezh failed
to reveal the infectious agent or combination of agents that could
lead to such a severe process.
At the moment when rejection of the necrotic tissues began, doctors
from Voronezh addressed specialists of our hospital and asked for
our advice. During a teleconference, they showed us photographs
of the child. We cannot publish them now for ethical reasons, because
they shock even professionals. To put it simply, part of the boy's
face is just absent now.
After the first shock was over, I spoke to specialists in maxillofacial
and plastic surgery who were present at the teleconference and asked
them whether they would manage to do anything for the boy if we
take him to our department. They discussed the problem and decided
that something could still be done: they will attempt a serious
of long and difficult surgeries and finally perform transplantation
of soft tissues with the formation of new lips, cheeks, etc.
I understood that taking this child to our department would mean
great responsibility and a serious psychological ordeal for the
entire medical staff, because such things are very hard to look
at. But, after hearing the surgeons' words and seeing the boy's
tears on the photograph, I made up my mind.
The child has already gone through two surgeries: the remaining
necrotic tissues have been removed from his face and jawbones, several
teeth have also been removed, a tracheostoma has been set, and gastrostomy
is planned (the child cannot receive adequate feeding through his
mouth and will receive enteral nutrition directly into the stomach).
Our bacteriological examinations showed that the child has got a
mixed infection caused by several kinds of bacteria and fungi, including
very rare and grave ones (mucor). Now he needs prolonged and intense
antifungal (Cancidas and Ambisome) and antibacterial therapy, which
has already been started. He will also need special balanced enteral
nutritive mixtures and parenteral (IV) feeding, disposable probes
and catheters, and many other things for comfortable treatment and
alleviation of his condition. Unfortunately, most of these things
are currently lacking at the hospital. Moreover, since now we receive
less financing, there is little hope that we will receive the necessary
money from the budget.
Dear friends! This is my personal plea to you: let us try to save
this boy together!
With hope and respect,
Dmitri V. Litvinov,
Head of Department of Oncohematology-16.
April 27, 2006
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News
5.06.2009 Vitalik Sotnikov
is back from Germany after a surgical operation. The boy and his mother are more than
satisfied with the results of the treatment.
2.05.2009 Our old friend Vitalik Sotnikov left
for Germany again with his mother on April 23. He will soon have his seventh surgery
at the Munich clinic. The surgeons are satisfied with the results of earlier treatment and
promise that this time Vitalik will go home without a mask at last. We thank Sergei,
who financially supports Vitalik; he has paid for this stage of treatment, too.
13.08.2008 Vitalik Sotnikov
is back from Germany. He is feeling fine. The last surgery was successful: adhesions
have been separated, and now the boy can freely open his mouth.
Orthodontic braces have been set, and correction of the lower lip has been performed.
Unfortunately, there is still something to do. When time comes, Vitalik will
go to Germany for the next (and hopefully the last) surgery.
1.04.2008 Vitalik Sotnikov has just returned
from Munich to Moscow. All things planned by German surgeons have been implemented:
a skin flap on a vascular pedicle has been transplanted, defects of the upper and
lower lips have been healed, and the tracheostoma has been closed. The final
cosmetic correction of the face will take place in June.
We thank Sergei, who regularly helped the Sotnikovs cover part of the expenses
associated with their visits to Germany.
13.03.2008 The news from Germany: Vitalik Sotnikov had
his final - and successful - reconstructive surgery on March 11. It lasted 10 hours. The physicians are satisfied
with the results, and soon Vitalik will be allowed to take off his mask. He is still at the intensive care unit but
feels all right and can speak and eat. We are looking forward to seeing him in Moscow.
25.02.2008 Vitalik Sotnikov and his mother are to go to Munich for
the next surgery on March 3. They are full of optimism. Vitalik is looking forward
to the moment when he takes off his mask, which he has been wearing for two years.
1.02.2008 Vitalik
Sotnikov and his mother have come back to Moscow from Munich. At first
the German doctors thought that they would perform two surgeries during
this visit to Germany and thus complete Vitalik's treatment. However, later they
decided it would be more reliable to perform these surgeries with a break
between them. So Vitalik's final surgery is yet to take place. He will go to
Munich in the beginning of March. But most medical problems have been
resolved. Vitalik is feeling fine and very optimistic.
The boy's mother Lyuba has brought us a letter of gratitude, which she wrote
together with the boy.
15.01.2008 Vitalik Sotnikov
and his mother are in Munich again. We hope that the third reconstructive
surgery will be successful. In this case, it will be the end of the two-year
struggle for the boy's life. We thank Sergei, who handed $25,000
to Vitalik's mother so that she could pay for the third stage of the
treatment. We thank Masha, who always helps the Sotnikovs during their
visits to Germany, organizing their departures and arrivals at the airport
and providing them with a translator.
24.12.2007 Vitalik
Sotnikov has come back from Germany again. The boy and his mother are extremely
pleased with the results of the second surgery. Now it is easy for
Vitalik to eat all by himself. More than fifty percent of the required
work has already been completed. Vitalik will have another surgery
at the end of January. Let us wish him all the best in the coming New
Year.
10.12.2007 On December 2, Vitalik Sotnikov underwent a
nine-hour surgery in Germany. Today he will be transferred back to
his ward from the intensive care unit. The physicians are satisfied with the
results of the surgery. We are happy for the boy and looking forward to \
his return to Moscow.
30.10.2007 Vitalik is back from Germany.
German physicians are planning two more surgeries for him.
The next one is to take place at the beginning of December. During
the remaining month, Vitalik must train his mouth as much as possible.
He can already eat by himself. But the mobility of the lower jaw is still
insufficient, and the boy will have to work hard to get prepared for
the next stages of surgical treatment.
The first surgery cost about 15,000 euro, and the second surgery
will cost approximately the same sum. If everything goes right,
the third surgery will follow. So we continue the fundraising
for Vitalik's treatment.
22.10.2007 Vitalik Sotnikov with
his mother are still in Munich. Now, under the physicians' control,
the boy is learning to use his mouth again. It is just as difficult
as learning to walk again after a long break! However, Vitalik's
achievements are good: he has already learned to eat all by himself.
6.10.2007 Vitalik Sotnikov has had
his plastic surgery! An extremely complex surgical intervention
on his face and jaws took place at the Munich hospital on October 2.
It was successful. The child is already back at the department.
He is very hungry all the time.
20.09.2007 Vitalik
Sotnikov is at last going to Germany for treatment. He is to
leave in the nearest few days. He has already received consultations
by correspondence from specialists of two Munster clinics: those
of pediatric plastic surgery and maxillofacial surgery (Profs.
Grantzov and Erenfeld). Prof. Erenfeld, who heads the clinic
for maxillofacial surgery, has offered two-stage surgical intervention
with a month's break. The approximate cost of the treatment is
40,000 euro; however, since the problem is unique, the exact
sum will be known only after the first stage of the treatment is over.
Also, Vitalik will need money for travel, board and lodging.
Dr. Erenfeld is expecting Vitalik and his mother to arrive on September
27. The boy is to go through an examination, and the first surgery
will take place on October 2. The second surgery is scheduled
for the beginnng of November.
Vitalik has already spent almost a year and a half in Moscow.
During this time, he has become much more grown-up. Physicians
and volunteers deeply respect this active and courageous boy.
Sergei, who pays close attention to Vitalik's destiny, handed
$25,000 to the boy's mother yesterday. Approximately the same
additional sum is still needed. We hope that you will help.
On September 17, 2007, Vitalik was shown on TV; see
here.
20.06.2007 The news about Vitalik Sotnikov: as to
his main disease, everything is all right. The boy will soon go to Germany,
where plastic surgeons will provide a consultation and possibly the
first surgery. Now we are waiting for an invoice from the German clinic.
4.04.2007
D.V. Litvinov, Department of Oncohematology and Polychemotherapy-16:
"The situation with Vitalik
Sotnikov is not bad in principle. He is still receiving supportive
chemotherapy. We discussed the tactics of facial plastic surgery with
our surgeons several times and understood that there is no
unambiguous solution to this problem. We decided to receive
a consultation by correspondence from Germany and sent Vitalik's
documents to the sarcoma group of the Berlin hospital that specializes
in head and neck tumors and soft-tissue sarcomas. A professor from
Berlin wrote us a e-mail stating that Vitalik's case is unique
and therefore difficult. He has no ready answers to our questions now
and wants Vitalik to arrive at his clinic for several days, so
that this professor could see and examine the child personally. So now we will
try to send Vitalik to Germany for a consultation and then make
the optimum decision. After all, the boy has only one face."
21.02.2007
Dmitri V. Litvinov, Head of the Department of Oncohematology-16, tells:
Vitalik Sotnikov is receiving
supportive therapy. Antibacterial therapy for the soft-tissue defect
is still necessary.
16.01.2007
Vitalik Sotnikov receives
due treatment for his main disease. However, the physicians
have not yet come to a decision concerning the required plastic surgery
of his face tissues.
10.10.2006
Head of the Department of Oncohematology-16 Dr. Dmitri V. Litvinov tells
about the condition and treatment of Vitalik Sotnikov:
"The staff of the Department of Oncohematology and Chemotherapy
thanks the kind people who provide financial help necessary for
continuation of Vitalik's treatment. I remind you that this five-year-old
boy has leukemia, and its treatment at a local hospital was complicated
by a severe infection of facial soft tissues, resistant to standard
antimicrobial therapy. The boy was admitted to our department in
extremely grave condition, and an examination revealed an association
of several microbial agents. Their therapy required expensive drugs
lacking at the hospital, but your help made it possible to provide
the necessary therapy to the child. His condition has improved
to such an extent that presently Vitalik is receiving out-patient
treatment. Antileukemic therapy continues. However, unfortunately,
two gram-negative rods are still present in a culture from the wound
on his face. They require specific antibacterial therapy (Meronem,
Timentin, Ampholip). We hope that we will be able to continue
the therapy thanks to your help. After debridement of the infectious
lesion, we hope to conduct a reconstructive operation with plastic
surgery of facial soft tissues."
26.06.2006
For Vitalik Sotnikov, ten more vials of Ampholip worth 50,875
roubles ($1885) have been bought. Vitalik's condition is comparatively
fine. He is active, has good appetite, watches animated films on
TV, and even goes out when it is not too hot. Vitalik's mother is
also "coming to her senses" and learning to smile again
together with her son. She has written a short letter of gratitude
to readers of our Web site:
"I, the mother of Vitalik Sotnikov, just want to thank all
of you for helping us! We are so grateful to everybody who is concerned
about Vitalik's health and life. I can't say that he is healthy
now, but still some steps forward have been made. He can smile,
play, and even, little by little, walk on his own legs again. To
put it short, now he wants to live. We would not succeed without
your help; this is clear.
Thank you very much again for your help!"
17.05.2006
Bought for Vitalik from April 28 to May 15, 2006:
Nutriflex B.Braun solution for parenteral nutrition, 5 packs (1
l), total cost 3500 roubles (about $120), and 20 packs (2 l), total
cost 20,720 roubles ($770); Ampholip for a total of 104,525 roubles
($3870).
Dr. Dmitri V. Litvinov, Head of the Department of Oncohematology-16,
is telling:
"The child's condition is more or less stable and satisfactory.
There has been no notable fever for two weeks. The wound on his face is
almost clean now. Considering the absence of fever, the child does not
receive Cancidas, Ciprinol, and Trichopol any more. However, he is still
receiving Maxipime (which is presently available at the hospital) and
Ampholip. Yesterday a control culture from the wound was taken, and
we'll know the answer in four days. It is possible that the therapy will
be corrected according to the results of the culture study.
Presently we are planning another CT scan of the skull, lungs, liver,
and spleen in order to find sites of infections, especially fungal ones.
We'll pay special attention to the right maxillary sinus, because the
previous CT examination revealed some signs of maxillary sinusitis,
probably fungal. If they persist, we will have to open the sinus
surgically and to evacuate the pus and fungi.
If the CT scan shows that the sinusitis is already over and no fungi (or
other infectious agents) are found in several successive cultures, we
will discuss the time of flap transplantation to the cheek. Today the
child was examined by Dr. A.V.
Lopatin, who heads the Department of Craniomaxillofacial Surgery,
and Dr. A.V. Bystrov, Head of
the Center of Microvascular Surgery. They were satisfied with the boy's
condition and discussed the plans of plastic surgery.
Actually, Vitalik is feeling more or less fine. He even went out for
a short walk when the weather was warm. He has gained 5 kg since the
moment of his admission to the RCCH. About a week ago, a gastrostoma was
set. Parenteral (IV) feeding is presently partially preserved, but we
will reduce its share in favor of enteral feeling (through the
gastrostoma). The child also gets some mashed food through the mouth,
because he wants it very much, but soon he will have to receive food
only through the gastrostoma, because this is necessary for complete
healing of the wound and will be necessary during the engraftment of the
flap after the surgery.
Now about the drugs and other needs. Since the grave fungal lesion is
mostly due to Absidia, which is the worst of all fungal infectious
agents and sensitive only to Ambisome/Ampholip (actually, Fungisone is
less expensive but highly toxic), the child will have to take Ampholip
till the flap is perfectly healed. There is no other way out. Now the
boy receives the optimum therapeutic dose of this drug. However, it is
bad for the kidney, and nobody can predict the future course of the
treatment. Maybe we will have to reduce the dosage or to make some
breaks in the treatment. So, it is difficult to plan our
need for Ampholip for a long time, and we can make plans only for a week
or so. Since even now the tests show excess kidney loading, next week
we'll administer Ampholip to the child once in two days rather than
every day. Fortunately, the wound is already clear.
The child will also need 1 bag of IV nutrition for two days. As to
enteral nutrition and antiseptics, Vitalik's mother buys them herself
using the money donated by Vadim (over $2000).
As to his main disease, the child is in remission. He receives
chemotherapy with reduced doses of drugs, which are presently available
at the department.
We will decide on the surgery during the next week, and it will
become clear how much money is needed for surgical materials.
We are whole-heartedly grateful to everybody who has helped Vitalik
during the most difficult times. Let us hope that they are already
over."
9.05.2006
 Dr. Dmitri V. Litvinov, who head the
Department of Oncohematology-16, commented on the treatment of Vitalik Sotnikov
"While the child was in Voronezh, he went through only the
first stage in the therapy of his main disease: induction of remission.
Although remission has been attained, the protocol has only been
started. The treatment should be continued to the end. Otherwise,
a relapse is inevitable. But high-dose chemotherapy in Vitalik's
case is presently impossible because of extremely grave bacterial
and fungal complications. So, he is receiving reduced-dose chemotherapy
accompanied by powerful antifungal and antibacterial therapy. The
most important problem now is to suppress the infection and at the
same time to prevent appearance of leukemic cells in the blood.
If we manage to do this, complete therapy of the main disease will
be possible, but it is still impossible to say when the basic chemotherapy
may be resumed.
During the entire treatment, which will last several months, the
child will need expensive medications: Cancidas (one 50-mg vial
worth $600 for two days) and Ampholip (instead of Ambisome, which
is lacking in Russia now - 1.5 vials worth $200 daily), as well
as solutions for parenteral feeding (about $1000 per months) and
consumables. Thus, the daily expenses for Vitalik's treatment are
about $650.
The date of reconstructive surgery is not yet being discussed: at
first, the infection should be fully suppressed.
We thank the charitable foundation of the Help Group of our hospital,
which immediately provided the necessary help to us and enabled
us to start the child's treatment without delay. We rely on your
further support, because it will be impossible to help the boy without
due sponsorship."
They have helped
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