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Short-Term Outcomes of Simultaneous Inguinal Hernia Repair at Laparoscopic Appendectomy in Children: Cohort Study 儿童腹腔镜阑尾切除术同时进行腹股沟疝修补术的短期疗效:队列研究
Pub Date : 2024-02-25 DOI: 10.15690/vsp.v23i1.2651
V. Gavrilyuk, D. Severinov, YA Zubkova
Background. Nowadays, simultaneous techniques have been widely adopted in abdominal pediatric surgery as they allow to perform surgical interventions for several diseases at the same time. However, the safety of such interventions requires further studies. Objective. The aim of the study is to analyze the short-term outcomes of simultaneous hernia repair in laparoscopic appendectomy in children. Methods. The study included data from patients hospitalized with suspected acute appendicitis in 2022–2023. The study group included children operated for acute appendicitis and who had signs of patent processus vaginalis. Percutaneous internal ring suturing (PIRS) was performed in all cases. The control group (no indirect inguinal hernia was revealed) was formed by pairwise matching of patients by gender, age (± 1 year), and appendicitis type. The surgery time, the blood loss volume, the beginning of enteral feeding, and the presence of postoperative complications were analyzed. Results. The compared groups (13 individuals each) were comparable in gender (38% boys), age (median age about 10 years), and appendicitis type (catarrhal — 31%, phlegmonous — 38%, gangrenous — 31%), and white cell count at admission, presence of serous exudate and omentum changes revealed during surgery. The beginning of enteral feeding, the stool, as well as total duration of hospital stay after surgery did not differ in two groups. Moreover, both groups were comparable in terms of surgery duration, intraoperative blood loss volume, pain syndrome severity. No pyo-inflammatory complications of abdominal cavity or postoperative wounds were revealed during the hospital stay. Conclusion. Simultaneous hernia repair via PIRS method is effective and safe method of surgical management of pediatric patients with combination of acute appendicitis and inguinal hernia.
背景。如今,腹部小儿外科已广泛采用同步技术,因为这种技术可以同时对多种疾病进行外科干预。然而,此类手术的安全性还需要进一步研究。研究目的本研究旨在分析腹腔镜阑尾切除术中同时进行疝修补术的短期疗效。研究方法研究纳入了 2022-2023 年住院的疑似急性阑尾炎患者的数据。研究组包括因急性阑尾炎接受手术且有阴道口闭锁迹象的儿童。所有病例均进行了经皮内环缝合术(PIRS)。对照组(未发现间接腹股沟疝)按性别、年龄(±1 岁)和阑尾炎类型进行配对。分析了手术时间、失血量、开始肠内喂养的时间以及术后并发症的发生情况。结果比较组(每组 13 人)在性别(38% 为男孩)、年龄(中位年龄约为 10 岁)、阑尾炎类型(卡他性阑尾炎 31%、痰性阑尾炎 38%、坏疽性阑尾炎 31%)、入院时白细胞计数、手术中发现的浆液性渗出物和网膜变化等方面具有可比性。两组患者开始肠内喂养的时间、大便情况以及术后住院总时间均无差异。此外,两组在手术时间、术中失血量、疼痛综合征严重程度等方面也具有可比性。住院期间未发现腹腔或术后伤口化脓性炎症并发症。结论对于合并急性阑尾炎和腹股沟疝的小儿患者,通过 PIRS 法同时进行疝修补术是一种有效、安全的手术治疗方法。
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引用次数: 0
Combination Treatment for Severe Forms of Mucopolysaccharidosis, Type I (Hurler Syndrome): Case Report 治疗严重粘多糖病 I 型(赫勒综合征)的综合疗法:病例报告
Pub Date : 2024-01-12 DOI: 10.15690/vsp.v22i6.2701
N. D. Vashakmadze, N. V. Zhurkova, Marina A. Babaykina, Albina V. Dobrotok, O. Gordeeva, L. S. Namazova-Baranova
Background. Hurler syndrome (mucopolysaccharidosis, type I) is a rare hereditary disease with chronic course. The main methods for Hurler syndrome management are hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT). In recent years, combination treatment (ERT administration both before and after HSCT) has shown its efficacy in case of disease progression. Clinical case description. The presented clinical cases demonstrate the efficacy of ERT administration in patients with Hurler syndrome after HSCT: in the first clinical case due to the decrease in alpha-iduronidase activity 2 years after HSCT, in the second clinical case due to the aggravation of the patient's condition (cardiovascular and respiratory systems, hepatomegaly, although the level of enzyme and glycosaminoglycans in the patient's urine remained within normal values). Conclusion. Combination treatment including ERT not only before HSCT, but also in case of clinical state worsening after HSCT, plays significant role in stabilizing the patient's condition, preventing rapid progression of symptoms and development of life-threatening complications (especially cardiovascular ones).
背景。赫勒综合征(粘多糖病 I 型)是一种罕见的慢性遗传性疾病。治疗赫勒综合征的主要方法是造血干细胞移植(HSCT)和酶替代疗法(ERT)。近年来,联合治疗(在造血干细胞移植前后同时使用酶替代疗法)在疾病进展的情况下显示出了疗效。临床病例描述。所提供的临床病例证明了在造血干细胞移植后对赫勒综合征患者进行 ERT 治疗的疗效:第一个临床病例是由于造血干细胞移植 2 年后α-氨基脲酸酶活性下降,第二个临床病例是由于患者病情加重(心血管和呼吸系统、肝肿大,尽管患者尿液中的酶和糖胺聚糖水平仍在正常值范围内)。结论包括 ERT 在内的联合治疗不仅在造血干细胞移植前,而且在造血干细胞移植后临床状态恶化的情况下,都能在稳定患者病情、防止症状迅速恶化和出现危及生命的并发症(尤其是心血管并发症)方面发挥重要作用。
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引用次数: 0
Hereditary Amino Acid Metabolism Disorders and Urea Cycle Disorders: to Practicing Physician 遗传性氨基酸代谢障碍和尿素循环障碍:致执业医师
Pub Date : 2024-01-12 DOI: 10.15690/vsp.v22i6.2700
N. V. Zhurkova, N. D. Vashakmadze, Nataliya S. Sergienko, Anastasiya N. Dudina, M. S. Karaseva, L. Selimzyanova, A. Y. Rachkova, Y. Kotalevskaya, Andrej N. Surkov
Hereditary amino acid metabolism disorders (aminoacidopathies) are clinically and genetically heterogeneous group of hereditary metabolic diseases caused by enzymes deficiency involved in amino acid metabolism, that finally leads to progressive damage of central nervous system, liver, kidneys, and other organs and systems. Hereditary urea cycle disorders occur because of enzyme deficiency leading to impaired urea synthesis and hyperammoniemia in patients. The age of disease onset and clinical manifestations severity range from milder, intermittent forms to severe, manifesting in the first hours of life. Expanded neonatal screening (implemented in Russian Federation at 01.01.2023) allows to diagnose diseases from these groups in the first days of life, to prescribe timely pathogenetic therapy. Altogether it helps to prevent the development of disease severe complications. Raising awareness about hereditary aminoacidopathies and urea cycle disorders among pediatricians, neonatologists, neurologists, gastroenterologists, ophthalmologists is a topical issue of modern pediatrics.
遗传性氨基酸代谢病(aminoacidopathies)是一组临床和遗传异质性遗传代谢病,由参与氨基酸代谢的酶缺乏引起,最终导致中枢神经系统、肝脏、肾脏及其他器官和系统的进行性损害。遗传性尿素循环障碍是由于酶缺乏导致患者尿素合成障碍和高氨血症。发病年龄和临床表现的严重程度不一,有的病情较轻,呈间歇性发作,有的病情严重,可在出生后数小时内发病。扩大新生儿筛查(俄罗斯联邦于 2023 年 1 月 1 日实施)可以在新生儿出生后的最初几天诊断出这些疾病,并及时进行病理治疗。这有助于预防疾病严重并发症的发生。提高儿科医生、新生儿科医生、神经科医生、消化科医生、眼科医生对遗传性氨基酸病和尿素循环障碍的认识是现代儿科的一个热点问题。
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引用次数: 0
Belimumab in a Patient with Systemic Lupus Erythematosus with Juvenile Onset and Steroid-induced Diabetes: Clinical Case 贝利木单抗治疗一名幼年发病的系统性红斑狼疮患者和类固醇诱发的糖尿病:临床病例
Pub Date : 2024-01-12 DOI: 10.15690/vsp.v22i6.2649
M. Kaleda, I. Nikishina, Alesya V. Firsa
Background. The management of children with systemic lupus erythematosus (SLE) is usually associated with lifelong systemic glucocorticoids administration and, thereby, high risk of serious side effects, including steroid-induced diabetes. The belimumab (B-lymphocyte stimulator inhibitor) administration significantly reduces the glucocorticoids dose, the risk and severity of steroid therapy complications. Clinical case description. The patient was diagnosed with SLE at the age of 16 years. Therapy with hydroxychloroquine and oral glucocorticoid at a high dose (methylprednisolone 56 mg per day) was initiated. Steroid-induced diabetes was diagnosed 1 month after the therapy start; avascular necrosis sites were revealed in 2 months. Mycophenolate mofetil made it possible to achieve the disease activity control. However, the belimumab was prescribed 5 months after diagnosis verification due to continuous insulin requirement and avascular necrosis progression. Conclusion. Belimumab is the only genetically engineered biologic drug approved for the treatment of children with SLE. As a result of its use, it was possible to stabilize the patient's condition quickly (within 3 months), to reduce significantly the dose of oral glucocorticoid, methylprednisolone (from 24 to 8 mg/day), to achieve remission of steroidinduced diabetes with further insulin withdrawal, and also to relieve avascular necrosis clinical symptoms.
背景。系统性红斑狼疮(SLE)患儿的治疗通常需要终生使用糖皮质激素,因此出现严重副作用的风险很高,包括类固醇引起的糖尿病。服用贝利木单抗(B淋巴细胞刺激抑制剂)可显著减少糖皮质激素的剂量,降低类固醇治疗并发症的风险和严重程度。临床病例描述。患者在16岁时被诊断患有系统性红斑狼疮。开始使用羟氯喹和大剂量口服糖皮质激素(甲基强的松龙 56 毫克/天)治疗。治疗开始 1 个月后,诊断出类固醇诱发的糖尿病;2 个月后,发现有血管性坏死部位。霉酚酸酯(Mycophenolate mofetil)使疾病活动得到了控制。然而,由于持续需要胰岛素和血管坏死进展,在确诊5个月后才开始使用贝利木单抗。结论贝利木单抗是唯一获准用于治疗儿童系统性红斑狼疮的基因工程生物药物。使用贝利木单抗后,患者的病情得以迅速稳定(3个月内),口服糖皮质激素甲基强的松龙的剂量大幅减少(从24毫克/天减至8毫克/天),类固醇诱发的糖尿病在进一步停用胰岛素后得到缓解,血管性坏死的临床症状也得到缓解。
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引用次数: 0
Analysis of the Treatment Efficacy in Late Diagnosis of Alport Syndrome in a Child: Clinical Case 儿童阿尔波特综合征晚期诊断的疗效分析:临床病例
Pub Date : 2024-01-12 DOI: 10.15690/vsp.v22i6.2705
S. Y. Volgina, N. A. Solovyeva, G. A. Kulakova, E. A. Kurmayeva, Liliya I. Mukhametdinova, E. L. Rashitova
Background. Alport syndrome is a systemic, hereditary, progressive disease characterized by ultrastructural changes in the glomerular basement membrane caused by pathogenic variants of type IV collagen genes. The use of angiotensin-converting enzyme inhibitors (ACEI) for nephroprotection is effective at the microhematuria and/or albuminuria stage. Treatment tactics in case of nephrotic syndrome development in such patients remains the subject of discussion. Clinical case description. The patient was diagnosed with proteinuria at the neonatal period and hematuria at the age of one month. The hereditary nephritis was diagnosed at the age of 6 years; the ACEI was administered, however, the proteinuria continued to increase. The diagnosis was confirmed at the age of 8.5 years via the puncture nephrobiopsy: collagenopathy, type IV, focal segmental glomerular sclerosis. Moreover, chronic bilateral sensorineural hearing loss and bilateral myopic astigmatism were diagnosed. Ciclosporin A (125 mg/day) was additionally prescribed. The increase in the cystatin C, urea, uric acid, cholesterol levels in blood was mentioned after 14 months of treatment. These parameters decreased after reducing cyclosporine A dose to 100 mg/day, however, proteinuria has increased. Angiotensin II receptor blocker (candesartan 8 mg/day) was prescribed to enhance nephroprotective therapy at the age of 10 years 2 months. Another increase of the immunodepressant dose was performed at the age of 11, it led to decrease in the estimated glomerular filtration rate and increase of creatinine, cystatin C, urea, cholesterol, uric acid, and potassium levels in the blood. These changes were considered as cyclosporine-dependent. The dose of cyclosporine A was reduced to 125 mg/day, and to 100 mg/day from the age of 14. There was no progression of chronic kidney disease at the follow-up at the age of 15.5 years. Conclusion. Nephroprotective treatment of a child with Alport syndrome initiated after the development of nephrotic syndrome did not stop the chronic kidney disease progression. Whereas relatively high doses of ciclosporin A have reduced proteinuria but led to nephrotoxicity and cyclosporin dependence.
背景。阿尔波特综合征是一种系统性、遗传性、进行性疾病,其特点是由 IV 型胶原基因的致病变异引起肾小球基底膜的超微结构改变。使用血管紧张素转换酶抑制剂(ACEI)保护肾脏在微量血尿和/或白蛋白尿阶段是有效的。如果这类患者出现肾病综合征,治疗策略仍是讨论的主题。临床病例描述。患者被诊断为新生儿期蛋白尿,一个月大时出现血尿。6 岁时确诊为遗传性肾炎;当时服用了 ACEI,但蛋白尿仍在增加。8 岁半时,通过穿刺肾活检确诊为:IV 型胶原病,局灶节段性肾小球硬化。此外,还诊断出慢性双侧感音神经性听力损失和双侧近视散光。此外,还处方了西克洛孢素 A(125 毫克/天)。治疗 14 个月后,患者血液中的胱抑素 C、尿素、尿酸和胆固醇水平有所上升。将环孢素 A 的剂量减至 100 毫克/天后,这些指标有所下降,但蛋白尿却增加了。在患者 10 岁 2 个月时,为了加强肾保护治疗,医生给他开了血管紧张素 II 受体阻滞剂(坎地沙坦 8 毫克/天)。11 岁时,再次增加免疫抑制剂的剂量,导致估计肾小球滤过率下降,血液中的肌酐、胱抑素 C、尿素、胆固醇、尿酸和钾含量增加。这些变化被认为是环孢素依赖性的。环孢素 A 的剂量减至 125 毫克/天,从 14 岁起减至 100 毫克/天。在 15.5 岁时的随访中,慢性肾病没有恶化。结论阿尔波特综合征患儿在出现肾病综合征后开始接受肾脏保护治疗并不能阻止慢性肾病的发展。而相对大剂量的环孢素A虽然减少了蛋白尿,但却导致了肾毒性和环孢素依赖性。
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引用次数: 0
Niemann-Pick Disease: Seven Questions about it 尼曼-皮克病:七个相关问题
Pub Date : 2024-01-12 DOI: 10.15690/vsp.v22i6.2702
N. D. Vashakmadze, N. V. Zhurkova
Acid sphingomyelinase deficiency is a rare hereditary disease caused by enzyme deficiency due to mutations in the SMPD1 gene. Decreased enzyme activity leads to accumulation of sphingomyelin in lysosomes. This disease is characterized by wide diversity of clinical manifestations: from infantile neurovisceral form (Niemann-Pick disease type A) with severe rapidly progressive neurodegeneration to chronic visceral form (Niemann-Pick disease type B) with almost no central nervous system involvement. There is also intermediate phenotype: chronic neurovisceral form (Niemann-Pick disease type A/B) that includes manifestations two other forms, both visceral and neurological. The disease course is most commonly progressive and multi-system due to sphingomyelin accumulation in cells of the monocyte-macrophage system, as well as in other cells such as hepatocytes.
酸性鞘磷脂酶缺乏症是一种罕见的遗传性疾病,由于 SMPD1 基因突变导致酶缺乏。酶活性降低会导致鞘磷脂在溶酶体中积聚。这种疾病的临床表现多种多样:从伴有严重快速进展性神经变性的婴儿神经内脏型(尼曼-皮克病 A 型)到几乎不累及中枢神经系统的慢性内脏型(尼曼-皮克病 B 型)。还有一种中间表型:慢性神经内脏型(尼曼-皮克病 A/AB 型),包括内脏和神经系统两种表现。由于鞘磷脂在单核-巨噬细胞系统细胞以及其他细胞(如肝细胞)中积聚,该病的病程通常是进行性和多系统的。
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引用次数: 0
Brain Morphometry is an Advanced Method of Neuroimaging Mapping in Children 脑形态测量是绘制儿童神经影像图的先进方法
Pub Date : 2024-01-12 DOI: 10.15690/vsp.v22i6.2707
Alexey I. Firumyants, L. S. Namazova-Baranova, Georgiy A. Karkashadze, O. P. Kovtun, Viktor V. Dyachenko, N. Shilko, Elena N. Rudenko, Alexey V. Meshkov, Nataliya S. Sergienko, Yuliya V. Nesterova, Leonid M. Yatsick, Anastasya I. Rykunova
The use of magnetic resonance imaging in morphometry, as quantitative assessment of brain parameters (thickness, surface area, volume), allows to detect changes in many neuropsichiatric conditions that were previously considered intact. This article provides data on neuroimaging brain morphometry and effective use of this method in neurosciences.
磁共振成像在形态测量中的应用,作为对大脑参数(厚度、表面积、体积)的定量评估,可以检测到许多以前被认为是完好无损的神经系统疾病的变化。本文提供了有关神经成像脑形态测量的数据,以及在神经科学中有效使用这种方法的情况。
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引用次数: 0
Role of Calcineurin Inhibitors in the Management of Atopic Dermatitis in Children 降钙素蛋白抑制剂在治疗儿童特应性皮炎中的作用
Pub Date : 2024-01-11 DOI: 10.15690/vsp.v22i6.2666
K. Efendieva, L. S. Namazova-Baranova, Juliya G. Levina, V. Kalugina, A. Alekseeva, Elena V. Vishneva, K. Volkov
Atopic dermatitis (AD) is a widespread chronic inflammatory skin disease that has a significant impact on various aspects of patient's life. This review presents modern view on AD pathophysiology, its correlation with other concomitant diseases, and covers practical aspects of external anti-inflammatory therapy implementation. The analysis of clinical studies has shown the significant role of calcineurin inhibitors in the effective treatment of AD in children from its first manifestations at early age.
特应性皮炎(AD)是一种广泛存在的慢性炎症性皮肤病,对患者生活的各个方面都有重大影响。这篇综述介绍了特应性皮炎病理生理学的现代观点及其与其他并发疾病的相关性,并涵盖了外部抗炎疗法的实际应用方面。临床研究分析表明,钙神经蛋白酶抑制剂在有效治疗儿童AD方面发挥着重要作用,因为AD在儿童幼年时期就已开始显现。
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引用次数: 0
Breast Milk Jaundice 母乳性黄疸
Pub Date : 2024-01-11 DOI: 10.15690/vsp.v22i6.2656
I. Belyaeva, E. Bombardirova, Elena O. Kurnatovskaya
The results of modern studies on breast milk jaundice pathogenesis, that is common form of neonatal jaundice, are presented. The major risk factors and diagnostic methods (excluding other forms of jaundice syndrome at recurrent and lingering jaundice in newborns) were defined. The main therapy approaches for breast milk jaundice were presented. Issues of phototherapy indications were discussed. The feasibility of maintaining breastfeeding in case of breast milk jaundice development was proved. This condition requires the attention of pediatricians despite the relatively favorable course and outcomes. The need to continue studies on pathogenetic therapy of such patients was noted.
本文介绍了有关母乳性黄疸(新生儿黄疸的常见形式)发病机制的现代研究成果。界定了主要的危险因素和诊断方法(不包括新生儿黄疸复发和黄疸持续存在的其他形式的黄疸综合征)。介绍了母乳性黄疸的主要治疗方法。讨论了光疗适应症的问题。证明了在出现母乳性黄疸的情况下坚持母乳喂养的可行性。尽管母乳性黄疸的病程和疗效相对较好,但仍需要儿科医生的关注。会议指出有必要继续研究此类患者的病因治疗。
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引用次数: 0
Supplemental Feeding Implementation: Window of Opportunities for the Intestinal Microbiota Development and Immune Responses Modulation 添加辅食:肠道微生物群发展和免疫反应调节的机会之窗
Pub Date : 2024-01-11 DOI: 10.15690/vsp.v22i6.2663
I. Belyaeva, L. S. Namazova-Baranova, E. Bombardirova, Regina A. Shukenbayeva, T. Turti
This review summarizes stages of intestinal microbiota development in infant and immune responses modulation associated to these stages. The leading role of breastfeeding in the optimal microbiota and associated immune responses development during the first half of child’s life is presented. The biological feasibility of supplemental feeding implementation at the second window of opportunity (4–6 months) is justified, as well as role of supplementation products (including cereal) in adult microbiota development.
这篇综述总结了婴儿肠道微生物群的发展阶段以及与这些阶段相关的免疫反应调节。文章介绍了母乳喂养在婴儿前半生的最佳微生物群和相关免疫反应发育中的主导作用。在第二个机会窗口期(4-6 个月)添加辅食的生物学可行性以及辅食产品(包括谷物)在成人微生物群发育中的作用得到了论证。
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引用次数: 0
期刊
Current pediatrics
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