Vol 8, No 6 (2017)

Articles
Breathing disorders during sleep in premature infants with broncopulmonary dysplasia and pulmonary hypertension
Solomakha A.Y., Petrova N.A., Ivanov D.O., Sviryaev Y.V.
Abstract

Infants with severe and moderate bronchopulmonary dysplasia (BPD) are characterized by long-term persistence of apnea of prematurity, mainly central genesis, and more significant decrease of ЅрО2. The aim of our study was to assess the character and severity of breathing disorders during sleep in infants the first year of life, born prematurely and having BPD complicated by PH. Were examined 40 infants who were born at 23-31 weeks of gestation, weight at birth less than 1700 g. 31 infants had BPD (mild form was diagnosed in 9 infants, moderate form – in 12 infants and severe form – in 10 infants), 11 infants had BPD complicated by PH. Patients were divided into 3 groups. The first group was made up of the infants without BPD. The second group includes infants with BPD, and 3 group was made up of the infants with BPD complicated by PH. Cardiorespiratory monitoring was performed immediately before discharge from hospital (35-43 weeks post-menstrual age) (infants had not been routine monitored for at list 5 days and had not been received oxygen for at list 8 days). We used “The brief screening questionnaire for infants with sleep problems”, developed by A. Sadeh (author's permission to use the questionnaires was received), as the screening of disorders of sleep in infants. The result was obtained the comparative characteristics of cardiorespiratory indices in the groups of infants and evaluated the character and severity of breathing disorders during sleep, made testing applications screening questionnaire.

Pediatrician (St. Petersburg). 2017;8(6):5-10
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Renoprofilaxis in secondary chronic pyelonephritis in children
Ahmedjanova N.I., Dilmuradova K.R.
Abstract

Patients with secondary pyelonephritis have a high risk of developing chronic renal failure and a decline in the quality of life already in childhood. This pathology is prone to chronization, recurrence and progression with the formation of nephrosclerosis and the development of CRF, leading to disability of the body and requiring extraordinary interventions. Annually in the world among children it is fixed about 50 million cases of infection of urinary ways. In an open, prospective comparative study, the results of the analysis of the outcomes of the therapeutic and prophylactic efficacy of various therapies are presented in 85 children aged 4-15 years with chronic dysmetabolic pyelonephritis. Objective: to develop the principles of secondary prevention of chronic dysmetabolic pyelonephritis in children. Patients were divided into 2 groups depending on the method of treatment. 1 group consisted of 48 patients who used conventional methods of treatment. Group 2 consisted of 37 patients with children who received complex therapy: regional lymphotropic antibiotic therapy + electrophoresis with 0.5% euphillin. The results of our studies showed that after the conventional treatment there was no positive dynamics of the studied indicators of the functional state of the kidneys. A comparative assessment of the results of the study of the functional state of the kidneys and indices of endogenous intoxication showed a high efficiency of the combined use of regional lymphotropic antibiotic therapy + electrophoresis with euphyllin. Complex treatment, recommended by the authors, promotes renoprophylaxis: prevention of frequent recurrence of the disease and development of renal failure.

Pediatrician (St. Petersburg). 2017;8(6):11-16
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Possibilities of osteopathic correction of functional disorders in children
Kuzmina J.O., Potekhina J.P., Tregubova E.S., Mokhova E.S.
Abstract

Osteopathy is a branch of clinical medicine based on a holistic approach which uses manual methods on the stages of prevention, diagnosis, treatment and rehabilitation and is aimed at restoring the body's natural ability to self-correction. The article presents an overview of randomized controlled trials of the results of osteopathic treatment of children of different age groups presenting functional alterations. All the trials were held in the Russian Federation over the recent years. On the grounds of the presented data it is possible to draw a conclusion about the proven clinical effectiveness of osteopathic treatment in hypoxic-ischemic lesions of the central nervous system, in particular, in hypertension-hydrocephalic syndrome, in the mild form of bulbar dysarthria as a consequence of a birth injury of the craniovertebral junction, dysplasia and subluxation of the hip joint, low degree myopia with the accommodation spasm, neurogenic dysfunctions of the urinary bladder complicated by the chronic bullous cystitis and vesicoureteral reflux. The sooner osteopathic treatment starts, the better is the result. Osteopathic treatment is safe. It allows to reduce the medicinal load and the risk of polypragmasy in children. It goes well with other methods of treatment, which is especially important for children of the first year of life. Osteopathy can enrich the clinical medicine toolkit and occupy a rightful place in the system of healthcare delivery to children.

Pediatrician (St. Petersburg). 2017;8(6):17-23
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Main causes of parents dissatisfaction by the accessibility and quality of ambulatory-polyclinic care for children
Yuryev V.K., Sokolova V.V.
Abstract

One of the main tasks of the national healthcare is to increase the accessibility and quality of medical care to the population. One way of assessing the quality of care is to study patient satisfaction with medical care through sociological research. The degree of patient satisfaction reflects not only the social effectiveness of medical organizations, but also the work of all health systems. The bulk of medical care a child receives in the conditions of the polyclinic. Parents, being legal representatives of the child, can objectively assess the quality of medical care provided to them in the children's polyclinic, and, if necessary, protect his legitimate interests. With a view to identifying the main causes of the dissatisfaction of the child population of Saint Petersburg by the accessibility and quality of ambulatory-polyclinic care, the anonymous questionnaire of 1488 parents of children receiving the medical care in outpatient polyclinics was conducted. It found that in children's polyclinics parents often face difficulties when calling the doctor home, visiting a pediatrician and subspecialties doctor, passing medical examinations and procedures. Parents were not always satisfied with the preventive activities and sanitary and hygienic condition of the polyclinic. There are cases of inattentive and mistreatment by medical personnel. In General, over half (53.2%) parents have remained completely unsatisfied or not fully satisfied by the quality of provided ambulatory-polyclinic care.

Pediatrician (St. Petersburg). 2017;8(6):24-29
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Children of the Arctic: dynamics of medico-demographic indicators
Orel V.I., Okhlopkov M.E., Grigor'eva A.N., Burtseva T.E., Chasnyk V.G., Sereda V.M., Kim A.V., Gureva N.A., Sharafutdinova L.L., Roslova Z.A., Orel V.V., Buldakova T.I., Libova E.B., Rukavishnikov A.S., Nosireva O.M., Kakanov A.M.
Abstract

Maintaining and improving the health of the population, especially children and teenagers, is one of the most important state task, the solution of which allows to ensure the availability of human resources, the country's defense and reproduction of the healthy population. Currently in the Russian Federation, there are negative trends in the health status of children in all age categories: the growing incidence, prevalence of chronic diseases, the presence of morphological abnormalities, high prevalence of risk factors among children, a decrease of quality indicators of children's health. There is a significant change in the pattern of morbidity in childhood, reflected in the increase in the number of chronic and combined forms of disease, the increase in the frequency of intrapartum damage and hereditary pathology, which in turn leads to an increase in the number of children with disabilities. The issues of improving medical care in remote and inaccessible localities are actively discussed on all platforms and meetings of the circumpolar countries of the Union. It is clear that much of the health of the population in the Arctic is determined by the welfare of the country. However, some progress in this direction in recent years and our country. In this regard, it is highly important to assess the dynamics of medico-demographic indicators in the Arctic regions during the implementation of major Russian programs in the field of protection of motherhood and childhood in the Republic of Sakha (Yakutia).

Pediatrician (St. Petersburg). 2017;8(6):30-37
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Influence of the phenotype of the disease on the parameters of the antioxidant defense system and the level of some interleukins in the blood of patients with chronic obstructive pulmonary disease
Pavlyuchenko I.I., Kokov E.A., Kokova L.N., Okhremenko O.S.
Abstract

Chronic obstructive pulmonary disease (COPD) is a common disease involving the pathological process, of bronchopulmonary and cardiovascular systems. This is a complex disease in which inflammation plays a leading role in the formation of the whole complex of pathological changes. COPD accompanies local deficit of antiproteases, excessive formation of active forms of oxygen, inducing uncontrolled lipid peroxidation and oxidative stress. An increase in the level of proinflammatory cytokines, such as IL-6, IL-8, TNF-α, is particularly significant in the combination of chronic obstructive disease with metabolic syndrome. Determination of a specific phenotype of COPD, and the degree of disruption of protective and adaptive systems in these forms of the disease course allows optimizing the treatment regimens for patients. The purpose of this work was to identify additional biochemical and biophysical markers of phenotyping and monitoring of therapy in patients with COPD of different phenotype and severity level in the acute stage on the basis of studying the main indicators of the system of antioxidant protection of blood and some cytokines. Significant differences in antioxidant system (AOS) indices in patients with COPD of different phenotype and severity were determined. The established differences in the activity of erythrocyte enzymes and the overall antioxidant activity of blood plasma can serve as an important additional link for the phenotyping of COPD. Complex treatment with the use of anticoagulants, normalizing the rheological properties of blood and mucolytics with pronounced antioxidant properties, reduces the level of prooxidant load on the body due to correction of metabolic processes and has the most pronounced effect on AOS blood parameters and cytokine profile.

Pediatrician (St. Petersburg). 2017;8(6):38-41
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Bone mineral density and bone metabolic markers in laboratory in men with marfanoid habitus
Timofeev E.V., Belousova T.I., Vutrih E.V., Zemtsovsky E.V., Olkhovik A.Y.
Abstract

The aim of the research was the study of bone mineral density (BMD) and activity laboratory markers of bone metabolism in juniors with power shortages and marfanoid habitus (MH).

Materials and methods: Twenty 119 males are underweight aged 18 to 25 years old (average age of 20.4 ± 1.5 years). All surveyed was conducted anthropometric, phenotypical, Echocardiography study to identify the mitral valve prolapse (MVP), laboratory examination of the bone forming token (Osteocalcin, alkaline phosphatase), and the dissolution of bone tissue (β-CrossLaps), Dual-energy X-ray densitometry (L1-L4).

Results: Revealed a significant reduction in BMD females with MH as compared to control (Z-criterion –1.23 ± 0.73 and 0.34 ± 0.80, STD, respectively, p < 0.00001). BMD significant decrease (–1.5 STD) found a third of individuals with MH and not seen in the control group, p = 0.01. When assessing young BMD depending on the severity of MVP statistically reliable differences had been received. At the same time that boys with MVP in conjunction with signs MH is characterized by the lowest BMD values. In the analysis of laboratory parameters revealed a significant increase in Osteocalcin and alkaline phosphatase in the Group of persons with MH, indicating bone forming activity in these patients. At the same time, for people with MH is characterized by increasing the level of β-CrossLaps (marker of the dissolution of bone tissue). With the increased activity of the dissolution of bone tissue associated bone such signs as dolyhostenomelia, deformations of thorax and arachnodaktylia.

Conclusion: bone signs dysembriogenesis involved in the diagnostic algorithm MH, contributes to the abnormal formation of bone tissue in these patients. For them is characterized by activation synthesis and dissolution of bone tissue, reducing BMD.

Pediatrician (St. Petersburg). 2017;8(6):42-49
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Potential Use of Transspinal Direct Current Stimulation For Cerebral Circulation Correction
Sirbiladze G.K., Suslova G.A., Pinchuk D.J., Sirbiladze T.K.
Abstract

Research objective: to prove the potential use of Trans spinal direct current stimulation for treatment of brain systems functioning disturbance attached with regulation of vasal tonus. Identify the most effective localizations and exposure regimens, so that in the future they can be used purposefully, for the treatment of cerebral blood flow disorders.

Materials and methods. 38 children aged 4-12 years were examined who were treated with TSDCS and who had EEG at the beginning of the course of treatment – signs of hemolytic dysfunction with ICD-10 diagnoses as mental retardation (F70-F79), disorders of psychological development (F80-F89) or as behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98). The following examinations were performed: an electroencephalogram, a neurological examination. The trans spinal direct current stimulation was carried out by a constant current of 100-200 μA, during 30-40 min. At the same time, the cathode was located lateral from the spinous process of the seventh cervical vertebra C7, and the anode counterlaterally to the cathode in the lumbosacral region at the level of the spinous processes L5-S1. A total of 3 to 5 sessions of TSDCS were conducted. A repeat EEG examination with the determination of Hemolucleodynamics Coefficient (HC) was performed 7-10 days after the last TSMP session.

Result. After the course of TSDCS, all patients significantly decreased the HC score. In 27 patients (71%) patients, HC decreased to the norm value (≤1,2). In 23 patients (29%), HC values corresponded to the first degree of hemolytic dysfunction.

Pediatrician (St. Petersburg). 2017;8(6):50-55
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Starvation in childhood and obesity in senior age
Khoroshinina L.P., Shabrov A.V., Buynov L.G.
Abstract

The problem of children's starvation remains relevant and actual at the present time, as in the 21st century experts from the leading countries of the world coordinate their efforts to create programs aimed at eliminating extreme poverty and hunger of. At the same time, the analysis of obesity prevalence typical for the population of some countries of the world, indicates an increase in the number of obese people in both economically developed and developing countries. In this article we are talking about the common severe degree of abdominal obesity in people of older age groups, survivors in childhood, long periods of fasting. Studied 594 history and Protocol of autopsy of people in older age groups, born from 1927 to 1941 and the dead on the hospital for war veterans in St. Petersburg from 1989 to 2000. The whole array of documents was structured by sex, age, the fact of living in the blockaded Leningrad. Severe degree of obesity was considered to be exceeded more than 7 cm of thickness of deep abdominal subcutaneous layer of adipose tissue. It is well established that former young residents of the besieged Leningrad, regardless of gender, age, die sooner than men and women in the comparison groups; men who survived long periods of starvation in children, were dying earlier than men in the comparison group and earlier than women of the main group; women who have experienced a long period of starvation before the age of 11 years, often dying because of cardiovascular diseases than women in the corresponding subgroup comparisons; the emergence of pronounced obesity in older age-governmental groups from the former young residents of the blockaded Leningrad, determined by elk not only the fact of prolonged fasting, but child sex and age, which accounted for starvation.

Pediatrician (St. Petersburg). 2017;8(6):56-61
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Cerebral damage pathogeny peculiarities in local and globalcerebral perfusion impairment models in rats
Zelenenko M.A., Pechatnikova V.A., Zaplutanov V.A., Tsygan N.V., Verlov N.A., Khotin M.G., Vasiliev A.G., Trashkov A.P.
Abstract

A complex study of clinical and laboratory pathogenic features of cerebrovascular disease has been performed in rats using two experimental models: local ischemia with cerebral infarction and global ischemia caused by acute or chronic impairment of cerebral circulation without verified site of brain damage. A pronounced difference has been demonstrated between the two studied models of cerebral impairment. The development of brain damage site constituting 20-30% of the total cortex of the impaired hemisphere was demonstrated to be accompanied by a considerable increase of basic nervous tissue damage markers (neuron-specific enolase, S100β-protein), development of endothelial dysfunction and hemostasiological disturbances. Irreparable cerebral circulation impairment by ligation of carotid arteries was followed by considerably lower lethality in the experimental animals, neurospecific markers’ moderate dynamics but however side by side with pronounced and inadequately compensated manifestations in the hemostasis system and vascular endothelium caused by brain hypoxia.

Pediatrician (St. Petersburg). 2017;8(6):62-71
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Correlation analysis of T2-weighted images and Medical Research Council scale in corticosteroid-naive patients with Duchenne muscular dystrophy
Suslov V.M., Pozdnyakov A.V., Ivanov D.O., Rudenko D.I., Malekov D.A., Suslova A.D., Ulyanenko D.I.
Abstract

Because of the necessity of objective instrumental methods for assessing the state of skeletal musculature in patients with Duchenne muscular dystrophy, the aim of our work was to evaluate the correlation between manual methods of assessment of the muscle strength and the results of magnetic resonance imaging (MRI) of the skeletal muscles of lower limbs. We have examined 15 corticosteroid-naive patients with Duchenne muscular dystrophy. Patients were divided into 2 groups: ambulant patients (average age 8.1 years) and non-ambulant patients (mean age 12.7 years). Muscle strength of lower extremities of all patients has been evaluated by Medical Research Council scale and MRI of skeletal muscles of the pelvic girdle, thighs and lower legs has been performed. The following results have been obtained: ambulant patients have been characterized by a high correlation of MRC scale and MRI of the lower extremities in the evaluation of the pelvic girdle and thighs muscles and the total score (pelvic girdle, thighs and lower legs) and salient correlation in the evaluation of the lower legs muscles. Non-ambulant patients have been characterized by moderate correlation in the evaluation of pelvic girdle and thighs muscles, as well as the total score of lower limbs. There was no correlation between MRC and MRI results in the muscles of the lower legs. Magnetic resonance tomography is able to reliably estimate the degree of fatty infiltration in Duchenne muscular dystrophy and is the method of choice in the diagnosis and evaluation of the severity of this disease.

Pediatrician (St. Petersburg). 2017;8(6):72-79
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Influence of CRP on cognitive function of patients with combined and isolated forms of atherosclerosis of cerebral and coronary vascular pools
Bilyutin-Aslanyan R.S., Vasiliev A.G.
Abstract

Cognitive impairment (CI) is a major health problem in the modern world in connection with the trend of increasing life expectancy and noticeable increase in the number of elderly people with CI and dementia. Therefore research aimed at finding and studying potential biomarkers predicting higher risk of developing CI and vascular dementia is a high priority. The study includes 207 patients (106 men and 101 women at the age of approximately 60 years. The main group includes 162 patients and there are 45 healthy individuals in the control group without clinical signs of atherosclerotic lesions, but with risk factors of their development. Patients with CPR level exceeding 10 mg/L were not included in the study. Patients with isolated and multifocal atherosclerosis of the coronary and cerebral pools have been compared by indicator of subclinical inflammation – CRP and assessment of neuropsychological test MMSE. The obtained results testified to the presence of inflammatory component in the pathogenesis of CI: the concentrations of CRP were significantly higher in patients with a low MMSE score (multifocal) than patients with higher scores of neuropsychological testing (isolated). Thus inflammation, potentially contributing to the atherosclerotic process is the basis of the relationship between high levels of CRP and cognitive impairment. At the early stages of the disease, with isolated forms of atherosclerotic vascular lesions of the heart and the head rise of CRP level can be considered the indicator of CI. With severing of the disease and the involvement of coronary and cerebral pools an increase the concentration of CRP follows. After that we have revealed a negative correlation of CRP with a marking score of cognitive function on a MMSE scale in these pathologies, i.e., the level of CRP can serve as a biochemical predictor of cognitive impairment. The obtained results indicate a significant role of CRP, its identification and monitoring can be the basis for the prevention and early diagnostics, it will also reduce the risk of severe CI, thereby maintaining higher quality of life of patients.

Pediatrician (St. Petersburg). 2017;8(6):80-85
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MR-patterns of brain’s hypoxic-ischemic lesions in term newborns
Melashenko T.V., Pozdnyakov A.V., Lvov V.S., Ivanov D.O.
Abstract

Perinatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and development of severe neurological disorders that determine the quality of life of these children. In developed countries, the frequency of detection of hypoxic-ischemic encephalopathy (HIE) among full-term newborns is 1-6 per 1.000 live births. In our country, hypoxic-ischemic brain damage is observed in 15-30% of full-term newborns. The term HIE is a clinical diagnosis combining neurological disorders and biochemical changes caused by perinatal HI (hypoxiа-ischemia). The pattern of acute brain damage depends on the degree of cerebral maturity, the severity and duration of hypoxiа-ischemia. The most vulnerable regions are the structures of the brain with high level of metabolism. Such structures in term infants include cortical neurons and neurons of basal nuclei, a subcortical white matter. MRI allows to diagnose brain lesions in term infants in the acute period of HIE. Safety, non-invasiveness and large diagnostic capabilities of MRI allow this method to be considered the gold standard of neuroimaging in neonatology. In this review we described the main MRI patterns of brain injury in term neonates following HIE.

Pediatrician (St. Petersburg). 2017;8(6):86-93
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The using of low-FODMAP diet is an important step in the treatment of children with irritable bowel syndrome
Nalyotov A.V., Vunichenko Y.S.
Abstract

Diet therapy, in most cases, is the first stage of treatment of diseases of the gastrointestinal tract. Especially, this question remains relevant in patients suffering from functional gastrointestinal disorders. The irritable bowel syndrome is one of the most common of functional gastrointestinal tract disorders in the population. The Rome criteria IV are basic recommendations for the diagnosis and treatment of functional gastrointestinal disorders in patients of different ages. The diet with a reduced content of fermentable oligosaccharides (fructans and galactans), di- (lactose), monosaccharides (fructose) and polyols (FODMAP) is recommended by current international consensus for patients of different ages with irritable bowel syndrome. The article presents current findings on the low-FODMAP diet effect on the clinical manifestations of irritable bowel syndrome. The elimination of various foods in the diet of patients with different clinical variants of irritable bowel syndrome according to the low-FODMAP diet scheme leads to a decrease in gassing and normalization of contractile activity of the intestine. It significantly reduces the frequency of exacerbations of the disease and improves the quality of life of such patients. A number of clinical studies using the low-FODMAP diet in adult patients and children with irritable bowel syndrome are presented. It is concluded that further clinical studies to study the effectiveness of the low-FODMAP diet in patients with irritable bowel syndrome are needed. Especially this issue remains relevant in pediatric practice.

Pediatrician (St. Petersburg). 2017;8(6):94-98
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The role of cytokines and their genetic polymorphism in the development of hypoxic-ischemic encephalopathy among full-term newborn children
Panova M.S., Panchenko A.S.
Abstract

The problem of ischemic brain damage among newborns is still relevant in the modern world. The frequency of occurrence of this pathology among full-term newborns remains at a fairly high level, both in Russia and abroad. Moreover, it has a high mortality rate and the percentage of early childhood disability is 60-70%, participating in the development of such diseases as minimal brain dysfunction, infantile cerebral palsy, epilepsy. According to the World Health Organization, about 20% of children suffer from neuropsychic disorders, whose causes in 65-80% of cases are perinatal brain lesions of hypoxic origin. The article deals with modern concepts of molecular genetic mechanisms of development of hypoxic-ischemic encephalopathy among newborns, as well as issues of classification and conditions under which this pathology develops. The author studied the latest domestic and foreign literature data on the properties and role of pro and anti-inflammatory cytokines, such as IL-1, IL-4, IL-6, IL-8, IL-10, IL-13, TNF-α, which are, according to modern concepts, one of the main links in the pathogenesis of ischemic brain injury. Also, special attention is paid to their genetic polymorphism, since qualitatively or quantitatively the genetically altered molecules of cytokines affect the immune response. Investigation of the level of cytokines and their genetic polymorphism before the onset of clinical symptoms will allow prediction the onset of the disease and preventing the adverse effects of the damage of the central nervous system.

Pediatrician (St. Petersburg). 2017;8(6):99-104
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Enteral nutrition in palliative medicine in children
Zavyalova A.N., Gostimskii A.V., Lisovskii O.V., Gavschuk M.V., Karpatskii I.V., Pogorelchuk V.V., Mironova A.V.
Abstract

Complete care of a patient is important in palliative medicine. The necessity of nutrition support is determined by the severity of nutritive, trophic deficit, features of diseases which can cause (or which have already caused) protein-energy deficiency. Nutritive support is a multidisciplinary problem: it concerns not only a dietitian and an intensive care specialist but also a surgeon, a gastroenterologist, an oncologist, a dentist and other specialists who face patients unabled to satisfy their needs by physiological way. The feeding using gastral tube or gastrostomy should be special because oral cavity is switched off the nutrition. Efficiency of treatment rises while adapting enteral nutrition to specialties of digestion and metabolism in various types of pathology. Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction and in patients who are critically ill. Enteral nutrition is often used for children as well as for adults. Children may require enteral feeding for a wide range of underlying conditions, such as for malnutrition, for increased energy requirement, for metabolic disorders and also for children with neuromuscular disorders. Two main steps help to solve the problem of malnutrition: choosing the composition of formula and choosing the way to deliver the formula. This article gives a specification in using various feeding formulas according to different diseases and describes different ways to deliver the formula (from gastral tube to gastrostomy). If swallowing reflex is absent the formula should be delivered directly to stomach. The best way for a long-term or permanent nutrition support is feeding using gastrostomy. This article describes some surgical aspects of different types of gastrostomy from classical one to modern percutaneous endoscopic gastrostomy.

Pediatrician (St. Petersburg). 2017;8(6):105-113
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Clinical case of interstitial tubal pregnancy treatment with mifepristone and misoprostol
Malysheva A.A., Abramova V.N., Reznik V.A., Ruhljada N.N., Taits A.N.
Abstract

The article presents the experience of drug treatment of inertial tubal pregnancy. Currently, ectopic pregnancy is one of the most serious pathologies of pregnancy, leading to a decrease in the woman's reproductive health and directly threatening her life. In this clinical case, the possibility of treatment of ectopic pregnancy with mifepristone and misoprostol in a hospital of the 3rd level, with a patient's refusal of surgical treatment, has been demonstrated. At the moment, according to clinical recommendations adopted in the Russian Federation, interstitial tubal pregnancy is an indication for surgical treatment. Instructions for the use of mifepristone and misoprostol do not provide indications and treatment regimens for ectopic pregnancy. Medicamentous treatment of ectopic pregnancy is possible only with early diagnosis, in hospital settings and with the patient's voluntary consent. We have demonstrated the possibility to consider drug treatment not only as a therapy for despair, but also as an alternative to surgery leading to operative trauma of the reproductive organs, which is more extensive with the rare localization of interstitial tubal pregnancy, namely not only removal of the fallopian tube, but excision of the uterine tube trunk angle. Operative treatment of ectopic pregnancy leads to various complications that reduce the reproductive function of patients. Conservative treatment, perhaps, will help in the subsequent to avoid complications associated with surgical treatment and preserve the ability to procreate, in women with a burdened obstetric-gynecological anamnesis.

Pediatrician (St. Petersburg). 2017;8(6):114-117
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Rational and Irrational Components of Difficult Life Situation Assessment by Adults (on the example of relatives of children who suffer from serious and life-threatening diseases)
Dermanova I.B., Alexandrova O.V., Tkachenko A.E., Kushnareva I.V.
Abstract

The article analyzes the role of rational and rational conscious components in difficult life situations assessment (DLS). Such indicators as meaningful goals, satisfaction of life process and its result, as well as the concept regarding life controllability are referred to the rational conscious aspects. As irrational conscious aspects there are studied indicators of irrational attitudes and religious commitment. The authors have verified the hypothesis about various roles of these indicators in cognitive assessment of difficult life situation of adults who are close relatives of a child who suffers from a serious life threatening disease. Based on the study works there have been a conclusion that a more satisfactory situation assessment more often correlates with higher indicators of life meaningfulness in case of refusing from irrational attitudes. However, in certain cases actualization of irrational attitudes in combination with the emerged religious commitment can be connected with the feeling of encouraging situation clearness (particularly, in cases of elder subjects who are relatives of elder children). The feeling of insolubility of the situation can be accompanied with the disappointment in religion and actualization of obligation towards oneself. In general, religious commitment of a person does not correlate with the felling of controllability of life, but it can reduce the severity of situation experience. The significant factor in perception of the situation severity, connected with the meaningfulness indicators and irrationality, is the age of a child.

Pediatrician (St. Petersburg). 2017;8(6):118-124
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Women’s quality of life dynamics in postpartum period
Korgozha M.A.
Abstract

The article presents the results of the study of characteristics and dynamics of the women’s quality of life in the third trimester of pregnancy and six weeks after delivery. The study involved 240 women, patients of the Perinatal Center of Saint Petersburg State Pediatric Medical University, during the third trimester of pregnancy and six weeks after the delivery. Research subjects were divided into three study groups, depending on the presence and severity of negative emotional manifestations in women in the third trimester of pregnancy. It was revealed that the indicators of physical, mental and social functioning in women, who underwent negative emotional manifestations of different severity in the third trimester of pregnancy, are below the average population data. It is shown that the intensity of negative emotional manifestations in women in the third trimester of pregnancy does not affect the subjective assessment of the overall health and life status. The appearance of negative emotional manifestations of different severity in women in the third trimester of pregnancy significantly reduces the subjective assessment of pregnant women’s own physical functioning in the context of daily and professional activities. It was revealed that for women underwent mild negative emotional manifestations in the third trimester of pregnancy, the situation of labor is the most stressful and has a significant impact on the quality of life in the late postpartum period. This category of women is at risk and needs more thorough medical support and professional psychological assistance.

Pediatrician (St. Petersburg). 2017;8(6):125-130
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Professor Max Wilms: 150th anniversary of birth - in memoriam
Morgoshiia T.S., Siroejin N.A.
Abstract

The research activity of M. Wilms is characterized by diversity of its objects and breadth of breadth of its scope. A surgeon-oncologist, he is known to have devoted a number of his studies, to purely theoretical issues of Oncology. On the other hand, M. Wilms contributed to the development of clinical surgery and Oncology, offering a number of new methods of diagnostics and treatment of major forms of malignant tumors of the genital organs and kidney, making a significant contribution to the practice of world medicine. Classical studies of teratogenic tumors of the ovaries and testicles, mixed tumors, tumors of kidney belong to M. Wilms. The tumor described by M. Wilms in 1899 which is named after him is one of the most frequent malignancies in children usually occurring at the age of 2-5 years but which can also occur at any age, even in very old patients. In the same year his famous monograph “Mixed tissue tumor of the kidney” was published. In 1904 M. Wilms was awarded the title of Professor, and two years later he published his fundamental work “Intestinal obstruction – pathology and clinic” (1906), which brought M. Wilms fame and recognition among surgeons, oncologists and pathologists all over the world. M. Wilms also made contribution into pediatric surgery. In 1906 he proposed to classify the intussusception types, depending on the name of the colon which forms the intussusception head (the iliac colon, caecum, etc.). Analyzing the etiology of Hirschsprung's disease Max Wilms is known to have adhered to the theory of prolonged spasm of the anal canal and, consequently, to inception of secondary megacolon (1904). His assumptions he confirmed by performing manometric studies at the level of the anal canal of the rectum, and in the treatment he applied the method of anal bougienage. A talented scientist and teacher, demanding and fastidious towards himself and his disciples, Max Wilms published more than 130 research papers, of most of which he was the sole author.

Pediatrician (St. Petersburg). 2017;8(6):131-134
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