Vol 10, No 2 (2019)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.