Vol 8, No 4 (2017)

Articles
Inherited disorders (dysplasia) of the connective tissue. Which of the two existing national recommendations is preferable?
Zemtsovsky E.V., Timofeev E.V., Malev E.G.
Abstract

The article describes the current algorithms of diagnostics of inherited (dysplasia) of connective tissue (DCD) that are currently in force in the territory of the Russian Federation, compared in terms of identification of morpho-functional cha racteristics of heart. Describes the shortcomings of these algorithms do not take into account the gender features of the prevalence of signs. According to the algorithm, developed by experts of Russian Society of Cardiology (RSC), highlight dysplastic phenotypes, most of which is now a marfanoid habitus (MH). Revision of the diagnostic algorithm, which takes into account the specificity of individual MH bone signs and their gender dimensions. It is proved that for young people with MH is characterized by increased frequency of cardiac anomalias (atrial Septal aneurysm, the functional asymmetry of the aortic valve), identified structural features heart-relative myocardial hypertrophy of the left ventricle, increasing the diameter of the aorta. The features of heart rate in patients with MH – relative tachycardia during daylight hours, reducing the symptoms of sinus arrhythmia, decreased heart rate variability power spectral. It is shown that for boys with MH is characterized by lengthening the electrical systole (QT interval), 21.4% of cases greater than 480 Ms. At the same time, the DCD diagnostic algorithm that is described in the recommendations of the Russian Scientific Society of therapists (RSSIM leads to over diagnosis this condition in young age does not allow to identify the structural and functional features of the heart and could not be recommended for practical use.

Pediatrician (St. Petersburg). 2017;8(4):6-18
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Detection, diagnosis and clinical tuberculosis in children with hiv infection
Vasilieva E.B., Lozovskaya M.E., Klochkova L.V., Yarovaya I.A., Noskova O.M.
Abstract

The problem of combination of tuberculosis (TB) and HIV remains relevant. Majority of HIV patients are young adults, 90% of which are women of childbearing age, thereby increasing the perinatal HIV transmission rate. In 2014 in Saint Petersburg, >5,000 children with perinatal contact HIV were reported and >300 children were confirmed with HIV infection. We present a comparative analysis of the case histories of 20 children with TB-HIV and 30 with tuberculosis without HIV infection. The analysis identified several cases of delayed diagnosis. In >50% of the cases, the diagnosis of HIV infection was confirmed after 1 year. Four children with HIV infection were diagnosed at school age and connected to suspected cases of tuberculosis. The clinical detection of TB occurs more commonly in children with HIV infection than in those without HIV infection (25% and 5%, respectively). In both groups, tuberculosis of the intrathoracic lymph nodes was predominantly observed; however, generalized forms of TB were also diagnosed in the group with co-infection (25% of the cases). HIV patients often have decreased body mass, low-grade fever, lymphadenopathy, and anemia. Hepatosplenomegaly was equally observed in both groups. More than one third (35%) of patients with co-infection had negative sensitivity to tuberculin, and Diaskintest was positive in 50% of the cases. The prevalence and severity of TB in children with HIV infection correlates with the severity of immunosuppression.

Pediatrician (St. Petersburg). 2017;8(4):19-25
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Incidence of primary school age children with post-trumatic stress disorder
Ershova I.B., Glushko Y.V.
Abstract

Presents the results of evaluations of morbidity 123 primary school children suffering from post-traumatic stress disorder (PTSD), caused by the military actions in the Donbass region. By us the data analysis was conducted patient cards (f. 112/u) and medical statements (f. 027/u) children study groups, over the period of appealability throughout the year. Revealed an increase the incidence of somatic pathologies in children survived the military events that were recorded in 2.5 times more likely than in the comparison group (children who have not experienced combat operations). The first place in the structure meets pathology occupied somatoform dysfunction of the autonomic nervous system, recorded in 100% of children, who experience the stress of combat operations. Second place among children 7-9 years with PTSD, occupied acute respiratory diseases, with a prevalence frequencies of of developing complications after them 2.1 times, which was interpreted as lowering infectious resistance of the organism under the influence of strong stress factor. By the multiplicity of handling of children to the doctor by us highlighted a group of frequently ill children. Is noted that the the number of younger schoolboys for a long time and frequently ill in the main group predominated вy 2.3 times. Among children 7-9 years with PTSD was not a single child who during the school year never would not been sick. Additional psychoemotional load on the body caused by adaptation to school loadings can exacerbate the health conditions and increase the incidence rates of primary school children.

Pediatrician (St. Petersburg). 2017;8(4):26-31
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Qualitative analysis of the nephrotoxicity of gold nanoparticles in case of enteral administration
Lipatova V.A., Botchey V.M., Knyazeva L.A.
Abstract

The experiments on animals show the different effects of gold nanoparticles. Gold particles of various sizes may have a variety of toxic effects on the tissues, and more damage is often produced by small nanoparticles. In this work histological and ultrastructural changes of renal parenchyma caused by enteric administration of gold nanoparticles of small sizes (2 nm) were studied used different concentrations of colloidal solutions of gold nanoparticles: 10 µg/ml; 50 μg/ml; 100 µg/ml in drinking water within 7, 14 and 28 days. There were 9 groups of animals (non-linear mice weighing 20-25 g) on different dates of the experiment, as well as 3 control groups of mice, respectively, each term of experiment. Histological and ultrastructural changes were detected in the material of all groups of experimental animals compared with control. In general all small focal alterations relate to a small number of vessels, individual profiles of tubules and single cells. Light microscopy analysis of the overall picture of integrity of renal parenchyma showed that the most pronounced changes are observed in the cortex of the organ. Medulla is less affected. It identifies, first of all, microvascular disorders, then the renal tubular epithelium changes and finally, a minor involvement of interstitial elements in the response. Tubules of nephrons compared with the renal corpuscles undergo more changes at all dose levels of exposure and in all periods under study. Signs of dystrophy and necrobiosis often relate to the cell cytoplasm and less of their nuclei. Evidence of microvessel disorders detected in the renal cortex is not dependent on the dose of administered nanoparticles already in the early stages of the experiment. Histological findings as a whole are confirmed by the presence of ultrastructure alterations, that points to the primacy of cell damage.

Pediatrician (St. Petersburg). 2017;8(4):32-38
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The role of hypocalcemia and vitamin D3 in pathogenesis of phobias in chronic autoimmune Hashimoto’s thyroiditis
Stroev Y.I., Sobolevskaya P.A., Churilov L.P., Utehin V.J.
Abstract

Today, autoimmune Hashimoto´s thyroiditis is the most common cause of hypothyroidism. Thyroid hormones are involved in almost all metabolic processes, their deficiency leads to disruption of metabolic processes in all organs and systems, which is the reason for the rich clinical picture and variety of symptoms of hypothyroidism. The deficiency of thyroid hormones also has a significant negative impact on a person's mental health, identifying a diverse clinical picture – from mild disorders to serious mental disorders. For hypothyroidism, such psycho-neurological changes as drowsiness, weakness, loss of interest in the surroundings, loss of memory and intelligence are also characteristic. Delirious and delirious-hallucinatory conditions are described, as well as anxious and depressive conditions. Hypothyroid psychoneurological disorders have recently become more common, and therefore their diagnosis and correction are becoming more urgent. Persons with hypothyroi dism often mistakenly go not to the endocrinologist, but to a psychiatrist and receive therapy, but psychotropic drugs and antidepressants in hypothyroidism don´t give the proper effect and even are contraindicated. Hypocalcemia is very often observed with Hashimoto´s thyroiditis, it can be explained by autoimmune parathyroiditis with a hypoparathyroid clinic, that is, with autoimmune thyroiditis, the function of parathyroid glands may be disrupted. The article presents the results of our own research. A group of patients with autoimmune thyroiditis and hypothyroidism was examined. Complaints, anamnesis and clinic of the disease, levels of TSH, thyroid hormones, total and ionized calcium, inorganic phosphorus, vitamin D3 were studied.

Pediatrician (St. Petersburg). 2017;8(4):39-42
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Features of total hip arthroplasty in the treatment of secondary coxarthrosis of different genesis in older children
Khrypov S.V., Krasavina D.A., Veselov A.G., Komolkin I.A., Aphanasiev A.P.
Abstract

Total hip arthoplasty (THA) in school children with secondary hip arthritis is the least studied treatment in orthopedic surgery. The need for THA arises much less often in children than in adults, but is a pressing problem. Indications for joint replacement at the age of 12–17 years include secondary hip arthritis of various etiologies such as dysplastic (congenital and paralytic), posttraumatic, infectious allergic (juvenile rheumatoid arthritis and Bechterew’s disease), postinfectious (osteomyelitis and tuberculosis of the joints hip joint) associated with severe pain, joint contractures, and decreases in motor activity. The aim of this study was to evaluate the effectiveness of THA in adolescents with stage 3 hip arthritis. A two-stage method of surgical treatment in cases of limb shortening of >4 cm is proposed. We present the results of the treatment in 45 patients. The proposed surgical technique achieved satisfactory results in 68% of the cases. The method allowed the restoration of hip joint function and limb length in all patients. Based on these results, we recommend the use of this method in the treatment of severe forms of secondary coxarthrosis as a result of dysplastic, paralytic, postinfection, systemic autoimmune, and posttraumatic processes.

Pediatrician (St. Petersburg). 2017;8(4):43-47
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Potentially Pathological Alpha-Pattern as a Variant of Vigilance EEG in Drug-Resistant Epilepsy
Chukhlovin A.A., Aleksandrov M.V., Lytaev S.A., Kasumov V.R., Pavlovskaya M.E., Arkhipova N.B.
Abstract

As a result of pathomorphosis affecting the mechanisms of electrical activity generation interictal EEG may show reduced epileptiform changes whereas clinically apparent epileptic seizures may be present. In these cases patterns of dominant alpha activity are sometimes recorded on the scalp. In this study variations of alpha activity in patients with refractory epilepsy are classified. A group of 50 refractory epilepsy patients aged between 20 and 55 years who were submitted to Polenov Russian Scientific Research Institute of Neurosurgery in 2014-2017 was included in this study. They underwent scalp EEG as a part of their presurgical assessment. In 12 cases patterns of potentially pathological alpha activity were observed. Three variations of alpha-patterns were described: 1) alpha-rhythm with decreased regional diversity and a marked synchronization in temporal areas; 2) alpha-rhythm with reduced epileptiform complexes integrated into the spindles, 3) decelerated non-rhythmic alpha activity distorted by the higher frequency components. Distinguished varieties of potentially pathological alpha-activity according to their order here represent gradual functional decline of normal thalamo-cortical interaction. Considering clinical manifestation of drug-resistant epilepsy with frequent seizures in these patients, reported varieties of alpha activity can not be interpreted as Landolt’s syndrome (forced normalization of EEG). Invasive electrocorticographic monitoring demonstrated that bursts of sharpened polyphasic waves coinciding with alpha-rhythm on scalp EEG are consistent with epileptic discharges on the brain cortex surface. This allows to think of these components as correlates of epileptic activity. Therefore, on a number of occasions in patients with epilepsy a dissonance between clinical signs and electroencephalographic patterns recorded during restful wakefulness may be observed, when epileptiform components are absent or reduced to nonspecific complexes.

Pediatrician (St. Petersburg). 2017;8(4):48-56
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Features of delivery in patients with perinatal fetal death
Ivanova L.A., Titkova E.V.
Abstract

The article presents the features of the course of the birth act in patients with perinatal fetal death, in comparison with the control group of women who gave birth to children who survived 7 days of life. The comparison of the anthropometric data on the parturient (weight at the time of delivery, the results of pelviometry), the incidence of various anomalies of the bone pelvis in women, the sex of the newborn, the timing of delivery, the presentation of the fetus, the duration of the anhydrous interval, the first, second and third periods of labor, Epidural anesthesia, perineotomy and episiotomy, the imposition of obstetric forceps, the imposition of a vacuum extractor, the provision of a medical sleep, labors induction, labors stimulation, amniotomy, manual examination of the uterus cavity, blood transfusion) and surgical delivery by cesarean section. A number of significant differences in the main group and the comparison group that can be regarded as predictors of perinatal fetal death are revealed. For example, women with various abnormalities of the pelvis, in particular the uniformly deformed and transversely pelvic pelvis, children born from premature pregnancy, in the pelvic presentation, with a reduction in the duration of the first period of labor, an increase in the duration of the second and third periods of labor, are at risk for perinatal fetal death, Performance of amniotomy, manual examination of the uterine cavity, blood transfusion at the puerpera. At the same time, the frequency of most obstetric manipulations in both groups does not differ significantly.

Pediatrician (St. Petersburg). 2017;8(4):57-63
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Clinical assessment of detection of ventricular extrasystoly in patients without structural changes of heart: a prospective study
Koziy A.V., Olesin A.I., Litvinenko V.A., Konstantinova I.V.
Abstract

Aim. The aim of the study was a clinical assessment of the integrated determination of predictors of life-threatening ventricular arrhythmias (LVA) in patients with ventricular extrasystole (VE) without structural changes in the heart to predict the development of cardiovascular disease in a prospective study.

Material and methods. From 1997 to 2014 199 patients with neurocirculatory dystonia (NCD), complicated with VE II-V class EE at the age of 18-35 years (mean 27.3-2.6 years) were observed in District Military Clinical Hospital of the Ministry of Defense of the Russian Federation, City Hospital named after St. Martyr Elizabeth. All patients, in addition to a general clinical examination, determined late potentials of the ventricles (LPV), QT interval variability (QTd), heart rate turbulence (HRT), and also indicators reflecting the possible mechanism of VE development.

Results. The results of the study showed that in patients with NCD complicated by VE, the detection of indicators reflecting the presence of VE caused by the mechanisms of early post-depolarization and re-entry is a predictor of the development of coronary heart disease (CHD) and hypertension (HB). The positive prognostic significance of the indicators showing the presence of VE with these development mechanisms for the development of CHD and HB averaged 74% and 44% respectively, and with the appointment of сlass III drugs for elimination of VE and (or) development of unstable ventricular tachycardia, the risk of developing CHD increased to an average of 93%. Identification of NDC patients with indicators reflecting the presence of VE due to delayed post-depolarization is a predictor of the development of gastrointestinal tract (GT) diseases with positive prognostic significance, averaging 61%. Positive prognostic significance with respect to the development of CHD, HB, GT diseases for the detected LPV, QTd > 80 ms, pathological values of HRT VE did not exceed 30%. Indicators and predictors, which characterize the mechanism of development of VE and the risk of LVA occurrence in patients with NCD complicated by VE, were highly correlated (r > 0.50) with risk factors for cardiovascular and gastrointestinal system diseases.

Pediatrician (St. Petersburg). 2017;8(4):64-72
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Modern forms of dental preventive care for children
Kim A.V., Rubezhov A.L., Koloskova T.M., Bezhenar S.I.
Abstract

Diseases of teeth and oral cavity have a high prevalence in pediatric population. In adolescents of 15-17 years, the incidence of caries in permanent teeth is higher than in children of 0-14 years. Epidemiological studies of dental health of children in various regions of the Russian Federation in 2010-2015 years showed no tendency to decrease the level of diseases of mouth and teeth. Prevalence and intensity of diseases remains at a high level. More than 80% of the surveyed children are in need of complex dental treatment. The current situation of pathology of teeth and mouth in children is due to several reasons such as low level of hygiene education, environmental degradation, poor nutrition, presence of chronic diseases, among older children, the presence of harmful habits, health-care organizations lack of effective preventive work. In turn, untreated inflammatory diseases of the oral cavity and teeth, being the source of the infection, may lead to somatic pathology of different organs and systems. The existing organization of children dental care is focused more on treatment than on prevention of diseases of teeth and oral cavity. As a rule, parents bring children to dental clinic for treatment of already developed disease. Referrals to the dentist for preventive measures are rare. In this regard, it is necessary to develop new organizational forms of dental care, from the point of view of the preventive orientation, close to children's educational organization.

Pediatrician (St. Petersburg). 2017;8(4):73-77
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Biochemical profile of rats with non-alcoholic fatty liver disease of various gravity and its correction with Remaxol
Trashkov A.P., Brus T.V., Vasiliev A.G., Artyomenko M.R., Pechatnikova V.A., Gumennaya M.A.
Abstract

Despite the long period of studying non-alcoholic fatty liver disease, its timely diagnosis, prevention and treatment remains one of the most pressing problems of medicine. However, the arsenal of effective and safe medicines used for this task is limited. The goal of this study was to elaborate a model of non-alcoholic fatty liver disease of varying severity in laboratory rats, and to analyze the influence of hepatoprotector medicine Remaxol upon the dynamics of biochemical parameters in experimental groups. The model of non-alcoholic fatty liver disease in laboratory rats permits to reproduce disease of va rying severity: semi–light severity of the disease (non-alcoholic hepatic steatosis) and average degree of severity (nonalcoholic steatohepatitis). The introduction of the test drug was carried out daily during 10 days of experiment starting from day 28th. Used model in experimental animals was characterized by the development of bilirubinemia, cholesterolemia (mainly due to triacylglycerides), activation of peroxidation, cytolytic and cholestatic syndromes. The severity of metabolic disturbances in the rats depended on the severity of the simulated disease. The analysis of the functional activity of the liver changes on the background of the application of Remaxol was performed for 11 parameters, yielding a complete picture of their condition. Distinct therapeutic effect of infusion of Remaxol on the model of liver steatosis (mild fatty liver) and in models of moderate severity (steatohepatitis), aimed at correcting observed violations was demonstrated in the study.

Pediatrician (St. Petersburg). 2017;8(4):78-85
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Сerebral oxymetry in neonatology
Evsyukova I.I.
Abstract

The frequency of disturbance the functional development of newborn brain after intrauterine and birth asphyxia determines the necessity the finding objective methods of timely diagnosis the alteration of brain oxygenation for the target therapy. During last years the special attention of investigators was attracted to use for this purpose in newborns the noninvasive, informative and portable method near-infrared spectroscopy (NIRS). Cerebral oxymetry successfully used for estimation brain circulation of the blood and blood volume in the brain vessels with combination constant monitoring blood pressure. This review outlines the basic principles, advantages NIRS technology in clinical studies brain oxygenation in healthy full term and premature newborns and also after asphyxia, vacuum extraction and cesarean section. Monitoring brain oxygenation in newborns which received cooling after heavy asphyxia permits during first 10 hours after birth to prognosis unfavorable outcome or fix the further strategy of treatment cerebral ischemia. Presented clinical use this method for treatment premature newborns with respiratory distress and circulatory insufficiency. It may help to determine the optimal target oxygen saturation. It is alsow useful monitoring during intensive therapy of extremely preterm neonates, due to the risk of impaired cerebral blood flow auto regulation in these patients. Indicated the perspectives of cerebral oxymetry in neonato logy for new diagnostic, treatment and prophylactic perinatal CNS damage.

Pediatrician (St. Petersburg). 2017;8(4):86-91
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The modern methods of X-Ray based diagnostic in cases of ectopia cordis associated with pentalogy of Cantrell
Kosovtsova E.V., Pozdnyakov A.V., Pilyugov N.G., Naumov A.B., Marchenko S.P.
Abstract

Pentalogy of Cantrell with ectopia cordis is an extremely rare and lethal congenital anomaly included congenital hearth disease (CHD), midline supraumbilical abdominal wall defect, defect of lower sternum part, deficiency of the anterior diaphragm, a defect in the diaphragmatic pericardium. The complexity of this syndrome is usually incompatible with life. Depending on the location of the protruding heart and on the extent of the body wall defect, ectopia cordis may be grouped into cervical, thoracic, thoracoabdominal, or abdominal types. The heart mostly uncovered, covered with a serous membrane less often, and covered with skin rare. Depending on combination defects pentalogy of Cantrell classified for 3 different classes by Toyama (classified in 1972): 1 class – complete syndrome (all five defects), 2 class – probable syndrome (included intracardial defect and ventral abdominal wall defect) 3 class – incomplete syndrome (with various combinations of defects present, including a sternal abnormality). Presented clinical case newborn pentalogy of Cantrell first Toyama class. We used X-Ray for firstly diagnostic, for visualization CHD was performed CT. For postnatal diagnostic CHD are used Echo and CT. CT allows graphically to see the type of CHD and predict a surgical treatment. The strategy of surgical treatment and further prognose are depend on combination of anomalies within the framework of pentalogy of Cantrell. By CT we determined atresia of the pulmonary artery with major aorto-pulmonary collateral arteries (MAPCA), ventricular and atrial septal defects.

Pediatrician (St. Petersburg). 2017;8(4):92-98
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Experience teaching cycle "Examination of temporary disability" in Saint Petersburg state pediatric medical university
Orel V.I., Gureva N.A., Menshakova I.V., Sharafutdinova L.L.
Abstract

The main purpose of the temporary disability expertise is to evaluate the patient's health status, the quality and effectiveness of the treatment, the ability to carry out professional activities, as well as determining the extent and timing of temporary disability. One of the main tasks of examination of temporary disability, along with the adoption of science-based decisions about the patient's working capacity and determination of temporary disability is the identification of the employee long-term or permanent disability to the established procedure for survey on mediko-social examination. Regulatory documents there are levels of examination of temporary disability in a medical organization: the attending physician and the medical Commission of the medical organization. The right medical organization for conducting work and services in examination of temporary disability is determined by the presence of the license for medical activity and the examination of temporary disability. The participants in the expert process should have a document enhance the skills of professionals involved in the declared works (services). This article presents the experience of the Department of social pediatrics and public health, faculty of postgraduate and additional professional education SPbSPMU for training physicians, Deputy chief physicians in the examination of temporary disability, chairmen and members of medical commissions, the organization and carrying out examination of temporary incapacity.

Pediatrician (St. Petersburg). 2017;8(4):99-104
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The Differentiated Directions of Psychological Correction in Families with Children with Asthma
Nikolskaya T.I., Galitsyna E.Y.
Abstract

The current article analyzes the parental defensive styles, codes and types of upbringing in families with children diagnosed with asthma in comparison with families of healthy children. The study involved 80 families. Of these, 41 families with children with asthma (41 mothers and 37 fathers) and 39 families with children without chronic diseases (39 mothers and 38 fathers). It was revealed that the fathers of children with asthma differ in educational insecurity, and mothers have persistent educational stereotypes that interfere with effective interaction with the child. In mothers of children with asthma, non-adaptive protective styles predominate, and fathers distort, whereas in the parents of healthy children adaptive protective styles are expressed. With the cluster analysis, three groups of families with children with asthma are distinguished, differing in the level of effectiveness of family functioning. The conjugation of violations of family functioning and the severity of the asthma in a child was determined. Based on the data obtained, differentiated directions of psycho-correction for families with children with asthma are described, depending on the severity of the child's disease and the level of effectiveness of family functioning. A trial program of psychological correction was conducted, according to the described directions. The analysis of the results of the second study showed the effectiveness of the proposed program of psychological correction for families with children suffering from bronchial asthma.

Pediatrician (St. Petersburg). 2017;8(4):105-110
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85 years of teaching latin in St Petersburg state pediatric medical university (the first 50 years in the history of the department of Latin)
Ivakhnova-Gordeeva A.M., Bakhvalova O.Y.
Abstract

The article outlines the early formative years in the history of the Department of Latin language in the Pediatric Medical Institute and traces the development in approaches to teaching Latin medical terminology, first introduced in 1932. After the abolition of gymnasium education the higher school had to deal with a lack of knowledge of classical languages. At the beginning, teaching Latin as the language of medicine was based on traditional methods of gymnasium education. Archival documents show the subject scope of the department which was in constant search for text material and special means of target training of medical students. Methodological problems of teaching and criteria for evaluation of knowledge were being gradually developed over the years in discussions with teachers at department meetings. The article offers details on the life and achievement of the first head of the department Konstantin P. Avdeev, together with an analysis of his scientific and practical activities. Avdeev’s wide interests and erudition come to the fore in his active work as a lecturer at a number of scientific organizations in Leningrad. Having amassed a unique library of over 7 thousand volumes, he was a famous bibliophile, an expert and a collector of bookplates (ex libris). The depth of his knowledge and a wide range of interests have shaped the values and promoted a creative approach to teaching medical Latin that still remains an important part of teaching the subject to first-year medical students. The article also provides brief information on Nora N. Zabinkova, his successor, whose activity has coincided with qualitative changes in the methods of teaching Latin. These changes were inspired by professor Maxim N. Chernyavsky, the head of the Department of Latin at the I.M. Sechenov First Moscow State Medical University. The Department of Latin in Leningrad Pediatrical Medical Institute was among the few in first introducing and then spreading the new methods of teaching Latin and medical terminology in all medical schools across the country.

Pediatrician (St. Petersburg). 2017;8(4):111-117
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History of the study of hemorrhagic disease of newborns
Ivanov D.O.
Abstract

The article describes the main historical periods of the study of hemorrhagic disease of newborns. Clinical observations, describing bleeding of newborns, which occurs without visible damage, known since the seventeenth century and are found in the works of Francois Mauriceau and Georg Wolfgang Wedel. The role of the liver injury in the development of bleeding of infants noticed English physicians John Huxham (1672-1768) and John Cheyne (1777-1836). In 1871 Ludwig Grandidier conducted differential diagnosis between umbilical bleeding of neonates and the hemophilia clinic. Later I.P. Pavlov showed, that the clotting time of dog’s blood significantly prolongs when you turn off the liver from the blood circulation. In that way, partly began to understand the etiology of hemorrhagic syndrome, but the pathogenesis of this suffering, in diseases of the liver remained unknown. Charles Wendell Townsend in 1894, describing 50 cases of coagulopathy of newborns, at the first time paid attention to the connection between breastfeeding and development of bleeding and offered to call this nosological form as "hemorrhagic disease of newborns". In the late 20s of the last century Henrik Dam have identified the unknown substances from green lucerne leaves and described them as the fat-soluble vitamin K (coagulation). In 1943 H. Dam and E. Doisy received the Nobel prize for the discovery and establishment of the chemical structure of vitamin K. In 1943, a group of Soviet biochemists have synthesized a water-soluble analogue of vitamin K (K3, vicasolum), quickly introduced into clinical practice and showed their high efficiency in patients with hypovitaminosis K. In 1945 Yu.F. Dombrovskaya suggested that haemorrhagic disease of newborns caused by deficit of vitamin K. Further researching of the development of haemorrhagic disease of newborns is associated with the study of the biochemistry of the pathogenesis of the disease, identify its various forms and development of treatment techniques and prevention, depending on the identified features.

Pediatrician (St. Petersburg). 2017;8(4):118-125
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