CSF Bypass Surgery in Children with Hydrocephalus: Modern Possibilities, Prospects and Ways of Solving the Correction of Complications

The chapter discusses modern and promising approaches to the use of CSF shunting operations in children. CSF shunting operations remain the only effective method for correcting persistent CSF circulation disorders in CSF resorption disorders with the development of intracranial hypertension and hydrocephalus. The chapter is devoted to general ideas about CSF dynamics and biomechanical properties of the craniospinal system that affect CSF dynamics, and gives a pathogenetic assessment of CSF dynamics in the development of intracranial hypertension and hydrocephalus. Aspects of genetics and genomics of anomalies in hydrocephalus are touched upon. Pathological changes in the brain around old ventricular shunts are described. The authors consider the types of CSF shunting operations for hydrocephalus in children. Possible complications of CSF shunting operations are analyzed with the algorithm for their correction and management tactics for this group of patients

Risk factors for cardiovascular diseases in patients received complex treatment for cranial and craniospinal tumors in childhood

Aim. To study the traditional risk factors for cardiovascular disease (CVD), indicators of endothelial function and exercise tolerance in patients received complex treatment for cranial and craniospinal tumors in childhood, including radiation therapy.Material and methods. We compared examination data of 48 patients who underwent treatment for brain tumors using cranial and craniospinal irradiation in childhood (mean age, 21,7±4,3 years, mean period after the end of treatment, 6,9±5,4 years), and 20 healthy volunteers. Examination methods included assessment of lipid profile, vascular stiffness and endothelial function using the Photoplethysmography and occlusion test, cardiopulmonary test, and in patients who underwent craniospinal irradiation, also echocardiography and duplex ultrasound of extracranial arteries.Results. Compared to healthy individuals, patients after a brain tumor were found to have lower blood pressure, higher heart rate (HR), significantly lower exercise performance (peak oxygen consumption, 19,8±6,4 ml×min-1×kg vs 30,3±5,8 ml×min-1×kg, p<0,0001) and a higher prevalence of dyslipidemia (56% vs 5%, p<0,0001), as well as an increase in the augmentation index, indicating higher stiffness of large vessels (-7,3±16,3 vs -20,3±7,9, p=0,001), and a trend towards a decrease in the occlusion index (p=0,051). Echocardiography and duplex ultrasound revealed no radiation-associated abnormalities.Conclusion. Determining the mechanisms and prognostic significance of the identified risk factors for CVD (dyslipidemia, decreased exercise tolerance, increased heart rate and vascular stiffness) in this category of patients requires further research. Regular monitoring of risk factors, primarily the lipid profile, and the use of preventive measures for individuals with an increased risk of CVD should be recommended

ХАРАКТЕРИСТИКА ГЛОМЕРУЛЯРНОЙ ГЕМАТУРИИ У ДЕТЕЙ

Hematuria is a significant manifestation, which can reflect both renal disorders and other urinary tract diseases and also be a symptom of systemic illnesses. High prevalence, diversity of etiological and trigger factors, latent course of hematuria and phenotypic resemblance of a number of underlying nephropathies symptoms cause increased interest and urgency of further investigations of such diseases features. The examination of 56 children showed that the most common cause of glomerular hematuria was hereditary kidney diseases, associated with collagen IV type mutations — 64% (Alport syndrome — 56%, thin basement membrane disease — 44%) and IgA-nephropathy — 36%. Comparative analysis of these conditions is presented in this study.Гематурия — важный признак, отражающий патологическое состояние почек и других органов мочевой системы, служит также проявлением системных заболеваний. Частая встречаемость, многообразие причин, способствующих возникновению гематурии, латентное течение и фенотипическое сходство проявлений ряда нефропатий, вследствие которых она возникает, обусловливают повышенный интерес к дальнейшему изучению особенностей заболевания. В результате обследования 56 детей показано, что наиболее частой причиной гломерулярной гематурии выступают наследственные заболевания почек, связанные с мутацией коллагена IV типа, составляя 64% случаев (из них с синдромом Альпорта — 56%, болезнью тонких базальных мембран — 44%), а также IgA-нефропатия — 36%

Severe neurological outcomes after very early bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD)

To test the association between bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD) and long-term clinical outcome and to identify risk factors for severe outcomes, a dataset comprising 504 patients from the international registry study ARegPKD was analyzed for characteristics and complications of patients with very early (� 3 months; VEBNE) and early (4�15 months; EBNE) bilateral nephrectomies. Patients with very early dialysis (VED, onset � 3 months) without bilateral nephrectomies and patients with total kidney volumes (TKV) comparable to VEBNE infants served as additional control groups. We identified 19 children with VEBNE, 9 with EBNE, 12 with VED and 11 in the TKV control group. VEBNE patients suffered more frequently from severe neurological complications in comparison to all control patients. Very early bilateral nephrectomies and documentation of severe hypotensive episodes were independent risk factors for severe neurological complications. Bilateral nephrectomies within the first 3 months of life are associated with a risk of severe neurological complications later in life. Our data support a very cautious indication of very early bilateral nephrectomies in ARPKD, especially in patients with residual kidney function, and emphasize the importance of avoiding severe hypotensive episodes in this at-risk cohort. © 2020, The Author(s)

DURATION OF POSTVACCINAL IMMUNITY AGAINST HEPATITIS B IN HEALTH CARE WORKERS IN ST. PETERSBURG

Immunization against hepatitis В is the most effective method of preventing this disease. Study of quantitative characteristics of postvaccinal immunity against viral hepatitis В in 214 health care workers from different institutions of St. Petersburg has shown that HBV vaccine provides a long term immunity in 80% of cases with the absence of manifest forms of the disease. The duration of circulation of high titers of antibodies depended on the age of people when vaccination was provided. The highest level of immunity was observed in people vaccinated before the age of 30 years (84,0–90,6%). Reduction of immunity level in vaccinated health care workers after 5 years from the date of vaccination requires revaccination against viral hepatitis B after pre-vaccination screening