Open Access
Access granted
Subscription Access
Vol 6, No 4 (2015)
- Year: 2015
- Articles: 24
- URL: https://bakhtiniada.ru/pediatr/issue/view/95
Articles
Children's oncology in St. Petersburg: achievements and prospects of development
Abstract
The statistics (incidence, mortality, survival) characterizing a problem and the oncological care to children with malignant tumors in St. Petersburg are presented in the article. It is proved that intensification in the therapeutic regimens according to immunohistochemical features, age, extending of tumor significantly raised survival rates, having approached them to the world. The five-year survival of children treated in the 90th of the last century in St. Petersburg, was 60,9 %, at the beginning of the 2000th increase of survival to 69,3 % with approach to European survival (71,8 %) is noted. Improvement of indicators of survival, first of all, should be explained with progress in therapy of the most widespread localizations - leukemias and central nervous system tumors. Thanks to an intensification of treatment it was succeeded to improve considerably results of treatment of children with acute leukemia: the survival from 10-15 % in the 70-80th reached 80 %. Traditionally good results were observed at Hodgkin’s lymphoma: the 5-year overall survival was 94% with event-free survival of 87 %. Using of the European protocol for treatment of Wilm’s tumor (SIOP 93-01) increased survival of children with a unilateral tumor to 94,4 % at the overall survival more than 80 %. Improvement of overall survival in children was influenced also by introduction in practice protocols of BFM (Berlin-Frankfurt-Münster) for treatment non-Hodgkin’s lymphoma thanks to what 5-year event-free survival increased from 30 to 81 %. Now the perspective in children’s oncology are development of molecular and genetic diagnostics with search the germ mutations at a hereditary cancer syndrome, definition of a range of somatic mutations in genes at sporadic malignant tumors at children.
Pediatrician (St. Petersburg). 2015;6(4):5-12
5-12
Prerequisites to improvement of predictive model of childhood Hodgkin’s lymphoma
Abstract
Background. Calculation of relative tumor burden in Hodgkin’s lymphoma patients is the simplest and significant parameter which can be used in daily clinical practice as a risk factor. The aim of study was the assessment of influence of relative tumor burden on the late results of a disease. Material and methods. This research included data on 126 patients with Hodgkin’s lymphoma aged from 0 till 18 years (middle age of 11 years), treated risk-adapted treatment according to the DAL-HD and SPBLH-05. Boys was 70, girls - 56 (a ratio 1,25 : 1). Fifty-eight patients (46 %) are stratified in favorable risk group, 50 (39,7 %) - in intermediate risk group, and 50 (39,7 %) are included in unfavorable risk group. Results. Overall survival at 5 years was 93 % (range 91-95 %), event-free survival - 88 % (85-91 %). The average relative tumor burden was 129,4 cm3/m2 (7-609,7 cm3/m2). When carrying out ROC-analysis value of 122,7 cm3/m2 (р ˂ 0,0001) appeared the critical parameter, which worsen the prognosis of a disease. Overall survival in a patients cohort with this volume was 69,6 %, with the volume less than 122,7 cm3/m2 overall survival was 97,2 % (р = 0,00002). Conclusions. The relative tumor burden is the parameter which is significantly reducing survival rates in children with Hodgkin’s lymphoma. Opinion on interrelation of clinical and laboratory parameters with “sarkoma’s saturation” or tumor volume as end result of immunological frustration, it is represented the most perspective direction of studying of Hodgkin’s lymphoma.
Pediatrician (St. Petersburg). 2015;6(4):13-18
13-18
Clinical and laboratory features of infectious mononucleosis depending on the etiological factor in children
Abstract
The article contains the results of observations in 54 children aged 1 to 6 years with infectious mononucleosis. The evaluated of clinical and laboratory data with consideration of the etiological factor of the disease. Depending on the etiology there are 3 groups of patients: 18 with EBV-associated IM, 18 with CMV IM and 18 with mixed etiology mononucleosis (EBV + CMV). All children received antibiotic therapy (cephalosporin of third generation), immunostimulatory drugs, in a dosage of age (recombinant interferon Alfa-2b) and symptomatic treatment. Verification of pathogens was carried out by enzyme-linked immunosorbent assay, were determined separately specific immunoglobulins M and G antibodies to EBV antigens and CMV. Disease in all children was accompanied by fever, tonsillitis, lymphadenopathy, enlarged liver and spleen. A laboratory study of characteristics was carried out at the time of admission and on day 11 of hospitalization. Intoxication with EBV IM were significantly more common than with CMV IM (p = 0,018). The pasty face was noted when mixed IM significantly more frequently than when monoethylamine versions (in comparison with EBV-IM p = 0,03, with CMV IM - p = 0,001). Splenomegaly in EBV + CMV IM more often met in comparison with EBV-IM (p = 0,01) and CMV- IM (p = 0,02). More significant levels of neutropenia and limfomonotsitozis occurred during the EBV-IM. Leukocytosis and increased ESR were more pronounced with CMV IM. Indicators of aminotransferases increased more significantly if EBV IM + CMV IM (in comparison with EBV IM p = 0,04, with CMV IM p = 0,05). On 11th day of hospitalization when the EBV IM in comparison with CMV IM remained more pronounced neutropenia and monocytosis (p = 0,04 and p = 0,05 respectively), nonspecific changes in laboratory indicators (leucocytosis, increased erythrocyte sedimentation rate) - CMV IM (p = 0,05 and p = 0,04 respectively).
Pediatrician (St. Petersburg). 2015;6(4):19-22
19-22
Clinical and epidemiological evaluation of cases of hepatitis E in St. Petersburg
Abstract
Hepatitis E - zoonotic disease that has received a nosological independence twenty years ago, when Russian scientist, Professor M. S. Balayan, identified the pathogen (hepatitis E). It was believed that the disease can manifest itself only in the acute form, and occur only in regions with subtropical and tropical climate conditions. The development and introduction of practicing of modern scientific research methods for detecting antibodies to activator change, to view the global prevalence of infection and present doubts on inabilities of transformation into a chronic form. The purpose of our research was to conduct a retrospective analysis of hospital cases of acute jaundice hepatitis E in St. Petersburg. Etiologic accessory to hepatitis E implemented by discovery in serum of patients a specific marker of infection hepatitis E- an anti-HEV. In the analysis of archive documentation for 2000-2014 from the patients which were hospitalized in the Clinical Infectious Diseases Hospital by S. P. Botkin only 15 patients were diagnosed with “acute hepatitis E”. Which indicates the presence of patients with acute hepatitis E infection among hospitalized in hospitals of the city of St. Petersburg are not endemic for this disease. The presence of cases of disease of the indigenous inhabitants of the city during the past years, which isn’t going beyond its limits, indicates the existence of “autochthonous” hepatitis E.
Pediatrician (St. Petersburg). 2015;6(4):23-26
23-26
The role of genetic factors in the formation of dependence on opiates
Abstract
Sociological surveys show that the average age of drug users in recent years has drastically decreased from 18 years to 13 years. Among children of aged from 5 to 7 years the episodes of drug use have been reported. At the same time their parents addicts contribute to this. Statistics show that more than 60 % of drug addicts are young people aged from 17 to 35 years. More than 20 % are children, students, and only 15 % are people older than 35 years. The use by mother during pregnancy psychoactive substances (PAS) is one of the major risk factor for congenital addiction. The most important risk factors for drug abuse are genetic ones. There are two main genetically dependent factors. The first factor is genetically determined high level of the dopamine which encourage a person on a constant search for new sensations, dissatisfaction peace, and search risky situations. The second one is a low level of the hormone serotonin which results in depression in stressful situations. The stressful situations become very deep. Certain factors increase the risk of addictive behavior of offspring may appear at birth. Many people who started the abuse at early age consciously preferred drug to alcohol. That is the adoption of alcohol caused them to aversion to alcohol because of the memories of his father-alcoholic. However based on the biological characteristics while it is not so easy to predict the likelihood of addiction and clearly define in advance the tendency or, on the contrary, human resistance to drug intoxication and dependence.
Pediatrician (St. Petersburg). 2015;6(4):27-31
27-31
A study of morbidity on the territory of the municipality of stara zagora in connection with air pollution aerosols lead
Abstract
Within 5 years (2009-2013) surveyed the annual dynamics of the concentration of one of the major air pollutants in the municipality of Stara Zagora - lead aerosols and their impact on public health. In the process of monitoring parallel analyzed the average monthly levels of this pollutant. The problem of lead poisoning associated with heavy environmental pollution (primarily atmospheric air) is most relevant to large industrial cities. In the current environmental situation, the best indicator of the negative impact of lead pollution on the body is the level of morbidity of the population, which depends on the concentration of lead particulate pollutants in ambient air. When evaluating relationship pollution-morbidity on the outcome of hospitalization for different age groups the correlation dependences between the average annual concentration of lead aerosols and various diseases. For this purpose were formed correlation matrix for all types of registered diseases (associated with the impact of lead aerosols on the body), according 10 the International classification of diseases for 3 age groups: 0 to 17 years, 18 years and older and the total population. The analytical data show a significant dependence of the development of several classes of diseases as a result of exposure to toxic lead aerosols contained in the air. In the age group from 0 to 17 years the effect of pollution by lead compounds set the highest correlation dependence diseases of the skin and subcutaneous tissue, registered at the hospital, and for a group of 18 years and more with diseases of the blood and blood-forming organs. Lead aerosols and dust particles have an additive effect on the diseases of the circulatory system in the group of the total population in the municipality of Stara Zagora.
Pediatrician (St. Petersburg). 2015;6(4):32-38
32-38
Mechanism of disturbance of reproductive functions in women soldiers under extreme conditions local conflicts and pathogenetic approaches to correct them
Abstract
The analysis of psycho-emotional status and homeostasis rates in women with primary dysmenorrheal who have done military service in the extreme conditions in Transdniestria has been performed. Assessment of the severity of neurotic syndromes suggests that women soldiers with the menstrual cycle are characterized by marked affective lability, asthenic and depressive symptoms, affective tensions and insomnias. The multidirectional changes in peripheral blood corpuscles, biochemistry rates and the blood serum hormone rates in women of given community have been revealed. It was determined that military women have menstrual cycle disorders classified as dysmenorrheal that is related to the increase of cortisol concentration and the trend to prolactine increase, while female civilians this disease is related to the increase of follicle-stimulating hormone. Military women who take part in military actions and suffer of dysmenorrheal are characterized with metabolic disorders with the domination of catabolic reactions and the changes in blood serum lipid ranges. The lower rates of cholesterine, lipoproteids of high density and higher rates of triglycerides compared to ones in patients from the control group prove this. The correlation of neurotic syndromes and features of hormonal regulation in women military. Neuropharmacological analysis demonstrated the increased effectiveness of therapeutic interventions in patients receiving antidepressants in women survivors are vital stress, suggesting the involvement monoaminergic systems of the brain in the formation of this gynecological pathology.
Pediatrician (St. Petersburg). 2015;6(4):39-44
39-44
No inducible synthase inhibitors produce a positive effect on indexes of central hemodynamics in rats with septic shock
Abstract
The purpose of the study was to evaluate the efficacy of NO inducible synthase (iNOS) inhibitors involved in simulation of septic shock in rats. Model of septic shock (SS) was obtained in rats by intravenous administration of live Bifidobacteria culture. Aminoguanidine was used as a selective inhibitor of iNOS. Indexes of central hemodynamics measured by direct method where analyzed. Vascular endothelial function was rated by determination of nitric oxide (II) (NO), vascular endothelial growth factor A (VEGF-A) and tissue plasminogen activator (tPA) in plasma. Hemostatic parameters were evaluated by the level of soluble fibrin monomer complexes (RKMF). Intravenous administration of live Bifidobacteria culture in rats proved to cause an adequate and effective septic shock model with characteristic changes of hemodynamics in laboratory animals, development of endothelial dysfunction and hemostasis system activation in response to bacteremia. INOS inhibitors have a positive impact on hemodynamics in septic shock. NO is not the only factor in the development of hypotension in septic shock. INOS inhibitors appear to affect the extent of vasopressor dose utilized in the therapy of septic shock contributing to improvement of microcirculation and tissue oxygenation.
Pediatrician (St. Petersburg). 2015;6(4):45-50
45-50
The structure of the thymus and mesenteric lymph nodes of newborn rats as a result of the prenatal influence of ethanol
Abstract
The present study was undertaken to examine the structural features of the thymus and cranial mesenteric lymph nodes of newborn rats that have occurred as a result of antenatal alcohol intoxication. We used a set of morphometric, anatomical and histological methods. A study of the cranial mesenteric lymph nodes performed on 45 newborn rats born to 18 female mongrel white rats seven months of age. The studies were conducted in compliance with the order of the Ministry of Health of the USSR N 755 from 12.08.1977 and the order of the Ministry of Higher and Secondary Special Education of the USSR from 13.11.1984, "On the rules of work with experimental animals". Females, on which was received investigated offspring exposed to 15 % ethanol as the sole source of fluid for 1 week, one and three months before pregnancy, during pregnancy and after its completion. It is shown that depending on the duration of pregravid exposure to ethanol occur progredient changes in the structure of the thymus and cranial mesenteric lymph nodes. In the thymus, as well as in the lymph nodes, decreases the number of lymphoid cells and stromal elements content increases. In lymph nodes there are significant changes in the structure of the sinus system. The severity of the identified morphological changes due to the duration of the effects of alcohol on the system "mother-placenta-fetus”.
Pediatrician (St. Petersburg). 2015;6(4):51-55
51-55
Gastrointestinal complications of cancer treatment in childhood
Abstract
Gastrointestinal and liver toxicity are ones of the complications of combined modality treatment for malignant tumors in childhood. Issues of gastrointestinal complications after radiation therapy and chemotherapy are considered in article. We describe the clinical presentation, diagnosis and treatment of diseases and syndromes associated with the effects of the specific treatment. Among infectious complications accented reader's attention to such serious complication such as cryptosporidiosis, cytomegalovirus infection, and viral hepatitis B and C. Described in detail the clinical pattern of cytomegalovirus hepatitis and enterocolitis. The most common effects of abdominal irradiation are post-radiation enteritis and venoocclusive disease, the occurrence of which is associated with concomitant use of cytotoxic drugs and radiation the liver. Often the development of hepatotoxicity is associated with high-dose chemotherapy with allogeneic or autologous stem cell transplantation, as well as prolonged use of methotrexate in patients with acute lymphoblastic leukemia at the stage of maintenance therapy. The article describes the phase drug metabolism in the liver and pathogenesis of disorders. This article lists the chemotherapy agents, the use of which in the schemes of chemotherapy can induce the development of hepatocellular toxicity. Recommendations for dispensary observation and examination of patients with identified disorders of the gastrointestinal and hepato-biliary system.
Pediatrician (St. Petersburg). 2015;6(4):56-61
56-61
Features of pathogenesis, clinical course and diagnosis of acute cholecystitis of patients with decompensated cardiovascular diseases
Abstract
The work presents the features of pathogenesis, clinical course and diagnosis of acute cholecystitis of patients with decompensated cardiovascular diseases have been submitted in this report. The main diseases of cardiovascular system that affects the prognosis of acute cholecystitis have been set off. The sufficient detailed is written about the criteria for patients at risk. Listed severe somatic diseases, which are frequent in older patients being treated in surgical hospitals. The pathogenetic link between inflammatory disease of the gallbladder and cardiovascular system has been explained. The problem of mutual deterioration between acute cholecystitis and different manifestations of coronary artery disease has been reviewed. The noting widespread introduction of new non-invasive methods (ultrasonography, computer tomography and magnetic resonance tomography) and invasive (endovideosurgery) diagnostics. Detailed characteristics of such instrumental techniques as ultrasonography, magnetic resonance cholangiopancreatography, magnetic tomography, endoscopic retrograde cholangiopancreatography, diagnostic laparoscopy has been given. The role of specific biochemical markers of necrosis has been showed: creatinephosphokinase, its heart fraction, troponin test. Possible changes on the electrocardiogram of patients with acute cholecystitis and reasons for their appearance have been described. Detailed recommendations for the identification of acute myocardial infarction of patients with acute cholecystitis using markers of myocardial damage have been given.
Pediatrician (St. Petersburg). 2015;6(4):62-68
62-68
Features response and course of typical pathological processes in burn disease in puberty
Abstract
In response to burn injury in the body of the child in puberty naturally develop typical pathological processes, which include almost all organs and systems, leads to severe disruption of homeostasis failure of adaptive mechanisms. Burn is the most powerful stress factor that causes changes in the body that are typical of the general adaptation syndrome. The main pathogenesis and peculiarities of typical pathological processes in burn disease significantly affected are determined by the endocrine system. Produce hormones are involved not only in the starting mechanism, but also in the development of compensatory-adaptive reactions, mobilizing the body's protective properties. Thus, a feature of adolescence is that at this age the body undergoes a qualitative change to the restructuring of all systems. There are significant morphological and functional restructuring of important metabolic processes in the body organs like the pituitary gland, adrenal glands, thyroid and pancreas, characterized by high activity of metabolic processes, strengthening of cell and tissue differentiation, intensification of regenerative processes. The consequence is excessive functional activity of organs and systems at rest, associated with low and often paradoxical reactivity to external shocks, including a burn injury, which leads to a decrease in functional and adaptive capabilities of the organism adolescents. All these features to consider when choosing the strategy of surgical treatment of persons puberty, burn victims.
Pediatrician (St. Petersburg). 2015;6(4):69-74
69-74
Cerebral Glial Tumors: General Principles of Diagnostics and Treatment
Abstract
Cerebral glial tumors continue to be a relevant issue of contemporary medicine in spite of considerable breakthroughs in oncology and neurosurgery. Cerebral gliomas constitute about 40-45 % of all glial tumors’ general structure; these tumors are mostly diagnosed at the age of 30-60 thus affecting the most able-bodied segment of population. Glial tumors usually arise out of astrocytal or oligodendrocytal cell population and are characteristic of high growth rate, invasiveness, early metastatic ability, high rate of recurrence and unfavorable prognosis. The present paper focuses at the contemporary clinical classification of gliomas based upon their location, histogenesis and activity of growth. Invasive growth with absence of distinct macroscopic border between the tumor and normal brain tissue is a characteristic peculiarity of glial brain tumors. This type of growth is peculiar for fast-growing highly malignant gliomas (anaplastic astrocytomas, glioblastomas). It is characteristic of unfavorable outcome. Anaplastic gliomas like a majority of malignant tumors are characteristic of intensive development of pathologic vascular network which boosts the rate of tumor growth as well as the intensity of metastases-forming also increasing the risk of cerebral hemorrhage into the tumor. Nodal type of growth with distinct border and moderate infiltration is less typical and may be found in case of conditionally benign gliomas with more favorable prognosis. The paper gives a detailed review of basic surgical, radiological and chemotherapeutical approaches towards treatment of gliomas. Closing the review the authors conclude that methods described in the paper do not exhaust all suggested improvements of glial tumors treatment and that elaboration of novel methods will bring neurooncologists closer to solving this actual problem.
Pediatrician (St. Petersburg). 2015;6(4):75-84
75-84
Distorted development: the elaboration of Victor Lebedinsky’s ideas
Abstract
This paper provides promising areas of the research of laws and mechanisms of distorted children’s development. The paper is based on the results of the analysis and compilation of empirical data of the author’s longitudinal study of mental development of 170 children with autistic spectrum disorders who were hospitalized in the children’s psychiatric hospital N 6 in Moscow in 1997-2015 years more than once, and 36 children with certain autistic features who were adapted well enough to mass kindergartens and schools in 2010-2015 years. In our research we try to develop several key ideas of V. V. Lebedinsky on the distorted development in the following ways: 1) the study of an uneven development of physical functions by using not only the model of speech development, but the model of development of different kinds of symbolic activity as well; 2) the different types of abnormal links (isolation, confusion, adhesiveness, fixation, star-type links) in regard to the different types of behavior, symbolic activity, emotional states and types of the child’s contact with other people are explored; 3) the different factors, including the restored attachment with close people and the role of child’s personal activity in choosing productive development or refusal from the development in key fields, which determine a high variability of distorted development, are studied; 4) the method of therapeutic observation is being worked out which is based on the identification and support of the natural mechanisms of compensation of distorted development and on the thorough knowledge of adaptive forms of distorted development which are spreading fast in the modern population.
Pediatrician (St. Petersburg). 2015;6(4):85-89
85-89
Interim results of neuropsychological analysis of the development of children with perinatal risks
Abstract
This article presents a brief description of the normative mental development of the elder preschool children: features hemispheric interaction between the cerebral hemispheres, dynamic, spatial and motor praxis, memory, visual-objective, visual-spatial and acoustic-verbal gnosis and originality of speech, thought and attention. Besides, this article illuminates analysis of the interim data obtained in the course of neuropsychological investigation of cerebral organization of mental functions among preschoolers whose mothers have an anamnesis of various risk factors of perinatal pathology of the fetus. The analysis of the data illustrates that very often agenda had difficulties in carrying out tests for visual gnosis, audio-verbal memory, dynamic and spatial praxis. Also it was hard for children to compile stories for narrative paintings and series of narrative pictures. Besides, it was recorded that the majority of children have shown attention fatigue and instability of attention and the high level of exhaustion. So the interim results received on this level of experimental research illustrate the existence of tendency of defection in the process of formation of high psychic functions among children with different risk of development of perinatal pathology in their anamnesis. But in the cause of the insufficiency of experimental data it is to early to make strict conclusions concerning the concrete consequences of the different perinatal risks for brain organization of child’s psychic activity.
Pediatrician (St. Petersburg). 2015;6(4):90-96
90-96
The relation to pregnancy, the child, motherhood of women in IVF situation
Abstract
Research objective - studying of features of the relation to pregnancy, the child, motherhood of women in IVF situation. Selection: 100 married pregnant women aged from 28 till 42 years (the first pregnancy of the first trimester, complications in the anamnesis isn't present) representing two groups on 50 people: 1) after artificial insemination (empirical group); 2) in a situation natural pregnancy (control group). The leading motives of pregnancy, types of the attitude towards themselves, pregnancies, to the child, people around, the prevailing installations in the sphere of the family relations, features of representation of future mothers about themselves and "the ideal parent" are defined by testing. Distinctions in all respects with women from control group are found. It is established that in vitro fertilisation the high level of readiness for motherhood according to its motivational characteristics is observed. Prevalence of constructive motives of pregnancy against concern in the health and aspirations to meet social expectations is revealed. The leading types of a gestational dominant are optimum and euphoric, the hypertrophied positive emotional background of pregnancy is observed. In the future of a bike probability the dependent relations with the child, preference of the sponsoring or authoritative style of family education. Revaluation of own parental qualities when comparing with image of ideal mother is observed. Results allow to carry women to the group of risk demanding psychological maintenance before and after the childbirth.
Pediatrician (St. Petersburg). 2015;6(4):97-104
97-104
The method of serial drawings and stories in psychological counseling to resolve disputes between parents about the child's upbringing
Abstract
The urgency to develop new approaches to psychological counseling families in situations of settling disputes between the parents on the upbringing of the child is determined by the increasing frequency of such requests to clinical psychologists. Such consultations suggest the need for a rapid assessment of the psychological state, characteristics and relationships of experiencing parental divorce children. The aim of the article - to provide a description of I. M. Nikolskaya method of serial drawings and stories; to demonstrate the possibilities of its use in psychological counseling for resolution of the dispute between parents about parenting and procedure of meetings with the child on a clinical example. The method of serial drawings and stories is the integrative art therapeutic technology based on the projective approach. The method simultaneously solves the problem of psychological research and counseling in the specific situation of the child and his parents appeal to the psychologist. The article presents the short description of the method procedure, its stages and aims, the order of drawings topics. The techniques of art therapeutic interview and its advantages (concrete, detachment, structured, therapeutic effect) and showed. The information obtained through the application of the method in the form of images and texts can serve as an objective material to draw conclusions about the child’s subjective family situation view and well-being in the family. To illustrate the possibilities of the method of serial drawings and stories the clinical case of 7 years girl’s psychological counseling, conducted at the request of her mother in connection with the judicial review of the order of father and daughter meetings after a divorce, is analyzed.
Pediatrician (St. Petersburg). 2015;6(4):105-111
105-111
Neuropsychological and psychometric analysis of the defect at children and adolescents with endogenous mental pathology
Abstract
This article presents a compound neuropsychological/psychometric analysis of manifestations of defects in children and adolescents with endogenous pathologies. The research was organized among children with diagnosed schizophrenia spectrum disorders: child type schizophrenia, schizotypal personality disorder and other forms of schizophrenia. All patients were on the stationary treatment and had verified diagnosis, defect in cognitive sphere was close to oligofrenic like defect. The experimental group (EG) - 74 children (52 boys), average age - 11,0 ± 2,9 years. Control group (CG) - children and adolescents (64 children, among them 38 boys) from Moscow schools, average age - 11,1 ± 3,0 years. The neuropsychological research was taken on 20 children from EG and on 15 children from CG. Qualitative and quantitative analyses of data included the formulation of criteria of marks of the psychometric and neuropsychological results. Based on our research data we distinguish specific compounds of manifestations of certain cerebrum structure dysfunctions and cognitive dysfunctions that are common in children with schizophrenia spectrum disorders. We also illustrate the differences in localization (in interhemispheric cooperation, cortical structures, subcortical structures) of primary dysfunctions in patients diagnosed with various schizophrenia spectrum disorders. Neuropsychological and psychometric analysis had shown that patients by their functional status are heterogeneous group. The defection of intellectual activity is not total but partial with gradual involvement of different aspects.
Pediatrician (St. Petersburg). 2015;6(4):112-115
112-115
Main improvement organizations of federal specialized (oncologic) institute as a unit of health system
Abstract
Recently economic analysis of health care is demanded and actual due to becoming more and more urgent need for restructuring and a choice of priorities for this boundary section of medicine. In the article are considered strong and weaknesses of health system models, including in option of a so-called transitional economy on the example of federal N. N. Petrov Research Institute of Oncology. Now the N. N. Petrov Research Institute of Oncology can call establishment of national health system with state regulation of programs of general obligatory medical insurance. In this model of health care the state obliges employers and citizens to deduct part of the income on the health insurance, and producers of medical services to provide the population with medical care, including with mediation of insurance companies within obligatory medical insurance. Introduction of this model allowed to provide citizens with full medical care at the expressed reduction of expenses (to 8-12 % of gross domestic product). In the majority of medical institutions medical care is “free”, therefore, to maintain market balance at increase in demand for service, "waiting lists" are entered, patients with “priority” diseases are exposed to treatment, often there are complaints to the unfriendly attitude towards patients. The ideal health system has to provide medical services in unlimited volume without insurance premiums, deductions or individual share at a full freedom of choice of the doctor. Common problem for all systems, mentioning in no small measure functioning of oncologic establishments, is uncertainty of a state role and involvement of each of participants (the state, insurance companies, suppliers of medical services) in realization of various potential functions and problems of health care.
Pediatrician (St. Petersburg). 2015;6(4):116-123
116-123
The rare case of a combination two brain tumors with total colon polyposis
Abstract
Objectives of publication: Presentation of a rare clinical observation from our own practice. Key points: The combination of brain tumors and colon polyposis often described in the literature as a syndrome Turcot. Turcot's syndrome is a genetic disease with different clinical manifestations. This is a rare syndrome (a little more than 150 cases are described), and therefore, the standardization of approaches to diagnosis and treatment is not currently defined. We present the clinical case of manifestations of the Turcot’s syndrome of our practice. Сlinical observation: Male patients, from birth to the skin marked multiple cafe-au-lait spots. At age 14 years, according to a magnetic resonance imaging multiple brain tumors are revealed, two different histologically tumor brains (one of which is benign (pilocytic astrocytoma), the other is malignant (anaplastic ependymoma)) and total colon adenomatous polyposis were diagnosed. Currently, syndromic pathology is not verified. Receives one of polychemotherapy protocols for treating tumors of the central nervous system. It is planned to conduct additional studies aimed at clarifying the genetic defect, with a view to a possible optimization of the therapy (modification of the plane of polychemotherapy, use of an option of radiation therapy, use of a target therapy). Conclusions: The results of a comprehensive survey of the use of modern techniques of molecular biology and cytogenetics affect the prognosis of the disease and treatment strategy.
Pediatrician (St. Petersburg). 2015;6(4):124-134
124-134
Pulmonary toxicity of anticancer therapy from childhood Hodgkin’s lymphoma
Abstract
Pulmonary toxicity is one of serious complications of combined modality treatment for malignant tumors. Issues of pulmonary toxicity after radiation therapy and bleomycin-included chemotherapy are considered in article. Pneumonitis developed after treatment divided into early and late, causing the deterioration of respiratory function. The article examines the emergence of pulmonary toxicity after radiotherapy and chemotherapy, especially with the inclusion of bleomycin. The most significant adverse effect of the bleomycin using is interstitial pneumonitis followed by pulmonary fibrosis, which is diagnosed in 46 % patients. The mortality of patients with bleomycin-induced pulmonitis is 3 %. The article describes the clinical manifestations of complications and methods of diagnosis. Bleomycin-associated pneumonitis diagnosed in 3-5 % patients receiving doses of ≤300 mg, and in 20 % patients after total doses ≥500 mg. In addition to the study of pulmonary function tests in the article the technique of performing CT of the chest with the construction of three-dimensional reconstructions using applications “Volume rendering”, allow to diagnose early and late pulmonary toxicity. The diagnostics of the late pulmonary toxicity are difficult because clinical symptoms are usually absent or expressed at moderate and low level. For timely diagnosis of this condition should be carefully controlled to an annual survey of laboratory tests, including spirometry and measurement of carbon monooxide diffusing capacity, as well as the control radiography and CT of the chest. The density gradient of the lung tissue is relatively small for the visual assessment of moderate diffuse pulmonary fibrosis, and the use of three-dimensional image allows you to improve the perception of the data, without the need for additional scanning study area.
Pediatrician (St. Petersburg). 2015;6(4):135-139
135-139
The medical informative systems in pediatric practice - problems and prospects
Abstract
Data on the use of modern medical information systems (MIS) in Russian medicine, including in pediatrics are presented. Advances and problems in creating a single unified MIS, diagnostic information systems are highlighted. Information about existing questionnaires in the area of life quality assessment of healthy and patients suffering from pulmonological profile are provided. The problems of diagnostics of chronic diseases of small bronchial tubes at children are observed. It is important to determine the probability of the diseases formation for the usage of financially-based and informative methods of research, aimed at timely identification of the disease are considered. Data of the studies of the prevalence of chronic diseases of the small bronchi of children with the help of specialized questionnaires which were hold in two regions of the Russian Federation are included. The results confirmed the high sensitivity of the methods used and showed a significant excess of the actual prevalence of bronchopulmonary diseases in children compared with statistical data on the uptake. These methods of diagnostics screening have no analogues in pediatrics. MIS with analysis possibility and decision support diagnostic decisions are rather rare, and absent in pulmonary practice. Thus, there is a need for the establishment of unified information systems for diagnostic use in medicine. In particular, in the field of pediatric pulmonology the introduction of an MIS developed on the basis of a proven questionnaire will help to solve the problem of timely detection of chronic allergic and non-allergic respiratory diseases in children in primary care.
Pediatrician (St. Petersburg). 2015;6(4):140-146
140-146
Clinical and laboratory criteria of gravity and the principles of treatment of acute infectious mononucleosis, Epstein-Barr virus etiology of the children
Abstract
The lecture presents the results of many years own research and analysis of the literature on the clinical presentation and therapy of acute infectious mononucleosis, Epstein-Barr viral nature of children. The detailed characterization of the leading clinical syndromes such as fever, intoxication, lymphoproliferative, gepatolienalny syndrome, exanthema. The clinical and laboratory criteria for evaluating the severity of the disease. Principles of drug therapy are presented in accordance with clinical guidelines (treatment protocol) and standards of care for children with infectious mononucleosis. In the treatment leading place etiotropic and immunotropye funds. In pediatric practice, the most widely used and combined antiviral drug viferon immunotropic who appoint 150 000 IU - children up to 7 years, 500 000 IU - children 7-12 years and 1 000 000 IU - children over 12 and adults 2 times per day every 12 hours within 10 days. After a course of therapy with interferon will be a significant reduction in terms of the febrile period and intoxication, difficulty breathing and nasal lymphoproliferative syndrome, a significant reduction in the duration of hospital stay. Viferon also has a positive effect on the speed of the normalization of the hemogram and hemostasis indicators, such as prothrombin time and activated partial (partial) thromboplastin time. Synthesis of endogenous interferon inducers (anaferon children, tsikloferon, derinat) cause prolonging circulars in the blood of its own interferon. Antibiotic therapy is conducted at parenchymatous tonsillitis, taking into account the sensitivity of selected microorganisms. Symptomatic therapy includes the use of fever-reducing, vasoconstrictors, antihistamines. With the development of toxic-allergic rash viferon-apply ointment, gel viferon, allergoferon.
Pediatrician (St. Petersburg). 2015;6(4):147-153
147-153
At the root of SPbSPMU: by memory of the founder of the Department of Operational surgery and topographic anatomy prof. F. I. Valker
Abstract
This article is about a scientist, a surgeon, an anatomist, a founder of the doctrine of the development of organs and systems of human after birth. It is based on archival and printed sources. His role as an important organizer, founder and a head of the department of operative surgery and topographic anatomy of the Leningrad Pediatric Medical Institute is mentioned. He was the closest student and a follower of of Professor V. N. Shevkunenko he made a significant contribution to the study of the morphological features of organs and systems during humans postnatal development. His outstanding abilities as an organizer and teacher are shown on the example of a creation of the department of operative surgery in Tashkent Medical Institute and in Leningrad Pediatric Institute, and also on being an acting head of the department of operative surgery and topographic anatomy at the Military Medical Academy during evacuation in the time of the Great Patriotic War, and participating in the organization of assistance to the wounded solders during the Civil, the Finnish wars. His style of teaching, the principles on which he built his relationship with colleagues, students, doctors, and his role in educating of a whole generation of well known scientists and teachers is shown. A large number of anatomical facts of the development of organs and systems of human, obtained by F. I. Valker was summed up in his life's work: "Development of a human after birth" (1951). The evolution of the postnatal development of the nervous, cardiovascular and urinary systems, as well as respiratory and digestive systems is shown in this big work. This doctrine is still of a practical an theoretical importance for doctors of many specialties, especially pediatricians and pediatric surgeons.
Pediatrician (St. Petersburg). 2015;6(4):154-159
154-159