The article is devoted to the young children’s healthcare in Samara region in the period from 1918 to 1940. The aim of the study was to demonstrate the evolution of healthcare system for children of the first three years of life in Samara-Kuibyshev region in the 1920-1930s (according to archival and literary sources). The results of historical and medical research have shown that children's healthcare in Samara-Kuibyshev region during this time period achieved significant success in implementation of urban and rural children's institutions (children’s health centers, nurseries, infant-feeding centers). Human resources increased significantly, medical staff qualification improved. All that together led to enhancement of children primary care, children and infants mortality decrease. At the same time, the performed analysis has revealed the crucial problems of children's healthcare in Samara. Archival materials from Samara region characterize the situation with children's healthcare in the country in general during the tragic years of famine (1921-1922 and 1932-1933). These years were accompanied by increase of children morbidity and mortality. Statistics has shown that the areas affected by famine had natural decline in the population even in 1937. The results of this research of evolution of healthcare system for young children in Samara region during first two decades of Soviet Russia can be used in the educational process (history of pediatrics) of students in Samara medical colleges and universities, they can assist with creation of fundamental work on the history of children’s healthcare in the Soviet Union.

The article discusses recent ideas about autism: classification approaches, incidence, etiology and pathogenesis, clinical manifestations and diagnosis, comorbid medical conditions, early detection approaches and medical care for children with autism spectrum disorders. The focus is on the information needed for pediatricians in their practice to provide effective medical care for children with neurodevelopmental disorders.

Kidney stone disease (KSD) is a disease caused by the formation of calculi in kidneys and other parts of the urinary tract. The rate of hospitalization of children with KSD worldwide is increasing. The adequate method of calculus extraction and further therapy according to calculus composition and metabolic disorders are crucial for effective treatment of patients with KSD and recurrence risk reduction. This review covers surgical (extracorporeal lithotripsy, percutaneous nephrolithotripsy, retrograde intrarenal surgery, ureterolithotripsy, laparoscopy, open surgery) and non-surgical (lithokinetic and litholytic) therapy. Special attention is paid to metaphylaxis, or recurrence prevention, and calculi formation. It is noted that medication of children with KSD can be aggravated by various adverse reactions, complexity in drugs dosages in children of first years of life. Moreover, all surgical methods are characterized by high risk of postoperative complications development. The relevance of KSD genetic nature in children, the role of lifestyle changes in disease development, the implementation of new drugs for metabolic disorders correction are presented in the article.

Pulmonary involvement in children with connective tissue systemic diseases is rare pathology that, however, has significant impact on treatment strategy and prognosis. This article presents data on the pulmonary involvement incidence, development, clinical features and results of visualization methods in children with such connective tissue systemic diseases as systemic sclerosis, juvenile dermatomyositis, systemic lupus erythematosus, and Sjogren’s syndrome. The issues of pathogenesis, risk factors of lung damage, therapeutic approaches and prognosis are considered.

Background. Rib osteomyelitis is extremely rare in childhood. This localization of purulent focus represents only 1% of all osteomyelitis cases. The typical manifestations of ribs osteomyelitis are fever, chest or back pain. However, these clinical signs are not always present, and the disease can manifest in other way.

Clinical Case Description. Mother with 14 years old child K. have applied to the regional children's hospital admission department. The child had complains of right upper quadrant abdominal pain and in right part of the chest, difficulty in breathing. The disease began 2 days before admission with fatigue, weakness, and pyretic fever (39 °C). Complaints remained over time. The patient was hospitalized with the diagnosis: “Chest impact injury with severe pain syndrome? Right lung contusion?". The ultrasound examination of pleural cavities and the right anterior chest surface has revealed osteomyelitic phlegmon in VII intercostal space on the 3rd day of hospitalization. It was lanced and drained under general anesthesia, about 7 ml of liquid pus were obtained. The child received treatment according to clinical guidelines for the management of patients with such nosology. The final diagnosis was: «Acute hematogenous osteomyelitis of the VII rib, local form. Osteomyelitic phlegmon of VII intercostal space. Right pneumonitis. Bilateral mild hydrothorax». The boy was discharged on the 10th day since surgery in satisfactory condition.

Conclusion. The described clinical case is interesting for pediatric surgeons, traumatologists, infectious disease specialist. Particular attention should be paid to the clinical features of the disease and anamnestic information in such unclear clinical cases. It will allow to exclude traumatic injuries and assume the local inflammatory process.

Background. Obstructive lesion of upper respiratory tract in fetus is extremely rare pathology with adverse perinatal outcomes.

Clinical Case Description. Ultrasound examination of fetus (gestational age 21 weeks 6 days) has revealed one-sided isolated main bronchus atresia. Atresia was presented as enlargement of right lung due to mucus accumulation, its increased echogenicity, mediastinal displacement to the left and left lung size reduction. We performed differential diagnosis with cystic-adenomatous lung malformation type III, congenital lobar emphysema and pulmonary sequestration. These conditions are also characterized by lung echogenicity and volume increase but they are usually limited to one lung lobe or segment, and pulmonary sequestration has a systemic blood supply. The use of high-frequency transducers, lung vessels Doppler imaging and volume echography allow us to investigate in detail the lung structure of the fetus, correctly calculate the lungs volume and timely the main bronchus atresia at the second trimester of pregnancy.

Conclusion. The ultrasound diagnosis of isolated main bronchus atresia is based on revealing of increased lung volume on ipsilateral side, its increased echogenicity, presence of hypoechogenic linear tubular structures (bronchocele), mediastinal displacement to the opposite side and extreme hypoplasia of the contralateral lung. Prognosis for the life is unfavorable.

 Background. Nasopharyngeal cancer is rare malignant tumor of childhood. The clinical signs of this disease are rhinolalia, nasal breathing difficulties, headache and lymphadenopathy. There are no clinical cases of this nosology described previously in Russian literature.

Clinical Cases Description. 1. Patient T., 11 years old, was moved from otolaryngology to oncology department due to CT findings of lump in the nasopharynx. At admission the child had complaints on fatigue, nasal  stuffiness, headache for past 3 months, pain in the neck at turning of his head. The histological study of this lump closing choanae at both sides was performed — nasopharyngeal carcinoma was revealed. 2. Patient A., 14 years old, was hospitalized in oncology department after self-admission to pediatric oncologist with complaints on rhinolalia for a month and jugular glands increase on both sides, weight loss (2 kilos) during last 3 months. Prior to this he was managed on outpatient basis and in infectious diseases department with the diagnosis “Infectious mononucleosis. EBV associated (antibodies (IgG) to capsid antigen of Epstein–Barr virus — 5.4 copies/ml), atypical moderate course”. The generalized lymphadenopathy was revealed during examination in the oncology department. Multiple conglomerates of lymph nodes groups were revealed on CT scans. The histological study of biopsy sample from affected lymph node has shown metastases of nasopharyngeal carcinoma. The therapy according to the NPC-GPOH-2003 protocol was prescribed with marked positive dynamics after 3 months.

Conclusion. The presence of headache, nasal breathing difficulties, body weight loss, fever in combination with lymphadenopathy in the neck  requires caution regarding nasopharyngeal cancer and in differential diagnosis with any other infectious or inflammatory diseases.  

Background. The importance of timely leptospirosis diagnosis and treatment has increased due to sporadic children morbidity. It is crucial in order to prevent the complications and adverse outcomes development.

Clinical Case Description. The data from literature and our own clinical observation of leptospirosis with benign outcome in infant (with kidney damage, purulent meningitis, hemorrhagic syndrome and congenital heart disorder) is presented.

Conclusion. The description of leptospirosis symptoms and course in the child is presented in the form of analysis of the clinical setting for further medical education, including differential diagnostics with viral hepatitis.