Vol 10, No 2 (2019)

Community-aquired pneumonia in asthmatic children with different duration of inhaled corticosteroid therapy
Bulatova E.M., Nesterenko Z.V.

Background. The continuing increase of the prevalence of asthma in the world, the lack of the expected therapeutic effect of current programs, make this phenomenon to be studied. One of the main causes of asthma exacerbation and worsening of the prognosis in the children’s population are infectious diseases that occur in connection with steroid therapy used in the asthma treatment.

Aim: to study the relationship of steroid therapy in asthmatic children with the occurrence of community-acquired pneumonia, that changes asthma symptoms in them.

Materials and methods. 39 children aged 3-18 years old with atopic asthma who received corticosteroid therapy, were examined. All patients were divided into 4 groups: Group 1 – patients received inhaled corticosteroids for 2 years; Group 2 – for 3-5 years; Group 3 – for more than 5 years; Group 4 – patients with newly diagnosed asthma and a short course of corticosteroid therapy in the remission.

Results. The frequency of community-acquired pneumonia was analyzed in all groups. Strong positive correlation between the duration of use of moderate and moderate/high dose inhaled corticosteroid therapy in asthmatic children for more than 2 years and the occurrence of community-acquired pneumonia with development of complications (pulmonary hypertension, pulmonary fibrosis, pulmonary bullae, bronchiectasis) in 48.7% them was revealed.

Conclusions. Strong positive correlation between the duration of moderate and moderate/high dose inhaled corticosteroid therapy in asthmatic children for more than 2 years and the occurrence of community-acquired pneumonia in them was revealed, that necessitates the antibiotics to be included in the medication therapy of asthma.

Pediatrician (St. Petersburg). 2019;10(2):7-12
How do the intestinal infections proceeding with the haemocolitis syndrome influence anthropometrical indicators of the nutritional status of children?
Klimova O.I., Gonchar N.V., Razd’yakonova I.V., Lobzin Y.V.

This article presents the results of a study of the nutritional status of children with acute intestinal infections (AII) occurring with hemocolitis syndrome. It was found that the nutritional status reflects the severity of the pathological process, and its dynamics allows to evaluate the effectiveness of therapy. The aim of the work was to study the changes in anthropometric indicators of nutritional status in the treatment of AII with hemocolitis syndrome in children. 50 patients with AII with hemocolitis syndrome aged from 5 months to 8 years were observed in an infectious hospital. Patients were divided by age: group 1 – breast age (n = 10), group 2 – early age (n = 27), group 3 – preschool age (n = 10), group 4 – school age (n = 3). The nutritional status of patients was studied in dynamics on the 1st and 7th day of inpatient treatment according. Analysis of research data was performed using Studentʼs t-test, U-Mann-Whitney test, Kruskal-Wallis criterion. The level and harmony of physical development of children in all groups at the time of admission to the hospital did not differ significantly. In the course of treatment, positive dynamics was noted in group 1 by the values of body mass index (BMI) (p = 0.05), Z-score BMI (p = 0.04), body weight deviation by height (in %) (p = 0.05); in group 2 – by the values of body weight by height (p = 0.05). Positive dynamics of nutrition indicators in group 1 was combined with a high frequency of diagnosis of unspecified forms of AII (60%). The negative dynamics of most indicators was observed in group 3, which was accompanied by a high frequency of diagnosis of refined (bacterial) etiological forms of AII (90%). The obtained data show that the dynamics of nutritional status of patients with AII with hemocolitis syndrome during therapy was more favorable in infants and young children and less favorable in preschool children, depended on the etiology of the disease and reflected its impact on metabolism.

Pediatrician (St. Petersburg). 2019;10(2):13-20
Clinical and functional features of the upper gastrointestinal tract in children with chronic gastroduodenitis in 3 and 6 months after eradication therapy
Gurova M.M., Kupreenko V.V.

We studied the morphological and functional features of the stomach and duodenum in children with chronic gastroduodenitis (CGD) associated with Helicobacter pylori infection in 3 and 6 months after successful eradication therapy. Initially we carried out examination of 155 children with CGD associated with Helicobacter pylori (HP)-infection in the acute phase of the disease. In the following we examined 100 children in 3 and 6 months after the proven eradication of HP. We found that manifestations of abdominal pain syndrome was significantly decreased (100% in the acute stage versus 7% and 5% at 3 and 6 months after eradication, p < 0.01). At the same time, almost 30% of children still had symptoms of intestinal dyspepsia (31% and 36% of children after 3 and 6 months) in the form of rumbling along the colon and changes in stool. The morphological changes in the stomach and duodenum preserved in 37% of cases: was present lymphoplasmocytic infiltration of gastric mucous and atrophy in 9%. These changes were positively correlated with the identification of CagA factor. Changes in the motor-evacuation function of the stomach were characterized by disturbances in the anthro-duodenal regulation in 25% of children and positively correlated with disorders of acid-neutralizing function.

Pediatrician (St. Petersburg). 2019;10(2):21-26
Autonomic and endothelial dysfunction with neurocirculatory asthenia in young men of call-up age
Ivanov V.S., Levina L.I., Ivanov S.N., Vasilenko V.S.

Young men of call-up age with neurocirculatory were asthenia were examined for autonomic regulation of cardiac activity and vasodilatory reserve of the arteries. The functional state of the autonomic nervous system (ANS) was studied with the aid of rythmography with analyse of heart rate variability. The following parameters were studied: vegetative regulation type, responsiveness of departments of ANS and autonomic provision of cardiac activity. The type of vegetative regulation was determined by the mean value of RR interval and indication of the heart rate variability (∆RR). Reactivity of parasympathetic and sympathetic divisions of the ANS and autonomic support of cardiac activity were investigated using breathing test. To ensure vegetative dysadaptation cardiac activity includes reaction with low vegetative coverage of both divisions of the ANS and paradoxical reaction in which there is a decrease in ∆RRmax (instead of increase) and an increase in ∆RRmin instead of decrease. These reactions indicate autonomic dysfunction. Vasodilatory reserve of the arteries was investigated using ultrasonography of the brachial artery with compressive sample and determination of endothelium-dependent vasodilation. It was found that in boys with neurocirculatory asthenia vagotonic and sympathetic types of vegetative regulation are often determined by disadaptative vegetative provision of cardiac activity, which is accompanied by endothelial dysfunction with reduced vasodilator reserve of the arteries.

Pediatrician (St. Petersburg). 2019;10(2):27-31
Physical development of children in St. Petersburg: to the discussion about methods of evaluation
Gritsinskaya V.L., Novikova V.P.

Anthropometric evaluation is an essential feature of pediatric evaluation. Different countries use different approaches in pediatric growth assessment. The article presents a comparative analysis of the body length (BL) indicators of modern school-age children in St. Petersburg with regional standards (1991) and international standards (WHO Growth Reference 2007). Anthropometric evaluation was conducted among 6207 children aged 7 to 17 years; the median, standard deviation and centile distribution of the BL values of school-age children were determined. We found that the values of BL of modern school-age children are higher than that their peers had thirty years ago; in boys, the maximum difference is found during the pubertal growth spurt; Non-parametric and parametric indicators of BL in senior pupils of St. Petersburg are higher than in the standards of the World Health Organization; in junior schoolchildren no difference was found. The data we obtained create the prerequisites for the development of modern regional standards for growth assessment of children and school-age children in St. Petersburg and their practical use for pediatric examinations.

Pediatrician (St. Petersburg). 2019;10(2):33-36
Cardiac arrhythmias and predictors in patients of young age with marfanoid habitus
Timofeev E.V., Zemtsovsky E.V., Reeva S.V.

Cardiac arrhythmias are frequent manifestations of hereditary connective tissue disorders (HCTD). Such HCTD as Marfan syndrome (MS), the primary mitral valve prolapse are characterized by frequent supraventricular and ventricular extrasystoles, prolonged PQ and QT interval, reduced heart rate variability and frequent findings of other predictors of heart arrhythmias. Cardiac arrhythmias as well as their predictors in patients of young age with marfanoid habitus (MH) were not previously evaluated.

Materials and methods. A total number of 238 patients of young age were examined. All patients received phenotypic and anthropometric screening and Holter ECG. Cardiac arrhythmias, duration of QT interval (QTc), QT dispersion (QTd), heart rate variability and heart rate turbulence were estimated.

Results for young people with MH as compared with the control group are characterized by frequent detection of paired (42.6% vs 9.7%, p= 0.00001), group (17.0% vs 4.2%, p = 0.01) supraventricular extrasystoles, ventricular extrasystoles in pathological quantity (10.6% vs 1.4%, p = 0.02). Pathological value of heart rate turbulence is detected significantly more frequently in individuals with MH. During evaluation of variability a significant decrease in all spectral (HF, LF, VLF), as well as most statistical (SDNN, pNN50) indicators was revealed. Patients with MH are characterized by prolonged QT interval (QTc threshold in 480 ms overcomes 21% of boys with MH, p = 0.00001) and increase the variance of the QT interval (threshold of 50 ms overcomes 37.5% of girls with MH, p = 0.0004).

Pediatrician (St. Petersburg). 2019;10(2):37-46
Effectiveness of nephrolithiasis surgical treatment on the background of replacement testosterone therapy
Tagirov N.S.

The goal of the study is to assess the effectiveness and safety of testosterone replacement therapy in males with androgenic deficiency and nephrolithiasis who require surgical treatment.

Patients and methods. All in all 565 patients were involved in the study. In 226 of them (40%) surgical treatment was used. In a majority of these cases (90%) contact uretherolithotripsy was used. In half of the patients uretheroscopy had revealed large and long-lasting concrements. In order to assess the effectiveness of nephrolithiasis surgical treatment on the background of testosterone replacement treatment the assessment of hormonal status during pre- and postoperative periods was accomplished, duration and intensity of pain during the early post-operative period was evaluated as well as narcotic analgetics application frequency and the duration of antibacterial therapy and the stay in the hospital.

Results of the study. Replacement testosterone therapy during the early postoperative period in male patients with nephrolithiasis and androgen deficit has been demonstrated to reduce the leukocyteuria duration and the need for antibacterial therapy thus decreasing the stay at the hospital. Replacement testosterone therapy in male patients with nephrolithiasis and androgen deficit who had dealt with surgical treatment has been shown to decrease the pain duration and intensity thus decreasing the need for narcotic analgetics. The use of replacement testosterone therapy in the complex treatment of nephrolithiasis in patients after surgery contributes to faster liquidation of hyperglycemia and normalization of carbohydrate metabolism. Replacement testosterone therapy in male patients with androgen deficit and nephrolithiasis who need surgical treatment contributes to reduction of kidney stone disease relapse rate.

Conclusion. Replacement testosterone therapy in male patients with nephrolithiasis and androgen deficit who need surgical treatment considerably improve the postoperative period quality.

Pediatrician (St. Petersburg). 2019;10(2):47-54
Forensic medical examination of alcohol-attributable mortality in Saint Petersburg
Davydova Z.V., Yagmurov O.D.

This article presents an analytical material on the relationship of alcohol consumption and mortality in St. Petersburg for the period 2015-2017 years, which is based on the data of the city Bureau of forensic medical examination. The analysis of deaths found that the problem of abuse of alcoholic beverages (including ethanol containing) remains relevant, as indicated by the high (up to 30%) frequency of detection of acute ethanol poisoning in forensic examination of corpses. We found that ethanol poisoning in the structure of poisoning occupy the second place, while drug poisoning (opiates, cannabioids, cocaine) confidently and by a large margin occupy the first place. However, more than 75% of those who died from acute drug poisoning had alcohol in their blood. In cases where the death was violent, alcohol was found in the blood of more than 60% of the victims. High rates of alcohol intoxication were found in cases of death from low temperatures and mechanical asphyxia (hanging). About 25% of the victims of road accidents (pedestrians, drivers, passengers) were intoxicated. Our study showed no dynamics of reducing the frequency of alcohol intoxication and in cases where death occurs from diseases. When comparing certain types of non-violent death, it was found that most often the state of alcoholic intoxication accompanied (was the background) in cases of death from diseases of the digestive system: hemorrhagic pancreatitis, cirrhosis, gastric ulcer and duodenal ulcer, varicose veins of the esophagus (in 24-53% of cases), somewhat less – in diseases of the cardiovascular system (in 25-29% of cases).

Pediatrician (St. Petersburg). 2019;10(2):55-62
Non-pharmacological pain-relieving treatment in pregnant women with dorsopathies
Vaganova Y.A., Suslova G.A., Gaiducov S.N.

The present study assesses the effectiveness of the relief of pain syndrome in pregnant women with dorsopathies by using an isometric kinesitherapy complex. The analyzed groups differed in the type of the performed exercise, with the first group attending a course of isometric kinesitherapy procedures (group 1) or the second group undertaking a course of therapeutic gymnastics in pregnant women with dorsopathies. The duration of each course was 7.5 hours (3 times a week for a period of 5 weeks, a total of 15 procedures), classes were conducted under the supervision by a doctor of therapeutic physical training. 170 pregnant women were examined with the average age of: Me = 31 (LQ = 26; UQ = 38) years (р > 0.05 between the groups). The low back pain (LBP) was assessed using the Oswestry questionnaire, the EuroQol 5-D questionnaire, the visual analogue scale (VAS), the verbal rating scale, the McGill short questionnaire and a medico-social form. The level of disability was assessed by using the results of the Oswestry questionnaire. Completing the questionnaires and the scales was made before the first kinesitherapy procedure (a complex of isometric exercises) and therapeutic gymnastics and completing it again after the last procedure, respectively. A prospective non-randomized controlled study was conducted in which p = 0.05 was taken as the value of statistical significance level for this study (p). The data analysis yielded statistically significant results confirming the effectiveness of the complex of isometric exercises aiming at relieving the pain in pregnant women with dorsopathies. In group 1, a decrease of the low back pain (LBP) was detected 2.47 times more often than in group 2 with p = 0.001.

Pediatrician (St. Petersburg). 2019;10(2):63-68
Food protein-induced enterocolitis syndrome in pediatric practice
Novikova V.P., Pokhlebkina A.A.

One of non-IgE-mediated disorders that pediatricians and allergologists have to deal with is food protein-induced enterocolitis syndrome (Food Protein Induced Enterocolitis Syndrome, FPIES). Cow milk and soy proteins are the most common cause of FPIES. Other foods that can cause FPIES include a wide range of solid food stuffs, such as grains, vegetables, fruits, and poultry. Food-borne enterocolitis is usually accompanied by acute recurring vomiting and diarrhea, lethargy, pallor, dehydration, and even hypovolemic shock. FPIES often occurs after the first introduction of complementary foods containing trigger products, usually not accompanied by fever or a significant increase in the level of C-reactive protein, and generally has a good prognosis. Depending on the severity of the disease, metabolic acidosis and meth-hemoglobinemia may develop. In chronic cases anemia, hypoalbuminemia and eosinophilia may occur. In acute cases laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking 6 hours after a meal. Manifestations of FPIES usually disappear within 24-48 hours after elimination of the causative food. Radiological evaluation and other methods like endoscopy and gastric juice analysis can yield nonspecific results. Data on the incidence of FPIES is limited, and approximate assessment of affected children rate varies from 1.5 to 30 per 10,000. Further studies are needed to identify clinical subtypes and predisposing factors for the development of FPIES compared to immediate-type IgE-mediated gastroenteropathy.

Pediatrician (St. Petersburg). 2019;10(2):69-74
Endocrine and metabolic consequences of surgical interventions in uterine myoma: pathogenetic characteristic
Chaava L.I., Kakhiani E.I., Tsygan V.N., Drygin A.N., Pakhomova M.A.

This paper presents analysis results of the research on endocrine and metabolic disorders in women who underwent surgery interventions for uterine myomas. Uterine myoma is one of the most common gynecological diseases. Main types of surgical interventions to treat uterine myomas are: hysterectomy, which is an organ-removing operation with various volume of surgical intervention: supravaginal amputation or extirpation of the uterus. Another type is myomectomy — an organ-preserving operation — when myoma nodes are removed, but the uterus and ovaries are preserved if they have no pathology. Removal of the uterus with appendages or without ovaries results in a decreasing production of estrogens, which play a key role in regulation of metabolism and various functions of the body systems. Estrogen deficiency, occurring after hysterectomy, deprives patients of a comprehensive protective effect of female sex hormones in all types of metabolism and normal functioning of organ systems. Hypoestrogenemia leads to development of a post-hysterectomy syndrome that comes out in early development of atherosclerosis, circulatory diseases, osteoporosis, psychological status disorders and urogenital disorders. Hypoestrogenemia is a key link in the pathogenesis of endocrine and metabolic disorders after hysterectomy. Endocrine disorders can be found at almost all levels of the regulatory and executive axis of the endocrine system. So far, hormonal function of the peripheral endocrine glands after myomectomy has been poorly studied. Currently available publications give no data on endocrine and metabolic disorders in patients after the myomectomy.

Pediatrician (St. Petersburg). 2019;10(2):75-82
Biological and pathophysiological role of adiponectin
Petrenko Y.V., Gerasimova K.S., Novikova V.P.

Adipose tissue is now recognized as an important endocrine organ that secretes numerous protein hormones, including leptin, adiponectin, and resistin. Adiponectin is a hormone that is produced by white adipose tissue. Adiponectin has been isolated independently by several groups of scientists. In humans, this protein is encoded by the ADIPOQ gene. Adiponectin receptors are widely distributed in many organs and tissues including liver, heart, pancreas, kidneys, muscles and many other cell types. A serum concentration of adipocin correlates with body mass index (BMI). Decreased level of adiponectin leads to obesity, the development of gestational complications in pregnant women, as well as a high risk of diabetes mellitus development and atherosclerosis. A high concentration of this hormone has anti-inflammatory, antiatherogenic, antiproliferative and cancer-defense mechanisms. Adiponectin strongly suppresses hepatic gluconeogenesis by inhibiting genes involved in glucose production. Obese people have lower blood levels of adiponectin than normal weight individuals. Adiponectin’s anti-inflammatory and anti-apoptotic properties result in protection of the blood vessels, heart, lungs, and colon. Adiponectin, an abundant adipocyte-secreted factor with a wide-range of biological activities, improves insulin sensitivity in insulin target tissues, modulates inflammatory responses, and plays a crucial role in the regulation of energy metabolism.

Pediatrician (St. Petersburg). 2019;10(2):83-87
Prevention of toxicity in chemotherapy with high doses of methotrexate in children
Evsiutina E.P., Dinikina Y.V., Belogurova M.B., Aleksandrovich Y.S.

Methotrexate (MTX) is a widely used anti-tumor drug, folic acid antagonists. The effectiveness of high doses (more than 1 g/m2) of MTX in a monotherapy or in a combination with other chemotherapeutic drugs has been proven in a treatment of a large spectrum of oncological diseases in children such as osteosarcoma, tumors of the central nervous system, lymphomas, acute lymphoblastic leukemia. The use of high doses of MTX is often fraughted with development of life-threatening complications such as MTX-induced acute kidney injury, neurotoxicity, myelosuppression. Currently developed recommendations for therapeutic monitoring and supportive care, including hyper-hydration, urine alkalization and leucovorin therapy, allow to reduce toxicity of MTX, but in some patients it is not always possible to prevent the development of complications. Cohort studies in order to identify risk factors for toxicity after high doses of MTX in children with different forms of cancer are limited, as well as comparing various types of supportive care regimens, including, infusion therapy. Studying of development mechanisms of MTX toxicity depending on background conditions will allow to improve existing recommendations and develop new and most effective standards of supportive therapy with respect to the individual specifics of patients.

Pediatrician (St. Petersburg). 2019;10(2):89-98
Bariatric surgery metabolic effects
Mirchuk K.K., Vasilevskiy D.I., Anisimova K.A., Davletbaeva L.I.

Obesity is considered now as a chronic relapsing lifelong disease, with a tendency to progression. According to the WHO, it present about 60% of the population of economically developed countries is overweight, 25-30% – is obesity. Russia is in fifth place in the world in the prevalence of obesity and overweight, being second only to the United States, Mexico, Hungary and Scotland. According to the Research Institute of Nutrition in the North-West region of the Russian Federation, 29.7% of women and 18.5% of men are overweight. Associated with obesity diseases include atherosclerosis, type 2 diabetes, hypertension, coronary heart disease, hormonal disorders, some cancers, etc. In proportion to the number of obese people increases and the incidence of pathological conditions associated with overweight. The vast majority of 95% of obese people die from causes directly related to overweight. The life expectancy of patients with overweight is reduced by 10-20 years, depending on the age of development and severity of obesity. The effectiveness of the conservative methods of correction associated with overweight in the arsenal of medicine today is low due to the complexity of the impact on their main cause – overweight. The article presents modern ideas about the mechanisms of action, hormonal and metabolic effects of the main types of bariatric operations. High long-term efficacy of surgical treatment of obesity-associated dis-orders of lipid and carbohydrate metabolism, arterial hypertension has been shown.

Pediatrician (St. Petersburg). 2019;10(2):99-109
Results of efferent therapy in monochorionic diamniotic twins with dissociation of fetal development (three clinical observations)
Vetrov V.V., Ivanov D.O., Reznik V.A., Romanova L.A., Vartanyan R.A., Sergienko O.I., Chikhladze V.U.

The article presents three clinical observations of successful conservative treatment of pregnant women with monochorionic, diamniotic twins (MDT), coming naturally. In all cases, there were manifestations of twin-to-twin transfusion syndrome (TTTS) with progressive blood flow disorders in the utero-placental space with a pronounced delay in the development of one of the fetuses. In the early stages of pregnancy was supposed to terminate the pregnancy, but the women refused. Pregnant women were admitted to the perinatal center at 23, 23 and 24-25 weeks, respectively. During the examination, the diagnosis was confirmed, at the same time in all cases, the patients found manifestations of endotoxicosis and inflammatory response. Pregnant conducted methods of detoxicational (efferent) therapy in the form of photomodification of blood with sessions of laser and ultraviolet radiation in combination: in the first case — plasmaexchange with 5% albumin solution No 6 and the cascading plasmafiltration No 5; in the second observation - with medium volume plasmapheresis No 7, hemosorption No 1; in the 3rd observation – with plasmapheresis No 7, hemosorption No 3. Complications at efferent therapy was not, indices of homeostasis of pregnant women in the dynamics normalized. Blood flow disorders in the placenta persisted, but there was a steady increase in body weight of the fetus. In general, women’s pregnancies were prolonged for 11, 13 and 9 weeks, respectively (in the first two cases, women were even temporarily discharged home). Childbirths in all cases were performed by operational pathway, there were no complications in childbirth and after childbirth in mothers. All six children were born alive with mild and moderate prematurity and did not need long-term intensive care. All were on breast-feeding, in dynamics surveillance caught up with contemporaries in development.

Pediatrician (St. Petersburg). 2019;10(2):111-120
Clinical case of non-immune hydrops in a preterm infant with paroxismal tachycardia
Andreyev A.V., Kharlamova N.V., Mezhinskij S.S., Pesenkina A.A.

Non-immune hydrops of the fetus is a heterogeneous pathology, which is usually the final stage in the development of intrauterine diseases, manifested by clinically pronounced hydration in the absence of signs of immune sensitization. This pathology is characterized by relatively high mortality in both antenatal and postnatal periods. The causes of non-immune hydrops of the fetus are very diverse, arrhythmias being one of common causes of non-immune hydrops. As are a starting factor for the development of non-immune hydrops in utero they are more often observed in the period from 29 to 32 weeks of gestational age. The reasons for a fetus to be prone to develop arrhythmias in the later stages of pregnancy are unknown. However, they may be due to changes velocity of impulse propagation along the aberrant pathways of the cardiac conducting system. Nevertheless, it is this factor that further leads to the accumulation of fluid in serous cavities and tissues, the most common form of arrhythmia in the fetus being supraventricular tachycardia. The article describes a clinical case of non-immune hydrops in a preterm infant with supraventricular paroxysmal tachycardia is presented. The close relationship between rhythm disturbance in the fetus as well as the emergency and further increasing of non-immune hydrops is noted. The symptoms of this pathology are discussed, the data of functional and laboratory diagnostic methods. Attention is paid to parameters of mechanical ventilation of the lungs; scheme of cardiotonic support in the treatment of this case of non-immune hydrops is given.

Pediatrician (St. Petersburg). 2019;10(2):121-128
Algorithm of hearing monitoring of children with congenital heart disease
Garbaruk E.S., Nnomzoo A.A., Pavlov P.V., Gorkina O.C.

Congenital heart disease (CHD) is one of the most common types of birth defect. Often newborn hearing screening is not performed for infants with congenital heart disease because of serious health problems at birth. Hearing loss in children with CHD may have late onset due to different stages of CHD treatment. The monitoring of the auditory function is required for early identification of hearing loss in children with CHD, however algorithm of follow-up assessment is not currently defined.

Objective – estimation of prevalence, types and time of hearing loss onset in children with congenital heart disease and development a follow-up assessment for CHD children.

Results. 148 children with congenital heart disease have been evaluated with auditory brainstem response testing, otoacoustic emissions, impedancemetry, behavioral hearing tests. The patients ranged in age from 7 days to 6 years. 55 children had hearing loss: 28 children with conductive hearing loss and 27 children with sensorineural hearing loss, 2 of them with auditory neuropathy. 6 children had late onset sensorineural hearing loss. The age of delayed hearing loss identification ranged from 4 months to 5 years.

Conclusion. Children with CHD require long-term monitoring of the auditory function; an algorithm of follow-up assessment for children with congenital heart disease is proposed. Audiological assessment in children with CHD should include auditory brainstem response registration for auditory neuropathy identification.

Pediatrician (St. Petersburg). 2019;10(2):129-135
Myocardial bridge and coronary artery fistulas in a patient with angina
Kholkina A.A., Kovalev Y.R., Isakov V.A., Gonchar N.O.

Cardiovascular diseases (CVDs) are the leading cause of mortality among the population. At the core of the progression of the coronary heart disease is the atherosclerosis of the coronary arteries, which is found in majority of patients suffering from angina and in patients with myocardial infarction. However, in some cases, coronary angiography reveals, that patients with the mentioned clinical manifestations have their coronary arteries unchanged. This is treated as syndrome X or microvascular angina. Along with that, development or aggravation of the coronary heart disease may be based on the congenital peculiarities in the coronary arteries location and structure, such as muscular bridges and fistulas of the coronary artery. This is confirmed by a number of studies, which indicate the role of the above mentioned pathologies in the occurrence of angina and myocardial infarction. Nevertheless, there is also the opposite view, which is supported by a number of specialists. According to them, the presence of the mentioned peculiarities in the structure of the coronary channel is deemed as the patient-specific norm. Hence, the issue of the surgical treatment of the patients with the aforementioned coronary arteries anomalies remains controversial. The clinical case report of the patient with the symptoms of angina pectoris, in which the coronary angiography did not reveal the stenosis of the coronaries arteries, but located the myocardial bridge and the coronary fistula. The role of the congenital coronary vessels pathology in the angina pectoris is analyzed. The diagnosis guidelines and the tactics of the conservative and surgical treatment of patients with the above mentioned syndromes are discussed.

Pediatrician (St. Petersburg). 2019;10(2):137-141
My way to surgery began in childhood... Autobiographic essay
Romanchishen A.F.

The autobiographical essay presents the history of the formation of the head of the department of hospital surgery with courses of traumatology and military surgery Anatoly Philippovich Romanchishen as a person, a surgeon, a high-class specialist in endocrine surgery. The author recalled his school years and his teachers who guided his life path, how it was decided to enter the Leningrad Pediatric Medical Institute. He was lucky to study the specialty under the guidance of such great teachers as A.A. Rusanov, F.H. Kutushev, L.N. Kamardin. The author was linked with the pediatric institute (academy, university) for 50 years and is grateful to it for his wide education, broad professional horizons, which covers the diagnostic of diseases, treatment of both children and adults. Since 1991 and today, Anatoly Philippovich heads the department of hospital surgery. Over the years of his leadership, a lot has been done, including establishing international relations with leading endocrine surgeons of many countries to exchange experience. Russian Endocrine Symposiums with international participation were held in 2003 and 2014 in St. Petersburg under the guidance of Anatoly Philippovich with the help of staff of the department. As a doctor, teacher, researcher, he performs an enormous amount of work, has hundreds of publications in domestic and foreign journals. He is an author of manuals, textbooks, and monographs on surgery of the endocrine system organs. Professor Anatoly Philippovich Romanchishen constantly works at the forefront of science and practice, charging everyone with his energy. He is a worthy surgeon of the Russian surgical school who teaches students and young professionals.

Pediatrician (St. Petersburg). 2019;10(2):145-150

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