Vol 9, No 2 (2018)

The article presents the data of a complex analysis of the course of the early period of the newborn in children born to 456 women who were delivered in the maternity hospitals of St. Petersburg and the Leningrad Region in 2009-2016. These patients were divided into the main group (99 women who gave birth to live children who died in the first 7 days of life) and a comparison group (357 women who gave birth to live children who survived the first 7 days). Estimated the duration of pregnancy at the time of delivery, clinical features of newborn children in the group of patients with perinatal losses, in comparison with the control group, were analyzed. The article compares the anthropometric data of newborns (weight and height at birth), Apgar scores, and the frequency of fetal hypotrophy. The results of the clinical analysis of the blood of newborn children of the patients of the main and control groups (hemoglobin, erythrocytes, leukocytes, platelets and venous blood glucose) were also evaluated. A number of significant differences in the main group and comparison group that can be regarded as predictors of perinatal fetal death have been identified. Thus, the risk group for perinatal fetal death includes preterm newborns with hypotrophy, low body weight, smaller body length, a low Apgar score, changes in the clinical analysis of blood (lowering of hemoglobin, erythrocytes and platelets, and an increase in the level of venous blood glucose). The level of leukocytes in peripheral blood in newborns in both groups is not significantly different.

The study is held in order to estimate the efficiency of applying the methods of manual therapy on pregnant women during the second and third trimesters of their pregnancy to relieve pain caused by dorsopathy. During the period from October 2015 until March 2017 was defined a “study” group (n = 25) and the “control” group (n = 25) of pregnant women with the diagnosis of “dorsopathy” (mostly osteochondrosis 66%, scoliosis 18%, intervertebral hernia 16%). The age of pregnant women is ranged from 22 up to 39 years with the gestational term from 18 to 38 weeks. During the study the following methods are used: cranio-sacral technique, traction technique, myofascial release, post-isometric relaxation, and soft tissue techniques. The number of therapy sessions for pregnant women with dorsopathy is ranged from 1 to 4. To assess the quality of life and, separately, of the pain syndrome was used McGill questionnaire, visual analogue scale (VAS), verbal rating scale, questionnaire EuroQol-5D, Oswestry questionnaire, as well as medical and social characteristics of pregnant women with this pathology. Decrease of pain syndrome was noted in patients already after the first session. Preliminary results were already evaluated and allow us to speak about the effectiveness of applying manual therapy for pregnant women at their II and III trimesters of pregnancy. The data obtained not only prove the reduction but also the complete elimination of the back pain syndrome caused by dorsopathy.

VVD hypotensive type significantly reduces the quality of life, prevents normal growth and differentiation of organs and tissues of the child’s body, promotes the formation of a number of life-threatening pathological processes in adulthood. In order to determine the initial vegetative tonus in 63 children aged 11-14 years suffering from hypotensive type VVD, the averaged values of cardiointervalograms consisting of 100 consecutive cardiocycles were determined. Vegetative reactivity has been studied through the conduct and evaluation of a clinoortostatic test, consisting in the sequential recording of blood pressure and cardiograms first in a horizontal and then in an upright position. As a control group, 27 practically healthy peers were examined, who underwent a similar complex of clinical, laboratory and instrumental studies. Statistical processing of the obtained results was carried out by parametric and nonparametric methods with the help of STATISTICA and Microsoft Excel for Windows packages on the IBM “Pentium 166” computer. As a result of the study, a significant difference in vegetative tone was found in children with hypotensive VVD from normal. In this case, vegetative status is characterized either by the initial high level of functioning of sympathoadrenal regulatory mechanisms with insufficient increase in their adaptive activity or by the predominance of the initial cholinergic vegetative tension and the corresponding hypersympathicotonic reactivity, which is the marker of the greatest threat of transformation in this group of children of the hypersensitive type to the hypertensive and then into hypertensive disease.

Formation of a school maturity at children of younger school age is the main objective of modern education. Special attention in the last decades is paid to children with disturbances of a musculoskeletal system, in particular, to children with the cerebral palsy (CP). Such children study at special correctional schools which prepare the pupils for independent life and work in society.

Research objective: to estimate adaptation of children of younger school age with cerebral palsy to occupations at correctional school.

Materials and methods. 75 children with the diagnosis are examined: Cerebral palsy, spastic diplegia mild or moderate severity, delay of psychomotor development, pseudobulbar dysarthtia. All children studied in state-funded educational institution for children with limited opportunities of health special (correctional) comprehensive school (the IV look) No. 584 "Ozerki" of Vyborgsky district of St. Petersburg (school No. 584 "Ozerki"). The age of children was from 7 to 11 years. The following indicators were estimated: quality of life of children by means of the questionnaire of PedsQL for category of children of 8-12 years, electroencephalogram indicators, the neurologic status, extent of disturbance of the speech. Children were examined by the neurologist, the psychologist and the logopedist.

Results. 72% of children had the average and low level of adaptation. According to classification by L.A. Wagner (1989), “the low level” of adaptation prevailed at boys (42.2%) (the negative relation to school, suppressed mood, frequent complaints to an illness). “High level” also dominated at boys (33.4%) while at girls “the high level” of adaptation was observed only at 6 people (20%). Clinical inspection taped that at children the hyper excitability syndrome prevailed (at boys – 51.2%, girls – 63.3%). Also it was noticed that extent of disturbance of the speech depends on degree of a lesion of the central nervous system and also on age and sex features. The quality of life of children of elementary school is reduced. In scales of the questionnaire of PedsQL “physical functioning”, “emotional functioning”, “life at school” points don’t exceed 50. Only in a scale “social functioning” an indicator more than 70 points.

Conclusions. The complex rehabilitation including the medical, psychology and pedagogical and logopedic care is necessary for children of elementary school of school No. 584 “Ozerki”.

Dysplasia of the main veins (DMV) is known by the names of authors had described this pathology as the Klippel-Trenone syndrome (KTS). Many authors consider the cause of the syndrome to be the impact of various teratogenic factors. These include drugs, infectious agents, radiation exposure, domestic and occupational hazards. Teratogenic factors can damage embryo vessels, causing local stasis and hemorrhages, which can be cause for the perverse formation of veins and surrounding tissues. The clinical picture of severe and extremely severe degrees embryonic type DMV is quite simple. It include asymmetric hypertrophy of the extremities, “disfiguring” in patients with extremely severe degree, extensive cyanotic vascular spots, often accompanied by papillomatous nevus of the skin. The spots are located on the anterolateral surface of the thigh and lower leg. Embryonic veins, which can be found under the spots – a characteristic pathognomonic sign of the KTS. Disturbances in the shape of the limb and external signs of angiodysplasia (vascular spots, atypical veins) in children with mild to moderate severity degree are less pronounced and can be inconstant. Examination and treatment of children with DMV, depending on the severity of the lesion, it is rational to start from the time of detection to 6 years. Phlebography reveal various variants of violation of the surgical anatomy of the veins of the affected limbs. Medium and light forms of dysplasia of the main veins should be differentiated with similar forms of fetal type, congenital Parkes Weber syndrome and acquired iliofemoral thrombosis (atypical veins above the bosom). Sometimes there are combinations of dysplasia of the main, deep, intermuscular and superficial veins. The following operations, according to the indications, are performed: phlebectomy and perforant veins ligation; embryonic veins removal and main outflow correction; musculoskeletal system surgery, abdominal and retroperitoneal surgery, as well as amputation of affected limb. Treatment including surgical and non-surgical methods should be comprehensive and should be performed in highly specialized, multidisciplinary hospitals.

We present the case of postmortem diagnosis of rare in forensic medical practice disease — of arrhythmogenic dysplasia and the analysis of morphological and microscopi manifestations of the disease. Arrhythmogenic right ventricular dysplasia (ARVD) belongs to primary cardiomyopathy. This pathology of unclear etiology is usually an isolated impairment of the right ventricle (RV), often running in the family, characterized by fatty or fibrofatty infiltration of ventricular myocardium accompanied by heart rhythm disorders (HRD) of the ventricles of various severity, including ventricular fibrillation. Prevalence of ARVD has been studied not enough due to the fact that the onset of the disease is often asymptomatic. In 80% of cases it is revealed under the age of 40, more frequently in males. Some authors consider ARVD to be the cause of sudden cardiac death (SCD) in 26% of children and adolescents. SCD may be the first and the only manifestation of ARVD, particularly in young people and sportsmen. According to the data by the American authors, ARVD is diagnosed posthumously approximately in 5% of SCD cases in people younger than 65 years of age and in 3-4% cases of death in young sportsmen during competitions. Opinions as to pathogenesis of the disease come to two theories: ARVD is a congenital anomaly of development of RV myocardium called dysplasia. The onset of tachycardia may be postponed for many years until RV is considerably enlarged and the size of arrhythmogenic substrate is big enough to cause persistent ventricular tachyarrhythmia (VT). The second theory connects the onset of RV dysplasia with metabolic disturbances involving RV and causing progressing myocyte replacement (apoptosis). Islets of fibrofatty tissue revealed in ARVD form arrhythmogenic substrate carrying conditions for development of reentry underlying malignant VT.