Bickerstaff Brainstem Encephalitis and overlapping Guillain-Barré syndrome in children: Report of two cases and review of the literature.

Bickerstaff Brainstem Encephalitis (BBE) is a rare autoimmune encephalitis, characterized by acute ophthalmoplegia, ataxia and altered state of consciousness. Together with Guillan-Barrè Syndrome (GBS) and Miller-Fisher Syndrome, it forms a spectrum of post-infectious demyelinating diseases. Overlapping forms between BBE and GBS (BBE/GBS) are described in patients with lower limbs weakness and typical signs of BBE, suggesting a combined involvement of Central and Peripheral Nervous System (PNS), but only few reported cases are focused on pediatric population. We reviewed all cases of pediatric BBE in the literature, to determine if any patient showed features suggestive for BBE/GBS. Data analysis focused on the diagnostic tests performed (e.g. anti-GQ1b antibodies), neuroimaging and nerve conduction studies (NCS). Further attention was given to the therapeutic management and to patients' outcome. We additionally present two previously unreported pediatric cases. Our review retrieved 19 cases of BBE/GBS, only 2 of which were originally and correctly diagnosed by the authors. The prevalence was higher in male subjects (ratio 3:1) and median age at diagnosis was 8 years. Anti-GQ1b were positive in 46% of the patients, while NCS were altered in 64%. Only 25% of the patients that underwent brain MRI showed abnormal findings. The incidence of BBE/GBS has been underrated in the past, mostly due to an underestimation of the PNS involvement. We therefore suggest to investigate all patients with a clinical picture suggestive of BBE/GBS through electroencephalogram, NCS, brain and spine MRI in order to promptly achieve the correct diagnosis.

[Cardiometric data as indications to surgical treatment of elderly and senile patients suffering from thyrotoxicosis].

On the basis of studying clinical symptoms of thyrotoxicosis in elderly patients and an analysis of results of investigation of the heart the authors marked out additional indications to surgical treatment of this category of patients. Results of surgical treatment of elderly and senile patients suffering from thyrotoxicosis are also described.

[A possible association of fatal pneumonia with mutations of pandemic influenza A/H1N1 sw1 virus in the receptor-binding site of the HA1 subunit].

The paper gives the results of sequence analysis of 150 positive samples in real-time RT-PCR, including 47 autopsy materials from patients (including 10 pregnant women), who died from fatal pneumonia mainly in November-December 2009, in whom the lifetime etiological diagnosis had not been made and hence no early etiotropic therapy performed. 70% of the primary materials from the deceased patients were found to have pandemic influenza A(H1N1) v mutants in the lung tissue with D222G (15%), D222N (15%), D222E (2%) substitutions, as well as a mixture of mutants (38%). Nasopharyngeal lavages from 3 Chukotka deceased patients exhibited only consensus (nonmutant) D222 virus variants; there was a mixture of consensus and mutant virus variants in the trachea and a mixture of mutant ones in the lung. Preliminary data from the study of the interaction of the hemagglutinin of two strains having D222G and D222N mutations with 9 oligosaccharides imitating the variants of cell receptors for influenza A virus suggest that there is a double receptor specificity for alpha2'-3' and alpha2'-6'-sialosides with a preponderance of alpha2'-3'-specificity. Further spread of the mutants that have acquired a high virulence and preserved their capacity for the respiratory route of human infection may lead to the situation similar to that seen in the 1918-1919 pandemic. Another scenario for evolution of the virus is to preserve its receptor specificity for alpha2'-3'-sialosides and high virulence with losses of alpha2'-6' specificity and capacity for aerosol transmission, by damping the pandemic.

[Spread of new pandemic influenza A(H1N1)v virus in Russia].

The paper presents the results of the investigations of the development of a influenza A(H1N1)v pandemic, conducted by the D. I. Ivanovsky Research Institute of Virology, Russian Academy of Medical Sciences, and collaborating laboratories in the European part of Russia, in the Urals, Siberia, and in the Far East. In the prepandemic period (April 27 - June 11, 2009) its first diagnosis was established on May 21, 2009; the first strain was isolated on May 24, 2009; the data on complete genome sequencing were sent to the GenBank; the sensitivity of the strain to commercial antiviral commercial agents was studied. In the early pandemic period (June 11 - August 15), 73 patients who had come from 14 countries of Europe, America, and Asia were identified; 19 virus strains (partially or completely sequenced) were isolated. The pandemic period (August 15 - December 1) was marked by absolute dominance of pandemic influenza virus virtually in the absence of seasonal influenza; the first death caused by pandemic influenza was detected in late August; 3053 subjects were infected with the pandemic strain, as shown by polymerase chain reaction diagnosis; 202 strains were identified.

[Specific clinical course of thyrotoxicosis and results of surgical treatment of elderly patients].

Age is one of the most significant risk factors of the development of diseases of the thyroid gland. Hyperthyroidism is much more difficult for diagnosing in elderly patients since its symptoms might be rubbed off and somewhat atypical. Rather often the cardial symptoms in elderly and senile patients are brought to the forefront when there are no other external manifestations of the disease. One of the most difficult questions in decision on the strategy of treatment of toxic goiter in elderly people having thyrotoxicosis is the question of indications to surgery. The article describes clinical symptoms and exact indications to surgical treatment in elderly people with thyrotoxicosis and assesses long-term results.

[Clinical significance of functional variants of matrix metalloproteinase genes in thyroid cancer].

Under analysis were results of genetic investigations of 105 patients with thyroid cancer (TC) treated from 2004 through 2007 in the St. Petersburg City Center of surgery and oncology of the endocrine system organs. The patients' age was from 17 to 80 years (mean age 51.6 +/- 1.9 years). The influence of functional variants of matrix metalloproteinase genes in TC was determined. A reliable correlation was noted between certain gene markers and TC patients' age. An association was revealed between matrix metalloproteinase-3 5A (more active allele) and size of the tumor. A reliably decreased frequency of hyperactive genotype MMP-1 2G was detected in a group of women with metastatic forms of papillary cancer as compared with patients without metastases. It was shown that MMP genes could be a substantial factor of slowing down the rate of malignant growth and invasive properties of cancer of the thyroid gland.

[Results of surgical treatment of nodular diseases of the thyroid gland in senile patients].

The article presents an analysis of results of surgical treatment of 90 patients aged older than 75 years (mean age 78.0+/-2.8 years) with nodular diseases of the thyroid gland. The influence of a concomitant pathology in other organs on the course of diseases of the thyroid gland was established. It was noted that in senile patients malignant tumors appeared three times more often against the background of a benign pathology of the thyroid gland than in young patients. Main indications for surgical treatment were compression syndrome and cancer of the thyroid gland. The results of treatment of malignant tumors of the thyroid gland in senile patients and causes of postoperative complications were studied. Unfavorable results of treatment were due to prolonged observations at the pre-admission stage, predominance of patients (63.0%) with the 4th stage of disease, almost half of them had anaplastic cancer.

[Activation of sanogenesis mechanisms in central nervous system disorders]. / Aktivizatsiia sanogeneticheskikh mekhanizmov pri narusheniiakh tsentral'noi nervnoi sistemy.

Brain dysfunctions develop in brain injuries. Drug therapy is aimed at restitution processes which are often insufficient for recovery of impaired functions. Activation of the compensatory mechanisms of damaged and intact hemispheres will modify the time and qualitative characteristics of the restitution period. With this aim in view, transcranial electromagnetic stimulation in physiological range of efferent pathways and audiovisual stimulation of afferent pathways are recommended.

[Thermography in the differential diagnosis of nodular goiter and thyroid cancer]. / Termografiia v differentsial'noi diagnostike uzlovykh form zoba i raka shchitovidnoi zhelezy.

The thermographic method of diagnosis was used in examination of 201 patients with different surgical diseases of the thyroid. The correct thermographic diagnosis was made in 59 of 66 patients with thyroid carcinoma. Pseudopositive results took place in 14 of 87 patients with benign diseases of the thyroid. Thermography was also used for revealing recurrent tumors of the thyroid gland.

[Thermography in the diagnosis of thyroid neoplasms]. / Termografiia v diagnostike novoobrazovanii shchitovidnoi zhelezy.

Thermographic procedures were used in the examination of 70 patients suspected of bearing thyroid tumors in whom 131I scanning had revealed hypofunction of nodes ("cold" nodes) as well as 38 patients who had been operated for thyroid tumors at different periods. Thermographic diagnosis of primary thyroid tumor was confirmed histologically in 49 cases. Pseudonegative results were established in 5 cases. Pseudopositive results were recorded in 6 out of 21 cases of benign lesions of the thyroid. Recurrences were identified thermographically in 16 patients operated for thyroid tumors. No pseudonegative results were obtained.