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Vol 4, No 4 (2013)

Articles
The role and place of modern educational technologies in medical school
Levanovitch V.V., Suslova G.A., Gostimsky A.V.
Abstract
This article reviews aspects of the organization of the educational process in medical school using advanced simulation technologies. It contains a brief historical background of the origin and development of simulation technologies.The necessity of introducing simulation in graduate and post-graduate training of students and doctors is justified. The problems of modern medical education and methods of their solutions with the phantom simulation classes are described.The aspects of the optimal organization of phantom simulation classes and learning process, based on the experience of the Center of Modern Educational Technologies in Saint-Peterburg State Pediatric Medical University are addressed.It presents modern concepts and methods of new educational technologies in the educational process.
Pediatrician (St. Petersburg). 2013;4(4):3-7
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Laser osteoperforation for the treatment of acute osteomyelitis. 10 years experience
Krochek I.V., Sergyiko S.V., Privalov V.A.
Abstract
The results of treatment of acute hematogenous osteomyeLitis (CSO) were analyzed into two groups. For general group (142 children) was used laser osteoperforation with diode lasers with wave length of 0.8, 1.64, 1.9 microns. In the comparison group (93 children) was performed the mechanical osteoperforation by electric drill. The Laser osteoperforation was performed into both walls of the medullary chanal in the affected metaepiphysis and the adjacent part of the bone shaft with the formation of 8 to 20 holes. For ekstramedullar phase additionly was used small incisions for opening purulent streaks. The proposed method let to reduce frequency of complications for children with CSOs up 16.1 % to 7.0 %. The stable remission was observed for 96.3 % of children after usage laser technology, after traditional surgery it was observed in 91.4 %. The transition to the chronic phase of the disease in the general group was marked two times less than after traditional operations. The advantages of the method of Laser osteoperforation are fewer frequency of complications, faster recovery period, good tolerance and good functional results.
Pediatrician (St. Petersburg). 2013;4(4):8-17
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Specials clinical symptoms the local and general forms of surgical infection of soft tissues on the children’s age
Barhatova N.A.
Abstract
In article include results of analyses specials clinical and laboratories manifestations the local and general forms of infection on the soft tissues at the children in different age. Were revealed the most significant factors of risk development general form of infection in the children´s age. Also were determined clinical specials of systemic inflammatory response syndrome in dependent of the character inflammatory reaction of soft tissues, time of hospitalization and time of surgical intervention. Were revealed the most typical combinations symptoms of systemic inflammatory response syndrome on the child in different age. It´s allow improve early clinical diagnostic of sepsis on the child and shorten time of start equivalent therapy of general forms of infection.
Pediatrician (St. Petersburg). 2013;4(4):18-22
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The analysis of sensitivity of Escherichia clinical strains, isolated from ill children to antibiotics, antiseptics
Paliy G.K., Nazarchuk O.A., Paliy D.V., Nazarchuk S.A., Gonchar O.O., Bereza B.N., Kordon Y.V., Zaderey N.V., Trofimenko Y.Y.
Abstract
In the research the results of the study of sensitivity of Escherichia clinical strains (E. coli n 110) to antibiotics, antiseptics are presented. The Escherichia were isolated from ill children. According to the data of the research, we found high sensitivity of E. coli to combined penicillin antibiotics (amoxicillin/clavulanate, piperacyllin/tazobactam), cefalosporines (ceftriaxone, cefepime); meropenem; fluoroquilones (gatifloxacine, levofloxacine). The Escherichia had low sensitivity to amoxicillin/sulbactam, streptomycine, kanamycine, cefazoline, cefamandol, cefuroxime. High antimicrobial activity of decasan, miramistin with superiority of decasan according to E. coli, was proven.
Pediatrician (St. Petersburg). 2013;4(4):23-27
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The concept of placental insuffisiency
Melnikova V.P., Aksenov O.A., Boronina T.A., Nasyrov R.A.
Abstract
The authors propose classification of placental insufficiency, based on the fact that the placenta, as a provisory organ, has an exclusive ability to develop compensatory processes to be present during the whole pregnancy. The authors established the role of placental barriers, in particular the syncytiocapillary membranes, in developing placental insufficiency. The Immunohistochemical methods allow us to detect the presence of antigens and different classes of immunoglobulins on the membranes. Dystrophic and necrobiotic changes in the syncytiocapillary membranes increase the permeability of the placental barrier and contribute to the penetration of specific antibodies and pathogenic antigens to foetal organs. The risk of intrauterine infections of the foetus increases sharply if the woman has suffered a respiratory infection during pregnancy.
Pediatrician (St. Petersburg). 2013;4(4):28-32
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Nonalcoholic fatty liver disease in childhood
Kornienko E.A., Vlasov N.N., Chistyakova A.V.
Abstract
In recent years the non-alcoholic fatty liver disease (NAFLD) has become one of the most common liver disease in children and adolescents. This phenomenon is explained by the sharp rise in obesity among the population worldwide, including children, and increased co-morbidities associated with obesity. There is sufficient evidence that age and gender are important determinants of the risk for the development of fatty liver disease in children. There is reason to believe that an important role in the pathogenesis of NAFLD in children may play a hormonal profile in adolescents, family history, the state of insulin sensitivity and the level of adipocytokines. However, these studies are still limited to a small number of observations. Liver biopsy remains the standard for the diagnosis and staging of NAFLD. At the same time, children in some cases observed morphological pattern, which is not typical for adults. There is a need for the development of alternative non-invasive methods of diagnosis of NAFLD and imaging of hepatic steatosis . Clinically, the disease occurs in children is diverse and can be malignant, but the natural history and prognosis are still to be determined. Also the necessary lifestyle changes in NAFLD in children are not determined reliably, and a multi-center randomized clinical trials on the drug therapy are not compleated.
Pediatrician (St. Petersburg). 2013;4(4):33-43
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Autoimmune gastritis in children with autoimmune diseases
Zvyagin A.A.
Abstract
The results of inspection of 70 children for autoimmune gastritis are represented. Children with blood serum antibodies to stomach parietal cells were selected for more profound investigation. It was shown, that autoimmune gastritis in the childhood is one of the components of multiorgan autoimmune pathology in 0-33 % of patients and is characterized by minimum clinical, morphological and endoscopic data, combination with Helicobacter pylori.
Pediatrician (St. Petersburg). 2013;4(4):44-47
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New diagnosis in pediatric practice: autoimmune pancreatitis
Yagupova A.A., Kornienko E.A., Loboda T.B., Fadina S.A.
Abstract
Autoimmune pancreatitis (AP) is not well-known disorder, it hasn’t been described in children yet. Current data about epidemiology, mechanisms of development, pathological and clinical signs of AP are descripted in the article, including international criterions of its diagnosis. Among 57 children with confirmed diagnosis of chronic pancreatitis 4 correspond to criteria of AP. 2 from 4 children had primary AP, the rest 2 - secondary AP, associated with inflammatory bowel disease. Primary AP had prominent clinical manifestation and immunological markers of AP: high level of IgG4, anti-lactoferrin antibodies, prednisolone treatment reduced flare. Prolong remission support became possible only in case of using azathioprine and pancreatic enzyme Creon.
Pediatrician (St. Petersburg). 2013;4(4):48-55
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Diagnostic features of traumatic brain injury in childhood
Chukhlovina M.L.
Abstract
The review article concerns some issues of improved diagnostics and main neuro-radiological criteria of traumatic brain injuries in childhood. Special attention is given to anatomic and physiological features of brain in children, aiming for proper evaluation of severity in traumatic brain injury. We provide a summary of data concerning modern echniques of brain trauma diagnostics, and its consequences in children. Utility of neurovisualization, electrophysiological techniques, biochemical approaches for detecting the brain damage biomarkers, demonstrated in order to determine severity of brain trauma in childhood.
Pediatrician (St. Petersburg). 2013;4(4):56-60
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Functional endotelian condition of woman with metabolic syndrome associated with autoimmune thyroiditis
Popov V.V., Priima N.F., Kanavets N.S.
Abstract
The purpose of the research was a complex clinical-instrumental examination of structural and functional artery condition of patients with metabolic syndrome, autoimmune thyroiditis -euthyreose and subclinical hypotheriosis at the background of substitution therapy. Three groups were made during the research: 1 group (23 women) with metabolic syndrome without pathology of thyroid gland, 2 group (14 people) with autoimmune thyroiditis - euthyreose, 3 group (14 woman) with subclinical hypotheriosis. The instrumental examination included assessment of endothelial function and artery hardness, intima-media complex by ultrasound method. The results showed that first two groups of patients ware characterized by the increase of artery hardness with endothelium dysfunction, having normal indices of endothelium-independent vasodilatation (EIVD). The prescription of substitution therapy led to the improvement of the indices of EDVD and to the decrease of the progressing of vascular hardness.
Pediatrician (St. Petersburg). 2013;4(4):61-64
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Regional Features of Saint-Petersburg Schoolchildren Level of Health
Zemlyanoy D.A., L’vov S.N.
Abstract
The article presents the results of the study of three grades schoolchildren health level. The authors have revealed that the percentage of children of the 1st health group does not exceed 13 %. It has been determined that educational process intensification does not take into account the features of modern schoolchildren health status. Reliable growth of children of the 2nd and 3rd health groups (in dynamics of health indicators over the training period) including ophthalmic, musculoskeletal and nervous systems disorders has been detected. According to the analysis of the database, coming generation health protection is one of priority directions among educational and medical institutions activities.
Pediatrician (St. Petersburg). 2013;4(4):65-68
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Surgical treatment of diffuse toxic goiter in children. A review of the literature
Gostimsky A.V., Peredereev S.S.
Abstract
Diffuse toxic goiter (DTG) is an autoimmune disease, to which there is a genetic predisposition. In children DTG is less common than in adults. Manifestation of graves‘ disease in childhood has a number of peculiarities. During the DTG in children is usually manifested thyrotoxicosis, requiring long-term treatment to achieve euthyroid, tendency to relapse and more frequently than adults, accompanied by ophthalmopathy and the large size of goiter. Diagnosis of graves‘ disease is based on the clinical picture of thyrotoxicosis, the existence of which is confirmed by the level of thyroid hormones and TSH in the blood. There are three types of treatment of patients DTG: medical, radioactive iodine therapy and surgery. There is no а single glance at the choice of the volume of operations in children.
Pediatrician (St. Petersburg). 2013;4(4):69-76
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Need born prematurely newborn with transient hypothyroxiemia in treatment preparation hormone of the thyroid gland?
Skorodok I.L., Khesina T.E., Afanasieva M.Y., Mullakhmetova Z.I., Gegkieva A.B.
Abstract
Transient hypothyroxinemia born prematurely (TGN) consider the most widespread variant of the condition of the thyroid gland beside prematurely been born infants. In connection with negative influence hypothyroxinemia on PMR born prematurely infants, many researchers are biased to purpose treatment. TGN often matches with different disease, reduction of the neurological development, and breach visual and speech abilities children (particularly, deeply born prematurely). Not wholly understandable, is TGN effect to somatic pathology, bring about nut-speech breaches or - an apyfenomen born prematurely newborn. The United opinion about need of the purpose therapy all unripe newborn while is absent, necessary further controlled studies.
Pediatrician (St. Petersburg). 2013;4(4):77-83
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Role and place of DNA diagnostics in infection clinics
Tretjak A.T., Vostokova L.P., Chukhlovin A.B.
Abstract
The review article is addressed to general pediatricians. It considers common approaches, technical principles and applications of DNA polymerase chain reaction (PCR) usage in clinical microbiology. Comparative significance of immunological (antigen-based) and PCR/nucleic acid based diagnostics for detection of various viral, protozoan and bacterial infections is discussed. PCR applications are considered for diagnostics of different infectious diseases, e. g., viral hepatitis, sexually transmitted diseases, some zoonotic infections.
Pediatrician (St. Petersburg). 2013;4(4):84-92
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The case of recurrent abdominal pain in a girl
Pechkurov D.V., Voronina E.N., Allenova Y.E.
Abstract
Abdominal pain is often occur in practice of the pediatrician and gastroenterologist. Recurrent, intense, intractable abdominal pain for several years should be a symptom of anxiety. In this article, we present a case of long-term recurrent abdominal pain in a girl, accompanied by neurological symptoms, as a symptom of a rare disease - acute intermittent porphyria. Acute intermittent porphyria - inherited by dominant type disease characterized by lesions of the peripheral and central nervous system, the most frequent symptom of which is pain in the abdomen. Abdominal pain with this disease are recurrent paroxysmal and may be localized in different parts of the stomach, leading to the setting false diagnoses, multiple hospitalizations and unjustified surgical procedures.
Pediatrician (St. Petersburg). 2013;4(4):93-95
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The history of recurrent laryngeal nerve research
Vabalayte K.V., Romanchishen A.P.
Abstract
A. Burns described thyroid cancer in 1811. History of surgical treatment of thyroid cancer is presented in the article. N. I. Pirogov was the first in the world who performed thyroid resection under general anesthesia in 1847. A. A. Bobrov was the first who started to perform thyroid operations under recurrent nerves visual control since 1893. V. I. Razumovsky was the first who described anaplastic and medullary thyroid carcinomas in 1903. Tactics in thyroid cancer treatment in different country are presented.
Pediatrician (St. Petersburg). 2013;4(4):96-102
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Urgent surgery for thyroid diseases and complications of early postoperative period
Romanchishen A.P., Romanchishen P.A., Karpatsky I.V., Vabalayte K.V.
Abstract
The analysis of surgical treatment results of 27.253 patients with various diseases of thyroid cancer is performed in St. Petersburg, Endocrine Surgery and Oncology Center. A classification of urgent surgery for complications of disease (277/1.0 %) or postoperative states that required reinterventions (246/0.9 %) in period from 1973 to 2012 is developed. Altogether immediate and urgent operations are performed in 523 (1.9 %) patients. Various thyroid diseases (cervical-retrosternal goiter, anaplastic carcinoma, strumitis, thyroiditis) or the progression of inflammation of the neck and / or mediastinum became a cause of neck compression and subsequently required urgent interventions in 277 (1.0 %) cases. Complications of early postoperative period (mobility disorders of the vocal cords, postoperative bleeding, and rupture of the trachea) served as an occasion to emergency operations in 246 (0.9 %) cases. The measures of prevention, prompt diagnosis and appropriate treatment of patients with life-threatening complications in thyroid surgery are examined.
Pediatrician (St. Petersburg). 2013;4(4):103-115
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Features of psychological work with teenagers of group of risk on drug addiction emergenced
Vindorf S.A.
Abstract
Studying of ways of identification of “group of risk” and prevention of formation of addiсtive behavior at teenagers by means of psychopreventive and psychocorrectional actions in connection with growth of number of minors with addiсtive behavior. Psychological work with group of risk can be divided into some stages: diagnostic, psychopreventive, psychocorrectional, finishing
Pediatrician (St. Petersburg). 2013;4(4):116-119
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