[Difficulties in diagnosing the chronic course of tick-borne encephalitis in children]. / Trudnosti diagnostiki khronicheskogo techeniya kleshchevogo entsefalita u detei.

Infections transmitted by ixodic ticks in childhood account for about 20%, and tick-borne encephalitis accounts for up to 25% of cases. A feature of the course of tick-borne encephalitis is unpredictability and the possibility of chronization in 1-3% of cases with late diagnosis and inadequate therapy. The article presents a clinical observation of the disease in a child whose chronically progressive course of amyotrophic form was diagnosed 1 year and 8 months after the onset of the disease. The presence of anamnestic data, features of clinical manifestations in the dynamics and typical neurovirualization picture of the disease, even with negative results of serological and molecular genetic studies of blood and cerebrospinal fluid, allowed to make a diagnosis, prescribe etio-pathogenetic therapy and thereby stabilize the patient's condition. The use of complex drugs in the treatment, such as Cytoflavin, allows to optimize the course of the disease.

[FIRES Syndrome in a Preschool Child]. / Sindrom FIRES u doshkol'nika.

Severe epileptic syndromes of childhood are an urgent problem for pediatric neurologists and neuroresuscitators. The article presents a clinical observation of FIRES syndrome in a pediatric patient, which is a form of severe drug-resistant epilepsy in children of preschool and school age, the development of which is caused by hyperthermia, probably associated with herpesvirus (human herpesvirus type 6) infection. The features of the progressive course and the difficulties of diagnostic search are reflected. An empirical approach to etiotropic therapy is described, since the disease manifested itself with respiratory manifestations and fever. The tactic of pathogenetic treatment is described, in which drugs of polyfunctional action, such as Cytoflavin, have a priority, many years of experience in the use of which allows the authors to recommend it as a starting intensive therapy.

[Structural epilepsy or herpes simplex encephalitis relapse: diagnostic problems]. / Strukturnaya epilepsiya ili retsidiv gerpeticheskogo entsefalita: diagnosticheskie trudnosti.

The article gives the clinical case of herpes simplex encephalitis relapse with the resistant seizures in a child. What we describe is a clinical approach towards the differential diagnostic of the seizures in structural epilepsy, which are resistant to anticonvulsants, or late herpes simplex encephalitis relapse. Good clinical perspective may be the indication of the intratecal synthesis of the IgG-specific antibodies to the herpes simplex type 1 and 2. Conducting etiotropic treatment with the appointment of acyclovir and pathogenetic therapy with the use of Cytoflavin contributed to the rapid and stable remission of epileptic seizures and regression of neurological deficit.

Quantitative Electroencephalography Indicators in Children with Acute Purulent Meningitis.

The aim of the present work was to assess the state of brain bioelectrical activity in children during the acute period of bacterial purulent meningitis, with quantitative mathematical analysis of the changes found. The studies included 31 children on days 1 and 6 from onset of illness: 16 children (8.9 ± 2.4 years) admitted to the Pediatric Scientific Clinical Center for Infectious Diseases with laboratory confirmation of diagnoses of purulent meningitis (due to Neisseria meningitidis) (n = 11) or Streptomyces pneumoniae (n = 2) or unidentified pathogen (n = 3)), along with 15 healthy children. Electroencephalogram (EEG) traces were recorded from all these children in the state of calm waking using a Neuron-Spectrum 4/VP 16-channel electroencephalograph. Clinical assessment of the EEG included analysis of background rhythms, zonal differences, and detection of pathological types of activity. Quantitative analysis consisted of the mean power (µV2) and amplitude (µV) of the α, θ, and δ rhythms, along with mean power ratios - α/θ and α/δ. Visual analysis of the EEG in 100% of children in the acute period of purulent meningitis showed diffuse slowing with detection of δ and θ waves. Focal changes in the form of sharp waves were seen in 18.8% of cases (three patients). No cases displayed periodic activity. Meningitis patients showed significant reductions in the α/δ (p = 0.001) and α/θ (p = 0.048) spectral ratios. ROC analysis showed that the α/θ value was <0.18 and the α/δ value was <0.02 (sensitivity 100% and specificity 80%, AUROC 0.9), which may be evidence of the likely development of cerebral edema. Thus, pediatric patients with acute purulent meningitis showed significant impairments to the normal α/θ and α/δ rhythm power ratios on the EEG, which is presumptively explained by suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.

[Clinical-etiological and MRI parallels of encephalitis in children]. / Kliniko-etiologicheskie i MRT paralleli entsefalitov u detei.

OBJECTIVE: Improving the diagnosis of encephalitis (EF) in children by establishing clinical, etiological and MRI parallels. MATERIAL AND METHODS: 364 children aged from 1 month to 17 years with EF were examined. MRI of the brain and spinal cord, blood and CSF examination for herpes viruses type 1-6 (HHV), enteroviruses (EV), tick-borne encephalitis viruses (TBEV), Borrelia burgdorferi (BB), varicella zoster (VVZ), herpes simplex (HSV1) and Epstein-Barr (EBV) were performed. RESULTS: The etiological structure was dominated by HHV types 1-6, tick-borne infections (19%), EV (14.6%), and other agents (6%). Clinical and topical variants of EF: leukoencephalitis (leukoePH) - 68.4%, polyoencephalitis (polioePH) - 22.8% and panencephalitis (panePH) - 8.8%. LEUKOEPH was more often caused by VVZ, EBV and BB, foci in the white matter of the large hemispheres, sensitive, cerebellar and pyramidal symptoms, acute course followed by complete recovery (65.8%), the risk of exacerbations and progression with the development of multiple sclerosis in 6% were observed in 80.7%. POLIO in 71.1% were caused by TBEV or EV, lesions were located in the thalamus, basal ganglia, cortex, manifested by deep depression of consciousness, epilepsy, central paralysis and speech disorders, in 83.1% there was a chronic course with the development of brain atrophy. PanEF was caused by cytomegalovirus in more than 1/2 of cases, with subtotal-total white matter damage, in 1/3 of cases - with the involvement of other structures, there was a chronic course with polymorphism of neurological symptoms, rare complete recovery (15.6%). The cerebellar form of EF in 88.7% was associated with VZV, subcortical and stem - with TBEV and EV, cortical and limbic - with HSV-1 and 2 and HHV-6. The outcomes of EF depend both on the timeliness of etiological and neuroimaging diagnostics, and on the adequacy of early therapy already with EF, including the use of acyclovir in combination with recombinant interferons alpha-2-ß with antioxidants, and the immediate appointment of Cytoflavin infusions upon admission to the hospital. CONCLUSIONS: Clinical and topical variants and forms of EF in children are associated with etiology, have different rates of complications, the nature of the course and outcomes, the knowledge of which makes it possible to optimize the diagnostic process.

[Problems of differential diagnosis of acute symptomatic infectious seizures and epilepsy in children]. / Problemy differentsial'noi diagnostiki simptomaticheskikh pristupov pri ostroi infektsii i epilepsii u detei.

Viral encephalitis, its complications and the newly diagnosed epilepsy in children require a complex approach to the differential diagnosis using laboratory and instrumental examinations. Possibilities of MRI in the differential diagnosis of seizures in children and in detection of ischemic-hypoxic and metabolic disorders in the suspected epileptic focus are demonstrated in the clinical observation.

[Clinical features of inflammatory bowel disease (ulcerative colitis and Crohn's disease) in geriatric practice in Saint Petersburg.]

Objective - to identify the clinical features of inflammatory bowel disease (IBD) in elderly and senile patients in St. Petersburg. A retrospective analysis of medical charts of 208 patients over 60 years old with inflammatory bowel diseases (IBD) was carried out: 60% of them with ulcerative colitis (UC), 40% with Crohn's disease (CD). The control group consisted of 867 patients aged up to 60 years (UC- 524 patients, 60,4%; CD - 343 patients, 29,6%). Concomitant cardiovascular diseases were detected in 87% of patients, broncho-pulmonary - in 25%, diseases of the bones and joints - in 35%, pathology of the kidneys and urinary tract - in 26,5%, and liver - in 44%. Debut and recurrent IBD were often accompanied (33,6%) by a worsening of somatic pathology (versus 8,7% in other age groups of patients). It's took longer to verify diagnosis of IBD in older patients, than in patients of young and middle ages. Patients with distal localization of the pathological process (proctitis and left-sided colitis) prevailed among patients with UC, the inflammatory form of the disease dominated in patients with CD.

[Role of transforming growth factor-beta in the development of some liver diseases].

AIM: To investigate the expression of transforming growth factor-beta 1 (TGF-beta1) in the liver tissue of patients with autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and chronic hepatitis C (CHC). MATERIALS AND METHODS: Liver biopsy specimens were histologically and immunohistologically examined in 37 patients with verified liver diseases (12 with AIH, 15 with PBC, and 10 with CHC). RESULTS: The expression of TGF-beta1 in the non-parenchymal liver cells of the patients with AIH and PBC with liver cirrhosis was statistically significantly higher than in those without the latter (p = 0.01 and p = 0.04, respectively). There was a positive relationship between the stage of fibrosis and the absolute content TGF-beta1 and CD68+ cells in the portal tracts (r = 0.51). The higher expression of TGF-beta1 was found in the patients with HCV and AIH than in those with PBC (p = 0.03 and p < 0.05, respectively). There were no differences in the expression of TGF-beta1 in the patients with AIH as compared to those with CHC (p = 0.55). The number of CD68-positive macrophages was higher in CHC than in AIH and PBC (p = 0.004 and p = 0.01, respectively). In autoimmune liver diseases, TGF-beta1 was mainly expressed by the macrophages located in the portal tracts and, in CHC, within the hepatic lobules. CONCLUSION: The enhanced TGF-beta1 expression in the nonparenchymal liver cells in AIH and PBC with liver cirrhosis confirms the role of this cytokine in development of fibrosis in autoimmune liver diseases. That in hepatitis of various etiologies versus PBC suggests that the TGF-beta1 signaling pathway may play an important role in an inappropriate immune response in hepatitides; and the variations found in the location of the macrophages expressing TGF-beta1 reflect a difference in the mechanisms of lesions.

[Principles and perspectives of primary biliary cirrhosis therapy].

A survey of existing methods of pathogenetic and symptomatic treatment of primary biliary cirrhosis has been made and it has reviewed prospective directions of its therapy. Is also presents a retrospective analysis of our own data of S-adenosylmethionine (Heptral) in 27 patients PBC receiving UDCA basic therapy. In its application intravenously of 400 mg 2 times daily for 3 weeks showed a reduction in the severity of pruritus, assessed by visual analogue scale, a subjective decrease fatigability and a decrease level of serum bilirubin.

[Solitary abscess in the region of the pons varolii]. / Solitarnyi abstsess v oblasti varolieva mosta.

An abscess in the region of pons varolii in a male 69 years of age with the erythrodermic form of mycosis fungoides is described. It is presumed that the source of the purulent infection were small skin excoriations from scratches due to excruciating skin itch. Long-term cytostatic and immunodepressant therapy promoted generalization of the infection and formation of the cerebral abscess.