Neurologist: S.P. Khomiakova

Signature: /Signature/

Stamp: Polyclinic * Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center * Ministry of Healthcare of Russia * ID 1027739507212 * for certificates

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Of Ministry of Healthcare of Russia

Ophthalmologist

Date and time: July 04, 2016

2.2 Repeated consultation of medical specialist, doctor of medical sciences (higher doctorate)

Medical records card No.: 41945

Patient’s full name: Filimonchik Viktoriia Alekseevna

Age: 21 months 1 week

Date of birth: September 26, 2014

Place of residence: Yaroslavl oblast, town of Yaroslavl, ulitsa Uglichskaia Str., house 21, Apt. 14

Complains: of OD redness

STATUS OCULORUM: Vis OD = spatial vision

Vis OS = spatial vision

Deviation: OD – converg to 10

Eyeglobes position in orbit: height OD<OS

Eyeglobes mobility: OD limited mobility outwardly. Fine nystagmus is observed periodically in direct look. Eyelids closure is incomplete in OD.

On examination: OS is quiet. OD – conjunctival injection.

Cornea: OD – multiple areas of keratopathy. Corneal reflex is absent in OD.

Pupil: OD<OS. OD – photoreaction is direct and consensual OD<OS.

Eye fundus: OD – behind the haze. OS – optic disc is pale-pink, with sharp contours. Pathway and caliber of vessels is almost unchanged. MZ, periphery is without abnormalities.

Additional methods of examination: soft contact lens on OD

Conclusion: Paresis n.abducens, n.facialis, n.ophthalmicus. No data on intracranial hypertension in eye fundus was obtained. OD – eye fundus is behind the haze.

Recommendations: 1. Soft contact lens sph-0,5 BC 8,2 for the right eye (scheduled replacement once every 7-10 days)

2. Corneregel®/ Solcoseryl® 8 times per day into right eye,

3. Complete occlusion of right eye during sleep.

4. VitA-pos® apply on lower eyelid before bed.

Date of examination: July 04, 2016

Diagnosis: H49.2 Sixth [abducent] nerve palsy

Clinical description:

Time of examination: 10:35

Ophthalmologist: O.A. Boginskaia

Signature: /Signature/

Stamp: Polyclinic * Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center * Ministry of Healthcare of Russia * ID 1027739507212 * for certificates

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Of Ministry of Healthcare of Russia

Otolaryngologist

Date and time: July 04, 2016

Consultation of medical specialist

Medical records card No.: 41945

Patient’s full name: Filimonchik Viktoriia Alekseevna

Age: 21 months 1 week

Date of birth: September 26, 2014

Place of residence: Yaroslavl oblast, town of Yaroslavl, ulitsa Uglichskaia Str., house 21, Apt. 14

Complains:

of disordered motor activity of right limbs, swallowing difficulty, installed tracheostomy.

Medical case history: on March 30, 2016 surgical treatment of atypical teratoid rhabdoid tumor was performed, on 5^th day tracheostomy was performed due to bulbar palsy development. Feeding is through nasogastric tube and also anatomically naturally. Choking troubles, liquids and solids sanitize from trachea. Currently patient has metastases into spinal cord.

Rhinoscopy: nasal respiration: conducted, on right side – nasogastric tube. Nasal cavity mucosa is pale, wet. General nasal passages: without abnormal secretion.

Pharyngoscopy: oropharyngeal cavity: palatine arches: contour sharply, of pink color, palatine tonsils: at the level of palatine arches, of elastic consistency. Posterior wall of pharynx is of pink color.

On external examination and neck palpation: on anterior surface of the neck at its usual position is tracheostomy with loaded cuffless tracheostomy tube Bivona No5,5. Mother takes care of tracheostomy and tube herself, she is able to change it herself once a week.

Conclusion: tracheostomy. Constant bearer of tracheal tube. Dysphagia. Bulbar palsy.

Recommendations: Diagnostic fiber-optic laryngotracheoscopy under anesthesia.

- Replacement of tracheostomy tube on tube No.4 with a cuff, preferably by Shiley.

Otolaryngologist: O.K. Timofeeva

Signature: /Signature/

Stamp: Polyclinic * Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center * Ministry of Healthcare of Russia * ID 1027739507212 * for certificates

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Of Ministry of Healthcare of Russia

Otolaryngologist

Date and time: July 06, 2016

2.2 Repeated consultation of medical specialist

Medical records card No.: 41945

Patient’s full name: Filimonchik Viktoriia Alekseevna

Age: 21 months 1 week

Date of birth: September 26, 2014

Place of residence: Yaroslavl oblast, town of Yaroslavl, ulitsa Uglichskaia Str., house 21, Apt. 14

Examination: child with diagnosis: tracheostomy. Constant bearer of tracheal tube. Dysphagia. Bulbar palsy.

Treatment conducted at time of examination: Replacement of tracheostomy tube was performed (cuffless tube No.5,5 was installed) on tube No.4 with expansion cuff system. Procedure went well. Tracheostomy channel is well-formed. Respiration through tracheostomy is satisfactory.

Recommendations: - due to mother’s attempts to fees a child through the mouth, it is recommended to try this with expanded cuff.

- Consider installation of gastrostomy with treating doctors.

Otolaryngologist: O.K. Timofeeva

Signature: /Signature/

Stamp: Polyclinic * Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center * Ministry of Healthcare of Russia * ID 1027739507212 * for certificates

Coat of Arms of Russian Federation

BIRTH CERTIFICATE

_________________________________ Filimonchik ___________________________________

last name

________ ______________________Viktoriia Alekseevna _______________________________

name, patronymic

was born on ______________________ September 26, 2014 ____________________________

date, month, year (in words and in figures)

____________________(twenty-sixth of September, two thousand fourteen) _______________

place of birth: _____________________ town of Perm ____________________________________

__________________________________ Perm Krai_ ____________________________________

________________________________ Russian Federation _______________________________

the entry whereof was made in the Birth Register on the 01^st of October of 2014 under No. 1467

Father _______________________________ Filimonchik ________________________________

last name

________________________________ Aleksei Viktorovich ______________________________

name, patronymic

___________________________________ Russian ______________________________________

citizenship

Mother______________________________ Filimonchik _________________________________

last name

___________________________________ Olga Iurevna ________________________________

name, patronymic

____________________________________ Russian _____________________________________

citizenship

Place of state registration: _________ Department of Civil Status Registration Office of town of Perm administration (Ordzhonikidze department) of Perm Krai_______________________

(name of Civil Status Registration Office authority)

Date of issue: October 01, 2014

Head of Civil Status Registration Office authority ____/ Signature/____ Iu.V. Melnichuk

Seal: Town of Perm administration * Department of Civil Status Registration Office of town of Perm administration Ordzhonikidze department * Coat of Arms of Russian Federation

III-ВГ No. 601860

57 14 183790