CC BY
53
axis of the upper limb remained correct and the elbow joint function remained to the full extent. The excellent results were obtained with 187 (84.2 %) and good ones — with 35 (15.8 %) children.
Therefore, the objective assessment of the results of the treatment of children with the posttraumatic varus deformation of the elbow joint makes it possible to conclude that differential approach to selection of operative treatment method of various types of the elbow joint varus deformation should consider all components of deflection causing deformation.
Conclusions
1. Application of differential surgical techniques of the treatment of the children's elbow joint varus deformation depending on deformation severity can enable obtaining excellent and good results.
2. Developed methodology of the surgical treatment of the children's elbow joint varus deformation is the optimal one and provides good anatomic functional and cosmetic results.
References:
1. Matelenok E. M. Projection of fate of the elbow joint damage//Orthop., traumatology and prosthesis. - 2001. - 4.
2. Shekin O. V. Prevention of humerus varus deformations in treatment of the children's transcondylar and supracondular fractions// Orthop., traumatology and prosthesis. - 2000. - 4.
3. Barrett I. R., Bellemore M. C., Kwon Y. M. Cosmetic results of supracondylar osteotomy for correction of cubitus varus//J Pediatr Orthop. - 1998. - 18.
4. Karatosun V., Alekberov C., Alici E., Ardic C. O., Aksu G. Treatment of cubitus varus using the Ilizarov technique of distraction osteogenesis//J Bone Joint Surg. - 2000. - 82.
5. Koch P. P., Exner G. U. Supracondylar medial open wedge osteotomy with external fixation for cubitus varus deformation//J Pediatr Orthop. - 2003. - 12.
Khaydarova Gavkhar Saidakhmatovna, Assistant, ENT Department of Tashkent Medical Academy E-mail: haydarovadoc@mail.ru
Matkuliev Haitbay Matkulievich, Professor, ENT Department of Tashkent Medical Academy
Shaykhova Khalida Erkinovna, Professor, ENT Department of Tashkent Medical Academy
E-mail: kulok@rambler.ru
Features of hearing impairment in children with perinatal pathology of the central nervous system
Abstract: The analysis of hearing loss in 58 children with perinatal CNS. The correlation of peripheral sensorineural disorders and degree of hemodynamic disorders in vertebrate arteries. The results showed a significant increase in the severity of peripheral hearing loss with increasing severity of the ground state from light to heavy.
Keywords: sensorineural hearing loss, perinatal CNS damage, audiologic examination.
Sensorineural hearing loss — a form of hearing loss, which affects any of the sections of the auditory analyzer sound-card, from the sensory cells of the inner ear, and ending with the cortical representation in the temporal lobe of the cerebral cortex. It is known that one of the risk factors for cerebral hemodynamic disorders of the inner ear and is hypoxia. Most often it develops in the background of preeclampsia and chronic placental insufficiency, which, in turn, are the result of gynecological, extragenital pathology and intrauterine infection [1, 575 -578; 9, 82-85; 10, 48-50; 11, 79-80].
Most often preeclampsia develops on the background of pyelonephritis (74 %), hypertension (44 %), obesity and endocri-nopathies (85 %). Preeclampsia is marked on the background of anemia in 2-3 times more often than in women with normal level of hemoglobin [8, 59]. All these factors lead to the development antenatal acute intrapartum hypoxia and asphyxia [2, 1605 -1615; 3, 571-576; 4, 84-87]. Severe toxic and hypoxic conditions, in turn, influence the circulation of the inner ear. The nature and degree of damage to the auditory system are directly depending on the severity and characteristics of lesions of the central nervous system [5, 12-16; 6, 54-57; 7, 53-55].
When cerebral disorders, not all neurons are not all areas are undergoing the same pathological disorders. Extremely vulnerable region parietal-temporal-occipital joint, which is the area of the adjacent circulation karotid and vertebro-basilar pools. The deterioration of blood supply leads to tissue ischemia of the brain, and in severe cases may develop necrosis and gliosis (brain destruction). The main damaging factor in the newborn, leading to brain damage, a perinatal hypoxia and intrapartum asphyxia.
Purpose of the study
Provide clinical and functional characteristics of the auditory sensory disorders and to develop an diagnostic algorithm in children with perinatal pathology of the central nervous system.
Material and methods
The work was carried out on the basis of the ENT clinic 2nd clinic TMA from 2011 to 2014. 58 children were examined to achieve this goal we were born with signs of hypoxia. The children were divided into groups according to the degree of hypoxia severity (mild, moderate and severe) — 14, 16, 28 people, respectively. For comparison, a control group was recruited children — 20 people. The age of patients ranged from 1year to 4 years of life. Therefore,
Features of hearing impairment in children with perinatal pathology of the central nervous system
for clarity, the severity of hearing loss was conducted a comparative assessment of the development of children born in the hypoxic conditions of varying severity and children in the control group.
The study of auditory function was examined on the device "Neuro-Audio" Company Neurosoft (Russia) TEOAE two classes: transient evoked otoacoustic emission (TEOAE) and emission at the frequency distortion product (DPOAE).
As a technique, objectified state of cerebral blood flow, using ultrasound imaging of the arteries of the brain base, basal veins, vertebral and basilar arteries, the extracranial segments of the common and internal carotid arteries. Transcranial Doppler lerografiyu performed using apparatus Acuson/28 XP-4 (US) line sensor L7 with the frequency of the radiation of10.0 and 7.0 MHz. We evaluated the following parameters: systolic, diastolic and mean blood flow velocity; resistance index (RI), which is determined by the tone pialno- capillary vasculature, blood viscosity and the value of intracranial pressure.
Results of the study
Common to both groups were complaints about sleep disturbances and behavioral-cal disorders. They were observed in 52 % and 24 %, respectively, and the main control groups. In addition to these complaints, the parents of children of the main group complained of speech disorders, hearing loss and neurodevelopmental disability.
Active complaints of speech disorders in children after a year of instituting the parents, only 6 % of patients, however, when viewed from the formation of pre-speech development disorders has revealed 69 % of people, which was manifested as a delay of speech formation and phonemic disorders. These abnormalities were observed in all patients with severe manifestations of hypoxia — 100 %, somewhat less — the children born in a state of moderate severity, — 75 % (p < 0.05) and 2 times less often — in patients that determined signs of mild hypoxia 42 % (p < 0.01).
The structure of complaints of hearing loss or lack of volatility of auditory responses was observed in 44 % and 17 %, and 13 % noted a reaction hyperacusis. The lag in motor development was observed in 80 % of children that was to the delay of the timing self-holding head, sitting, standing, walking. In 45 % of the children were observed structurally unstable moderate lag pace of physical development. 40 % identified a pronounced lag in motor development, ofwhich 32 % — with signs of severe hypoxia: the children on their own are not sitting, the article-supporting functions were missing. 13 % of children born in the moderate and severe conditions, had complaints of choking when feeding, and seizures.
Neurological status of each child was evaluated only once, when referring to the reception. Hypertension-hydrocephalic syndrome was significantly more common in the patients who had moderate to severe hypoxia, 80 % and 100 % compared with patients who had mild hypoxic condition of 46 % (p < 0.05, p < 0.01), indicating that high-level and depth of defeat of cortical-subcortical structures and their relations.
All patients who were born in hypoxic conditions occurred irritation syndrome of the peripheral auditory analyzer, manifested startle reaction in 23 %, a decrease of (lack of) these reactions at 62 % in the determination of hearing function in free field conditions, including volatility of auditory responses revealed 17 %, no — 49 %.
In all 3 subgroups of the main group had about the same number of patients, determine the response gipakuzii 65 %, 70 % and 60 %, respectively severity posthypoxic states (p > 0.05), increasing the proportion of patients seen against this background that revealed deep hearing impairment (anacusia) with increasing severity of the ground state. These disorders are 2 times more often detected in subgroups of children with moderate and severe condition of 81 %
and 82 %, compared with patients who had lung manifestation posthypoxic 44 %. In the course of the electrophysiological examination of the children in the control group showed no abnormalities.
According to Doppler ultrasound haemodynamic-violation in the vertebrobasilar basin in the extracranial level within physiological limits showed 35 %, of which 12 %, 9 % and 16 %, respectively 3rd degrees of hypoxic conditions. The asymmetry in excess of the physiological determined in 36 child (62 %).
Audiology methods of research have shown that children in the control group were observed deviations in the survey of hearing function. In all patients had normal type tympanograms (A); 29 children identified the absence of acoustic reflexes stirrup muscles with 1 or 2 sides, indicating the deep peripheral sensorineural disorders.
Of the 58 patients who were born in hypoxic conditions, in 39 children (67 %) revealed peripheral neurosensory disorders of varying severity, which was accompanied by an increase in the sensitivity of the auditory thresholds. Only in 2 (3 %) patients showed unilateral hearing loss, in 37 (64 %) were determined by bilateral sensorineural disorders, including patients who were born respectively 3rd degrees of hypoxic conditions were 9 (16 %), 12 (21 %) and 13 (22 %) patients. These hemodynamic changes were combined in 13 patients (22 %) from 2-sided vasoconstriction of the vertebral arteries, deepening under compression samples. Hemodynamic disturbances in the basin of the vertebral arteries and intracranial remained level for all children, which revealed the asymmetry of more than physiological.
In 5 (9 %) and 3 (5 %) patients who were born in hypoxia light and medium severe, defined body toning middle cerebral artery; 6 (11 %) patients who were born in mild hypoxia and 13 people (22 %) with signs of moderate to severe hypoxia determined reduction of blood flow in the middle cerebral artery (right localization was 4 people, a left — 9 people).
Sensorineural disorders of I degree detected in 2 (3 %) people, these children were born in hypoxia mild to moderate degrees; I—II level — 8 (14 %) patients; Grade-II-III in 23 (40 %) patients; hearing loss Grade III-IV were detected in 13 (23 %) patients. Mostly right-sided localization process was observed in 22 people (37 %), left-handed — in 13 patients (23 %), even snizhenie hearing with 2 sides was noted in 3 (5 %).
Thus, it drew the attention of not only the prevalence of profound sensorineural disorders (63 %) of the structurally unstable (17 %), but also the growth of the severity ofperipheral sensorineural disorders with increasing degree of the ground state of severity (deep hearing loss detected in 23 (39 %) children born in the moderate and severe conditions and in 5 (8 %) patients, is easy to identify posthypoxic condition at birth). The distribution ofperipheral sensorineural disorders in 3 subgroups of patients undergoing hypoxic conditions varying degrees, is shown in Fig. 1.
severe
Fig. 1. Distribution of peripheral sensorineural disorders in 3 subgroups of patients undergoing hypoxic conditions varying degrees
It was marked by significant increase of the peripheral extent of hearing loss severity with increasing severity of the ground state from light to heavy. At the same time in the comparison of subgroups with moderate and severe hypoxia progresirovanii significant differences in the degree of peripheral sensorineural disorders with increasing severity.
Conclusions:
1. Identified archaeological violation confirm the role of cerebro-vascular factor and indicate chronic vertebra-basilar vascular insufficiency in patients undergoing
hypoxic conditions varying degrees. The state of cerebral hemodynamics of compensation depends on the degree of hearing impairment.
2. The severity of peripheral sensorineural disorders is proportional to the degree of hemodynamic disorders in the system make it possible-night arteries.
3. The algorithm of diagnostics sensorineural disorders in children with perinatal pathology should be built based on you-revealed neurological and auditory abnormalities at early stages of development.
References:
1. Huppi P. S. Immature white matter lesions in the premature infant/P. S. Huppi//J. Pediatr. - 2004. - Vol. l45, № 5. - P. 575 -578.
2. Jiang Z. D. Brain-stem auditory impairment during the neonatal period in term infants after asphyxia: dynamic changes in brain-stem auditory evoked response to clicks of different rates/Z. D. Jiang, R. Yin et al.//Clin. Neurophysiol. - 2004. - Vol. 15, № 7. - P. 1605 -1615.
3. Jiang Z. D. Differential changes in peripheral and central components of the brain stem auditory evoked potentials during the neonatal period in term infants after perinatal hypoxia-ischemia/Z. D. Jiang, X. Xu et al.//Ann. Otol. Rhinol. Lar. - 2004. - Vol. 13, № 7. - P. 571 -576.
4. Jiang Z. D. Distortion product otoacoustic emissions in term infants after hy poxia-ischaemia/Z. D. Jiang, Z. Zhang, A. R. Wilkin-son//Eur. J. Pediatr. - 2005.- Vol. 164, № 2. - P. 84 -87.
5. Kryukov A. Features of brain hemodynamics in angiogenic kohleovestibulopaty and lipid distress syndrome//Bulletin of otorhino-laryngology. - 2003. - №1. - S. 12-16.
6. Kuts B. Dopplerographic blood flow rates in the main arteries of the head and neck in patients with sensorineural hearing loss gen-esis//News otorinolaryngology and logopathology. - 1999. - № 1. - P. 54-57.
7. Shayhova Kh., Khaydarova G. Application Vestinorm drug in the treatment of patients with sensorineural hearing loss of vascular origin//Dentistry. - 2010. - № 3-4. - S. 53-55.
8. Milch N. Treatment of iron deficiency anemia in pregnant//Obstetrics and Gynecology. - 1999. - № 3. - S. 59.
9. Khaydarova G., Shukurov D. The study of risk factors for the development of hearing loss in newborns//Dentistry. - 2013. -№ 1-2. - P. 82-85.
10. Ponomareva L. P. Hearing impairment in newborns//Attending physician. - 2005. - № 1. - S. 48-50.
11. Rojco Y. Perinatal risk factors for the development of motor and sensory impairment in extremely premature infants//Belorussian medical journal. - 2005. - № 1. - S. 79-80.
Shamsiyev Azamat, Samarkand State Medical Institute, doctor degree in medicine, department of pediatric surgery E-mail: azamat.shamsiev@mail.ru
Davlatov Salim,
Master degree in medicine, Department of surgical diseases № 1 E-mail: sammi-xirurgiya@yandex.ru
Kurbaniyazov Zafarjon, PhD in medicine, Department of surgical diseases № 1 E-mail: dr.kurbaniyazov@inbox.ru
Zayniyev Alisher,
Master degree in medicine, Department of surgical diseases № 1
E-mail: 30011987@bk.ru
Abdominoplastics of postoperative ventral hernia in patients with obesity of III—IV degree
Abstract: From 2008 till 2015 years in surgical departments 1st and 2nd clinic of Samarkand Medical Institute were operated 208 patients with postoperative ventral hernia of abdominoanterior walls. Important factors identifying surgical tactic is localization of hernia, size defect and presence of relapsing in amnesia. Abdominoplastic is not only cosmetic operation in patients suffering from obesity on excessive fat of deposit of abdominal wall, but also presence of postoperative ventral hernia-technical surgery using, allowing to improve results of hernioplastics. The treatment of patients with obesity must be complex and individual as estimation initial condition of patient such on choice treatment method, so far as in problem such operation enters not only weight loss of mass body but also normalization of metabolic process.
Keywords: Hernioalloplastics, dermotolipidectomy, Abdominoplastics.
