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Modern approach to the problem of acne
Analysis showed CCS2 complications (Table 2), which damage the pleura intraoperative period, there was a 18,7% (p9> 0,011) cases intraoperative bleeding 200 ml 31,2% (p^ <0,002), long duration of operation (more 2 hrs.) to 81,2% (p9 <0,001). Hemodynamic disturbances in the early postoperative period with low reliability observed in 25,0% (p> 0,05). If in the early postoperative period secondary infection and wound healing, as well as the discrepancy seams meet in 18,7% (p9 <0,008) cases, the complications in the form of full deformation and recurrence of keloid scarring surgical wound late after operation was observed at 18 7% of the cases and 12.5% respectively. In the present embodiment, the above-mentioned author thoracoplasty complications were observed much less frequently. That is, damage to the pleura to 2.18%, a long surgery in 6.51% of cases in the intraoperative period, hemodynamic disturbances in 4.8% of cases in the immediate postoperative period. In the late postoperative period for clinical and X-ray parameters observed in 1 child full relapse strain (4.8%). The emergence of the strain ofrecurrence appear to be associated with a wrong, abnormal growth of costal cartilage of the zone associated with the presence
of the patient's connective tissue dysplasia. KDCW In addition, he noted scoliosis, joint hypermobility, arachnodactyly that, in the our opinion contributed deformation relapse one year after thoracoplasty. Based on the above scientific statements can draw the following general conclusions: When conducting operations in the traditional version FCD to the application of our option transactions intra- and postoperative complications were observed in 29.5% of operated children, and (p9 <0,001) after the application of our proposed operations optimized version thoracoplasty rate decreased to 3.95%, that is. e., in more than 7 times. Our proposed option thoracoplasty children with KDCW allowed to reduce complication rates in the intra- and postoperative periods in 9.2 times, ie, from 23.2% to 2.52%.
Thus, we have developed thoracoplasty ways when FCD and KDCW are minimally invasive and very effective methods of treatment, can reduce the trauma of surgery, reduce the operation and, thus, anesthetic time, accelerate the activation time of patients and reduce the duration of pain, minimize operational and postoperative complications, improve cosmetic results.
References:
1. Абдрахманов А. Ж., Анашев Т. С., Тажин К. Б. Диагностика и хирургическое лечение воронкообразной и килевидной деформации грудной клетки//Травматология жэне ортопедия. - Астана, - 2005. - No 2. - С. 24-25.
2. Виноградов А. В. Деформации грудной клетки у детей (Хирургическое лечение и медико-социальная реабилитация): Автореф. дис. ... докт. мед. наук. - М, - 2004. - 22 с.
3. Жила Н. Г. Хирургическая моделирующая коррекция врожденных и приобретенных деформаций грудной клетки у детей и подростков: Автореф. дис. ... д-ра мед. наук. - Иркутск - 2000. - 16 с.
4. Малахов О. А., Рудаков С. С., Лихотай К. А. Хирургическая коррекция воронкообразной и килевидной деформаций грудной клетки у детей и подростков//Актуальные вопросы детской травматологии и ортопедии: Сб. тез. конф. детских травматологов-ортопедов России. - М., - 2001. - С. 260-261.
5. Разумовский А. Ю., Романов А. В., Рудаков С. С., Гаджимирзаев Г. Г. Торакопластика при врожденных пороках грудной клетки у детей//Актуальные вопросы детской травматологии и ортопедии: Сб. тез. конф. детских травматологов-ортопедов России. -М., - 2001. - С. 278-279.
6. Goretsky M.J., Kelly R. E., Croitoru D., Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum//Adolesc. Med. -2004. - Vol. l5. - P. 455-171.
7. Gizicka J. Ocena wakazan i metod leczenia operacynjnegolejkowatej bleatki piersiowej u dzici oraz analiza uzyskanych wynikow//Klin. Khirurgii dziecieceg A. M. w. Warszawie, kierownik Panst. zakiwydwo lekarskich. - 1962. - Vol. 9. - P. 80-87.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-69-71
Mirsaidova Munisa, Inoyatov Bakhrom,
Specialized Scientific practical Medical Center Dermatology and Venereology of Republic of Uzbekistan.
E-mail: munisa876@mail.ru
Modern approach to the problem of acne
Abstract: Acne actual problem of the modern youth. Treatment of acne topical problem in dermatology. Due to the
frequent recurrences of acne, the problem attacts scientists dermatologist to improve treatments by examining this issue in a more in — depth manner. This article provides an overview of the world literature on the study of acne on the basis of factors of complications.
Keywords: Acne, etiology, pathogenesis, treatment.
Acne — polymorphic multifactorial disease of the hair follicles and sebaceous glands, resulting from excess production of sebum, abnormal follicular hyperkeratosis, inflammatory and immune response in the dermis, the imbalance of lipids,
certain sex steroid hormones and genetic predisposition [6; 17].
Etiology of acne poorly understood. It is believed that the following factors play a role in the development of resistantacne: endocrinopathies, metabolic disorders, the imbalance of cellular
Section 7. Medical science
and humoral immunity, pathology of the gastrointestinal tract, the hepatobiliary system, central and autonomic nervous system, lowering the barrier-protective function of the skin [3; 5; 8].
Factors of development of acne:
- Genetic predisposition - the number, the size of the sebaceous glands and their sensitivity to the level of androgens (male sex hormones);
- Increased secretion of androgens during puberty, which promotes overproduction of sebum;
- Activation activity saprophytic flora sebaceous hair follicles (propionibacterium acne);
- The development of the inflammatory reaction in the hair follicle in the background hydrolysis of sebum and multiplication of bacteria in it Propionibacterium acnes;
- Follicular hyperkeratosis (excessive development of epithelial cells in the hair follicle, leading to blockage of the sebaceous gland duct epithelial cells horny scales);
- Hormonal changes, increased levels of male sex hormones (androgens), which cause an increase in sebum secretion and increase of both men and women;
- Hormonal changes in the body ofwomen during the premenstrual period (sometimes — during pregnancy);
- Mechanical factors: the habit of propping up chin in his hand, to hold his chin up the phone, wearing tight hats and shirts with tightly buttoned collar, which leads to excessive sweating;
- Squeezing ulcers rough or «black spots» (exacerbates acne, the formation of acne, cysts, which result in scars of the skin surface);
- Work in conditions of high humidity and temperature (in the kitchen or in the room with steam), which stimulates sweating (there is a complete blockage and inflammation of the sebaceous glands);
- The use of halogen-containing products or means (iodine, fluorine, bromine);
- Application of cosmetics with a high content of lanolin, paraffin, mineral oils (fatty creams, moisturizing lotions, sun creams, etc.);
- Receiving a number of drugs, particularly high contraceptive progestins, steroids, drugs lithium, anticonvulsants;
- food. Some foods, for example.chocolate, carbonated beverages, nuts, coffee [11; 13; 16].
Pathogenesis of acne. According to modern ideas, in the pathogenesis of acne played a leading role hyper secretion of sebum and formation of abnormal follicular hyperkeratosis, excess skin colonization P.acneus and the development of inflammation. Also, when colonization P.acneus initiates the migration of lymphocytes, complement activation, and followed with chemotaxis of neutrophils and macrophages in the area of sebaceous hair follicle and the synthesis of antibodies to P.acneus, causing damage to the sebaceous hair follicle development of the inflammatory response that manifests clinically formation of papules, pustules and nodes.
Against the background of excessive production of sebaceous secretion with a reduced concentration of linoleic acid develops pathological actinic akroinfundibulyume fillagrinin creased accumulation in the cells of the granular layer, which leads to obstruction of sebaceous hair follicle (SHF), the accumulation of secretions and the development ofhyperplasia. Blockage ductless SHF creates favorable conditions for the reproduction of anaerobic P.acneus in akroinfundibulyume secreting lipases that break down sebum triglycerides into fatty acids, followed by destruction SHF wall [5; 8; 11].
The clinical picture of acne. Varieties of acne:
- Comedones (comedosou acne comedonica);
- acnepapulosa et papulopustulosa;
- acneindurativa;
- acnephlegmonosa;
- acneconglobata;
- acnefulminans;
- acneinversa or hidradenitis suppurativa.
Blockage sebaceous gland filled with sebum, called comedones. They are non-inflammatory nodules solid consistency to 2 mm in diameter. The gradual increase in the volume of the nodules by the constant production of sebum creates the conditions for the conversion of some of them in the "open" blackheads Papular and papulopustulosa acne are the result of inflammation of different severity around the open or closed comedones. In mild form of the disease papulopustulosa acne resolve without scarring. In a significant expression of the inflammatory response, accompanied by damage to the structure of the dermis, the formation of scars in place of inflammatory elements. Most patients belong to the categories exactly acne comedonica and acne papulopustulosa. All other types are relatively rare, but no less important — or because of the severity, or because they require a different approach to therapy [14; 15].
Treatment. The problem of treatment of acne remains relevant despite the numerous studies and the large number of products for external, and for internal administration. However, there is a preparation for a complete solution to this problem. Available modern tools have a number of drawbacks, not completely solve the problem of acne and do not lead to a stabil remission.
Treatment algorithm for acne depends on the severity. Mild includes only topical treatment ofmoderate and severe includes not only local, but also systemic therapy. Treatment is necessary at the stage of formation of comedones — black dots in multiple advanced estuaries sebaceous gland or white millet subcutaneous nodules [1; 7].
Local treatment is aimed at reducing disorders of keratinization, and the elimination of follicular hyperkeratosis: leading to lysis of the comedones means (retinaldehyde, glycolic acid, azelaic acid), for regulating keratinization means (Cosmetics), peels (ultrasonic, glycol, mi-crodermabrasion), laser treatments (diode laser, wavelength 808 nm)
Mild disease (comedones, several small inflamed pimples) enough local treatment and mechanical removal of comedones in the beauty parlor. In moderate to severe (comedones, pustules in large numbers with severe inflammation) local treatment combined with the general, who is appointed by dermatologist after inspection by specialists: a gynecologist, endocrinologist, gastroenterologist (antibiotics, correction of hormonal disorders, etc.).
Systemic therapy is used for moderate and severe degrees ofsever-ity, and combined with an external treatment. Includes of 3 basic areas:
1. Antibiotics.
2. birth control (oral contraceptives).
3. Retinoids [7; 10; 12].
When systemic antibiotic treatment in addition to the direct action of a bacteriostatic drugs have non-specific antiinflammatory effect. For systemic therapy of acne most commonly used drugs are tetracycline and macrolides. Antibiotics are used for a long time (up to 6 weeks).
The criteria for selection of antibiotic therapy are: the suppression of the activity of Propionbakterium acnes, effect on other Gram (+) and Gram (-) flora, selective accumulation in the sebaceous glands, high bioavailability and good tolerability.
Combination oral contraceptives are effective even at normal androgen levels in blood. Most shows OCs with "epidermotro-phic" action. Assign OC from the 1st day of the menstrual cycle for 21 days with a 7-day break for at least 6 cycles reception. The visible effect is observed with the 3rd month of OC. Estrogen-progestin drugs are prescribed after systemic antibiotic therapy.
Influence of radiofrequency ablation on quality of life of patients with ventricular arrhythmia
Retinoids -izotretinoin — appointed in severe forms of acne, propensity to scarring and inefficiency of traditional treatment methods. He is stable remission even in severe forms of the acne and has expressed sebosupressive, leading to lysis of the comedones, anti-inflammatory and immunomodulatory effects. Consequently, retinoids act on all the main links in the pathogenesis of acne. The
duration of treatment with retinoids is 16-20 weeks. Side effects of retinoids — dose-dependent.
Thus, the appointment of an adequate effective therapy due to its influence on the pathogenetic mechanisms of the disease. An important prognostic are diagnosis, proper clinical evaluation, the timely appointment of adequate and safe treatments.
References:
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2. Akhtyamov S. N., Safarov GG Acne vulgaris: Questions of etiology and pathogenesis//Ros. Zh. Skin and Venereal Diseases. - 1998. -No 5. - S. 54-58.
3. Gusakov N. Modern acne problems//Sat: Topical issues of plastic, aesthetic surgery and dermatology. - M. - 2001. - SA-78-80.
4. Young's N.A., Logatchev M.F. Acne: the nature of the origin and development issues of systematization and modern landmarks in the choice of therapy//Dermatology. - 2006. - 4: 8.
5. Kubanova A.A., Samsonov V.A., Zabnenkova O.V. Modern features of the pathogenesis and treatment of acne.//West. Dermatology and venerologii. - 2003. - No 1. - S. 9-15.
6. Protsenko T.V. Acne (lecture for doctors). - K., - 2001. - 15 p.
7. Safarova G. Complex treatment of acne vulgaris in view of the pathogenetic mechanisms of resistance to antibacterial therapy and its influence on the process sebaceous excretions: Avtoref.dis ... kand.med.nauk. - M. - 1998.
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10. Cunliffe W. J. Acne vulgaris//Treatment of skin Disease/Ed/M. Lebwohlet all. - London, - 2002. - P. 6-13.
11. Kenshi Yamasaki, Gallo Richard L.//Eur.J. Dermatol. - 2008. - Vol. 18. - P. 11-21.
12. Halder A., Shaw J. C. Treatment of acne vulgaris//JAMA. - 2004. - 11:726-735. 13. Zaba R. Patogenesis and treatment of acne vul-garis//D ermatol. Allergol. - 2001. - 18. 131-140.
13. ZaengleinA., Thiboutot D. Acne vulgaris//Dermatology. - 2nd ed. - Mosby. - 2008. - P. 495-508.
14. Show J. C., White L. E. Persistent acne in adult women//Arch. Dermatol. - 2001. - 137 (9): 1252-1253.
15. Goodman G. Acne. Natural history, facts and myths. Aust Fam Physican. - 2006. - 35:9:613-616.
16. Webster G. F.//Br. J. Dermatol. - 2002. - Vol. 32. - P. 475-479.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-71-73
Kurbanov Ravshan Davletovich, doctor of medicine, professor, director of Republican Specialized Center of Cardiology Mullabaeva Guzal Uchkunovna, candidate of medicine, senior research worker of the Cardiac Arrhythmia Department of the Republican Specialized Center of Cardiology
Khamraev Ramesh Ravshanovich, head of Department of surgical treatment for heart arrhythmias
Salaev Ojbek Sabirzhanovich, junior research worker of the Cardiac Arrhythmia Laboratory Republican Specialized Center of Cardiology E-mail: Guzal-m@inbox.ru
Influence of radiofrequency ablation on quality of life of patients with ventricular arrhythmia
Abstract: This article provides information about dynamics of quality-of-life indicators relating to 53 patients with ventricular arrhythmia after catheter ablation. It was demonstrated that before surgery all patients had low indicators of life quality and mental health. Following the radiofrequency ablation, it was observed that quality-of-life indicators improved, reaching the reliable values by the 6th month of observation.
Keywords: ventricular arrhythmia, radiofrequency ablation, quality of life, mental health.
Non-ischemic (non-coronarogenic) ventricular arrhythmias (VA) amount to 10-30% of all heart rhythm disorders (HRD) and predominantly occur in people of working age [1; 2]. In 25-80% of patients these rhythm disorders provoke syncope, what significantly
deteriorates prognosis and increases the risk of a sudden arithmetic death in this category of patients [3; 4]. The effectiveness of drug therapy of non-ischemic ventricular arrhythmias does not exceed 50-60% [5]. It is known that a continued intake generates a drug
