Сахарный диабетВопросы патогенеза ахарный диабет (СД) является заболеванием цивилизации и сопровождает человечество на протяжении всей истории его развития. Первые письменные свидетельства о СД были обнару-жены в датированном 1500 годом до нашей эры древ-неегипетском папирусе Эберта, в котором заболевание обозначалось как состояние, сопровождающееся обиль-ным мочеотделением. В 30-50 годах нашей эры древне-греческий врач Аретей Каппадокийский впервые описал клиническую картину СД. Отмечая, что у таких пациен-тов «…жидкость не задерживается в организме, но весь организм сжижается и выходит наружу с мочой..», он на-звал заболевание «диабет» (от греческого «диабайно», означающее «проходить через или насквозь»). В XVII в. в Европе английский врач Томас Уиллис впервые выя-вил сладкий вкус мочи у больных диабетом и предложил к названию болезни добавить «сахарный» (от латинского «mellitus, означающий «сладкий, медовый»).ХХ век стал по-настоящему прорывным в истории диабетологии, периодом бурного развития знаний о па-тогенезе и этиологии СД, стремительного совершенство-вания инсулинов и средств их введения, создания новых сахароснижающих препаратов [1][2][3]. Однако, несмотря на имеющиеся успехи, о решении проблемы СД пока не приходится говорить. Парадоксально, но сегодня, спустя уже более века с момента разработки первых ме-тодов лечения СД, это заболевание не только остается одной из крупнейших мировых проблем, но и приобре-тает все большее распространение, принимая характер пандемии [4].Наибольшая опасность СД связана с его сосуди-стыми осложнениями, в частности, с диабетической нефропатией (ДН), развивающейся у 30-40% больных СД 1 и 2 типа и занимающей лидирующие позиции среди причин терминальной почечной недостаточности (ТПН) во всем мире [5, 6]. ТПН вследствие ДН оста-ется основной причиной смертности больных СД 1 типа (СД1), а у больных СД 2 типа (СД2) она занимает второе место после сердечно-сосудистой патологии [5, 6]. За-траты на обеспечение заместительной почечной тера-пией пациентов с ТПН в исходе ДН, а также на лечение ее осложнений постоянно растут и тяжким бременем ложатся на бюджет здравоохранения в разных странах, в том числе в России. Повреждение подоцитов при сахарном диабете
A unique clinical case of a combination of malformations of the anterior abdominal wall (omphalocele of large size) and malformation of the lymphatic system (congenital chyloperitoneum) is presented. Each of these defects can lead to a fatal outcome, and the combination of them has greatly increased the risk of developing an unfavourable outcome. The use of immunosuppressive therapy with Sirolimus used for the first time during the newborn period made it possible to completely stop the chyloperitoneum. This clinical example shows that in the treatment of surgical patients with multiple congenital malformations, a multidisciplinary approach and observation is necessary for timely response to the patient’s condition.
Purpose. Presentation of clinical cases of rare combination of omphalocele with pylorostenosis in the postoperative period and additional liver lobe. Materials and methods. In National Medical Research Center for Childrens Health of health surgical ward of newborns and infants for the 2019 us operated 2 children who performed surgery involving intra-operative decision making about further surgical tactics. Results. the results of surgical treatment of newborns with omphalocele combined with hypertrophic pylorostenosis and extra liver lobe are presented. Conclusions. In patients with malformations of the anterior abdominal wall in the postoperative period, when regurgitation syndrome appears, it is necessary to make a differential diagnosis between the functional and organic causes of obstruction. When confirming the organic nature of the obstruction, surgical intervention is indicated. It is necessary to be able to timely and objectively assess the risks and expediency of the approach when choosing surgical tactics in each individual case.
The short bowel syndrome (SBS, or simply short gut) is the most common cause for the chronic intestinal failure (CIF). The purpose of the study was to present the results of treatment of infants at risk for the development of post-resection SBS and the formation of CIF. Research materials and methods: 22 children threatened by the formation of post-resection SBS were treated in the Surgical Department of Newborns and Infants of the National Medical Research Center for Children’s Health (Moscow, Russia) from 2017 to 2021. Results: All patients have undergone the surgical treatment. The scope of the surgical intervention included adhesiolysis with the imposition of an interintestinal anastomosis. Simultaneous imposition of multiple interintestinal anastomoses (more than 4) was performed in 7 patients (32%). As a result, the CIF formation was avoided in 8 patients (36%) by maintaining the total length of the remaining small intestine. The follow-up period ranged from 12 to 46 months. Currently, 2 patients (9%) receive partial parenteral nutrition, and in 17 patients (77%) it was possible to achieve completely autonomous enteral nutrition. A lethal outcome was stated in 3 patients (14%) due to the development of a catheter-associated infection. Conclusion: in the course of this work, the principles of surgical treatment of patients threatened by the development of post-resection SBS and the formation of CIF were developed. Adequate parenteral and enteral nutrition can optimize intestinal adaptation and improve the nutritional status of the pediatric patient.
The review of topical issues of diagnostics and treatment of malformation of the anterior abdominal wall - omphalocele in newborns is presented. Currently, there are no specific, recognized criteria acceptable for the maintaining and further managing pregnancy, delivery and treatment of children with omphalocele. Prenatally, the possibility of predicting the tactics of surgical treatment and postoperative management of a newborn with omphalocele is not taken into account. In the choice of tactics of treatment of this category of patients there is a need to consider many factors, namely: the data for the antenatal diagnosis of the defect, duration of respiratory support at the stage of preparation for surgery, age at the time of surgical treatment, the size of the hernia SAC, and the size of the liver in the hernia SAC. These criteria are necessary to determine the possibility of radical surgery for the anterior abdominal wall or stage-by-stage treatment with the creation of a temporary abdominal cavity, with preliminary gradual immersion of the evented organs into the abdominal cavity under the control of the child’s hemodynamic and respiratory parameters, with the dynamic control of the occurrence and progression of pulmonary hypertension under the ultrasound control. To date, a unified approach has not been developed in the surgical treatment and postoperative care of newborns with omphalocele. The use of a variety of methods of surgical correction and their modifications reveals extensive potential for the treatment of different form of exomphalos, but leads to the fact that some of these techniques find their applications in a single universally accepted treatment of this condition. The lack of unified standards of prevention and organization of treatment approaches for newborns with various forms of omphalocele makes this problem very relevant. When preparing a literary review, such databases as PubMed, MedLine, CyberLeninka, and RSCI were used.
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