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CLINICAL CASES

    1. GBOU VPO RNIMU im. N.I. Pirogov the Ministry of Pub. Health of Russia (Moscow, Russian Federation)

    Keywords:khoristoma,the pancreas,abdominal pain,diarrhea,children

    Abstract:In the article is represented the observation of the case of the aberrant pancreas in the 5 year old child with the complaints of the paroxysmal abdominal pains and the dyspeptic manifestations in the form of liquid chair, vomitings with the use of separate products. It’s represented detailed clinical laboratory, instrument and the morphological dynamics of the clinical picture of disease, the stages of diagnostic search.

      1. Баиров Г. А. Хирургия поджелудочной железы у детей. Москва, Медицина, 1978, С. 47-54.
      2. Бельмер С. В., Костырко Е. В., Приворотский В. Ф., Луппова Н. Е. Аберрантная поджелудочная железа у детей // Вопр. дет. диетологии. - 2013. - Т. 11. - № 3. - С. 49-54.
      3. Винокурова Н. В. Диагностика и хирургическое лечение эктопии поджелудочной железы в стенку желудка у детей / Автореф. дисс. канд. мед. наук, Москва, 2008, 23 стр.
      4. Романов В. А. Эндоскопический атлас. Москва, Изд-во «Миклош», 1996, С. 101-102.
      5. Erkan N., Vardar E., Vardar R. Heterotopic pancreas: report of two cases. JOP. 2007; 8 (5): 588-91.
      6. Textbook of Gastroenterology, fifth edition. Edition by Tadataka Yamada. Wiley-Blackwell, 2009. P. 592.
     


    Full text is published :
    Khavkin A.I., Borzakova S.N., Bogomaz L.V., Kharitonova L.A. et al. THE ABERANT PANCREAS (KHORISTOMY) IN THE 5 YEAR OLD CHILD. Experimental and Clinical Gastroenterology Journal. 2016;125(01):102-106
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    1. Stavropol State Medical University (Stavropol, Russian Federation)
    2. G.K. Philippsky Child Clinical Hospital (Stavropol, Russian Federation)

    Keywords:primary sclerosing cholangitis,children,autoimmune liver diseases,cholestasis,primary biliary cirrhosis

    Abstract:Primary sclerosing cholangitis - autoimmune chronic cholestatic liver disease characterized by progressive course of latent and may proceed for many years. Naturally, the earlier the disease is detected, the longer lifespan. The article presents the clinical observation of a long asymptomatic autoimmune disease of the liver that is manifest only 6 months prior to an adverse outcome, but at the time of the manifestation of the child has already formed cirrhosis.

      1. Ивашкин В. Т., Буеверов А. О. Аутоиммунные заболевания печени в практике клинициста. - М.: ООО «Издательский дом «М-Вести», 2011. - С. 71-92.
      2. Лазебник Л. Б., Рыбак В. С., Ильченко Л. Ю. Первичный склерозирующий холангит // Consilium medicum. - 2003. - Т. 5, № 3. - С. 28-30.
      3. Нейман К. П., Голованова Е. В., Румянцев В. Г. и соавт. Воспалительные заболевания кишечника и первичный склерозирующий холангит // Экспериментальная и клиническая гастроэнтерология. - 2008. - № 2. - С. 63-70.
      4. Delbet P. Retrecissement du choledoque cholecystoduodenostomie // Bull. Mem. Soc. Nat. Chir. - 1924. - Vol. 50. - P. 1144-1146.
      5. Шифф Ю. Р., Соррел М. Ф., Мэддрей У. С. Вирусные гепатиты и холестатические заболевания / пер. с англ. В. Ю. Халатова; под ред. В. Т. Ивашкина, Е. А. Климовой, И. Г. Никитина, Е. Н. Широковой. - М.: ГЭОТАР-Медиа, 2010. - С. 65-84.
      6. Eaton J. E., Talwalkar J. A., Lazaridis K. N. et al. Pathogenesis of primary sclerosing cholangitis and advanced in diagnosis and management // Gastroenterology. - 2013. - Vol. 145, № 3. - P. 521-536.
      7. Голованова Е. В., Лазебник Л. Б., Конев Ю. В. и соавт. Аутоиммунные заболевания печени: клиника, диагностика, лечение. Рекомендации утверждены XV съездом НОГР в 2015 году // Экспериментальная и клиническая гастроэнтерология. - 2015. - № 7. - С. 97-107.
      8. Детская гепатология / под ред. Б. С. Каганова. - М.: Издательство «Династия», 2009. - С. 301-319.
      9. Детская гастроэнтерология: руководство для врачей / под ред. Н. П. Шабалова. - М.: МЕДпресс-информ, 2011. - С. 395-400.
      10. Циммерман Я. С. Первичный склерозирующий холангит: современные представления // Клиническая медицина. - 2014. - № 1. - С. 5-11.
      11. Подымова С. Д. Первичный склерозирующий холангит // Медицинский вестник Северного Кавказа. - 2009. - Т. 14, № 2. - С. 75-82.
      12. Bambha K., Kim W. R., Talwalkar J. et al. Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community // Gastroenterology. - 2003. - Vol. 125, № 5. - P. 1364-1369.
      13. Bergquist A., Lindberg G., Saarinen S. et al. Increased prevalence of primary sclerosing cholangitis among first-degree relatives // J. Hepatol. - 2005. - Vol. 42, № 2. - P. 252-256.
      14. Mieli-Vergani G., Vergani D. Autoimmune paediatric liver disease / World J. Gastroenterol. - 2008. - Vol. 14, № 21. - P. 3360-3367.
      15. Mendes F. D., Lindor K. D. Primary sclerosing cholangitis: overview and update // Nat. Rev. Gastroenterol. Hepatol. - 2010. - Vol. 7, № 11. - P. 611-619.
      16. Лопаткина Т. Н., Лин Е., Танащук Е. Л. и соавт. Варианты течения перекрёстной формы аутоиммунный гепатит-первичный билиарный цирроз // Врач. - 2014. - № 1. - С. 2-8.
      17. Yimam K. K., Bowlus C. L. Diagnosis and classification of primary sclerosing cholangitis // Autoimmun. Rev. - 2014. - Vol. 13, № 4-5. - P. 445-450.
      18. Singh S., Talwalkar J. A. Primary sclerosing cholangitis: diagnosis, prognosis, and management // Clin. Gastroenterol. Hepatol. - 2013. - Vol. 11, № 8. - P. 898-907.
      19. Marchioni Beery R. M., Vaziri H., Forouhar F. Primary biliary cirrhosis and primary sclerosing cholangitis: a review featuring a women’s health perspective // J. Clin. Transl. Hepatol. - 2014. - Vol. 2, № 4. - P. 266-284.
      20. Silveira M. G., Lindor K. D. Clinical features and management of primary sclerosing cholangitis // World J. Gastroenterol. - 2008. - Vol. 14, № 21. - P. 3338-3349.
      21. Maggiore G., Riva S., Sciveres M. Autoimmune disease of the liver and billary tract and overlap syndromes in childhood//Minerva Gastroenterol. Dietol. - 2009. - Vol. 55, № 1. - P. 53-70.
     


    Full text is published :
    Klimov L.Ya., Kuryaninova V.A., Kashnikov V.S., Eremeeva O.I. et al. THE PRIMARY SCLEROSING CHOLANGITIS IN THE 13-YEAR OLD GIRL. Experimental and Clinical Gastroenterology Journal. 2016;125(01):107-112
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    1. Saint Petersburg State Pediatric Medical University (Saint Petersburg , Russian Federation)
    2. Scientific Research Institute of Children’s Infections (Saint Petersburg , Russian Federation)

    Keywords:Clostridium difficile infection,recurrent course,children,diagnosis,treatment,prevention

    Abstract:In the last decade Clostridium difficile infection (CDI) has become a major cause of antibiotic-associated inflammatory lesions of the colon. Against the backdrop of the widespread increase in the frequency allocation of highly virulent strains C. difficile growing number of hard-to-therapy forms with recurrent infections. Standards of the treatment of recurrent CDI in children have not been developed. At the same time questions the effectiveness of primary and secondary prevention of CDI in recent years acute in the daily practice of pediatricians. The paper presents a clinical case of recurrent course of antibiotic-associated intestinal lesions caused by infection with C. difficile, a child of 13 years. Analysis of the case has highlighted the problems of diagnosis and treatment of recurrent CDI, the solution of which may include the following measures. When questionable results of screening to identify C. difficile toxins A and B in the feces of patients with diarrhea syndrome by enzyme immunoassay is necessary to continue studies reliable methods (isolation of toxigenic culture), that is to use multi-stage algorithms for diagnosis, as suggested by the existing recommendations. Treatment of the first episode of non-severe forms of the CDI with Metronidazole does not provide proof of clinical effect, which should be considered in practice. The results of continuous monitoring of the level of regional peculiarities C. difficile resistance to Metronidazole can help in selecting initial therapy CDI. The first CDI recurrence is more severe than the first episode, and accompanied and supported expressed by intestinal dysbiosis, demanding compensation active. The use of Vancomycin long course with a gradual reduction of the dose for the treatment of recurrent CDI does not guarantee the development of subsequent relapse, indicating that long-term maintenance of inflammatory changes in the intestinal mucosa, reduction of non-specific resistance of the organism against the backdrop of recurrent CDI and urges the need to find and use effective means of local anti-inflammatory therapy.

      1. Cocanour CS. Best strategies in recurrent or persistent Clostridium difficile infection. Surg Infect (Larchmt). 2011 Jun; 12 (3): 235-239.
      2. Debast S. B., Bauer M. P. European Society of Clinical Microbiology and Infectious Diseases: update of treatment guidance document for Clostridium difficile infection. Clin Microbiol and Infect. 2014; 20 (2): 45-48.
      3. McFarland L.V. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006; 101: 812-822.
      4. Kim J. W. Risk factors for delayed recurrence of Clostridium difficile infection. Intestinal Res. 2014 Oct; 12 (4): 266-267.
      5. Захарова Н. В., Филь Т. С. C. difficile и микробиота: как предупредить, диагностировать и лечить инфекцию. Дневник казанской медицинской школы. 2014; 3 (6): 53-58.
      6. Лобзин Ю. В., Захаренко С. М., Иванов Г. А. Современные представлениия об инфекции C. difficile. Клин. микробиол. и антимикробн. химиотер. 2002; 4 (3): 200-232.
      7. Щербакова А. В., Аджигайтканова С. К., Потешкина Н. Г. Clostridium difficile - ассоциированный колит: обзор рекомендаций. Лечебное дело. 2014; 3: 20-24.
      8. Корнеева О. Н., Ивашкин В. Т. Антибиотикоассоциированный колит: патоморфология, клиника, лечение. РЖГГК. 2007; 3: 65-70.
      9. Surawicz C. M., Brand L. J., Binion D. G., et al. Guidelelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013; 108 (4): 478-498.
      10. Шрайнер Е. В., Курилович С. А., Осипенко М. Ф., Власов В. В. Трансплантация кишечной микробиоты: терапевтический потенциал при болезнях органов пищеварения. РЖГГК. 2014; 24 (5): 63-68.
      11. Lanas A., Scarpignato C. Microbial flora in NSAID induced intestinal damage. A role for antibiotics; In: C. Scarpignato, A. Lanas. Bacterial flora in digestive disease. Focus on rifaximin. Basel: Karger, 2006.
      12. McFarland LV. Probiotics for the primary and secondary prevention of C. difficile infections: a meta-analysis and systematic review. Antibiotics. 2015; 4: 160-178.
      13. Коренев П. Б., Джахая Н. А., Гончар Н. В., Думова Н. Б. Проблемы лечения псевдомембранозного колита у детей. Матер. 11-го Междунар. Славяно-Балт. научн. фор. «Санкт-Петербург-Гастро-2009». Гастроэнтерология Санкт-Петербурга. 2009; 2-3: М39.
      14. Louie T. J., Miller M. A., Mullane K. M., et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011; 364: 422-431.
      15. Заплатников А. П., Захарова И. Н., Коровина Н. А. Clostridium difficile - инфекция у детей. http://www.rmj.ru/articles_435.htm
     


    Full text is published :
    Gonchar N.V., Nyrkova O.I., Razdyakonova I.V., Kvetnaya A.S. RECURRENT CLOSTRIDIUM DIFFICILE INFECTION IN THE 13-YEAR OLD CHILD. Experimental and Clinical Gastroenterology Journal. 2016;125(01):113-121
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