[Features of the architectonics of the structures of the nasal cavity and choanal zone in children with congenital malformations of the eyes]. / Osobennosti arkhitektoniki struktur polosti nosa i khoanal'noi zony u detei s vrozhdennymi porokami razvitiya glaz.

The article provides data on the embryogenesis of the eyeball, nasolacrimal canal and nasal cavity. A frequent combination of congenital choanal atresia and anomalies in the development of the eyes was noted, most likely associated with the temporal and topographic parallelism of the intrauterine development of these anatomical areas. In order to assess the condition of the nasal cavity and choanal region in congenital eye pathology, 43 children with ophthalmological malformations were examined. In 32 (74.4%) children, according to endoscopic examination, changes in the anatomy of the choanal region with a change in its size in the form of incomplete atresia were revealed. The results obtained allow the authors to recommend that all children with congenital ophthalmological malformations be examined and monitored by an otolaryngologist with an endoscopic examination of the nasal cavity and nasopharynx.

[Neurological disorders in preterm children with neuropathy]. / Nevrologicheskie narusheniia u nedonoshennykh detei s retinopatiei.

AIM: To establish the correlation between the frequency and severity of hypoxic CNS lesions in preterm children with neuropathy and improve the early diagnosis of lesions of the brain structures based on clinical ophthalmologic results. MATERIAL AND METHODS: The authors examined 712 premature infants with body mass <1500 g born before 30 weeks of gestation during 2006-2016. Ophthalmological monitoring of retinopathy (RP), an analysis of medical history, neurological examination and neurosonography were performed. RESULTS AND CONCLUSION: RP was found in 367 (51.5%) children. In 255 children, the disease regressed naturally. One hundred and twelve (15.7%) children, underwent laser coagulation of the avascular retina due to the severity of RP. Signs of intraventricular hemorrhages (IVH) were noted in 434 (61%) children in the neonatal period. IVH were found in 285 (77.6%) children with RP. RP with the regression after laser coagulation was combined with IVH in 98% of cases, with the higher frequency (55.3%) of IVH, 3rd degree. Periventricular leucomalation (PVL) was found in 10% of children without RP, in 22.3% of children with RP with naturally regression and in 51,7% of children with RP with laser coagulation of the retina. In 70 children, neurosonographic signs of ischemia of the head of caudate nucleus were identified on the 14-15th days of life. In this group, RP developed in 54 (77%) children, 27 (38.5%) children needed laser coagulation of the retina. The correlation found between the severity of RP and hypoxic CNS lesions in highly preterm infants might allow the prognosis of visual and neurosomatic disturbances in the early age and timely effective rehabilitation.

[ERRORS IN DIAGNOSIS AND TREATMENT OF IMMUNODEPENDENT PATHOLOGY (ORIGINAL CONCEPT)].

Based on many years of experience in 2009, we developed the original concept of a mixed approach to the treatment of infectious diseases in patients. During 2.5 years(from 2013 to June 2015) to have applied for consultative-diagnostic help of 3965 patients who had not verified the primary diagnosis. The basic principle of verification of the pathology of the removal of various causes immunosuppression. Based on our extensive, research and observation was often found in patients ascaridosis (55%) and giardiasis (65%), as a possible cause of immunosuppression. In 13% of patients was found the mucosal candidiasis. Among frequently and chronically ill persons we identified the active forms of Epstein-Barr virus (quantitative polymerase chain reaction in saliva) in 40%. The criterion for assessing performance immunogram was a decrease of two sigmal deviation from the lower age limit. In the study of neutrophil myeloperoxidase content observed decline (< 60%) in 99 (9.7%) of 1015 patients, indicating a fairly common cause of long-term permit infection in the tissues and persistence C. albicans. In the study of lymphocyte subpopulations often demonstrated reduction in the number of natural killer cells (26.7% of subjects), which shows a decline of one of the most important factors of congenital immunity. Among the humoral immune disorders often noted the decrease of total IgG (2.4%) and its subclass IgG1 (22.1%), indicating a significant diagnostic value determination of IgG subclasses it even with normal serum total. Thus, approximately 76% of patients often suffer set of a decrease immunity. Patients developed with mixed infections caused by various bacterial, fungal, viral and protozoan agents and worms. Immunological study of patients should be redynamics after eliminating the causes immunosuppression and sanitation foci of infection. Only multi-level examination of the patient will determine the final diagnosis and adequate treatment.

[Buffering capacity of the vitreous body in aggressive posterior retinopathy of prematurity].

PURPOSE: To investigate the role of vitreous body changes in the pathogenesis of aggressive posterior retinopathy of prematurity. MATERIAL AND METHODS: The study included 60 children with stage 4-5 retinopathy of prematurity demonstrating either classical or aggressive posterior form of progression. In all cases vitreous samples for laboratory testing were taken during surgery. RESULTS: The study showed that aggressive posterior retinopathy of prematurity is associated with more significant metabolic changes in comparison with classical form of the disease. The degree of biochemical imbalance of the vitreous appeared directly related to the stage of the disease, which was determined by the type and extent of retinal detachment. Volcano-shaped retinal detachment with intensive exudation within the posterior eye segment is considered the most severe variant of aggressive posterior retinopathy of prematurity. CONCLUSION: Aggressive posterior retinopathy of prematurity is characterized by substantial disturbance of metabolism of the vitreous body, which contributes to exudation and proliferation, thus aggravating the course of the disease and worsening the prognosis.

[The study of biochemical autoregulation of blood flow in the vascular basin of the inner carotid artery in premature children].

OBJECTIVE: Despite the importance of blood flow regulation (BFR) in cerebral vessels, in particular, during organism development, there is no studies in children in the first weeks of life. We studied biochemical autoregulation of blood flow in infants born at 24-25 weeks of gestation. MATERIAL AND METHODS: Eighteen infants with body mass 763±138 g were included in the study. RESULTS: There was a high frequency of intraventricular hemorrhages (77%, 14 infants), including those of III stage (50%) with ventriculomegalia (9 infants). Cystic periventricular leukomalacia developed in 50% (9 infants). Retinopathy of premature children with localization in the posterior pole of eyeball developed in 100% of cases. Results of capillary blood gas analysis (pO2, pCO2 and parameters of resistance index of anterior cerebral artery measured using Doppler ultrasound) were studied from 25 to 30 weeks of gestation. In the first weeks of life, spastic character of blood flow in the anterior cerebral artery against the background of hypoxemia and relative hypocapnia was found. No data on the hyperoxic autoregulation of blood flow was obtained. The hypercapnic mechanism of autoregulation had developed earlier and emerged from the 28th week of gestation. Conclusion. The dramatic increase in hypercapnia leads to the blood inflow to tissues and finally to the early development of retinopathy, periventricular leukomalacia and intraventricular hemorrhages.

[Health schools for patients with chronic cardiac insufficiency (innovative technologies)].

Modern programs for the management of patients with chronic cardiac insufficiency (CCI) envisage systemic preventive measures aimed to extend their information support, stimulate compliance, optimize feedback, modify lifestyle, and facilitate social adaptation. Traditional health schools for CCI patients as a form of secondary prophylaxis helps to achieve the above goals even though efficiency of this work needs to be further improved. Results of regular medical examination of 417 patients with CCI (294 women and 123 men) visiting local outpatient facilities in 2008 were analysed. 207 of them attended health schools, where they were educated and treated with the use of innovative technologies. It was shown that frequency of hospitalization for decompensated CCI was not significantly different in these and control patients. However, the educated patients needed less emergency ambulance care, made fewer unplanned visits to their doctors, and had better results of clinical and functional studies. The efficiency of education was gender related. Men showed significantly lower frequency of hospitalization, improved health scores and results of 6-min walking test.

[Cytokine therapy in the regulation of corneal reparative processes: an experimental and clinical study].

Cytokine monotherapy with Superlymph used in combination with the keratoprotector Applicoll in the treatment of superficial corneal layer defect resulted in rapidly alleviated inflammatory reactions, accelerated reparative processes, more qualitative epithelial defect recovery, by forming a finer scar, without opacity whereas the traditional treatment led to long-term healing and keratoleukoma in an experiment. The use of cytokine therapy with Superlymph in the complex treatment of corneal injuries and inflammation in children promoted a prompt and stable arrest of a local inflammatory process, accelerated epithelization, reduced opacity intensity, higher visual acuity, and shorter treatment.

[Preliminary results of primary implantation of flexible intraocular lenses in infants under 1 year of age].

The paper presents the results of surgical treatment in 12 (12 eyes) infants aged 3 to 11 months who had different forms of unilateral congenital cataract. The surgical techniques involved the following stages: formation of a sclerocorneal tunnel cut, 3.5 mm in width, anterior continuous circular capsulotomy (anterior capsular rhexis), aspiration-irrigation techniques for removal lens masses, implantation of a flexible intraocular lens (IOL) into the capsular sac, graded opening of the posterior capsule with anterior vitrectomy in some infants. The authors could achieve symmetrical capsular rhexis in 75% and intracapsular IOL fixation in all the cases. During 3-month-to-2-year follow-ups after surgery, IOL held its position in the capsular sac; IOL dislocation and lenticular body capture were not observed in any case.

[Surgical treatment of traumatic lesions of the orbit in children].

The paper presents an analysis of traumas of the orbit combined with craniocerebral trauma in children made according to data obtained at the eye microsurgery department, Morozov's Pediatric City Clinical Hospital. Fractures of the lower orbit wall account for around 70% of all orbit fractures; clinical signs of fractures of the lower orbit wall are defined; computer tomography is shown to be the most informative diagnostic tool. The paper contains indications for plasty of the lower orbit wall. Materials used in orbitoplasty are comparatively analyzed. The use of demineralized osseous implants is preferential.

[Laser coagulation in the treatment of different-type retinopathy of prematures].

Laser coagulation of the retina was made in 126 children (238 eyes) with retinopathy of prematures (RP) by an 810 nm diode laser ophthalmocoagulator. The methods of transscleral, transpapillary and combined coagulation were applied. As for children who needed coagulation, 39.9% of them had classical RP and 60.1%--fulminant RP (plus-disease). Stabilization in CRP was registered in 97.9% (the threshold process stage was an indication for surgery), and in FRP (plus disease) it was registered in 56.6%. The best effect from surgery in FRP was observed, when patient were operated on in FRP, stage 1 (process localization in zone 1) and stage 2 (process localization in zone 2), whereas, when the procedure was made at stage 3, the process was stabilized only in 37%. The authors elaborated a combined method of laser coagulation (including transscleral and transpupillary techniques), which brought up the rate of stabilization in FRP (plus-disease) to 75.8%. The results did not depend on a coagulation technique in CRP.

Are screening and surveillance for Barrett's oesophagus really worthwhile?

Oesophageal adenocarcinoma has a low incidence and still remains an uncommon cancer; however, it has been on the rise over the past 20 years. Barrett's oesophagus, a complication of gastro-oesophageal reflux disease, is the only known precursor of this adenocarcinoma. It can often be asymptomatic and probably goes undiagnosed in the majority of the population. There are no direct data supporting the practice of screening for Barrett's oesophagus and oesophageal adenocarcinoma among the general population or even in patients with chronic reflux symptoms. However, many argue that the detection of neoplasms at a curable state in a high risk population can perhaps justify screening endoscopy. No prospective, controlled trials have been conducted to support the effectiveness of surveillance, but some indirect evidence does exist. The cost effectiveness of surveillance programmes needs to be further assessed in prospective studies. Ultimately, the use of better tools to diagnose Barrett's oesophagus and dysplasia and the identification of high risk groups for progression to oesophageal adenocarcinoma could potentially make screening and surveillance a cost effective practice.

[Carbogen therapy in high myopia in children]. / Karbogenoterapiia pri vysokoi miopii u detei.

Forty-eight patients, aged 7 to 15, with the diagnosis of high developed myopia complicated by chorioretinal peripheral dystrophy were investigated. A total of 1500 examinations were made. The patients were shared between the main and control groups. Sex, age and the clinical pattern were compatible. The main-group patients received the carbogene therapy and routine neurotrophic treatment, while the controls received only the latter. The treatment course lasted for as long as 10 days (10 inhalations). There were no any complications during and after the carbogene inhalations. The conclusion, based on the data obtained, can be that the carbogene inhalations, when added to the neurotrophic treatment scheme, enhance the therapy efficiency in case of high, complicated and developed myopia in children.

[Pulse therapy in the treatment of optic neuritis in multiple sclerosis]. / Pul's-terapiia v lechenii opticheskogo nevrita pri rasseiannom skleroze.

Corticosteroids are the preparations in the treatment of optic neuritis at multiple sclerosis. The doses and methods of introduction of corticosteroids are chosen individually for the adults and children. A maximum effect is registered in a majority of cases of optic neuritis, when methylprednisolone is prescribed with the pulse-dose introduction, as compared to parabulbar injections or administration of corticosteroids per os. The recovery of vision at relapsing optic neuritis sets on faster and is of a more prolonged nature as compared to other variants of the introduction of corticosteroids. Therefore, the prescription of methylprednisolone as pulse-doses is more effective in both adults and children.

[Fluorescence angiography in the diagnosis of pathology of the fundus oculi in children]. / Fliuorestsentnaia angiografiia v diagnostike patologii glaznogo dna u detei.

Fluorescent diagnostics examinations were undertaken by the authors in different-age 410 children. The peroral fluorescent angiography (FAG) was used to examine 20% of cases, and the intravenous FAG was applied to 80% of cases. We offered the differential approach to dosing the solution, while making the peroral FAG examinations, which reduces the frequency rate of unfavorable reactions. The dosage ranged from 20 to 25 mg/kg with regard for purposes of examinations. The use of fluorescein did not cause any serious complications; nausea and a short faintness state were registered only in 10% of children. An examination of angiography images demonstrated that the phases of tinting of healthy tissue were identical to those tinted at the intravenous FAG. The below peculiarities of the child eye fundus were established: a weaker, as compared to the adults, pigmentation of the eye fundus, an insufficient differentiation of the macular zone and an immature peripheral retina in children during the neonatal period. Indications for FAG at congenital and acquired eye pathologies are specified.

[Multiple sclerosis with early onset: pathogenesis, clinical characteristics, possibilities in the treatment of its pathogenesis]. / Rannee nachalo rasseiannogo skleroza -- osobennosti patogeneza, kliniki i vozmozhnost' patogeneticheskoi terapii.

Early onset multiple sclerosis (MS) has some peculiarities in the disease course. 56 patients with definite MS with the onset at the age under 15 years were included in this clinical, immunogenetical and neurophisiological study. The analyses of the relations between different clinical characteristics of MS in children has shown, that patients with onset under 10 years, had rare relapses, but more progressive development of disability in contrast to the patients with MS onset at the age of 11-15 years. Duration of the first remission was associated with the time to sustained disability in children with MS. The number and volume of MRI T2-positive lesions in the white matter of the brain was associated with the age of onset, duration of the disease and with the number of relapses. In several cases the phenomena of clinical-MRI dissociation was observed. Generic HLA-DRB1 genomic typing was performed in all the patients. High frequency of DR2(15) genotype in MS-affected children in comparison with the group of healthy controls was more expressed as compared with MS-affected adults. The comparison of frequencies of DRB1 alleles in transmitted, i.e. appeared in the affected child haplotypes and in non-transmitted haplotypes confirmed results of the case-control study showing the very significant association of MS with DR2 alleles and extremely significant--with its DR15 subtype in children. The data of transmission/disequilibrium test (TDT) analysis provide strong evidence for linkage of DR15 alleles and susceptibility to sporadic MS in patients with disease onset before 15 years. The positive experience of management (beta-interferon-1a) was shown in MS-affected children in three cases.

[Electrophysiological methods for examining preterm children and diagnosis of retinopathy of prematurity]. / Elektrofiziologicheskie metody issledovaniia v obsledovanii nedonoshennykh detei i diagnostike retinopatii nedonoshennykh.

The first stage of the study was devoted to registration of visual evoked potentials (VEP) in 14 full-term and 27 preterm children without signs of neonatal retinopathy (NR) at the age of 6-7 months. The authors conclude that VEP in preterm children without signs of NR, born at different terms of gestation, reach the values of full-term children by the age of 6 months. These data should be taken account of when examining preterm babies for timely diagnosis of pathological changes in the visual analyzer and treatment. The second stage of the study was developed to registration of VEP and electroretinogram (ERG) in 36 children aged 4-12 years with cicatricial forms of NR. Changes in the central compartments of the retina were responsible for low visual functions in children with the cicatricial stages of NR. This abnormality is caused by displacement of the macular zone, impairment of its electrogenesis and topographic anatomic relationships. Examination of the marginal retinal periphery (superior external quadrant) once a year is obligatory for patients with cicatricial stages of NR in order to timely detect inapparent local fixed detachments or prevent them by timely prophylactic laser coagulation of the retina.

[Fulminant retinopathy of prematurity ("plus-disease"): incidence, risk factors, diagnostic criteria, and variations in course]. / Molnienosnaia retinopatiia nedonoshennykh ("plius-bolezn'"): rasprostranennost', faktory riska, kriterii diagnostiki i varianty techeniia.

The authors examined 363 premature children with retinopathy. The fulminant form PH ("plus-disease") was found in 21.5% of cases. The authors determined risk factors of this PH form, diseases of mother during pregnancy, pregnancy pathology, infectious diseases of a new-born child with development of sepsis and pneumonia, grave hypoxic and ishemic affection of central nervous system with intraventricular hemorrhage of III-IV degree, and also exposure of children to artificial lung ventilation for more than 7 days and estimation by Apgar scale at less than 6 points. There were the following ophthalmologic prodromes of fulminant PH in early neonatal period: gray color of the optic disk, gray-yellow background of the eye fundus, coiled arteries and varicosity in retina center, coiled vessels on periphery of the eye fundus, total retina edema, multiple hemorrhages at the eye fundus, a wide avascular zone. There are the following absolute signs of this form: rigidity of the pupil, iris vasodilatation, localization of process in I-II zone of the eye fundus, a significant varicosity in center of eye fundus, a coiled way of central arteries, vasodilatation and sharply coiled vessels at the border with avascular zone, exudative and proliferative changes both at site of peripheric torus and at other sections of the eye fundus. To estimate process gravity, forecast and more pathogenetically substantiate treatment, the following forms of fulminant PH are singled out: hemorrhagic (11.5%), exudative (21.8%), neovascular (14.1%) and mixed (52.6%).

[Immunogenetics of optic neuritis in children with multiple sclerosis]. / Immunogenetika opticheskogo nevrita u detei s rasseiannym sklerozom.

The aim of the work was to study immunogenetic peculiarities of optic neuritis in children with MS. Using PCR-SSP technique genomic typing was performed on HLA DRB1 gene (chromosome 6p21) of 56 unrelated children with ON registered at least once in clinically verified MS. 264 adult MS patients and 328 healthy controls from the same stratum of population were also genotyped. A very strong correlation of MS with DR15 (DRB1*150 ... alleles) was observed in comparison with healthy cases in the above population. In 39 cases of children with ON and MS both parents were also genotyped and the rate of their DRB1 haplotypes transmitted (patients) and non-transmitted (control cases) to their sick children were compared in accordance with affected family-based (AFBAC) method. A very strong correlation of demielinating disease with DRB1*150 ... alleles was verified. Transmission/disequilibrium test (TDT) was carried out to analyze correlation in selected families consisting of one sick child and two parents at least one of whom was heterozygous for DR15. The difference observed in transmission from these parents of DR15 alleles and alternative DRB1 alleles was extremely great providing obvious evidence for correlation of DR15 (DRB1*150...) alleles and susceptibility of children to ON and MS.