[Tuberculosis of the sternum in children].

Operations for tuberculosis and BCG lesion of the sternum were performed on 70 children of preschool age. Clinico-epidemiological features, results of complex X-ray investigation and complex treatment were analyzed. It was noted that in the recent years the number of children with the pathology in question became greater, the possibilities of standard roentgenography for the diagnosis are limited, computed tomography is of high diagnostic value as well as the efficiency of radical operations fulfilled against the background of combined antituberculous chemotherapy.

[Effectiveness of new diagnostic drug Diaskintest in children for tuberculosis diagnostic].

DST was ascertained to have a high sensitivity in virtually all patients with tuberculosis and a positive reaction was first noted in the infected. With stabilization and regression, the response to DST was much less pronounced than that in clinical and primary infection (that to the Mantoux test being more evident). DST showed its use as a marker of active tuberculosis not only in its local forms, but also in latent tuberculous infection. This makes it possible to apply DST when preventive treatment is performed. The agent may be used to monitor the progress of treatment. DST has a high specificity--healthy individuals had a negative response to DST while the Mantoux test was positive in many cases. The high specificity of DST was suggested by the fact that the persons vaccinated with (this caused BCG ostitis) had a negative reaction to DST while the Mantoux test was positive in all cases BCG-vaccinated BCG. The findings warrant the use of DST for the differential diagnosis of tuberculosis and BCG-associated complications and the possibility of differentiating postvaccinal and infection allergy in children and adolescents.

[Clinical trials of the new skin test Diaskintest for the diagnosis of tuberculosis].

A new reagent for a skin test given the name Diaskintest has been designed for the screening diagnosis of tuberculosis and preclinical and clinical trials conducted. Preclinical trials were carried out on 315 laboratory animals (guinea-pigs, albino mice). The reagent Diaskintest was ascertained to be nontoxic, to have no sensitizing properties, to be safe and specific, and to induce no positive reactions in BCG-vaccinated animals and healthy guinea-pigs. Its specific activity was comparable with that of the national reference--purified tuberculin PPD-L-2. With progression of tuberculous lesions, the guinea-pigs showed higher responses to Diaskintest dilution and the BCG-vaccinated animals lacked responses to Diaskintest with increased delayed type hypersensitivity. The clinical trial was permitted by the Federal Service for Surveillance in Health Care and Social Development of the Russian Federation. Clinical trials were conducted in 150 persons. The safety, specificity, sensitivity of Diaskintest were first examined in the clinical studies and its action was compared with the results of tuberculin skin test (Mantoux test) with 2 TE of PPD L-2. Diaskintest was ascertained to be highly sensitive when given in a dose of 0.2 microg in 0.1 ml. In patients with active tuberculosis and new cases of Mycobacterium tuberculosis infection, the agent induced a positive skin reaction (a papule of more than 10 mm) in 98-100% of cases (p < 0.05). The agent caused no reaction associated with BCG vaccination. The specificity of the test was 93-100% with 95% significance. The rate of overexuberant reactions (vesicular necrotic changes, lymphangitis, and lymphadenitis) was 4-14% with 95% significance. Tuberculosis patients with significant immunopathological disorders might have no skin sensitivity to Diaskintest, as to PPD L-2 (a negative test). The findings substantiate the use of Diaskintest for mass epidemiological surveys for the differential diagnosis of tuberculosis and BCG vaccination-associated complications. The agent may be also used to evaluate the activity of the process in patients with tuberculosis and the efficiency of treatment in combination with other methods and to make a differential diagnosis of tuberculosis.

[Suboccipital tuberculosis: the clinical and radiation and potentialities of current surgical treatment].

The clinical and radiological manifestations of suboccipital tuberculosis have been analyzed in 7 patients aged 7 to 35 years. A case of this condition accompanied by extensive vertebral destruction, abscesses, and basilar impression is described in a 7.5-year-old child. A radical stabilizing operation was successfully performed using the currently available technologies.

[Vertebral column growth in children after surgical correction of severe kyphosis in tuberculosis spondylitis].

The growth of the unit of vertebrae and intact vertebrae outside and within the instrumental fixation area was studied in children operated on for tuberculosis spondylitis complicated by severe kyphotic deformity. There was a considerable growth retardation of blocked vertebrae after radical spinal repair from the growth of intact vertebrae. Instrumental fixation of the vertebral column after its radical reconstruction causes no considerable retardation of the vertical growth of intact vertebral bodies; however, it leads to the advanced growth of their anterior versus posterior portions, which mediates a supplementary self-correction of residual kyphosis during growth. When compression implants are presented in the body for 2 years or more, most children develop degeneration of intervertebral risks within the fixation area.

[BCG ostitis in children: the epidemiological parameters of some regions of the Russian Federation].

The incidence of BCG ostitis was studied by the data of questionnaires sent from 36 areas of the Russian Federation (RF). Particular emphasis is laid on 15 northwestern RF regions where an indepth study dealing with the 2000-2004 detection rates of postvaccination osseous complications was conducted. The mean incidence rate was 6.62 per 100,000 vaccinated persons with great data differences between the regions. The reasons for the detected differences and the perspectives of further studies of the epidemiological indices of the incidence of postvaccination osseous complications are analyzed.

[Osteoarticular tuberculosis of the bones and joints in children: the present situation and prognosis].

In 1990-2005, a total of 855 children aged 4 months to 17 years were operated on for tuberculous lesions of bones and joints in a specialized department for surgery of childhood osteoarticular tuberculosis, Saint Petersburg Research Institute of Phthisiological Care. Changes in the course of the disease, its structure, and epidemiological features are analyzed. The lines to determine the urgency of the problem of osteoarticular tuberculosis in children within the next few years are given.

[The specific features of surgical spinal stabilization in children with tuberculous spondylitis complicated by severe kyphosis].

Procedures for anterior spine fusion and posterior instrumental spinal fixation have been developed for the surgical treatment of childhood tuberculous spondylitis complicated by severe kyphotic deformity. The optimum method of the instrumental fixation is the use of multisupport constructions with the heterodirectional action of corrective efforts (in 15 children). Anterior osteoplastic stabilization of the vertebral column, by applying brace cortical grafts with saddle-shaped hollows on the tips of its ventral projection, was applied in 6 children. A significant and steady-state correction of kyphosis was achieved in all the cases; there were no complications of anterior spine fusion and posterior instrumental fixation.

[Prediction of orthopedic sequels of operated tuberculous ostitis in children].

Thirteen of 84 children with tuberculous ostitis of the proximal tibial portion were repeatedly operated on 1.5 to 12 years after radical reconstructive surgery due to developed orthopedic sequels. Deformities of the tibia were found to develop in the earliest period and tibial shortening formed significantly later. An association of the development of anatomic and functional disorders with the values obtained in the quantitative analysis of the baseline X-ray films of the diseased extremity. The findings permits one to consider it possible to significantly predict orthopedic sequels in children operated on for tuberculous ostitis and accordingly to plan repeated medical examinations.

[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.

[Surgical elimination of instability in congenital spinal deformations in children]. / Khirurgicheskoe ustranenie nestabil'nosti pri vrozhdennykh porokakh razvitiia posvonochnika u detei.

Variants of congenital mechanical and dynamic instability of the spine in children are described. Experiences with the treatment of malformations of the spine resulting in mechanical (30 cases) and dynamic (139 cases) instability are analyzed. In most cases different titanium implants were used for dorsal fixation (150 operations). The specific feature of most interventions was their being performed in the period of active growth of the children (more that 60% were from 6 months to 5 years of age). It was found that the instrumental and osteoplasty stabilization failed to substantially influence the development of the spine.

[Osteoarticular tuberculosis in children: data extrapolation of a specialized clinic to the situation in the Russian Federation]. / Kostno-sustavnoi tuberkulez u detei: ékstrapoliatsiia dannykh spetsializirovannoi kliniki na situatsiiu v Rossiiskoi Federatsii.

Analyzing the activities of the Surgery Department for Osteoarticular Tuberculosis (OAT), Saint Petersburg Research Institute of Phthisiopulmonology, in children in 1990-2002 suggests that there is no system for comprehensive registration of OAT and in most cases its treatment is performed without taking into account the current surgical requirements. New organizational, methodological, therapeutic approaches recommended to ascertain the true OAT situation in children and to improve the results of its diagnosis and treatment, are presented.

[BCG osteitis in children (algorithms of diagnosis and treatment)]. / BTsZh-ostity u detei (algoritmy diagnostiki i lechenia).

In 156 children with osseous complications due BCG vaccination, the clinical features of disease, radiation and laboratory changes were studied. An algorithm of diagnosis of BCG ostitis and a system of organizational measures whose implementation make it possible to objective the statistical registration of BGC ostitis in Russia are proposed.

[Instrumental correction of severe kyphosis in tuberculous spondylitis in young children (new technology)]. / Instrumental'naia korrektsiia grubykh kifozov pri tuberkuleznom spondilite u detei mladshego vozrasta (novye tekhnologii).

A new mode has been proposed to correct deformities in tuberculous spondylitis complicated by more than 50 degrees kyphotic deformity. The mode involves extended repair of the vertebral column, supplemented by the use of Luque-modified posterior multisupport hooked contractors. The mode ensures correction deformity to 47 degrees. The procedures of a surgical intervention are described.

[Spinal cord stepping electrostimulation as a method for recovery of locomotor activity in vertebrogenic myelopathies]. / Elektrostimuliatsiia spinnogo mozga s éffektom "shaganiia" kak metod vosstanovleniia lokomotornoi aktivnosti pri vertebrogennykh mielopatiiakh.

The paper summarizes accumulated data on the parameters effective in calling alternate leg stepping and the areas of application of spinal cord electrostimulation, as well as the results of its application to restore locomotor capacities (tetra- and bipedal walking) of paralyzed patients.

[Correction of kyphosis in tuberculous spondylitis in children]. / Korrektsiia kifoza pri tuberkuleznom spondilite u detei.

Various modifications of radical reparative surgery were made in 145 children with tuberculous spondylitis were comparatively analyzed. Greatest correction of kyphosis was achieved by combining anterior spinal repair with posterior plunged contractors, in additional resection of the apical vertebral arch in particular. There is a direct correlation between the degree of compression of the dural sac and the severity of neurological disorders. Anterior decompression of the spinal cord is an obligatory surgical component in tuberculous spondylitis, eliminates central stenosis of the spinal canal; however, it is insufficient to eliminate neurological disorders caused by myelic ischemia.

[Stepwise motor rehabilitation of children with neurologic complications of tuberculous spondylitis]. / Etapnaia dvigatel'naia reabilitatsiia detei s nevrologicheskimi oslozhneniiami tuberkuleznogo spondilita.

The proposed protocol for postoperative motor rehabilitation of children with tuberculous spondylitis complicated by severe neurological disorders is based on the procedures developed by the authors to induce spinal locomotor activity. The developed algorithm of motor rehabilitation of spinal patients involves separate restoration of gait components (rhythmic stereotypic walking (spinal locomotion), maintenance of a standing posture and voluntary control over the movements ensuring gait. The stages of motor rehabilitation were defined by taking into account these factors and a child's neurological status. The use of the algorithm in the treatment of 11 children with tuberculosis and 13 children with other spinal diseases resulted in the restoration of normal compensatory gait or in its formation in the vast majority of patients.