[Clinical case of congenital cleft palate in 22q11.2 deletion syndrome]. / Vrozhdennaia rasshchelina neba pri sindrome deletsii 22g11.2. Klinicheskii sluchai.

The paper presents a clinical case of congenital cleft palate as a manifestation of 22q11.2 deletion syndrome accompanied by other systemic disorders having direct impact on functional indicators and perioperative period during cleft surgery. Specific for 22q11.2 deletion syndrome endocrine disorders affect the facial development. Multidisciplinary approach contributes to the early optimal treatment outcome and prevents further postoperative disturbances in maxillofacial development.

[The evaluation of the effectiveness of electrophoresis in the form of Polymineral wipes on the basis of iodine- bromine natural water in the young children suffering from the consequences of perinatal lesions in the central nervous system].

UNLABELLED: The background: the increased frequency of serious consequences of perinatal lesions in the central nervous system of the young children dictates the necessity to develop the effective methods of physiotherapy for the early-stage rehabilitation of such patients on the basis of an objective assessment of the adaptive reserves of the organism. MATERIAL AND METHODS: The present study involved 53 children at the age from 1 to 12 months presenting with the consequences of perinatal lesions to the central nervous system. Thirty of the children were treated with the use of electrophoresis in the form of Polymineral wipes on the basis of natural iodine-bromine water. The group of comparison was comprised of 23 children treated without physiotherapy. We estimated the clinical effectiveness and the level of adaptive resources based on the results of blood count measurements (the type of non-specific adaptive reaction and the reactivity level); in addition, the electro-acupuncture test was carried out with the use of the hardware-software complex for bioresonance (MOR) therapy. RESULTS: The clinical effectiveness of an electrophoresis in the form of Polymineral wipes on the basis of natural iodine-bromine water used for the treatment of the newborn infants with the consequences of perinatal lesions to the central nervous system amounted to 93.3%. The rearrangement of the adaptive reactions was apparent as the increase in the proportion of the antistress reactions from 63.3% to 86.7%, the decrease in the frequency of the reactivation reaction by a factor of 3.7, and the reduction of the reactivity level by a factor of 3.0. The repeated study with the use of the MORA-test revealed normalization of the altered indicators in all the children with the initially reduced or enhanced values of these indicators. In the comparison group, dynamics of clinical symptoms was less apparent, and the assessment of the adaptative resources revealed their decrease in 78.3% of the cases. CONCLUSION: The present study confirmed the beneficial effect of electrophoresis in the form of Polymineral wipes on the basis of natural iodine-bromine natural water on the dynamics of clinical symptoms and adaptive reserves in the infants suffering from the consequences of perinatal lesions to the central nervous system. The determination of the type of the nonspecific adaptive reaction and the level of reactivity in combination with the MORA-test can be a method for the assessment of the effectiveness and adequacy of physiotherapeutic modalities for the young children.

[Palivizumab: four seasons in Russia].

In 2010, the Russian Federation (RF) registered palivizumab--innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization.

[The role of enteral oxygen-therapy in the correction of functional disturbances in the autonomic nervous system of the children presenting with chronic diseases of the respiratory organs].

BACKGROUND: Vegetative dysfunction is observed in 60-90% of the children presenting with chronic respiratory diseases. Its timely identification and correction increases the effectiveness of the combined rehabilitative treatment of such patients. MATERIAL AND METHODS: The vegetative regulation was dynamically evaluated by the analysis of the heart rate variability in 95 patients presenting with bronchial asthma and chronic nonspecific lung diseases. The age of the patients varied from 7 to 16 years. Sixty children received the combined treatment including enteral oxygen therapy, the control group was comprised of 35 patients. RESULTS: The enteral oxygen therapy eliminated the vegetative disbalance in 80.0% of the children with bronchial asthma and in 88,0% of those suffering from chronic nonspecific lung diseases. The results of the spectral analysis of heart rate variability indicate that the total spectrum power (TSP) was significantly increased in the patients of the study group. This effect was accompanied by the restructuring of wave frequency ranges pointing out to the enhancement of the activity of the sympathetic-adrenal system. The integral index of adaptive reserves (AR) increased from 2.0±0,6 to 4.7±0,6 points (p<0.001) under the influence of enteral oxygen therapy; this parameter remained practically unaltered in the patients of the control group where it varied from 1.7±0,8 to 2.0±0,9 points (p>0.05). More manifest pronounced positive dynamics was observed in the patients presenting with initial vagotonia and the severe or moderate form of the disease. CONCLUSION: The present study has demonstrated the favourable influence of enteral oxygen therapy on the vegetative regulation mechanisms and the adaptive potential of the organism. Analysis of the heart rate variability may be a screening method for the evaluation of the effectiveness of the proposed therapeutic modality.

[Efficacy of levofloxacin (Tavanic) in the treatment of children with chronic pulmonary diseases]. / Effektivnost' levofloksatsina (Tavanik) pri khronicheskikh zabolevaniiakh legkikh u detei.

The efficacy of the fluoroquinolone levofloxacin in the treatment of 35 children with bronchopulmonary disease exacerbation was practically the same as that of amoxycillin/clavulanate, cefotaxime or ceftriaxone. The clinical and bacteriological results were favourable. The eradication of the pathogens responsible for the bronchopulmonary inflammations in 86% of the patients was stated. There is no doubt that fluoroquinolones should not be widely used in pediatrics. They should be considered as reserve drugs for the treatment of severe cases when the routine agents fail. Their use is justified when the situation is risky and the data on the pathogen susceptibility to the drugs are available. Still, levofloxacin is the most safe fluoroquinolone with low hepatotoxicity and lower effect on the central nervous system. The episodes of its negative cardiovascular action are less frequent. Moreover, the most frequent side effects of fluoroquinolones such as nausea, diarrhea or vomiting are less frequent with the use of levofloxacin. No signs of arthropathy in the patients treated with levofloxacin were observed in our trial.

[Our method of functional rheography of eye]. / Nasha metodika funktsional'noi reografii glaza.

The technology of rheoophthalmogram obtaining and processing is modified by creating an automated rheographic complex (ARGC). The test for assessing the function of ocular vessels includes recording of the background rheoophthalmogram, local 10-min hypothermal exposure (+10 +/- 2 degrees C), and repeated recording of rheoophthalmogram 10 and 20 min after hypothermal exposure. The test helps determine the type of neurovascular reaction and the index of ocular vessel elasticity. The studies were carried out in 1050 subjects, 133 of them without ocular disease and 917 patients with myopia, initial open-angle glaucoma, retinal vein thrombosis, central serous chorioretinopathy, central atherosclerotic chorioretinopathy, diabetic retinopathy, toxic degeneration of the optic nerve, and contusions of the eye.

[Treatment of mild and moderate hypertension with enalapril (multicenter study of enap and enap N in Ukraine)]. / Lechenie miagkoi i umerennoi arterial'noi gipertonii énalaprilom (mnogotsentrovoe issledovanie énapa i énapa-N na Ukraine).

AIM: Assessment of efficiency and safety of enalapril (enap) and its combination with hydrochlorotiaside (enap-N). MATERIALS AND METHODS: 127 patients with mild and moderate blood hypertension entered an open non-comparative multicenter trial. 60 of them received enap (group 1), 67--enap N (group 2). Group 1 patients were given enap for 2 weeks in a dose 10 mg/day. If this dose was not adequate to normalize blood pressure, it was raised to 20-40 mg/day. Patients of group 2 received enap-N one tablet a day for 3 weeks. If the pressure persisted higher than 140/90 mm Hg, the treatment was continued for 3 weeks more in a dose of 2 tablets a day. RESULTS: Blood pressure lowered under 140/90 mm Hg in 40 patients of group 1 (66.7%). Systolic pressure dropped by 10 mm Hg minimum and diastolic by 5 mm minimum in 18 group 1 patients (30%). Enap-N reduced blood pressure under 140-90 mm Hg in 44 of 67 patients (65.7%). Systolic and diastolic pressure dropped, respectively, in 23(34.3%) patients. CONCLUSION: Enap and enap-N tablets were found highly effective and well tolerated. Side effects were caused by lowering of blood pressure.

[Practical games as one of the forms for optimizing the academic process in physician postgraduate training]. / Delovye igry kak odna iz form optimizatsii uchebnogo protsessa v poslediplomnoi podgotovke vrachei.

Described in the article is one of the forms of optimization of the instructional process in the postgraduation physician training--"business-like games". Highly skilled, competent position of the teacher who conducts a business-like game secures an active participation in learning of students, helps in opening the mind, broadening the outlook on the problem under consideration, gives much incentive to further independent work on the discussed issues.

[A retrospective clinico-morphologic study of insulinoma]. / Retrospektivnoe kliniko-morfologicheskoe issledovanie insulinom.

Surgical material from 51 patients operated on for insulinoma is studied. Three histological variants of insulinoma are distinguished: adenoma-like, insular-ductal and carcinoid-like. The structure of Langerhans islands outside the tumour is described and the diagnostic criteria of insuloma-microadenoma are presented. Multiple nests of the endocrine cells are regarded either as a manifestation of the multifocal island pathology or as a marker of non-diagnosed insuloma. There is a need of distinguishing between the terms related to the nosology and histogenesis of endocrine pancreatic tumours.

[Radiologic localization of pancreatic insulinoma]. / Luchevye metody vyiavleniia lokalizatsii insulinom podzheludochnoi zhelezy.

Thirty-one patients with insulinoma of the pancreas verified during operation were examined. The localization of the tumor was detected by ultrasonic examination in 9.7%, by X-ray computed tomography in 38.9%, by angiographic study in 32.1%, and by endoscopic retrograde pancreatocholangiography in 11.1% of cases. Complex use of the methods allowed the localization of the tumor to be determined in 48.4% of cases. The smallest diameter of insulinoma diagnosed during ultrasonic examination and endoscopic retrograde pancreatocholangiography was 1.5 cm, X-ray computed tomography and angiography demonstrated tumors measuring 1.0 cm in diameter. The diagnostic efficacy of the methods increases when the tumor is located in the body and tail of the pancreas. The examination scheme for patients with suspected insulinoma must include ultrasonic study and X-ray computed tomography; when their results are negative angiography must be resorted to.

[The role of x-ray computed tomography in the topical diagnosis of insulinomas of the pancreatic gland]. / Rol' rentgenovskoi comp'iuternoi tomografii v topicheskoi diagnostike insulinom podzheludochnoi zhelezy.

Pancreatic insulinomas were intraoperatively revealed in 15 patients. X-ray computed tomography (CAT) revealed the tumor in only 6 (40 %) patients. The mean size of detectable insulinomas was 2.4 cm, that of undetectable ones 1.2 cm. X-ray CAT diagnosis is facilitated in case of a superficial localization of the tumor on the body or tail of the gland .

[The role of glucocorticoid receptors and HLA antigens in the pathogenesis of Cushing's syndrome]. / O roli gliukokortikoidnykh retseptorov i antigenov HLA-sistemy v patogeneze bolezni Itsenko-Kushinga.

Lymphocytic levels of glucocorticoid receptors were evaluated in 114 patients suffering from Icenko-Cushing's syndrome. Incidence of HLA antigens was determined in 94 of them. A significant rise of A10 and B27 antigen incidence compared to that in normal subjects allows these antigens to be considered genetic markers of Icenko-Cushing's syndrome. The levels of glucocorticoid receptors in lymphocytes of the patients are lower than in normal subjects both in the active stage of the disease and following bilateral total adrenalectomy. The patients carrying B27 antigen had lymphocytic receptor concentrations under the levels of such in patients free of the antigen carriage. Antigen B27 seems to be a cause of lower levels of glucocorticoid receptors in blood lymphocytes.

[Glucocorticoid receptors of the blood lymphocytes in Itsenko-Cushing disease]. / Gliukokortikoidnye retseptory limfotsitov krovi pri bolezni Itsenko-Kushinga.

45 patients with Itsenko-Cushing disease received combined therapy (unilateral adrenalectomy with subsequent therapy with mitotane, bromocriptine or their combination). The level of cortisol, the amount of blood lymphocytes and glucocorticoid receptors (GR) were determined over time, before adrenalectomy and on the 7th-10th day after it. Ten healthy donors were entered into the control group. A sharp decrease in the GR amount in blood lymphocytes was detected at the active stage of Itsenko-Cushing disease. After unilateral adrenalectomy the amount rose, in recurrence decreased. A significant increase in the GR amount was noted in remission. Therapeutic results were better in the patients with an increase in the GR amount in blood lymphocytes in the early postoperative period. The determination of GR in blood lymphocytes permits more objective assessment of therapeutic results and prognosis of a course of disease.