[The influence of genetic factors on the effectiveness of eradication therapy of Helicobacter pylori infection in children].

Efficacy of sequential eradication therapy for H. pylori was studied in 176 adolescents (mean age 14.3 years) with different PPI metabolism types. Group I consisted from the patients received omeprazole as PPI in combined treatment with amoxycilline, clarithromycine and tinidazole, Group II--patients treated with rabeprazole in the combination with the same antibacterial drugs. In all the patients, CYP2C19 genotype was identified as a control rate of PPI metabolism (extensive, intermediate and poor metabolizers). Sequential therapy in the children with intermediate and poor metabolic activity demonstrated a high eradication rate irrespective of PPI type (> 80%). In the patients with extensive metabolism taking omeprazole, eradication standard turned out to be lower (63.4%) than in the rabeprazole group (82.3%) (p = 0.026). Results of our survey confirmed a potential advantage of rabeprazole-based treatment compared with omeprazole-containing regimen in the sequential treatment of H. pylori infection in childhood.

[Immune polymorphism analysis of HLA class II antigens in ulcer diseases associated with Helicobacter pylori in children].

UNLABELLED: Previous investigations have linked specific HLA class II alleles DRB1 and DQB1 to H. pylori infection (Y. Huang et al., 2005). AIM: to investigate potential contribution of HLA-DRB1 and DQB1 alleles in H. pylori infection susceptibility in a Russian pediatric population. METHODS: Polymerase chain reaction-sequence specific primer (PCR-SSP) method was used to study the HLA-DRB1, DQB1 allelic frequency distribution in 162 children (93 female) with H. pylori infection was determined by culture, breath test and histology. RESULTS: The carrier frequency of DQB1*03 was higher among H. pylori--positive patients with chronic gastritis only compared with H. pylori-negative patients. The difference in carrier frequencies for HLA-DRB1*17 was higher in H. pylori-positive ulcer patients compared with an uninfected controls (chi2 = 3.69, p = 0.027). In addition, the frequency of genotypes that possess HLA-DQB1*07 allele in the H. pylori-positive children (with peptic ulcer/ chronic gastritis only) was significantly lower than that in the H. pylori-negative control group. CONCLUSIONS: HLA-DQB1*07 allele may be associated with protection against H. pylori infection independently of clinical outcome. At the same time, HLA-DRB1*17 allele might be associated with susceptible gene to peptic ulcer formation among H. pylori-positive children.

[Economic efficacy of thoracoscopic treatment for pleural empyema in children].

Results of treatment carried out during 1989-2000 years were analyzed in 164 children with pleural empyema. Economic analysis proves that videothoracoscopic pleural cavity sanation is more beneficial in acute period in 1.7 times and in long-term period--in 1.9 times, compared with traditional method (puncture and drainage). "Cost-efficacy" analysis shows that videothoracoscopic pleural cavity sanation allows increasing of clinical efficacy in 3.6 times in comparison with traditional treatment mode. "Cost-value" analysis shows improvement of life quality in 1.2 times after application of videothoracoscopic pleural cavity sanation compared with traditional method. Cost effectiveness of videothoracoscopic pleural cavity sanation for better life quality achievement is higher in 2.3 times compared with traditional method.

[Diagnostics and thoracoscopic treatment of pleural empyema in younger children].

174 children of all ages with acute destructive pneumonia complicated with pleural empyema were treated during 10 ten years using videothoracoscopic method; among them 74 children were of younger age (43%). General principles of modern diagnostics and videothoracoscopic pleural cavity sanations were formulated. Ultrasonography and computer tomography of the chest carried out in younger children give possibilities for clear differential diagnostics with other diseases. Advantages of endosurgical treatment are proved. Indications for planned recurrent pleural cavity sanations were worked out.

[Elective video-laparoscopic sanation for the treatment of general peritonitis at children].

Results of traditional and video-laparoscopic relaparotomy at children with appendicular general peritonitis are analyzed. Design--one-center, retrospective, case-control study. It is demonstrated that variant of relaparotomy does not correlate with survival and intensive care content. Long-term results are more favorable after laparoscopic surgery.

[The diagnosis and surgical treatment of hydatid disease of the liver in children].

An experience with the diagnosis and surgical treatment of hydatid disease of the liver included 191 patients aged from 2 through 15 years, 26 of them had a combined involvement of the liver and lung, in 7 patients there were combined lesions with other organs. Complicated echinococcosis was noted in 25 children. Ultrasonography was given the main role in the diagnosis. Videolaparoscopic hydatidectomy of the liver was performed in 62 patients. Solitary cysts of small and medium sizes located superficially were considered as indications to operation. In patients with large and gigantic cysts of special significance was capitonnage of the residual cavity. Use of albendazole as an antiparasitic agent for the recurrent disease and a prophylactic agent after operation for multiple and combined hydatid disease of the liver was found to be sufficiently effective.

Helicobacter pylori eradication in childhood after failure of initial treatment: advantage of quadruple therapy with nifuratel to furazolidone.

BACKGROUND: Failures of Helicobacter pylori eradication in children are common. AIM: To evaluate the efficacy of amoxicillin, bismuth subcitrate and omeprazole and nifuratel or furazolidone for H. pylori eradication in children who failed initial treatment with a standard triple therapy. METHODS: Seventy-six consecutive H. pylori-positive paediatric out-patients (aged 12-16 years; mean age 13.7 +/- 1.4) with chronic abdominal complaints who had failed one attempt of eradication of H. pylori using metronidazole-containing triple therapy were enrolled. It was an open prospective study. Patients were randomized to receive a 2-week course of bismuth subcitrate (8 mg/kg/day, q.d.s.), amoxicillin (50 mg/kg/day, q.d.s.), with either nifuratel (15 mg/kg/day, q.d.s.) or furazolidone (10 mg/kg/day, q.d.s.), plus omeprazole (0.5 mg/kg, once daily). RESULTS: There were 37 patients in the nifuratel group and 39 in the furazolidone group. Helicobacter pylori was eradicated in 33 of 37 (89%; 95% CI: 74.5-96.9; intention-to-treat) in nifuratel group and in 34 of 39 (87%; 95% CI: 72.5-95.7) in furazolidone group, respectively. Frequency of severe side-effects was greater with furazolidone (21%) than with nifuratel (3%; P = 0.0289). CONCLUSIONS: Nitrofuran-containing therapies consisting of a proton-pump inhibitor, amoxicillin and bismuth citrate plus either nifuratel or furazolidone produced good cure rates even among those who had failed prior therapy. Nifuratel is preferred because of the lower frequency of side-effects.

[Gastritis associated with Helicobacter pylori in the material of gastrobiopsies in the group of children with dyspepsia].

Helicobacter pylori (HP) was studied in gastrobiopsies from 180 children, 9 to 17 years old with chronic dyspeptic symptoms. The presence of HP was found in the stomach mucosa of 78.9% patients. The important morphological marker of HP-infection was presence of lymphoid follicles and signs of "active" chronic gastritis in the stomach mucosa (p < 0.001). Thus HP may be considered as an essential pathogenetic factor of chronic dyspeptic syndrome in children of a school age.

Childhood peptic ulcer in the Ural area of Russia: clinical status and Helicobacter pylori-associated immune response.

BACKGROUND: The relation of between Helicobacter pylori and the symptoms in children is still controversial. Determination of specific immunoglobulin (Ig) G antibodies to H. pylori may represent a useful test to screen the patients with acid peptic disease in childhood. The aim of this study was to investigate the spectrum of clinical symptoms, endoscopic and histologic lesions, and clinical value of serum IgG response to H. pylori in school-aged children residing in the Ural area of Russia for the identification of Helicobacter -related acid-peptic disease. METHODS: During 1998, 129 pediatric outpatients (mean age, 12.1 +/- 2.3 years; age range, 10-15 years; 41 boys, 88 girls) were undergoing gastroduodenal endoscopy for evaluation of chronic abdominal pain. H. pylori colonization was determined by histology, urease test, and polymerase chain reaction. H. pylori IgG antibodies were found by using an enzyme-linked immunosorbent assay. RESULTS: There was a high prevalence of H. pylori infection (80%) and peptic ulcers (24%) among the study group. Duodenal ulcers were detected in 31 of the children; all of them were H. pylori positive. Family history of peptic ulcers, nighttime pain associated with nocturnal awakening, fasting pain relieved by food, pain associated with meals, postprandial pain, bitter taste, and heartburn were the clinical signs that helped to distinguish the ulcer-positive children from the ulcer-negative H. pylori group. Duodenal ulcer patients had higher anti- H. pylori IgG titers compared with the levels of IgG antibodies in the infected children without ulcers ( P < 0.001). Peptic ulcer disease was a more common finding in the Ural ethnic group of Asians (Bashkirs) compared with the pediatric population of Russian origin. CONCLUSIONS: These results provide further evidence for a causal relation between H. pylori -associated peptic ulcer disease in childhood and relevant clinical symptoms. High titers of anti- H. pylori IgG might serve as a useful noninvasive indicator of ulcer disease.

Helicobacter pylori infection in childhood: results of management with ranitidine bismuth citrate plus amoxicillin and tinidazole.

BACKGROUND AND AIMS: To verify whether a triple therapy bismuth citrate plus amoxicillin and tinidazole eradicates H. pylori infection in pediatric patients. METHODS: Fifty children (30 females; mean age 12.4 +/- 1.1 years, range 10-15 years) suffering from upper abdominal complaints and Helicobacter pylori (H. pylori)-associated gastroduodenal disease were treated with a 4 week course of ranitidine bismuth citrate (400 mg, twice daily) plus oral tinidazole (20 mg/kg) and amoxicillin (50 mg/kg) for the first 2 weeks. RESULTS: The endoscopic diagnoses were: esophagitis (seven cases), gastritis (six cases), gastroduodenitis (43 cases), duodenitis (one case), gastric ulcer (two cases) and duodenal ulcer (13 cases). Helicobacter pylori was eradicated in 40 (80%) patients and clinical improvement was noticed in 39 (78%) of symptomatic subjects. Duodenal ulcers were healed in all the children, but lymphoid nodular hyperplasia was persistent in all patients, independent of the H. pylori status. The potentially drug-related adverse events (blackening of the tongue, six patients; diarrhea, one patient; disturbance of taste, two patients) were registered in seven (14%) patients and dark stools were observed in 48 (96%) patients. No children withdrew from the study because of either side-effects or clinical laboratory changes. No patient had toxic levels of blood bismuth (values ranged between 2.1 and 5.4 microg/L, mean value 3.4 +/- 1.04 microg/L). CONCLUSIONS: Findings suggest that the present treatment regimen is effective enough in the resolution of H. pylori-associated peptic ulcer disease of childhood.

[The functional classification of velopharyngeal closure after uranoplasty]. / Funktsional'naia klassifikatsiia nebno-glotochnogo smykaniia posle uranoplastiki.

The new nasopharyngoscopic functional classification of palatopharyngeal joining is based on the results of examinations of 57 children with congenital uranoschisis after uranoplasty and 19 healthy children aged 5 to 14 years by nasopharyngoendoscopy. The classification defines the causes of palatopharyngeal insufficiency and for the first time takes into consideration the disagreement between the palatopharyngeal lock and articulation. The proposed classification helps select the most effective method of rehabilitation of the above patient population and helps follow up the time course of changes in the function of the palatopharyngeal lock under the effect of treatment.