PERSISTENT COURSE OF YERSINIOSIS IN CHILDREN WITH GASTROENTEROLOGIC PATHOLOGY

F.N.RYABCHUK, Z.I.PIROGOV

Medical Academy of Postgraduate Education, Saint-Petersburg, RUSSIA

Purpose of the study: To assess clinical and laboratory features of persistence of yersiniosis infection in children with previous gastroenterological disorders.

Materials and methods: 168 patients with chronic duodenitis and malabsorption syndrome (98 and 65, respectively) were examined, terminal ileocolitis and mesenteric lymphadenitis of yersiniotic etiology was diagnosed in 43 children of them (25.8%).The complex examination included assessment of clinical and anamnestic data, indicators of a clinical minimum - blood analysis, coprograma, ultrasound of the abdomen, bacterial inoculation of feces for AEI, IHAT with yersiniotic diagnosticums, immune-enzyme analysis (IEA) of faeces fir yersinia and PCR of feces for yersenia DNA ( pseudotuberculosis and enterocolica). Results: persistent abdominal pains with epicenter in the right iliac region were peculiar for clinical manifestations of ileocolitis. The pain was not associated with food intake, and did not subsided after the intake of antacides, and did not alleviated after defecation. The pain completely disappeared after a course of purposeful antibiotic therapy, “corcscrew” symptom, desquamative tongue, enlarged liver and spleen, induration and pain along the umbilical vessels, the pain on palpation in the area of ​​ileocecal node, detection of enlarged mesenteric nodes were pathognomonic for yersiniosis infection. Dyspeptic disorders in children with ileocolitis were characterized by nausea (26 of 43 patients), recurrent vomiting (in 21 of 43), unstable stool (in 33 of 43). Exanthemas (in 18 children), lymphadenitises (in 24), reactive arthritis (in 18), uveitises (in 7) were significant manifestations of yersiniosis. IHAT with yersiniotic diagnosticums allowed to confirm the diagnosis in 35 children, 8 children had seronegative results. However, IEA of feces for yersiniotic antigens and PCR of feces for DNA of yersinia were positive in them.

Conclusion: 1. Assessment of clinical features of lesions of the ileocecal region and adequate interpretation of extraintestinal manifestations of the infection allows to set timely diagnosis for persistence of yersiniosis in children with gastroenterological disorders. 2. Current serological tests and PCR tests allow to confirm a specific infectious process and ensure the adequate treatment.

SOME FEATURES OF THYROID CARCINOMA

F.KH. SAIDOV, G.D. MAMMADBEYOV

Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku, AZERBAIJAN

The aim of the investigation was to study morphological features of thyroid cancer (TC).
333 patients with thyroid carcinoma at the age of 13-78 were operated in the department of endocrine surgery for the period from 2000 to 2010 (till October 20). Thyroid cancer is often encountered in woman, female to male ratio was 4: 1 (271 women and 62 men), which is consistent with the literature. Thyroid cancer is often observed at the age of 41-60 years (39.3%). However, the disease is often encountered in young people: at the age of 21-40 years - 35.1% of patients, under 20 years-3.9%. Among the papillary carcinomas at the age of 45 years there were 98 persons (79 -women, 19 - men), above 45 years - 89 patients (77 - women, 12- men), among follicular – there were 64 individuals at the age under 45 (49 - women, 15 - men), above 45 years - 53 patients (44 - women, 9 -men). For the characteristics of the patients subject to the degree of thyroid enlargement there was used the classification of O.V. Nikolayev, that allows more detailed description of the size of glands that play an important role in the identification of indications for surgery. Majority of the operated were persons with IV degree -149 persons (44.9%), with 3^rd degree - 101 patients (30.4%), and with 5th degree thyroid enlargement - 82 patients (24.6%). Papillary carcinoma (in 56.2% of observations) are among commonly encountered histological types of epithelial neoplasms. It shall be noted that in 5 patients, the diameter of papillary carcinoma did not exceeded 1 cm, which allows to refer it to papillary microcarcinoma to (15), according to the histological classification of WHO. Non-epithelial tumor - squamous cell carcinoma was found in 1 patient. Symptoms of associated focal thyroiditis were observed in 46 patients (with papillary carcinoma - in 33 of them, with follicular in- 11, with neural- in1, with anaplastic – in 1), of chronic thyroiditis - in 29 patients (of them with papillary carcinoma - in 14, with follicular - in14, with medullary - in1).

Encapsulated forms of epithelial tumors constitued 56.6% (188 cases), non-encapsulated - 43.4% (of 144 observations). Invasion into the thyroid capsule occurred in 173 patients, in 65 of them metastases in regional lymph nodes were found. We did not encountered distant metastases. Thus, thyroid cancer in most cases was in the form of papillary carcinoma (56.2%), mainly observed in women at the age of 41-60 years. In the half of observations thyroid tumors were encapsulated, inclined to metastasis into regional lymph nodes in 19.6%, that means a relatively favorable course of the disease.

Date: 2014-12-28; view: 746