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Table 1. - The reasons of development of depressions
The reasons of development of depressions Group1
Abs %
Absent 0 -
Psychotrauma 14 15.9 ± 3.9
The present somatic disease 72 81.8 ± 4.11
Physical pressure 0 -
Intellectual overstrain 2 2.3 ± 1.6
Mental disease 0 -
In total 88 100
The depression beginning in the first days after a AMI (40.9% — in a current 1-7 days, 37.5% — in a current 8-30 days) confirms thought that for the patient the diagnosis of a MI and connected with it change of the relation to, the habitual active life, is the most serious psy-chologic traumatic factor. Obviously, work of the internship doctor, the cardiologist in early post infract the period should be directed on overcoming stigma concerning weight of the transferred MI, on development of rational understanding of illness, possibility of logic reconsideration of life after a AMI.
At a part surveyed (19 patients — 21.6%) the AMI was observed repeatedly and in all cases at this group of patients development of DD was observed. It is interesting that in an origin of the majority of depressions (17.1%) at patients with repeated cases of a MI the reason also is the fact of the transferred AMI.
MI and the depression arising as consequence of the transferred AMI it is reflected in work capacity of patients (table № 2). So, at 27.3% of patients of group1 and 69.7% of patients of group2
(p<0,001) work capacity is lowered, whereas disability authentically is more often observed at patients of group1 (p<0,001). It can serve as the obvious proof of negative influence of the joined depression on sociolabor adaptation of patients.
Table 2. - Work capacity of patients
Work capacity Group1 Group 2
abs % abs %
It is kept 18 20.4 ± 4,30 7 21,2 ± 7.15
It is lowered 24 27.3 ± 4,75 23 69.7 ± 7.80
It is lost 46 52.3 ± 5,57 3 9.1 ± 5.01
It is raised 0 - 0 -
In total 88 100 33 100
Thus, for the majority of patients with a AMI the fact of presence ofheavy somatic disease is at the bottom of development of DD among which to a thicket there are disturbing depressions. A MI and depressions leads to decrease in work capacity and activity of patients.
Conclusion:
1. It is necessary to optimize rendering of the specialized (psychiatric) help by the patient with a AMI.
2. In early period of post infract work with the patient should be directed on overcoming stigma concerning weight of the transferred MI, on development of rational understanding of illness.
3. Great significance gets the organization of the advisory psychiatric help corresponding to modern requirements in cardiological hospitals, and also working out of educational programs on clinical psychiatry and psychopharmacotherapy for cardiologists, cardiosurgeon and other experts.
References:
1. Barth J., Schumacher M., Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis//Psychosom Med. - 2004. - Vol. 66. - P. 802-813.
2. Carney R. M., Freedland K. E., Sheps D. S. Depression is a risk factor for mortality in coronary heart disease//Psychosom Med. -2004. - Vol. 66. - P. 66:799-801.
3. Huffman J. C., Smith F. A., Blais M. A. at al. Recognition and treatment of depression and an-xiety in patients with acute myocardial infarction/Mm J Cardiol. - 2006. - Vol. 98. - P. 319-324.
4. Smulevich A. B. Depression in general medicine: a guide for physicians. - Moscow: Medical News Agency; - 2001. (in Russian).
5. Muxamadiyeva N. B. Features of formation and clinics depressive disorders in patients after myocardial infarction//Eur Sci Rev. -2016. - № 3-4 (March-April). - P. 181-182.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-120-123
Navruzova Visola Sarimbekovna, National cancer research center of Uzbekistan E-mail: drsharof@mail.ru
Modern possibilities of combined and complex cervical cancer treatment in fertile age patients
Abstract: The main treatments for patients with cervical cancer are radiation, surgical and medical, which are used in combination with each other or separately. The study included 204 patients with cervical cancer younger who underwent traditional combined radiotherapy, chemoradiotherapy and chemotherapy and radiation treatment. The results of treatment showed that the effectiveness of the therapy and quality of life is higher in the group where the received chemotherapy and radiation therapy using radiomodifier.
Keywords: fertile age, systemic chemotherapy, endoarterial regional chemotherapy, cervical cancer, fertility-sparing surgery, ovarian transposition, quality of life, effectiveness of treatment, dynamic monitoring.
The world marked increase in the incidence of cervical cancer in that in patients with preserved ovarian function, not only the effec-young women, especially from 29 to 45 years old. Analysis showed tiveness of the treatment, but also the quality of life. It is associated
Modern possibilities of combined and complex cervical cancer treatment in fertile age patients
with the acceleration, earlier puberty and the onset of sexual activity. In recent years more and more widely used radical surgery with preservation of the ovaries and the abduction of the radiation castration and preservation of reproductive function. The world reports have estimated that women under 50 years of age comprise 3% per year, with a particularly significant incidence increase in women up to 29 years, in Russia it is 2.1% per year. In the structure of oncological morbidity of female reproductive system of the Republic of Uzbekistan CC takes second place after breast cancer and the fourth place in the incidence of all cancers in the country (3). The highest cervical cancer incidence has been reported in women of45-55 yrs. The similar trend to CC increase in women of fertile age has been followed in other countries. Currently, there are following methods of CC treatment: surgery, combined radiotherapy, chemotherapy. Currently, there are following methods of CC treatment: surgery, combined radiotherapy, chemotherapy. However, the principal therapeutic methods for cervical cancer are surgery and radiation which are used both separately and in various combinations. In severe cases it is necessary to perform advanced surgery, the volume of which is directly depended on the advance of tumor process. Most CC patients who underwent radical treatment tended to keep the former style of life, social status, and work activities. The quality of life as an integral characteristic of physical, psychological, emotional and social functioning of a woman is based on her subjective perception. When performing radical surgery on young women with CC it is advisable to carry out the transposition of both ovaries in the lateral channels of the abdominal cavity, removing them from subsequent exposure to radiation in order to preserve hormone
function considering the serious consequences of post-castration syndrome. A distinctive characteristics of extended hysterectomy with ovarian transposition is the preservation of uterus — ovary and fallopian tube and their neurovascular connections located in the funnel — pelvic ligament [4; 6; 7].
Material and methods: We have analyzed the survey data and the phases of treatment 204 patients with CC. All patients examined in the treatment guidelines were divided into 2 groups:
Table 2. - Distribution of the followed
Group I — 112 (55.1%) patients, who underwent surgical treatment with ovarian transposition as a part of combined and complex therapy. Group II — 92 (44.9%) patients, who were performed surgery without ovarian transposition as a part of combined and complex therapy. Each group was divided into 3 subgroups: Subgroup 1 comprised the patients with stage T1b 2aN0M0, who underwent surgery + combined radiotherapy (CRT). Subgroup 2 comprised the patients with stage T2bN0-1M0 who underwent systemic PCT + surgery + CRT. Subgroup 3 comprised the patients with stage T2bN01M0 who underwent endoarterial regional continued chemotherapy (EARCCT) + surgery + combined radiotherapy CRT.
Analysis of the obtained data showed that the initial complaints of all 204 patients were general weakness, fatigue, watery or sanious discharges from the genital tract, pain in the abdomen and lower back. The symptom-complexes, specific to cervical cancer lesions, depending on the duration of the first signs in a varying degree were identified. Patients noticed the pains of different nature: dull, aching, cramping, or moderate, varying duration — constant, periodic or unannounced, various sites — low abdomen, in the back, in the crotch area, when urinating or during defecation. The condition of initial focus and tumor grading was evaluated as follows: tumor location (anterior lip, posterior lip ectocervix or endocervix, with/without transition on neighboring organs and tissues, tumor size, growth form, parametrical tissue infiltration, invading to regional lymph nodes.During our examination we mainly met the patients with exophytic 82 (40.2%) and endophytic growth — in 68 (33.3%) cervical tumors (Table 1).
Table 1. - Distribution of the patients with CC by tumor growth form (n=204)
Growth form аbs %
1 Exophytic tumor growth 82 40.2
2 Endophytic tumor growth 68 33.3
3 Combined tumor growth 54 26.5
All patients were distributed by TNM system as follows (tabl.2). patients by groups and stages (n=204)
Stage Main group (n=112) Control group (n=92) Total
^ibs % abs % abs %
TlbNoMo 5 2.5 2 0.9 7 3.4
T2 aNoMo 18 8.8 19 9.1 37 17.9
T2 bNoMo 57 27.9 32 15.9 89 43.8
T2 bNIMo 11 5.5 17 8.3 28 13.8
T3 aNoMo 21 10.2 22 10.9 43 21.1
Altogether 112 54.9 92 45.1 204 100.0
Depending on the type of combined (surgery + CRT) and distributed as follows (Tabl. 3). complex (NAPCT + surgery + CRT) treatment, the patients were
Table 3. - Distribution of the patients with CC by groups depending on the type of therapy
Subgroups Therapy type Stage by TNM I group (surgery with ovarian transposition) n=112 II (control) group (surgery without ovarian transposition) n=92
abs. % abs. %
1 surgery + CRT T,b,N„M„ 23 11.3 21 10.2
2 complex (NAPCT + surgery + CRT T2b-3 aN0-1M0 47 23.2 37 18.1
3 EARCCT + surgery + CRT T2b-3 aN0-1M0 42 20.6 34 16.6
The main clinical criteria of the effect of antitumor treatment are the immediate objective effect, the development of side effects, recurrence and period of their development, the survival rate of patients within 3 years of observations.
Chemotherapy was conducted by scheme: Methotrexate total dose of 50 mg/m 2 within the first 12 hours; 5 Fluorouracil 1000 mg/m 2 for the next 12 hours; Cisplatin 100 mg/m 2 during the following 48 hours. The total duration of chemotherapy introduction was
72 hours continuously. The patients had kept bed for 3 days, herewith to stand up or take up the position, bending endovascular catheter was not allowed. To prevent catheter thrombosis during the day the patients were injected Heparin 5000 ED 1 ml. through the catheter under the control of coagulation time. When the clotting time was higher than 5 minutes heparin injection was not introduced. After the introduction of total dose of chemotherapy in order to prevent bleeding from post-puncture holes and the development of hematoma, catheter removal was carried out by compression of the puncture area. After removal of the catheter it was made mechanical compression for 10-15 minutes. After hemostasis compressed aseptic bandage was applied. The patients had been in a supine position for 12 hours.
The distinctive feature of extended hysterectomy with ovarian transposition is the preservation of the uterus (ovaries and fallopian tubes) and their neurovascular connections located in funnel-pelvic ligament. There are several wing, posterior wall of pelvic, on both sides of spinal column, the upper abdomen, and others options for ovarian transposition: to iliac. The best optimal version is the transposition of ovary in the upper abdomen. As a result of transposition the ovaries are displaced on supplied "pedicle" into the upper abdomen and, herewith, they are removed from the zone of postoperative irradiation and become prevented from radiation castration. The important aspect in the performance of transposition is retroperitoneal conduction of neurovascular bundle and the location of appendages themselves in abdominal cavity. Transposition is carried out in several stages: It is made separation along vascular "pedicle" of ovary and fallopian tube 10-12 cm long; depending on the anatomic features of a woman its length can be adjusted; The upper and lower poles of ovaries are marked with tantalum clips, fixation of which are made with particular silk ligatures; that results in the possibility to visualize them easily on plain film of abdomen; Formation of the right and left lateral channels with the upper and lower apertures are realized by manual and knife way; The appendages are led via lateral retroperitoneal channels with a clamp and output in the abdominal cavity via the upper aperture. It is necessary to follow a careful monitoring of vascular "pedicle" to exclude its rotation, inflection, excessive tension and compression that is unacceptable and can lead to ischemia and ovary necrosis as a result of circulatory disorders; Fixation of appendages are made with certain silk ligatures to the lateral divisions of the abdominal wall in the hypochondrium; this makes available to remove the ovaries of the zone of possible exposure in postoperative period; during topometry their location is determined on the plain film of abdominal cavity. This sequence of surgical operations ensures the safety of ovaries and their vascular "pedicles".
The additional visual inspection of appendage location is performed after restoration of the integrity of pelvic peritoneum that separates the abdominal cavity from the pelvic organs and anatomical position of bowel loops.
Table 3. - Quality of life
Characteristics of radiotherapy after ovarian transposition: two-step CRT included remote telegammatherapy (RTGT) and intracavitary brachytherapy. RTGT was performed by «Theratron» or «AGAT-R" unit with split rate at 2 Gr to 50 Gr, 5 days a week. Brachytherapy was made using the "Gammamed" with ROD 5 Gr and 45-55 Gr SOD every other day. Pre-radiation preparation included topometry of pelvic organs. The effectiveness of the treatment process can not be reduced due to the reduced margins or dose reduction. It is known that the dose of15-18 Gr is sufficient for radiation castration. However, even the conduction a "high" transposition of the ovaries and their screening can not completely rid the gonads from radiation exposure. The latter varies depending on the fixation level of appendages, and in some cases exceeds tolerated dose, leading to deprivation of ovarian function. So, if the ovary is fixed below the iliac wing, the received dose of remote irradiation is 25-35 Gr instead of 1.5-5 Gr at high fixation.
Evaluation of the nearest outcomes of the treatment was conducted at three stages: during neoadjuvant chemotherapy, directly after surgery and after radiation therapy. To evaluate the side effects of systemic and endoarterial chemotherapy systematic examination ofpatients (not less than 1 time per week), which included complete blood count, urinalysis, biochemical blood analysis to determine the functional state of the liver and kidneys were conducted. There made electrocardiographic examination and X-ray examination of the lungs.
Treatment effect was evaluated by: 1) the degree of toxicity of chemotherapy by scale Sommon Sriteria Toxicity NCIC, 2) the general condition of the patient (Performance status) by Karnovsky scale (activity,%) and ECOG (WHO) by grading system [Gantsev Sh.Kh. 2004; Perevodchikova N.I, 2005]. The efficacy of conducted therapy was studied in postoperative period according to the pathologic analysis of postoperative material.
The main clinical criteria of the effect of antitumor treatment are the immediate objective effect, the development of side effects, recurrence and period of their development, the survival rate of patients within 3 years of observations. Overall survival analysis of patients showed that the efficacy of treatment in study and in control group were almost the same, in study group is slightly higher than in control. Unilateral and/or bilateral lymph cysts were revealed during the dynamic monitoring in 11.4% of patients who underwent conservative therapy or minimally invasive surgical correction- under ultrasound control it was performed aspiration of the content of lymphocyst and administration of antibiotics into the cavity.
To study the quality of life is a relatively new field of clinical research. However, it attracts more and more attention in the study of oncology diseases and can serve as the main criterion for clinical efficacy. Quality of life is considered one of the key parameters in the study of ultimate results of the treatment. Quality of life of patients in the dynamics of observation was determined by American system MENQOL. assessment (MENQOL)
Parameter Before treatment After treatment After a year
Study Control Study Control Study Control
Vasomotor symtoms 2.65±0.,5 2.35±0.4 3.32±1.,1 8.92±2.3 2.50±0.42 9.67±2.,8
Psychoemotional state 4.52±1.2 4.43±1.5 5.12±1.6 25.51±6.8 5.63±1.4 28.15±5.5
Physical state 7.82±2.3 7.32±2.2 6.35±2.2 21.93±5.7 10.14±2.4 24.12±4.7
Sexual sphere 2.35±0.56 2.51 ±0.6 3.42±0.8 8.17±2.4 3.55±0.6 9.16±3.3
Dynamic monitoring of patients was carried out with full completion, in the sequel every 6 months. Observation periods vary examination every 3 months during the first year after treatment more than 3 years.
Application of computer technologies in differential diagnosis of chronic peripheral arterial occlusive disease of the lower limbs
Conclusion: the analysis of the use of different methods of treatment of patients with cervical cancer at a young age showed that the use of himioterapiya radiation lecheniya combined with radiomodification provides a real opportunity to increase the effectiveness of treatment, reduce relapse rates and metastases. Study of remote results of combination treatment with CRT showed that
the performance of 3-year survival when using radiation therapy in combination with CRT on average 10-24%higher than in the other groups. Maintaining the high quality of life allows us to consider the study in determining a promising direction in Oncology, and also enables a more personalized approach to each case depending on the size, shape of tumor growth and age aspects.
References:
1. DiSaia P. J., Creasman W. T. (eds.). Clinical gynaecologic oncology. - 7th ed. - 2007; - Mosby Elsevier - 812.
2. Antipov V.A, Novikov O. V., Balahontseva O. S. Conserving therapy of early forms of invasive adenocarcinoma of cervix//Siberian J Oncol. - 2010: - № 1: 5-11. 3. Navruzov S. N.-Gafoor- Ahunov M. A., Aliyev D. A. Prospects for the development and improvement of cancer services in Uzbekistan. -Coll. scientific.art.: "Problems of Oncology". - Tashkent, - 2002, issue 2: 3-8.
3. Yuldasheva N.Sh, Navruzova V. S., Akhmedov O. M., Navruzova R. N., Umarova N. A. Defining the role and place of the biopsy in pathological changes of the cervix./II Congress of oncologists of Uzbekistan. October 6-7, - Tashkent city. - 2011: - 272.
4. Navruzova V. S., Navruzov R. S. Treatment of cervical cancer in younger women./News of dermatovenerology and reproductive health. -Tashkent. - 2/2012; 35-36.
5. Arbyn M., Anttila A., Jordan J., Ronco G., Segnan N., Schenck U., Wiener H., Herbert A., von Karsa L. European guidelines for quality assurance in cervical cancer screening. Second edition-summary document//Annals of Oncology. - 2010; - V21: - № 3: 448-458.
6. Beneditti-Paniti P., Bellati F., Manci N. et al. Neoadjuvant chemotherapy followed by radical surgery in patients affected stage IVA cervical cancer. Ann Surg Oncol - 2007; 14 (9): 2643-8.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-123-124
Rasulov Ulugbek Abdugafurovich, Central Military Hospital of the Ministry of Defense of the Republic of Uzbekistan, Head surgeon Ministry of Defense of the Republic of Uzbekistan.
E-mail: uli4-67@mail.ru
Application of computer technologies in differential diagnosis of chronic peripheral arterial occlusive disease of the lower limbs
Abstract: Is a block diagram of the diagnosis of chronic peripheral arterial occlusive disease of the lower limbs, which was developed on the basis of a computer program that allows you to make a differential diagnosis of these diseases and establish the correct diagnosis quickly and accurately.
Keywords: atherosclerosis, diagnostic algorithm, computer program.
The relevance of research. The prevalence of chronic peripheral arterial occlusive disease of the lower limbs is from 0.6 to 7.5% of the population [1; 3]. According to the report by WHO experts, chronic obliterating diseases of lower extremities arteries, is caused by intermittent claudication, affects about 5% of the elderly [7; 9]. Their structure is dominated obliterating atherosclerosis, followed by nonspecific aortoartheriit, diabetic angiopathy, thromboangiitis obliterans, Raynaud's disease and other rare diseases of the arteries.
Among the diseases oflower extremities arteries leading position firmly holds atherosclerosis, the frequency of lesions, according to different authors, 80-90% [2; 4]. The share of thromboangiitis obliterans, according to data of the same authors, there are only 1.4%. European statistics also notes a very low numbers of thromboangiitis obliterans (0.5-2%) among chronic peripheral arterial occlusive disease of the lower limbs [6; 8] Despite this, we should pay serious attention to the patients who suffering from thromboangiitis obliterans, since this disease, in contrast to atherosclerosis, mainly hurts younger males, and in this age group leading over atherosclerosis [5; 6; 8]. At the same time in recent years, cases ofatherosclerotis lesions oflower limb arteries increased at young adults [1; 4]. It is true that thromboangiitis obliterans hurts mainly vessels of small and medium diameter, and atherosclerosis are the largest and medium-sized, and therefore the greatest difficulties in the differential diagnosis arise in lesions of
the femoropopliteal segment, which occurs in 70% of patients with atherosclerosis obliterans and 20% suffering from thromboangiitis obliterans [7]. Despite the fact that the differential diagnosis of chronic peripheral arterial occlusive disease of the lower limbs problem the subject of many studies, the percentage of diagnostic errors according to different authors is 20-30% [2; 5], which leads to the wrong tactics oftreatment ofpatients. In the differential diagnosis ofchronic peripheral arterial occlusive disease of the lower limbs in addition to the clinical diagnosis are widely used instrumental and laboratory research methods, but they do not have sufficient specificity and does not clarify the clinical picture. For the correct diagnosis is necessary to make a differential diagnosis between these diseases, it is important to determine the treatment strategy.
The purpose of research. Improving the diagnosis of chronic peripheral arterial occlusive disease of the lower limbs on the basis of the algorithm and computer program.
Materials and methods of research. The Department of Thoracic and Cardiovascular Surgery of the Central Military Clinical Hospital Ministry of Defence of the Republic of Uzbekistan on the basis of our innovative research methods for the analysis of patients with chronic peripheral arterial occlusive disease of the lower limbs. 96 patients were subjected to the analysis, 83 (86%) were male, 13 (14%) — women. Of these atherosclerosis in 79 (82.3%), thrombo-
