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Vol 6, No 3 (2015)

Articles
Lessons of pediatrics to physiologist and physiology to pediatrician
Natochin Y.V.
Abstract
The results of joint studies and approaches to solve difficult problems of pathogenesis and treatment of patients in the departments of nephrology and pulmonology were analyzed. The studies have been done over 40 years in common by workers of Pediatric University and Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences. The paper is focused on the discussion of choice motivation of research issue and approaches of treatment based on fundamental investigations. The paradoxical phenomenon is revealed - in patients with nocturnal enuresis diuresis increased simultaneously with the rise of solute free water reabsorption. The essence of this phenomenon is established, the use of desmopressin or diclofenac in dependence of disease form ensured treatment of nocturnal enuresis. Green fluorescent protein is applied for study of absorption of native proteins in the intestine, the role of kidneys in protein metabolism and in redistribution of the amino acids in the body was shown. The efficacy of diuretics during the development of renal function is ascertained in children of different age; the cause of renal refractoriness to furosemide in patients with chronic renal failure is established. Measuring the ratio of furosemide/sodium excretion in patients with chronic renal failure showed that the reduction in diuretic delivery to site of action but not the defect of Na,K,2Cl-cotransporter underlay the lower renal response to the same dose of the drug. The effective treatment based on increase in furosemide delivery to thick ascending limb of Henle loop is developed. The new nonapeptide analogue is synthesized; its natriuretic effect is 50 000-fold greater than action of furosemide. The clinical significance of inadequate antidiuretic state in children with severe pneumonia is shown. As a result of these studies, graduates of Pediatric University L. P. Peresheina, L. N. Kosheleva, E. A. Zhukovskaya, V. V. Archipov, A. A. Kuznetsova, A.A. Kanashkina, A. S. Marina, M. V. Burmakin and others defended theses.
Pediatrician (St. Petersburg). 2015;6(3):4-15
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Risk of harmful use of a particular type of psychoactive substance in adolescents with conduct disorders
Grechanyi S.V.
Abstract
The purpose of the study was a statistical evaluation of the role of clinical and anamnestic data for the risk of a particular type of substances use with the harmful effects in adolescents with conduct disorders. Were studied 293 adolescents with a diagnosis of “Conduct disorder” and comorbid diagnoses “Harmful substance use” (mean age - 15,3 ± 0,1 years). Patients were divided into 4 groups. 1 subgroup comprised 89 patients with comorbid diagnosis of “Harmful opioid use”. 2 subgroup comprised 95 patients with comorbid diagnosis of “Harmful inhalant use”. 3 subgroup comprised 57 patients with comorbid diagnosis of “Harmful alcohol drinking”. 4 subgroup consisted of 52 patients with comorbid diagnosis of “Harmful stimulant use”. The result was obtained by logistic regression equation to calculate the risk of supplies to the patients particular clinical subgroup on the basis of statistically significant variables (anamnestic data). For the harmful opioid use subgroup is: “Family history of substance abuse on the one line”, “Schooling program for masses”, status “Is not working/not learning”, “Living with a partner”. For the harmful inhalant use subgroup is: status “Is not working/not learning”, “Living in a boarding school”, “Escape from the house (or boarding)/temporary accommodation in a shelter”. For the harmful alcohol drinking subgroup is: “Half family”, “Correctional school program”, “Supporting school program”, status “Student school”, status “Is not working/not learning“ (negative contribution to the result variable prediction), “Living in a boarding school”. For the harmful stimulant use subgroup is: “Useful family history”, ”Orphan or the parent(s) deprived of their rights” (negative contribution to the result variable prediction), status “Is not working/not learning” (negative contribution to the result variable prediction), “Escape from the house (or boarding)/temporary accommodation in a shelter”, “Living with a partner”.
Pediatrician (St. Petersburg). 2015;6(3):16-23
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Palliative surgery in locally advanced thyroid cancer
Bagaturiya G.O., Romanchishen A.F.
Abstract
The paper analyses the experience in palliative surgery in 137 patients with locally advanced forms of differentiated thyroid cancer. The paper describes the resections of the thyroid gland without the tumor tissue that germinated into the vital organs of neck or mediastinum. In some cases - the tumor was completely removed in patients with distant metastases. Such operations had to be performed in every fourth patient out of 464 patients with locally advanced carcinoma of the thyroid gland. Most of the patients undergoing palliative interventions, were elderly patients, that often had other illnesses. The need for such transactions occurred at the prospect of further treatment of patients with non-surgical methods, and serious complications of life-threatening tumors. In more than one in ten patients the palliative operation had to be completed with a temporary or permanent tracheostomy performed using the original method. The postoperative mortality rate was 4.3 % (6 cases). The causes of death were pulmonary embolism (2 patients), acute myocardial infarction (1 patient), purulent-septic complications (2 patients), acute cerebrovascular accident (1 case). The postoperative complications were: festering wounds (10 cases or 7.3 %), hypostatic pneumonia (21 patients or 15.3 %), bleeding (3 cases or 2.2 %). The 5-year survival rate after palliative surgery in patients with papillary cancer was higher compared to the group of patients with follicular carcinoma (43.0 % and 37.9 %, respectively). The same figures in patients with medullary carcinoma were significantly (p < 0.05) lower compared with those with papillary and follicular thyroid cancer and they amounted to 18.1 %. After the palliative surgery more than a third of patients survived for 5 years or more. That proves the validity of palliative interventions in this group of patients, and the relatively favorable current differentiated forms of thyroid cancer.
Pediatrician (St. Petersburg). 2015;6(3):24-28
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Modeling to close of interatrium septum defects of the heart
Lazarev S.M., Lazareva Y.Y.
Abstract
Atrial septal defect (ASD) of the secundum type are the most common lesions. More than half of the century a surgeons are operating second defect of ASD of the heart. But a choice to close this defect have the empirical character. In this work the method of the modeling on computer was used. Were studied biomechanical properties of the interatrial septum in norm and with the defect, fnd the methods to close such defects: to close to the patch, sutured, endovascular close defects use device “Amplatzer septal occlude” (ASO). This models was build with accounting famous the size of the tension for every tissue structure. The models of the tension and motion were to came out. Than the results were compared. This results allowed the authors had to determinate the use of relapse of ASD after close of the defects with patchs, suture, and the device of the “ASO”. Most the tension and the motion appear in the oval pit of the septum were discovered. Was notice that the tension and the motion were decreased with increased the thickness this part of the septum. Therefore the second ASD must be close with the stuffs or devices which equal or greater than thickness the interseptum patch. In this connection the patch from any stuff are not better the method of the operation or the stuff is must be greater 1,5 than the area of the oval pit. When the defect is sutured there is great the tension and motion in the region of the suture. It is the danger of the relapse of the heart defect. When the defect is close the device of “ASO” there is small the tension and motion in the part of contact the device and interatrium septum that exclude the defect relapse.
Pediatrician (St. Petersburg). 2015;6(3):29-35
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The functional state of cardiovascular system in patients with different forms of brucellosis
Magomedova S.A., Adilova M.A., Gipaeva G.A.
Abstract
It is known that damage organs and systems largely determines the course and outcome of brucellosis, with one of the most frequently involved in the pathological process in the brucellosis infection is the cardiovascular system. The highest incidence of brucellosis in the Republic of Dagestan occur among those aged 15-39 years, the share of this age group accounts for 75 % of all cases of brucellosis in the Republic, which determines a great social and economic costs of brucellosis infection. The article presents the results of a study of the functional state of the cardiovascular system in 222 patients with brucellosis defeat of the cardiovascular system at the age of 16 to 45 years, of which 110 (49.5 %) patients with acute brucellosis, 112 (50.4 %) patients chronic brucellosis. The diagnosis of brucellosis infection was put up on the basis of clinical, laboratory and instrumental complex examination including, including serological tests Heddlsona and Wright, as well as an intradermal allergy test Burne. Identified clinical laboratory, ECG changes and echocardiographic data suggest that it is expedient to use diagnosicheskih complex investigations: Holter ECG, echocardiogram and determination of cardiac enzymes that allow the early period to identify heart disease as well as provide a timely opportunity to assess the severity of of the disease, identify the symptoms of latent myocardial damage, to decide on the necessary treatment, including etiotropic and pathogenic treatment.
Pediatrician (St. Petersburg). 2015;6(3):36-40
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Мedical rehabilitation of children reconvalescent from infectious diseases according to the international classification of impairments, disabilities and handicaps
Skripchenko N.V., Pronina E.V., Lepikhina T.G., Vladimirova O.N., Ivanova M.V., Gonchar N.V., Goryacheva L.G., Bekhtereva M.K., Babachenko I.V.
Abstract
Infectious diseases are referred to as the most frequent and common diseases in our population, in children as well. Infectious pathology is often followed by the disorders in the organism structure and functions that requires medical rehabilitation measures. The purpose of this work is to prove the necessity of rehabilitation measures of certain level and form for those children who had different infectious diseases. The main research aim is to determine the organism disorders in its structure and functions in those children who recovered from infectious diseases according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH). Materials and methods: there was performed the health assessment of 103 children who had been discharged from the infectious departments of Scientific Research Institute of Children’s Infections (Departments of Respiratory Infections, Intestinal Infections, Neuroinfections, and Hepatitis) according to the health domains of ICIDH. Results: according to the stage of the organism disorders by ICIDH there were determined five groups. More than 36 % of children from the groups 3, 4, and 5 required the second stage of rehabilitation measures at the polyclinic and rehabilitation departments of Scientific Research Institute of Children’s Infections. Conclusion: International Classification of Impairments, Disabilities and Handicaps (ICIDH) can be used to develop the reasoning of level and form of rehabilitation measures in every child who had an infectious pathology.
Pediatrician (St. Petersburg). 2015;6(3):41-47
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Quality of life after Whipple pancreatoduodenectomy and pylorus-preserving pancreatoduodenectomy: a comparative study
Kokhanenko N.Y., Pavelets K.V., Radionov Y.V., Shiryajev Y.N., Borisova N.Y.
Abstract

The authors performed a comparative analysis of the Quality of life (QOL) in 97 patients after pancreatoduodenectomy, 55 of whom underwent pylorus-preserving surgery (PPDE), and 42 underwent classic Whipple procedure (GPDE). QOL was evaluated using questionnaire EORTC-QLQ-C30, version 3.0, and both analyzed groups were divided into 3 subgroups according to the time period after the surgery (less than 6 mo, 6-12 mo, and more than 12 mo). All the patients were operated on for pancreatic or periampullary cancer. During the first period after surgery (less than 6 mo), the integral QOL index is lower than in patients who were examined after the first 6 mo. After PPDE, parameters of physical, role, emotional, cognitive, and social functioning were higher than after GPDE; however, these differences were not statistically significant (p > 0,05). Indicators of QOL have changed with time, but intergroup (PPDE vs GPDE) differences were not statistically significant in every analyzed time period after surgery. Financial constrains were registered in patients of both groups and at different times after surgical treatment.

Pediatrician (St. Petersburg). 2015;6(3):48-51
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Reactive changes in neurons of the raphe serotonergic ом nucleus of after experimental stress in the neonate period and buspirone therapy
Droblenkov A.V., Pivnev A.V., Pyzhov V.A., Butkevich I.P., Mikhailenko V.A., Shimaraeva T.N.
Abstract
The identification of the raphe nucleus neurons reactive changes after experimental stress in the newborn period is necessary for a better understanding of the mechanisms of damage and adaptation of the serotonergic system in the brain during postnatal development. It is well known that the raphe serotonergic nucleus is the largest source of serotonergic nerve fibers through which the connection with the hypothalamus and other projection centers of “positive reinforcement system”. The study of reactive changes raphe nucleus neurons after experimental stress in the newborn period is necessary for a better understanding of the mechanisms of damage and adaptation of the serotonergic system in the brain during postnatal development as well as for possible correction of behavioral disorders. In 37 day old rats after injection of buspirone (experimental animals) and control (injected with physiologists cal solution) studied pain response in the formalin test (2.5 % injection solution of formalin in 1.0 l of a sole of the hind limb). In sections macrocellular raphe nuclei stained by Nissl, counted the number of unmodified, hypochromic, shrunken and hyperchromatic, shadowly cells, established area little changed neurons. Measured as the distance between the bodies of neurons and glial cells between the bodies and the bodies of neurons. It was found that after the simulation of stress in a large raphe nucleus neurons developing degenerative and compensatory-adaptive changes. Reduces the number and size of bodies of neurons containing substance Nissl, wrinkling occurs, strengthening and weakening of staining, the growth of the share of shadowly neurons. Also activated glioneuronal and interneuronal relationships. Reactive changes in the cells exposed to the compensation correction drugs that block receptors for serotonin.
Pediatrician (St. Petersburg). 2015;6(3):52-55
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Neuroprotective effects of cortexin and ischemic preconditioning
Zarubina I.V., Buznik G.V., Shabanov P.D.
Abstract
The purpose was to assess neuroprotective effects of cortexin and ischemic preconditioning in rats with occlusion of both carotid arteries. Methods. The Wistar rats were divided into two groups according to their resistance to hypoxia. All rats were raised in barocamera on altitude 11 000 m with speed 50 m/sec and exposition up to agonal breath. Rats resistant to hypoxia more than 10 min were qualified as high resistant (HR), less than 5 min as low resistant (LR) to hypoxia. Ischemic preconditioning was reproduced by the 3-times temporary occlusions of common carotid arteries (5 min each) with 15-min reperfusion interval between occlusions. The chronic ischemia was modeled by means of ligation (permanent occlusion) of both carotid arteries in 1 h (early preconditioning) or 24 h (delayed preconditioning) after preconditioning procedure. Cortexin 1 mg/kg was administered intraperitoneally 7 days after occlusion of carotid arteries. Neurological status was assessed using McGrow’s stroke-index. Results. In postischemic period, the functional and metabolic changes in the brain of HR and LR rats were more significant in conditions of delayed preconditioning. In group of early preconditioning, a number of survival rats on 7th day was more than in delayed preconditioning group. Cortexin administration (1 mg/kg, 7 days) increased quantity of survival rats, especially in delayed preconditioning group. The maximal effect of cortexin was observed in delayed preconditioning group. Also cortexin decreased malonic dialdehyde level and increased superoxide dismutase activity of the brain tissue in all groups of rats. Conclusion. The course administration of polypeptide drug cortexin reduces neurological deficit signs, recovers structure of individual behavior of rats with different resistance to hypoxia and performs antioxidant action in chronic ischemic damage of the brain on the background of early and delayed preconditioning.
Pediatrician (St. Petersburg). 2015;6(3):56-61
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Degenerative changes of the Medial arcuate hypothalamic nucleus neurons in the male hypogonadism model
Khodulaeva Y.N., Asaulenko Z.P., Baymarov A.A., Nikitina I.L., Droblenkov A.V.
Abstract
The study of patterns of hormonal regulation of sexual development of adolescents including mechanisms of physiological and pathological changes in the rate of maturation of the hypothalamic-pituitary-gonadal axis remains the subject of active research interest. The study of reactive changes of the medial arcuate nucleus of cells in experimental hypogonadism and degree of correction of these changes after testosterone therapy is necessary for a better understanding of the mechanisms of endocrine interaction gonads and gonadoliberin centers during puberty. The aim of this article was to determine the quantitative, structural changes of neurons, glio-neuronal and interneuronal relationships in the medial arcuate nucleus in experimental hypogonadism and the degree of correction of these changes after testosterone therapy. In male Wistar rats induced hypogonadism (model created by the removal of one gonad on postnatal day 2-3), and histological sections were examined medial hypothalamic arcuate nucleus puberty animals (2 months) and the absence of treatment with testosterone after correction. The control group consisted of intact animals puberty. It was found that after the experimental inhibition of testosterone production in newborn male rats in the medial hypothalamic arcuate nucleus of rat puberty develop degenerative (degenerative, atrophic) and compensatory-adaptive changes. First expressed in the reduction of the share and the decrease in the normochromic neurons area, wrinkling, the growth of the share of shadowly neurons. The latter expressed signs of activation glio-neuronal and interneuronal relations. Many reactive changes in the cells exposed to compensatory adjustment in the period of puberty.
Pediatrician (St. Petersburg). 2015;6(3):62-68
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Identification of concealed disturbance of blood coagulation (deficiency of factor XI) by polymerase chain reaction (experimental study)
Ussenbekov Y.S., Zhanserkenova O.O., Kasymbekova S.N., Siyabekov S.T., Sobolev I.V., Glushakov R.I., Terletskiy V.P., Proshin S.N.
Abstract
Minor bleeding is quite common in children and in some cases masks the serious disease of blood clotting. As a rule, this rare inherited disease associated with deficiency of coagulation factors as the I, II, V, VII, X, XI and XIII, as well as deficiency conjugate, most often, the joint failure factors V and VIII and factor whose synthesis associated with vitamin K. The pediatric clinic is difficult to fulfill a randomized trial because of the difficulty of identifying such children carriers of genetic abnormalities at a specific blood clotting factor. In connection with the model of deficiency of coagulation factor XI in a mammals (Bos Taurus L) with autosomal recessive type of inheritance is particularly promising. Deficiency of coagulation factor XI in cattle is inherited autosomal recessive defect. At the first time this pathology was recognized in Holstein cows in 1969. Frequently the etiologic factor of most hidden genetic defects in animals are point mutations in the coding region of the respective genes. On the contrary it has been found that deficiency of coagulation factor XI cattle (FXID) is a consequence of the insertion of nucleotide sequences within exon 12 of the gene FXI length of 76 base pairs. STOP codon (TAA) was resulted from insertion. Phenotypically deficiency of factor XI (FXID) in calves is resulted in disturbance of blood clotting and characterized by prolonged bleeding from the umbilical cord and anemia. Cows which are heterozygous in deficiency of coagulation factor XI have colostrum pink color. Those animals are frequently suffered from pneumonia, mastitis and endometritis. We monitored the breeding sires and Holstein cows on the carrier of the genetic disease: deficiency of coagulation factor XI. To detect the insertion of nucleotide sequences of 76 bp in size it is recommended to use the polymerase chain reaction.
Pediatrician (St. Petersburg). 2015;6(3):69-73
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Correction of mitochondrial dysfunction of rabbit cardiomyocytes using substrate antihypoxants
Vorob’eva V.V., Shabanov P.D., Proshin S.N.
Abstract
Features of energy metabolism in children with cardiovascular diseases are of great practical importance. It is prognostically important to determine the status of the energy of cardiomyocytes to normalize bioenergetic deficit cardiomyocytes in rheumatoid arthritis, myocarditis, congenital heart diseases to decrease reduction in myocardial contractility and reduce precondition for the progression of heart failure. The experimental and clinical studies of the pathogenesis of idiopathic cardiomyopathy in children in recent years indicate directly the damage of oxidative phosphorylation in myocardial tissue due to decreased activity of the mitochondrial electron transport system. Numerous congenital diseases like syndrome Ivemark, Holt-Oram, Ellis-Van Creveld, Ivemark, Noonan, Greeg, Kugel-Stoloff, Werner, West, Adams-Stokes, MERRF include cardiomyopathy in their symptoms. Vibration-type model of hypoxic cell metabolism was suggested to estimate antihypoxant succinic acid as cardioprotective substance in in drug “Amber-antitoks” on rabbit cardiomyocytes. The experiment of bioenergy dependent reaction of native heart mitochondria was studied by polarographic method performed using a closed membrane Clarke’ electrode. Pharmacological drug “Amber-antitoks” in dose as 8.4 mg/kg prevents the formation of bioenergy dependent hypoxia of cardiomyocytes and restore the activity of NAD-dependent, and suppress hyperactivity suktsinat-degidrogenaze enzyme-substrate complex of the respiratory chain. It causes reduction of the severity of mitochondrial dysfunction and the degree of morphological myocardial tissue damage. The protective properties of drug “Amber-antitoks” allow to recommend it for using in the treatment in combination with other drugs of cardiovascular disease in children.
Pediatrician (St. Petersburg). 2015;6(3):74-80
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Hypoxenum in therapy of asthenic condition of alcohol abuse
Vostrikov V.V.
Abstract
At present the need for a comprehensive approach to the treatment of patients with addictive disorders unchallenged. The choice of pharmacological agents used for the relief of symptoms of the disease at different stages is quite wide. This indicates for the need to optimize the therapeutic approaches to apply differentiated complex programs for using a specific drug therapy in different groups of patients. In recent years the great interest was attracted to pharmacological means and methods for improving utilization by the organism of oxygen circulating in it, reducing the oxygen demand of organs and tissues, thereby contributing to reduction of hypoxia and increase resistance to oxygen deficiency. Hypoxenum was allowed for medical use since 1996 year. Hypoxenum is able to both increase efficiency of oxygen use by mechanism of coupling effect due to a specific interaction with a first set of the respiratory chain of mitochondria and alter the conformation of the porphyrin resulting in decreased affinity for oxygen. Simultaneously the modification of ion transportation system in erythrocyte takes place. As a result the oxygen associated with hemoglobin easily desorbed and diffused into the cells and CO2, otherwise, more intensively binds porphyrin complex of erythrocytes. In our study we reproduced a double-blind, placebo-controlled, randomized, comparative clinical study of the efficacy hypoxenum (0.5 g/day, 14 days) after the relief of alcohol withdrawal in 40 patients with alcohol abuse. Our study revealed a pronounced effect of the drug on emotional and motivational status of patients. It was concluded that hipoxenum possesses high efficiency in group of patients in the period of postabstinence.
Pediatrician (St. Petersburg). 2015;6(3):81-85
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The role of androgenous deficiency in the development of urolitiasis in experimental ethylenglycol rat model
Tagirov N.S., Trashkov A.P., Balashov L.D., Balashov N.A.
Abstract
In spite of high incidence of urolitiasis there is still no integral concept explaining all its causing factors and conditions as well as mechanisms of its development. Judging by the clinical observations one may suppose the androgenous deficiency might boost the formation of stones in the kidneys however there are no decisive proofs of androgenous deficiency role in concrement formation in kidney. These proofs may be yielded by means of a crude experimental model. 60 albino male rats were studied in “ethylenglycol” rat model reproducing urolithiasis for the assessment of androgenous deficiency effect on the development of this disease. “Ethyleneglycol” model of urolithiasis consisted of adding 1 % ethylene glycol solution to drinking water for 4 weeks. Androgenous deficiency was reproduced by castration. The experimental model has successfully produced urolithiasis with considerable disturbances in the structure and function of kidneys including microconcrement formation. Androgenous deficiency (castration) was shown to considerably boost the development of urolitiasis caused by ethylene glycol. In spite of similar morphological signs of urolitiasis in both experimental groups the androgenous deficiency caused by castration has been demonstrated to speed up and worsen the development of the disease. The microconcrements by the papilla of kidney in castrated rats with androgenous deficiency formed earlier and were multitudinous and larger in size than in experimental animals receiving 1 % ethylene glycol solution to drinking water for 4 weeks but without castration.
Pediatrician (St. Petersburg). 2015;6(3):86-90
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Genetic factors modifying response to glucocorticoid treatment in chronic pediatric inflammatory bowel diseases
Zaletova N.K., Vostokova L.P., Chukhlovin A.B., Kornienko E.A., Tretjak A.T.
Abstract
The article concerns genetic factors that determine efficiency of steroid treatment for chronic inflammatory bowel diseases (IBD) in children, focused, mostly, on Crohn disease and nonspecific ulcerative colitis. Their incidence comprises 5 to 15 per 100 000 children and adolescents. In acute phase, therapy of these diseases is based on salicylates and glucocorticoids which regulate cytokine network and immune cell functions. Application of high-dose glucocorticoids (GCs) exerts а sufficient immunosuppressive action. These effects are performed via specific GC receptors in the target cell populations. Hence, numbers and functionality of GC receptors are important for clinical response to GC treatment. The aim of this review is discern major genetic effects upon functioning of glucocorticoid receptors. Here we discuss effects of N363S, ER22/23EK, and NR3C1 variants, the most known GC functional gene polymorphisms. These gene variants are often associated with altered GC gene expression in individual cases of IBD. Moreover, some other gene variants are able to modulate the GC receptor expression, thus making it difficult to assess genetic predisposition to altered clinical response to glucocorticoids. Hence, the regulatory effects of single gene variants upon GC receptors may not show direct correlations with clinical effects of the drug. Therefore, we propose an immediate way to assess the gene activity, i. e., quantitative analysis of the gene transcription (mRNA detection) in the patients’ cells before and during glucocorticoid therapy, presuming further application of this parameter as a predictive marker for evaluation of optimal therapeutic response in the individual IBD patients.
Pediatrician (St. Petersburg). 2015;6(3):91-97
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Liver transplantation in children and adults
Esaulenko E.V., Sukhoruk A.A.
Abstract
The article presents an analysis of modern domestic and foreign literature on the problems of liver transplantation in children and adults. Liver transplantation is performed for more than 50 years and it has become a reliable, rational way, and sometimes the only life-saving treatment for children and adults suffering from diffuse liver disease or unresectable tumors. Currently, the Russian Federation opened 14 centers for liver transplantation (in Moscow, St. Petersburg, Belgorod, Krasnodar, Irkutsk, Novosibirsk, Yekaterinburg and Nizhniy Novgorod), which is performed annually 200-240 operations. Estimated demand for the provision of this service is much higher: 52-64 center, and 2000-2500 operations per year. However, liver transplantation in children performs only in two centers in Moscow. Possibility of timely planning of liver transplantation in children of any age has now become a reality, but with a very limited capacity. Recently there has been improvement in diagnostic capabilities to identify various congenital and acquired diseases of the liver in children requiring liver transplantation. We can already predict the increase in demand for this type of surgery. In the North-Western Federal District is a center in which possible liver transplantation in adults, while the children’s opportunities for transplantation in the region do not have. The reasons leading to liver transplantation in children and adults are different. In adult practice dominated by cirrhosis in the outcome of chronic viral hepatitis B and C, whereas in children biliary atresia and congenital metabolic disorders.
Pediatrician (St. Petersburg). 2015;6(3):98-103
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The metabolic logistics of stress, diabetes mellitus and works by Bernardo Alberto Houssay
Churilov L.P., Utekhin V.I.
Abstract
The paper deals with redistribution of energetic and plastic resources in the organism during stress, acute phase response and diabetes mellitus. Assuming metabolic regulation is based upon balanced contradictory influences of diverse chemical signals (substrates, ions, autacoids, hormones, neurotransmitters, physiological autoantibodies) the peculiarities of insulin- and counter-insulin effects during acute and chronic adaptation under stress, acute phase response and diabetes mellitus have been discussed. The role of chronic stress and accompanying metabolic disorders has been accentuated as a basis for stress-associated diseases’ development. The role of outstanding Argentinean pathophysiologist Bernardo Alberto Houssay (1887-1971) is discussed. He had devoted himself to studies of pituitary bioregulators’ influence on insulin effects immediately after insulin discovery and had established in 1924 that pituitary removal is able to increase sensitivity to insulin in dogs, and developed “secondary diabetes mellitus” concept as a result of counter-insulin hormones’ excess (especially hormones of adenohypophysis and the adrenal glands (“steroid diabetes”). Bernardo Alberto Houssay was really the first to experimentally prove pituitary and adrenal bioregulators to oppose the insulin effects. Bernardo Alberto Houssay has been 46 times nominated for the Nobel prize for 17 years (1931 through 1947), and finally was awarded the Nobel prize in 1947 for achievements in Physiology and Medicine for disclosing the role of pituitary in carbohydrate metabolism (he was the first ever Nobel prize winner from Latin America). The paper discusses publications by B. A. Houssay, current development of his ideas, as well as historical and biographical information on his research and his scientific school of endocrinologists-pathophysiologists in the context of his epoch, on the background of history of Argentina [3 figs, bibliography: 34 refs].
Pediatrician (St. Petersburg). 2015;6(3):104-111
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Thyroid status as prognostic marker in oncology
Glushakov R.I., Vlaseva O.V., Sobolev I.V., Proshin S.N., Tapil’skaya N.I.
Abstract
In spite of advances in the treatment of malignant tumors of various localizations, in general, the survival rate for a variety of clinical entities remains unsatisfactory. There is no doubt that the predictive value of clinical stage of disease is very valuable. However in each particular case the correlation between the stage of disease and its outcome is rather probable than absolute. The current laboratory and pathological methods of risk assessment of course and recurrence of tumor in patients suffered from malignancies are not always sufficient, adequate and in most cases are able to ascertain a certain degree of risk without dosage adjustment possibilities. In the middle of the last century hypothyroidism was recognized as a risk factor for the development of certain malignancies, such as breast cancer, that has for several decades thesis conclusive clinical oncology. However at the turn of the century advances in molecular biology have called into question many of the existing dogma of experimental and clinical oncology. The review presents data about nongenomic properties of thyroid hormones (TH). Extracellular domains of integrin αVβ3, which is cell adhesion protein, are entrance for nongenomic way of TH. Binding of TH to αVβ3 results in activation of mitogen-activated protein kinase (fosfatidil-inositol-3-kinase). The finale effects of TH nongenomic action are cell proliferation, angiogenesis, migration of cells and elevated expression of tissue specific inflammatory genes. The clinical studies presented here trace pattern between increase in response to treatment and increase in survival of cancer patients with hypothyroid condition.
Pediatrician (St. Petersburg). 2015;6(3):112-117
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Organization of a simulation study in SPbSPMU
Gostimsky A.V., Kuznetsova Y.V., Lisovski O.V.
Abstract
In accordance with the order of the Ministry of Health and Social Development of the Russian Federation from January 15, 2007 N 30 to participate in the delivery of health care to citizens admitted students who have successfully completed the theoretical training and have practical skills acquired on models (phantoms). In 2013, in order to introduce innovative forms of learning SPbGPMU formed Center of modern educational technologies. For the development of all necessary manipulations in the Centre created a special phantom-simulation classes. In order to establish the required number of repetitions in the course teaching practical skills learning outcomes analyzed 252 5th year students of pediatric faculty. It was found that a great development of the 5th year students of medical procedures require at least 5 repetitions of each student with a teacher or a mandatory correction loop simulator. To master the algorithm requires the help of at least 7 repeats the clinical scenario, with enough 1-2 times the direct participation of the remaining repetitions of the student can observe and participate in the discussion of errors. The introduction of phantom-simulation training for students not only increases the interest in learning, but also makes it possible to repeatedly perform any medical procedures or diagnostic procedure without risk to the patient, and subsequently apply their skills confidently during practical training. Using simulators, mannequins, phantoms and dummies can not only master the different skills each student physicians, but also to develop the ability to interact with each other and work as a team by simulating real conditions. The possibility of multiple repetition of the same scenario allows you to bring the mastery of skills to automaticity.
Pediatrician (St. Petersburg). 2015;6(3):118-122
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Endovascular treatment in patients with combined pathology
Shloydo E.A., Pyaterichenko I.A., Zvereva V.V., Kovalev Y.R., Sizov A.V.
Abstract
Aortic valve stenosis is one of the most common diseases from the group of acquired heart disease, especially in elderly patients. Aortic valve replacement has become the “gold standard” and gives excellent results in all age groups of patients. For aortic valve replacement is sent to only one third of patients due to high risk due to age, severity of the defect, reduced contractility of the left ventricle, pulmonary hypertension and other comorbidities. One of the attempts to reduce the frequency of complications and mortality in this group of patients, and subsequently to make it possible to perform other surgical interventions, including aortic valve replacement, which is considered inoperable patients is holding a less traumatic surgery - aortic balloon catheter valvuloplasty. In the clinical observation deals with the case of heart disease - critical aortic stenosis, ischemic heart disease complicated by pulmonary hypertension and severe heart failure, in combination with gynecological diseases (uterine fibroids, endometrial hyperplasia in postmenopausal women), complicated by uterine bleeding and hemorrhagic anemia. Consider the risks of different surgical interventions. The possibility of modern endovascular care of patients in this situation simultaneously perform operations on uterine artery embolization, coronary angioplasty with stenting and aortic catheter balloon valvuloplasty. Also shown is the nearest and remote results of operative intervention.
Pediatrician (St. Petersburg). 2015;6(3):123-128
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