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Vol 7, No 3 (2016)

Community-acquired pneumonia in children. The modern features
Sergeeva E.V., Petrova S.I.
Acute respiratory infections are one of the most frequent diseases among children and teenagers around the World. Pneumonia which caused by infectious agents is dangerous disease of the lower respiratory tract that can lead to the death. The continuing high level of morbidity and mortality causes the issue. The article describes the WHO criteria for the diagnosis of community-acquired pneumonia (CAP) and CAP severity indicators, also radiographic signs of CAP and modern epidemiological data. The etiological structure of CAP has age-specific peculiarities. Streptococcus pneumoniae (S. pneumoniae) is leading causative agent of CAP, it causes invasive and non-invasive forms of pneumonia. The role of atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae) and viruses was mentioned. The etiology of CAP may vary depending on geographic area, vaccination coverage, using antibiotics. The modern methods for identification of S. pneumoniae were itemized in the article. The own identification from blood lytA gene and cpsA gene S. pneumoniae by polymerase chain reaction (PCR) frequency data was presented. Among examined patients who were hospitalized in clinic SPbGPMU in 2011-2015 years attending preschool children less than 5 years of age prevailed (which accounted for 48%). The invasive form is revealed at 34% of the patients with CAP. In this group of patients course of the disease was severity, there was complications such as pneumothorax, pulmonary edema, and pleural exudation.
Pediatrician (St. Petersburg). 2016;7(3):5-10
Iron deficiency anemia in children younger than 1 year:the search for the formula of success of outpatient management of patients
Zhukova L.Y., Khartchev A.V., Kolobova O.L., Sokolova N.E., Tarasenko A.N.
172 newly diagnosed cases of iron deficiency anemia (IDA) in children younger than 1 year who were hospitalized in the Department of Hematology Saint Petersburg Сhildren Hospital No 1 in St Petersburg 2010-2015 were analyzed. Anamnesis peculiarities of IDA and outpatient care of babies, including individual prevention of iron deficiency and ferrotherapy and the causes of identified deviations from the existing patient management recommendations were clarified. Defects of sideropenia prevention found in all examined children. The fundamental error of pediatricians during ferrotherapy were the lack of verification of the nature of anemia, violation of drug dosing iron, lack of monitoring the effectiveness of treatment, failure to comply with the required duration of the courses of therapy. Mistakes made by pediatricians during the prevention, diagnosis and treatment of iron deficiency anemia are primarily a reflection of the deficit of basic knowledge of doctors on this issue. The effectiveness of the prevention of iron deficiency in infants is largely determined by the individual outpatient pediatrician, the level of his training, psychological stability and ability to engage constructively with the parents of patients. Components of success of outpatient management of patients younger than 1 year with iron deficiency are: the presence of a modern background knowledge on the issue, understanding the health and social consequences of iron deficiency for the younger generation and the desire to make a personal contribution to improving the health of children in Russia.
Pediatrician (St. Petersburg). 2016;7(3):11-16
Immunohistochemical value to treat patients with chronic endometritis
Kolmyk V.A., Nasyrov R.A., Kutusheva G.F., Petrov V.V., Grigoryev S.G.
One of the main causes of violations of women’s fertility is the pathology of the endometrium. Structural and functional inferiority of endometrium due to pathological inflammation, naturally leads to disruption of the implantation process and clinically infertility and prenatal losses. Finding solutions treatment of endometrial pathology exclusively relevant for the prevention of reproductive health of society. The main causes of diseases of the endometrium is inadequate hormonal regulation, acute and chronic inflammation (endometritis). Consistently high frequency CE denies membership issues to the category of banal, more kontraversii recent years postulate avoiding one-sided perception of the disease solely as a classic suppurative inflammation. For chronic endometritis is often characterized by a long asymptomatic and complexity of initial diagnosis. Important role in the development of chronic endometritis today belongs to obligate anaerobes - Bacteroides and peptostreptokokki, combined with microaerophiles and facultative anaerobic microorganisms. A special place in the development of chronic endometritis takes herpes infection. Its prevalence in all, including reproductive age is quite high. Special attention is paid to the verification of chronic endometritis immunohisto-chemical (IHC) study of the endometrium. The method can not only identify the type of infectious agent, but also to establish phase process, which has an important role to determine the treatment strategy. A special role is played by immunohistochemistry in the identification of viral etiology of chronic endometritis, as this method can reliably detect the presence of antigens to a variety of viral agents.
Pediatrician (St. Petersburg). 2016;7(3):17-22
The features and diagnostics of differentiated thyroid carcinoma of children and adolescents
Skorodok Y.L., Yakovleva M.N., Gostimsky A.V., Zhelenina L.A.
The main purpose of research was to study and evaluate the featres and diagnosis of differentiated thyroid carcinoma of children and adolescents. The total of 63 patients with thyroid cancer who had undergone surgery in 1994-2013 in heir hildhood were examined. The history, clinical symptoms, results of pre- and postoperative instrumental and laboratory studies were analyzed. The research showed that three-quarters of thyroid carcinoma patients do not complain. Medical examinations of teenagers allowed to reveal the disease in more than half of cases. Significant place in the diagnostics of thyroid carcinoma occupies ultrasound and fine-needle biopsy (FNB). The most persistent symptoms of thyroid carcinoma are hypoechoic node and indistinct contours of node. The sensitivity of fine-needle aspiration biopsy in relation to thyroid carcinoma was 72.1%. Almost a quarter of patients with thyroid carcinoma combined it with autoimmune thyroid disorders.
Pediatrician (St. Petersburg). 2016;7(3):23-28
Working out of new examination method and dynamical assessment of primary school-aged children with postural abnormality based clinical-instrumental analysis
Trukhmanov I.M., Suslova G.A.

Aim. To evaluate the efficacy of a comprehensive survey of children with bad posture by using routine method combined with the non-standard functional test.

Materials and methods. We examined 91 children with bad posture aged from 7 to 10 years undergoing treatment in a rehabilitation center. Before treatment, all children were examined using the methods of visual diagnostics and functional tests. We then conducted a nonstandard test to determine the mobility of the sacroiliac joint using computed optical topography (COMET), developed in Novosibirsk research Institute of traumatology and orthopedics. A comparative assessment of the clinical results and hardware examination methods before and after treatment was done.

Results. Using computer topographic survey revealed abnormalities in 19 children (21 %), not detected during visual diagnosis on the primary admission. Using non-standard functional test in 34 children (37 %) was first identified functional block of the sacroiliac joint. During re-examination, the positive dynamics was revealed in 68 (75 %) children.

Conclusion. The conducted comprehensive survey in children has allowed to put a correct diagnosis at admission to treatment and to monitor the dynamics during the treatment course. Use of computer optical topography in combination with a number of standard and non-standard functional tests enhanced the accuracy and objectivity of the assessment of the musculoskeletal system of the patients, including allows to detecting functional blocks of the sacroiliac joint.

Pediatrician (St. Petersburg). 2016;7(3):29-34
Features of asthenic syndrome in children with ascariasis
Ershova I.B., Lokhmatova I.A.

Intestinal helminthic infections have various adverse effects on the health of children. Ascariasis is one of the most common intestinal helminthics. Long parasitism of the roundworm in the body of the child leads to the formation astheno-vegetative syndrome, lag in physical, mental and intellectual development.

The aim of our study was to investigate the featuers of manifestations of asthenic syndrome in children of different age groups with intestinal stage of ascariasis. The results of 133 children observations (age from 1 to 18 years) with intestinal stage of ascariasis were presented in our research. Rate the overall status of children with identifying syndromes related to manifestations of worm infestations, particular attention was paid to the terms of clinical symptoms appearance of he disease. The study showed that the asthenic syndrome occurs in 3 times more often in children with intestinal stage of ascariasis, compared to the relatively healthy children (p < 0.01). The most characteristic symptoms of asthenic syndrome were slackness and fatigue (62.4%), irritability (64.66%), capriciousness and hysterical states (61.65%), decreased memory and attention (43.61%), emotional lability (34%) and headache (25.56%). In preschool children more frequently (p < 0.01) were recorded capriciousness and hysterical state (over 75%). Complaints about the deterioration of memory and attention deficits (55.56–76.47%) were observed in school-age children more frequently (p < 0.01). Young people significantly more common complainted on headaches (62.5%; p < 0.05). Slackness, fatigue and irritability occurred significantly more frequently (p < 0.01) among all age groups of children with ascariasis.

Pediatrician (St. Petersburg). 2016;7(3):35-41
Expression of CD68 and Fas Ligand in Colon Mucosa of Patients with Inflammatory Bowel Disease as Prognostic Markers of Cancerogenesis
Santimov A.V., Kolobov A.V., Karev V.E., Kolobova O.L., Kostik M.M., Dubko M.F., Kalashnikova O.V., Masalova V.V., Snegireva L.S., Volkova N.L., Khvatov A.A., Belogurova M.B., Chasnyk V.G.
As it is known, colon carcinogenesis is associated with the inflammatory bowel disease (IBD). Colorectal cancer (CRC) being observed in 5.5-13.5 % of patients with ulcerative colitis (UC) and in 0.4-0.8 % of patients with Crohn disease (CD). The gut mucosa of patients with CD, but not with UC, as well as the stroma of CRC have elevated numbers of CD68(+) macrophages. It is known also that the expression of Fas Ligand (FasL), representing another branch of immunoreactivity, in the lesions of CRC and UC but not of CD is upregulated. The fact that enterocyte apoptosis is increased in lesions of CD and lymphocytes in UC are resistant to Fas-mediated apoptosis can be the keypoint for understanding the hypothesis [17], suggesting that cells express FasL and are able to kill Fas-expressing activated lymphocytes and escape rejection by the immune system, which can be the basis for differences in association of UC and CD with CRC. The aim of this study was to evaluate the number of CD68(+) macrophages and to analyze FasL expression in colon mucosa of patients with UC, CD and CRC in order to assess its value for prognosis of CRC. Expression of CD68 and FasL was analyzed immunohistochemically in the samples of colon mucosa taken from the affected areas of 4 patients with UC, 6 patients with CD and 10 patients with CRC. In addition in 7 CRC patients the samples taken from unaffected areas were analyzed. We find average expression of FasL in both unaffected and affected areas of CRC patients was higher than in CD patients (p = 0.04, p = 0.00). Average expression of FasL in affected areas of CRC patients was higher (p = 0.02) than in UC patients and the same (p = 0.23) as in unaffected areas of CRC patients. The revealed associations support the possibility to use expression of CD68 and FasL as prognostic markers for transformation of IBD to CRC.
Pediatrician (St. Petersburg). 2016;7(3):42-48
Spatio-Temporal EEG Markers for Recognition Auditory Images in Norm and Psychopathology
Belskaya K.A., Surovitskaya Y.V., Lytaev S.A.
The psychophysiological mechanisms of cognitive processes dysfunctions remain poorly understood. The purpose of this study was to modeling spatial-temporal parameters of coherent EEG assessment during auditory recognition in normal conditions and psychopathology. 40 healthy subjects and 72 patients with homogeneous psychopathological states depressive nature (average age of 34 ± 3.4 years) using the standard and original research methods were investigated. Individual-psychological characteristics and the severity of cognitive defect was evaluated according to the clinical interview, research verbal memory, the traditional methods of evaluating situational and personal anxiety, the differential diagnosis of depression. The study was conducted in St Petersburg “Psycho-Neurological Clinic No 1”. We have used the original method of studying the perception of auditory images, audiometry, computer electroencephalography with multidimensional mathematical treatment and psychological analysis of higher mental functions in patients with paranoid schizophrenia and control normal subjects. Analysis of coherence alpha- and beta-EEG rhythms in solving cognitive tasks for recognition of auditory images revealed that the functional interaction of the cortical areas normally significantly increased compared to background EEG. The features of the topography of functional relationships of alpha- and beta-EEG rhythms in the perception of auditory information are confirmed. Focuses interactions are recorded in the frontal areas. It marked the integration of these frontal zones with front associative cortex and temporal areas of the left hemisphere, as well as parietal and occipital areas of both hemispheres. At psychopathology reducing the number of coherent communications, violation of the formation of foci of coherence was registered.
Pediatrician (St. Petersburg). 2016;7(3):49-55
Vegetative Status with Arterial Hypertension in the Indigenous Population of the Far North and Migrants
Lytaev S.A., Tolstova E.A.
The increase of sympathetic activity can serve as a starting point for increase blood pressure for both humans and experimental animals. Activation of the sympathetic nervous system is important not only in the early stages of the disease but also contributes to the formation of the cardiovascular risk in life later. Comparative information about the vegetative status of indigenous people and migrants with hypertension in the Far North in a systematic scientific literature not presented. The purpose of this research was aimed for study of the dynamics of the vegetative status in patients with arterial hypertension in the Far North indigenous people and migrants. Condition of the autonomic nervous system by the residents of the Russian Far North with arterial hypertension was evaluated. The data using cardiointervalography and active orthostatic test in the indigenous population and migrants from Nadym district of the Tyumen region in the age of 18-60 years were obtained. The study involved 220 people working-age population (86 migrants and 134 indigenous peoples of the Far North). Among them are 41 patients with hypertension (26 migrants and 15 indigenous people). The average age of the surveyed migrants amounted to 40,1 ± 13,4 years for indigenous 37,8 ± 12,4 years. The duration of stay in the Far North for migrants was 14,9 ± 10,7 years. 5 options for autonomic tone, as well as differences in the autonomic nervous system disorders among migrants and indigenous peoples of the Far North with hypertension patients were installed. Violations of the autonomic nervous system for migrant are mild sympathicotonia coupled with significant impairment of vegetative support activities. It is typical for an unfavorable course of adaptation processes. For indigenous people the change reduces to a shift towards sympathicotonia without significant changes in vegetative support activities.
Pediatrician (St. Petersburg). 2016;7(3):56-62
Constitutional features of connective tissue as a risk factor of chronic pain in adolescents
Arsentev V.G., Voloshina E.A., Vyutrih E.V., Sergeev Y.S., Shabalov N.P.
A total of 504 male adolescents aged 14-18, cadet schools students were examined to identify primary head pain and functional abdominal pain. A 4-stage-blind clinical laboratory and case-control psychological examination, in which are formed two groups: basic - 90 boys with primary head pain and functional abdominal pain, and 93 healthy children (control group). Total number of teens with headaches was 76 (48 isolated headaches and 28 - headaches in conjunction with abdominal pain). The number of cadets with abdominal pain was 42, 14 was manifested monosemeiotic and 28 - in conjunction with headaches. Complex research revealed pathogenetic common primary headaches and functional abdominal pain, to identify risk factors for their development. The analysis of the results of complex examination adolescents univariate statistics significant association features of the connective tissue with the presence of primary headache, especially in combination with functional abdominal pain. Obtained significant differences in many biological, psychological and social characteristics. This fact indicates eligibility review genesis of functional disorders with painful symptoms in adolescents from the perspective of the biopsychosocial model. The present results indicate the importance of the state of the connective tissue as an essential component of the formation of predisposition to chronic pain. Other predictors of pain were advancing sexual development, emotional instability, additional sports classes.
Pediatrician (St. Petersburg). 2016;7(3):63-69
Assessment of vegetative regulation in young people
Reeva S.V.

Purpose. To estimate the prevalence and type of disturbance of the vegetative regulation in young adults and to compare the frequency of autonomic dysfunction with the severity of the phenotypic manifestations of inherited connective tissue disorders (ICTD).

Methods. 350 young adults were examined in a clinical study (collection of complaints), and with help the special “questionnaire for detection of signs of autonomic dysfunction”. At 61 young men was performed Holter ECG monitoring and cardiovascular tests D. Ewing. Results. The average number of complaints in the group of 317 healthy students was 6.5 ± 1.7. Almost all of the complaints have found significantly more frequent in girls. Examination with help special questioning for detection of autonomic dysfunction (AD) revealed AD a bit more often in girls than in boys (79 % and 64 %, respectively). Due to gender differences, further study carried out in a group of 61 young men. Нeart rate variability and autonomic test results in the groups of young men with and without AD according to the questionnaire did not reveal significant differences. At the same time in 30 % of young men without AD according to questionnaire have found an abnormal result in the active orthostatic test (AOT). Estimation of anthropometric indices and clinical features of inherited connective tissue disorders revealed that young men with AD based on the results of the questionnaire have more of skeletal and skin symptoms than that of young men without AD. The involvement of the skeletal system was present significantly frequently in young men with abnormal result AOP than that of young men with a normal result of AOP (90% and 55% respectively, p < 0,001).

Conclusion. Our study showed that AD present in the majority of young people. However, most often both subjective and objective signs of autonomic disorders common in young people with signs ICTD.

Pediatrician (St. Petersburg). 2016;7(3):70-75
Functional dyspepsia through chronic gastritis in patients with marfan syndrome and marfan-like states
Rudoy A.S., Uryvaev A.M.
The article presents the results of clinical and endoscopic examination of patients (n = 89; 33 ± 9,3 years; F : M/23 : 66) with confirmed chronic gastritis associated with hereditary disorders of connective tissue (Marfan syndrome phenotype and Marfan-like states) in order to examine the relationship associated HDCT as monogenic diseases - Marfan syndrome, as well as related pathology in the form of Marfan-like states with the clinical manifestations of functional dyspepsia and endoscopic picture of H. pylori infection in chronic gastritis. Diagnosis of Marfan syndrome was based on the revised criteria of Ghent. For the differential diagnosis with other “related” diseases of the connective tissue used syndrome diagnostic criteria of hypermobility of joints, Ehlers - Danlos syndrome. Evaluation of complaints and diagnosis of functional dyspepsia was based on the criteria of Rome III (2006) and the Florence Agreement. Evaluation of the symptoms of functional dyspepsia showed different from control (p < 0,05) lower frequency of epigastric pain syndromes and postprandial distress syndrome in a group with Marfan syndrome not associated with H. pylori infection and, at the same time, does not correlate with available in this group of patients a high frequency of precancerous lesions in the gastric mucosa. Frequent endoscopic manifestations associated with the HDCT served esophagitis gastroduodenal motility disorders and the development of GERD with catarrhal esophagitis (p < 0,05) and the absence of erosive and ulcerative lesions of gastroduodenal mucosa (p < 0,05). The findings strongly indicate the absolute necessity of endoscopic and morphological screening regardless of the presence of gastrointestinal complaints in patients with associated HDCT.
Pediatrician (St. Petersburg). 2016;7(3):76-83
Metaphylaxis Of Stone Disease In Smartphone Or Russian mHEALTH
Gadzhiev N.K., Brovkin S.S., Grigoryev V.E., Dmitriev V.V., Malkhasyan V.A., Shkarupa D.D., Pisarev A.V., Mazurenko D.A., Obidnyak V.M., Popov S.V., Tagirov N.S., Korol V.D., Petrov S.B.

Goal: to develop mobile application for patients with kidney stone for compliance maintenance and possible reduction of recurrence rate. Material and methods. Existing mobile applications for urolithiasis were meticulously reviewed by three groups of doctors each from different urological facilities from Saint Petersburg, Russia. Information used in our mobile application was from main urolithiasis guidelines of different urological associations. Direct application development was done by professional programmers. After application release urologist from all over the Russia were questioned about the usefulness of this product. Results. As a result of combined work application “Urolithiasis: patient assistant” was produced. Among 102 respondents 96 % evaluated this application as very useful, 3 % as useful and only 1 % considered it as a weak tool. Conclusion. Application “Urolithiasis: patient assistant” being first and single in Russian language consists of tools for compliance maintenance and plenty of other useful information regarding recurrence risk reduction and thus may be used in patients with kidney stones.

Pediatrician (St. Petersburg). 2016;7(3):84-91
Contemporary aspects of pathogenetically substantiated therapy of adenomyosis
Arutyunyan A.F., Gaydukov S.N., Kustarov V.N.
The purpose of our study was to assess the effectiveness of the use of drugs containing indole-3-carbinol and epigallocatechin-3 gallate in combination with effective natural methods (TES-therapy and hirudotherapy) depending on the degree of morphological adenomyosis. The study involved 205 women with diffuse adenomyosis. Based on survey data from 205 women surveyed in 67 verified adenomyosis first degree (Group 1), 79 - second degree adenomyosis (group 2), and 59 - third degree adenomyosis (group 3). Doppler results showed that in patients with adenomyosis first degree nizkorezistentny uterine blood flow was observed. Improvement of clinical symptoms of the disease, increasing the numerical values of R & D in the uterine arteries at the first degree adenomyosis indicates pathogenic effects of the proposed treatment. At the same time in patients with adenomyosis II-III degree was observed with highly bloodstream, indicating the deterioration of blood flow in the uterine vascular basin, as evidenced by some of hemostasis. Thus, studies have provided credible evidence pathogenesis mediated relations between the characteristics of the circulation of the uterus, the processes of neoangiogenesis, proliferation in the myometrium and the extent of spread of the disease, which will choose the appropriate methods of conservative treatment. Using drugs and Indinol epigallat affecting the basic pathogenetic mechanisms of adenomyosis, opens a new direction in the treatment of this disease, and effective natural methods - new opportunities in the treatment of adenomyosis.
Pediatrician (St. Petersburg). 2016;7(3):92-97
Microchimerism in children with perinatal pathology
Treskina N.A., Polyakova A.P., Volkova O.Y., Vasiliev V.E., Petrenko Y.V., Ivanov D.O.
The article presents the opportunity to identify the phenomenon of microchimerism in the genes of HLA loci A, B, C, DRB1, DQB1 by PCR-SSP. The sample group consists of the mothers and newborns with intrauterine growth retardation (IUGR) (20 pairs), hemolytic disease of the newborn (HDN) (21 pairs), after external rotation of the fetus (11 pairs), from women with malignancy (1 pair), autoimmune thrombocytopenia (1 pair), tuberous sclerosis (1 pair), bradyarrhythmias (1 pair). The control group consists of 13 pairs. Of the 138 studied blood samples microchimerism was detected in 33.9 % of patients and in 19.2 % of control group. Maternal microchimerism was found only in patients with perinatal pathology and was not met in the control group. Fetal microchimerism was distributed in all studied groups, but among patients with perinatal pathology, it was met three times more frequent than in the control group (23.9 % and 7.7 %, respectively). Significantly more frequent microchimerism was found in the group of patients with HDN than in the control (p = 0.04). In the other groups the occurrence of the chimeric gene from the control group was not statistically significant
Pediatrician (St. Petersburg). 2016;7(3):98-103
Hormonal regulation of postnatal growth from birth to age six months in Small-for-Gestational - Age children
Islamova K.F., Ivanov D.O., Petrenko Y.V., Kurzina E.A.
This article is devoted to the investigation hormonal mechanisms of postnatal growth from birth to age six months in small for gestational age children (SGA) with asymmetrical and asymmetrical IUGR. The IGF-1 and GH levels, insulin sensitivity (by homeostasis model assessment (HOMA-IR)) were measured blood at 3 and 6 months of age. The prospective study includes 40 SGA infants (group 1) - 24 - with asymmetrical (1a) and 16 with symmetrical IUGR babies (1b) and 17 appropriate for gestational age (AGA) infants (group 2). Most SGA infants showed rapid, or “catch-up” postnatal growth. Symmetrical IUGR infants with “catch-up” growth had higher IGF-1 and growth GH levels at 3 month of age than asymmetrical IUGR with “catch-up” growth (p < 0,05). From 3 to 6 months of age 77 % of infants with “catch-up” growth showed retardation of growth velocity. At 6 month of age SGA infants with “catch-up” growth had lower IGF-1, GH blood levels and HOMA-IR than at 3 months of age (p < 0,05). Infants without “catch-up” growth had similar hormone levels at 3 and 6 months of age. We suppose, that these changes of “GH - IGF-1” axis and insulin sensitivity at age 3 and 6 months in SGA infants are the mechanisms, which promote the postnatal growth. It can be assumed that the same mechanisms may underlie metabolic disorders in later life.
Pediatrician (St. Petersburg). 2016;7(3):104-110
Pancreatic type dysfunction of oddi sphincter in children
Privorotsky V.F., Luppova N.E.
Anatomical and functional characteristics of the pancreas and its close relationship to adjacent organs, primarily duodenum and biliary tract, cause its frequent involvement in pathological process. Difficulties in differentiation of functional and organic pathology of the pancreas are associated not only with the difficulties of diagnostic of functional diseases, but also with the problems of classification and definitions. As to realities of today optimal version is one proposed by the authors of ICD 10 and found further development in the materials of the Rome III consensus - namely the Oddi sphincter dysfunction in pancreatic type. Under this diagnosis there is the possibility for logical explanation of involvement of pancreas in pathological process. The article also describes the diagnostic criteria for the Oddi sphincter dysfunction in pancreatic type, which includes clinical, laboratory and instrumental signs. It is noted that the recommended set of instrumental examination in modern pediatric practice is not only unimplementable, but just is not necessary. The usefulness of the recommended methods (including procedures that are potentially dangerous in terms of developing pancreatitis) for functional disorders is discussing. In the article the issues of nutrition of children with diseases of the pancreas, as well as the program of medical correction of dysfunction of the sphincter of Oddi in pancreatic type, are described.
Pediatrician (St. Petersburg). 2016;7(3):111-116
Modern aspects of uterine bleeding treatment with placenta previa
Ryazanova O.V., Alexandrovich Y.S., Shifman E.M., Pshenisnov K.V., Reznik V.A., Kulikov A.V., Drobinskaya A.N.

Uterine bleeding caused by placenta previa is one of the main causes of massive blood loss and death in obstetric practice.

Objectives. To analyze the efficacy and safety of various therapeutic strategies to stop uterine bleeding in women in labor and puerperants on the basis of research results.

Materials and Methods. Available researches on the diagnosis and treatment of uterine bleeding with placenta previa between 2000 and 2015 were included in the study. The search was carried out in medical databases PubMed and Cochrane Library with free access to the publication.

Results. 61 publications were included in the analysis. The basic principles of diagnosis and intensive therapy of uterine bleeding with placenta previa are presented from the position of obstetrician and anaesthesiologist-resuscitator. Particular attention is paid to the analysis of studies evaluating the efficacy and safety of infusion-transfusion therapy in this category of patients. Main indications and contraindications to blood clotting factors and antifibrinolytic agents are shown.

Conclusion. The combined use of all available modern methods of stopping uterine bleeding can significantly reduce blood loss and help to improve disease outcomes. The most promising therapy is a targeted assignment of clotting factors concentrates under the control of thromboelastography which indicates the need for further research.
Pediatrician (St. Petersburg). 2016;7(3):117-127
Follow-up Study A Children Who Are Disordered Pneumonia
Oleinik N.A., Romanyuk F.P.
Pneumonia is one of significant problems among infections of low airways in children. Morbidity of common-acquired pneumonia (CAP) continues to go in last year’s. Data available in the literature show, that pneumonia with empyema possibly associated with high risk of chronic obstructive pulmonary diseases, asthma and recurrent case of pneumonia in last life. Fatal pneumonia or developing chronic obstruction lung diseases occur mainly in children after severe and complicated forms of pneumonia, this information is presented in native and foreign literature. Currently pneumonia with the heavy and complicated current is a major cause of infant mortality or promotes development of a chronic obstruction lung diseases. Mortality from pneumonia is 3-19% according to different authors. The risk of respiratory diseases in the 3-6 months after pneumonia increased in children who underwent pneumonia. After complicated CAP the complete resolution of the inflammatory happens on 6-9 month. After not complicated САР forms at 10-30% of children radiological changes within 2-6 weeks were noted. In one research it is reported that the full recovery from slow resolving pneumonia at 96% of children has come on 6-8 month of the dispensary period. Some authors in the scientific works use immunomodulators and vaccinations to reduce the residual variation in the lungs and improve recovery time dramatically of pneumonia. In follow up study the important task is a identifying and elimination of risk factors for improvement of treatment and dispensary period for slow resolving pneumonia, recurrent case of pneumonia, sever pneumonia.
Pediatrician (St. Petersburg). 2016;7(3):128-135
Psychological Rehabilitation of Patients with Physical Trauma Consequences by means of Micro-Motion Reactions Restoration Method
Petrova E.Y., Pakhomova M.A.
Physical trauma and treatment of its consequences lies in the domain of medical specialists: traumatologists, rehabilitologists. However rehabilitation of patients with physical trauma consequences may be also successfully treated by psychologists using “unfinished tasks” expressive approach. This method utilizes micro-motion reactions differentiation principle. Micro-motion reactions restoration method (MRR) is suggested and described. It is primarily oriented at clinical psychologists and rehabilitologists. The unique nature and originality of MRR method lies in ability to trigger development of various multidirectional and contradictory impulses and reactions that had been temporarily stalled in the episode of past physical trauma. This method does not aim at relaxation of tension by means of anesthesia or other forms of isolation of strain. The treatment permits each unfinished motion impulse born during trauma to fully bloom and develop completely. As a result self-reliance and trust in spontaneity of movement is restored. MRR method is best suited for acute trauma consequences. Besides psychologists MRR method may be used by traumatologists, rehabilitologists, and also relatives of patients and parents of children patients. MRR method in the hands of relatives and parents is especially useful for rehabilitation after trauma and surgery not only for the patients but also for the relatives and parents themselves for it helps them to cope with stress of their usual helplessness during long restoration period. Bearing in mind the prospects of development of special rehabilitation units in traumatological and orthopedic departments it is obviously highly advisable to enroll psychologists mastering MRR method in these teams for it may greatly improve the potential of proper successful rehabilitation of patients with trauma consequences.
Pediatrician (St. Petersburg). 2016;7(3):136-146
Case of heart disease in mixed streptococcal and Epstein - Barr virus infection
Levina A.S., Babachenko I.V., Chuprova S.N., Kochevaya N.V., Sharipova E.V., Ibragimova O.M.
Cardiac involvement in acute and chronic infectious diseases - an actual pediatric problem. Diagnosis of myocarditis in children for general practitioners is difficult due to the lack of pathognomonic, specific only to this disease complaints, clinical and laboratory features. Symptoms of infection and myocarditis (fever, severe weakness, fatigue, shortness of breath, palpitations, headache, systolic murmur at the apex of the heart) are often the same. Many cases of myocarditis in viral and bacterial diseases remain undiagnosed, resulting in the outcome of a chronic cardiac disease. In order to increase alertness of doctors in relation to cardiac pathology at infectious diseases we have described a clinical example of heart disease when mixed streptococcal and Epstein - Barr virus infection in a 11-year-old girl. The peculiarity of this case is that the main symptom, indicating inflammation of the myocardium, was the ECG negative dynamics - the emergence of AV block of 1 degree in sinus tachycardia, whereas the level of cardiac enzymes (CK-MB, LDH) remained normal. Communication with the previous infection, the presence of one large (the appearance of pathological changes on ECG as AV block 1st degree) and two small (laboratory confirmation of infection - Epstein - Barr virus and streptococcus, tachycardia) diagnostic criteria of myocarditis, lack of valve heart disease and other major diagnostic criteria of acute rheumatic fever has allowed diagnosis of acute infection (viral and bacterial) myocarditis, focal (with a primary lesion of the conduction system of the heart). Thus, the only comprehensive assessment of complaints, clinical, laboratory and instrumental data allows to establish the diagnosis of carditis in infectious disease.
Pediatrician (St. Petersburg). 2016;7(3):147-152
Allergy to cow’s milk protein
Platonova N.B.
The prevalence of allergic diseases is increasing year by year. Atopic dermatitis (AD) - the earliest clinical manifestation of atopy. By definition, atopic dermatitis is the allergic skin disease that occurs usually in early childhood in individuals with hereditary predisposition to atopic diseases having a chronic relapsing course, age characteristics of the location and morphology of the foci of inflammation, characterized by pruritus and caused hypersensitivity as to allergens, and to nonspecific irritants. Food and inhalant allergens play an important role in the formation of atopic dermatitis. The protein of cow’s milk is one of the first products to which developing sensitization. This is especially important for children in their first year of life. During this period neonatologists of the maternity hospital and precinct pediatricians are very important to assess the risk of a child’s food allergy and, if necessary, artificial feeding or supplementary feeding to recommend an artificial mixture, taking into account evaluation results. The proper purpose depends largely on whether the risk is realized or not, as well as the effectiveness of treatment in the presence of existing clinical manifestations, because a rational diet is the guiding principle of therapy of atopic dermatitis in infants. Unfortunately, precinct pediatricians do not always assess the situation correctly. The article gives a clinical case, an example of which analyzed the most typical errors made when bottle-fed infants with food allergy to cow’s milk protein.
Pediatrician (St. Petersburg). 2016;7(3):153-156
Neuroimaging of full term newborn´s brain with hypoxic-ischemic encephalopathy
Melashenko T.V., Pozdnyakov A.V., Alexandrov T.A.
Introduction. Hypoxic-ischemic encephalopathy (HIE) in full term newborn is the most frequent courses of neonatal mortality and development of neurology handicap. Magnetic resonance imaging (MRI) is common noninvasive method for detect of post hypoxic brain lesions in newborn. Method of research. We assessed MR-pattern of hypoxic brain injury using Philips Ingenia 1.5 Tl for examination newborn on 14-16 days after delivery. Protocol of MRI scans included axial and coronal plan T1, T2, Flair weighted imaging (WI) and diffusion tensor imaging (DTI) with program Fiber tracking and detected fractional anisotropy (FA). FA was measuring within cortico-spinal tract besides. 3D reconstruction allowed to visualized white matter along the axon direction of cortico-spinal tract. Studies. Four full term newborn (after 37 weeks gestation) have been examined and separated in two groups. First group included newborns with HIE (evidence of fetal distress, low Apgar Scores, low umbilical cord pH ˂ 7.1, necessity for resuscitation and neurological signs, second group consisted term newborn without any medical and problems of health. Results of research. We detected MR-patterns of basal ganglia and thalamus lesions in newborn with HIE (abnormal high signal intensity on T1 and Flair WI). We didn’t detect any abnormal MR scans in healthy newborns (control group). FA within cortico-spinal tracts besides (total and ROI-1) were lower in newborns with HI then in healthy ones. Conclusion. This investigation showed common MR patterns of brain lesions in full term newborns with HIE which included changes of signal intensity T1 and Flair from basal ganglia and thalamus as well as reduction of FA within cortico-spinal tract.
Pediatrician (St. Petersburg). 2016;7(3):157-161

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