The article presents a modern view on the prognostic factors of spontaneous resolution and effectiveness of treatment of children with vesicoureteral reflux (VUR). The most frequently used predictors of successful treatment of VUR (grades of reflux, distal ureteral diameter ratio to the distance of the lumbar vertebrae, reflux induction phase on mictional cystourthrography), delayed removal of contrast from the upper urinary tract, gender, age, antenatal hydronephrosis). Methodology, statistical significance, advantages, disadvantages of the described prognostic factors are analyzed.
Actuality. To date, there are few publications focused on pneumovesicoscopic ureteral reimplantation in young children. The article is devoted to surgical interventions in this age group. Material and methods. Surgical interventions on small volume bladder have significant technical difficulties. The authors assessed potentials for performing pneumovesicoscopic ureteral reimplantation by the Cohen technique in 14 children under 2 with various obstructive uropathies. Results. In all children, surgical interventions were performed according to preoperative plans. There were no conversions to an open procedure. As it has been found out, patient’s age and bladder volume were not limiting factors for this type of intervention. Conclusion. The pneumovesicoscopic ureteral reimplantation in young children is a hi-tech procedure which requires a unique equipment and a highly qualified surgical team. To reduce the procedure duration, further experience and more information are needed.
Представлено клиническое наблюдение инсулиномы у девочки 16 лет, у которой отмечены жалобы на приступы потери сознания с последующей ретроградной амнезией, сопровождавшиеся слабостью и головокружением. Больная был переведена в эндокринологическое отделение, где при регулярном контроле гликемии зафиксированы низкие значения (2,0-2,5 ммоль/л). Топический диагноз инсулиномы был установлен с помощью лучевых методов -мультиспиральной компьютерной томографии с контрастным усилением и магнитно-резонансной томографии, при которых в хвосте поджелудочной железы выявлена овальной формы опухоль размерами 12 × 10 мм. Девочке было проведено молекулярно-генетическое исследование гена MEN1 -мутаций в исследованном гене не выявлено. На период предоперационной подготовки с целью профилактики гипогликемического синдрома был назначен прогликем (диазоксид) в дозе 100 мг/сут, на фоне которого отмечалась стабилизация показателей гликемии. В дальнейшем была выполнена лапароскопическая дистальная резекция поджелудочной железы с опухолью. После операции достигнута стойкая эугликемия. При микроскопическом и иммуногистохимическом исследовании подтверждена нейроэндокринная опухоль поджелудочной железы G1. В обсуждении представлены данные об эпидемиологии, диагностике и хирургическом лечении инсулином у детей и взрослых. Ключевые слова: инсулинома, поджелудочная железа, лапароскопия, дистальная резекция поджелу-дочной железы с сохранением селезенки.We present a clinical case of insulinoma in 16 years-old girl. The patient complained about episodes of loss of consciousness, followed by retrograde amnesia and accompanied by weakness and dizziness. The patient was transferred to the Department of Endocrinology, where hypoglycemia was detected (2.0-2.5 mmol/l). Topical diagnosis of insulinoma was evidentiated with the help of radiological methods -multislice CT and contrast-enhanced MRI, which revealed an oval tumor 12 × 10 mm. The molecular genetic analysis of MEN1 gene was performed -no mutations were revealed. Prescribed Proglikem (diazoxide) therapy (100 mg/day) on pre-operative period was effective, patient's glycemia values stabilized. Further the laparoscopic distal pancreatectomy with tumor removal was performed. After the surgery we achieved stable euglycemia. On microscopic and immunohistochemical studies pancreatic neuroendocrine tumor G1 was confirmed. The discussion presents data on the epidemiology, diagnosis and surgical treatment of insulinomas in children and adults.
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