Опыт диагностики и лечения болезни Кавасаки в клинике Санкт-Петербургского государственного педиатрического медицинского университета и Д етской городской больнице №1 Санкт-Петербурга

Kawasaki disease (KD) is acute systemic vasculitis of unknown etiology. Approximately 20–25% of untreated patients develop coronary artery changes with a range of severity from asymptomatic coronary artery dilatation to giant coronary artery aneurysms with thrombosis, myocardial infarction, and sudden death. To date there is no official data on the incidence of KD in Russia. In Russia, the disease is not enough known now to a wide circle of physicians and often masks other more common diseases. Since 2010, the detection rate of KD has dramatically increased in Saint-Petersburg.Objective: to analyze the experience in diagnosing and treating KD in two largest hospitals of Saint Petersburg.Patients and methods. The retrospective study included data on 30 children (18 boys, 12 girls) who were hospitalized with a diagnosis of KD in the Saint-Petersburg State Pediatric Medical University Clinic and Children’s Hospital One (Saint Petersburg) between January 2011 and September 2016. Data are represented by median and extreme values. The age of the children was 2.8 (0.2; 4.6) years; of them 5 (16.7%) patients were under the age of 1 year. The children were hospitalized on 5 (1; 14) days of disease onset; KD was diagnosed on 9 (3; 52) day of the disease.Results. Immediately after diagnosis, 27 (90%) children received aspirin. In early stages (before 10 days of the disease), intravenous immunoglobulin (IVIG) therapy was performed in 15 (50%) children, one of them received IVIG before disease day 5 (on day 3), but without effect. On disease days 11-20 (immediately after diagnosis), 10 (33.3%) children were prescribed with IVIG; thereafter fever was abolished in all the patients. Their body temperature became normal on day 11 (6; 23). Ultrasonography revealed coronary artery lesions in 13 (43.3%) patients. Out of the 30 children followed up, one baby who fell ill at the age of 3 months and received IVIG died on day 30 of the disease.Conclusion. Currently, there continues to be a delayed diagnosis of KD. IVIG therapy was effective, especially in cases of timely diagnosis. It is necessary to increase awareness of KD among clinicians and ultrasound diagnosticians.Болезнь Кавасаки (БК) – остро протекающий системный васкулит неизвестной этиологии. Примерно у 20–25% не получивших лечения больных развиваются изменения коронарных артерий различной степени тяжести – от бессимптомной дилатации до гигантских аневризм, тромбоза, инфаркта миокарда и внезапной смерти. До настоящего времени официальных данных о заболеваемости БК в России нет. В нашей стране БК недостаточно известна широкому кругу врачей и часто проходит под маской других более распространенных заболеваний. В Санкт-Петербурге после 2010 г. резко возросла выявляемость БК.Цель исследования – проанализировать опыт диагностики и лечения БК в двух крупных стационарах Санкт-Петербурга.Пациенты и методы. В ретроспективное исследование были включены данные о 30 детях (18 мальчиков, 12 девочек), находившихся на стационарном лечении с диагнозом БК в клинике Санкт-Петербургского государственного педиатрического медицинского университета и Детской городской больнице №1 Санкт-Петербурга с января 2011 г. по сентябрь 2016 г. Данные представлены медианой и крайними значениями. Возраст детей составил 2,8 [0,2; 4,6] года, из них 5 (16,7%) пациентов были в возрасте до 1 года. Дети были госпитализированы на 5-е [1; 14] сутки болезни, диагноз БК установлен на 9-й [3; 52] день болезни.Результаты. Сразу после установления диагноза получили аспирин 27 детей (90%). В ранние сроки (до 10-го дня болезни) терапия внутривенным иммуноглобулином (ВВИГ) проводилась у 15 (50%) пациентов, из них 1 получил ВВИГ ранее 5-го дня болезни (на 3-й день), однако без эффекта. На 11–20-й день болезни (сразу после установления диагноза) ВВИГ назначен 10 (33,3%) детям, после чего лихорадка была купирована у всех пациентов. Температура тела нормализовалась на 11-й [6; 23] день. Поражение коронарных артерий при УЗИ выявлено у 13 (43,3%) пациентов. Из 30 находившихся под наблюдением детей у 1 ребенка, заболевшего в возрасте 3 мес и получившего ВВИГ на 30-й день болезни, зафиксирован летальный исход.Выводы. В настоящее время БК продолжает диагностироваться с опозданием. Терапия ВВИГ была эффективной, особенно в случаях своевременного установления диагноза. Необходимо повышение осведомленности клиницистов и врачей ультразвуковой диагностики о БК

Comparion of two techniques crosslinking for progressive keratectasia

Purpose: to compare surgical approaches, features of the postoperative period and functional results of conventional and opti- mized crosslinking techniques.Methods: We followed 2 groups of patients (10 patients, 10 eyes each), treated in Volgograd branch of the S.N. Fyodorov Eye Microsurgery Clinic for kerotoconus of the II-III degree according to the conventional method (I group) and the optimized technique (II group). the optimized technique consisted of the customized excimer laser corneal deepitalization to the depth of 2/3 of the epithelial layer. Excimer laser ablation with intraoperative «on-line» pachymetry was made by means of Schwind Amaris-500 Hz (Schwind, Germany).Results: Method of the optimized crosslinking with a customized depth of excimer laser ablation required a longer period for satu- ration of the cornea with solution of riboflavin (mean 5-10 minutes). However, it was accompanied with a less severe corneal syndrome, a complete reepithelization and an earlier postoperative recovery of visual functions. Six months postoperatively a 1-2-line improve- ment of BCVA and UCVA was achieved in 19 patients (19 eyes). Decrease of cylindrical component averaged 1.2 D in the group I and 1 D in the group II. Mean refraction change in SE was 2.2 D in the group I and 2.0 D in the group II. Six months postoperatively one patient from the group II had a 1-line regression of BCVA in comparison to the preoperative level accompanied with a 10 μm corneal thinning and corneal curvature steepening by 2 D at the top of keratoconus, which was regarded as an aggravation of initial state.Conclusion: Both approaches have proved their safety and effectiveness. However, incurrence of the above-mentioned case of state deterioration calls for the further comparative studies in order to evaluate clinical effectiveness of these methods

The efficacy and safety of corneal collagen cross-linking in progressive keratoconus with regard to long-term results

Purpose. To evaluate the efficacy and safety of a modified technique of corneal collagen cross-linking in comparison with the standard approach by the nature changes in clinical and morphological parameters of the cornea in the early and longterm postoperative period.Material and methods. The study included two groups of patients: the group 1 consisted of patients operated on for progressive keratoconus in the classical way of corneal collagen cross-linking – 25 individuals (25 eyes), the group 2 – patients treated by the modified cross-linking technique – 36 individuals (36 eyes). Before and after the procedure in the follow-up of 1, 3, 6 and 12 months, all patients underwent an extended ophthalmic examination, including the optical coherence tomography (OCT) of the cornea (Cirrus HD 3000, Carl Zeiss, Germany), the confocal microscopy (Confoscan4, Nidek, Japan).Results. Re-epithelialization of the cornea occurred faster in the group 2. In both investigated groups a significant UCVA increase (from 0.15±0.04 to 0.35±0.07 in the group 1 and 0.13±0.025 to 0.33±0.04 in the group 2) and the BCVA (from 0.3±0.08 to 0.5±0.05 in the group 1 and 0.4±0.04 to 0.87±0.18 in the group 2) was noted in the follow-up period of 6-12 months. After 1 month postoperatively the well-defined linear opacities in the middle and posterior layers of the stroma – the so-called «demarcation lines» or «posterior stromal hazes» appeared during the ophthalmic bio-microscopy as well as in the OCT of cornea in all observed patients. In this period the depth of the «demarcation line» position in the group 1 averaged 252±15.0μm, in the group 2 – 235±10.0μm. The confocal microscopy showed that histomorphological changes were more pronounced in the group 1 within all above-mentioned periods. In the 3-month follow-up in the group 2 a statistically significant reduction in our proposed scoring estimation of all the studied signs, and a maintenance of this trend were detected in the follow-up period after 6 and 12 months, that indicates a more mild and rapid regeneration of cornea after the corneal collagen cross-linking surgery performed according to the modified technique. The endothelial cells density (ECD) remained unchanged in all followup periods in both groups.Conclusions. Thus, a manifestation of positive dynamics in the postoperative UCVA, BCVA and the unchanged ECD in all cases allows to consider both options of corneal collagen crosslinking safe, with a comparable clinical efficacy. However, a more pronounced positive dynamics in the BCVA in the group 2, a milder course of the early postoperative period for patients, consisting in a more rapid completion of the re-epithelialization process, as well as and the availability of adequate and safe level histomorphological changes in the cornea after the cross-linking enable to recommend the modified technique for the treatment of progressive keratoconus

Experience in the diagnosis and treatment of Kawasaki disease in the Saint-Petersburg State Pediatric Medical University Clinic and Saint Petersburg City Children’s Hospital One

Kawasaki disease (KD) is acute systemic vasculitis of unknown etiology. Approximately 20–25% of untreated patients develop coronary artery changes with a range of severity from asymptomatic coronary artery dilatation to giant coronary artery aneurysms with thrombosis, myocardial infarction, and sudden death. To date there is no official data on the incidence of KD in Russia. In Russia, the disease is not enough known now to a wide circle of physicians and often masks other more common diseases. Since 2010, the detection rate of KD has dramatically increased in Saint-Petersburg.Objective: to analyze the experience in diagnosing and treating KD in two largest hospitals of Saint Petersburg.Patients and methods. The retrospective study included data on 30 children (18 boys, 12 girls) who were hospitalized with a diagnosis of KD in the Saint-Petersburg State Pediatric Medical University Clinic and Children’s Hospital One (Saint Petersburg) between January 2011 and September 2016. Data are represented by median and extreme values. The age of the children was 2.8 (0.2; 4.6) years; of them 5 (16.7%) patients were under the age of 1 year. The children were hospitalized on 5 (1; 14) days of disease onset; KD was diagnosed on 9 (3; 52) day of the disease.Results. Immediately after diagnosis, 27 (90%) children received aspirin. In early stages (before 10 days of the disease), intravenous immunoglobulin (IVIG) therapy was performed in 15 (50%) children, one of them received IVIG before disease day 5 (on day 3), but without effect. On disease days 11-20 (immediately after diagnosis), 10 (33.3%) children were prescribed with IVIG; thereafter fever was abolished in all the patients. Their body temperature became normal on day 11 (6; 23). Ultrasonography revealed coronary artery lesions in 13 (43.3%) patients. Out of the 30 children followed up, one baby who fell ill at the age of 3 months and received IVIG died on day 30 of the disease.Conclusion. Currently, there continues to be a delayed diagnosis of KD. IVIG therapy was effective, especially in cases of timely diagnosis. It is necessary to increase awareness of KD among clinicians and ultrasound diagnosticians