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Combined use 10% solution of acetylcysteine and 3% solution of sodium chloride as an nebulizer inhalation resulted in a significant decrease in duration of oxygen therapy, shortening of hospital treatment of patients on average for 2.1 bed-days in patients of IV group compared with the control group, and for 0,9 and 1,1 bed-days compared with II and III groups respectively (table 2).
Nebulizer therapy 10% solution of acetylcysteine and 3% sodium of chloride solution in this study was not associated with significant
adverse side effects, which corresponded to a sufficient level of the drug safety.
Conclusion. Thus, the combined use of a nebulizer inhalations of 10% solution of acetylcysteine and 3% solution of sodium chloride in comparison with the isolated use ofmedications is an effective method of complex treatment of acute bronchiolitis in infants, promotes the improvement of patency and decreases edema of airways, the intensity and duration of cough, decrease sputum viscosity, reduce the duration of oxygen therapy and periods of hospital treatment.
References:
1. Bronchitis and bronchiolitis. Acute obstructive conditions ofrespiratory tracts. Scientific-information material. - Moscow, - 2011. - P. 198.
2. Ivashev M. N.., Sergienko A. V. Clinical pharmacology of acetylcysteine.//Successes of the modern natural science. - 5. - 2013. - P. 116-117.
3. Stenins O. I., Paunova S. S., Chakvetadze S. S., Donin I. M. Inhalation therapy of broncho-obstructive syndrome in infants with acute respiratory diseases.//Pediatric Journal. - 2010; 89:10. - P. 62-65.
4. Ushkalova E. A. Acetylcysteine in the clinical practice: the present time and perspectives.//Pharmateca. - 2007. - № 17. - P. 30-36.
5. Shavazi N. M., Lim M. V., Zakirova B. I., Lim V. I., Tursunkulova D. A. The assessment of the degree of broncho-obstruction in acute bronchiolitis in infants.//Materials of III conference of the Association of Doctors of Emegency Medical Care of Uzbekistan. Tashkent, October - 29-30, - 2015. - P. 285.
6. Shavazi N. M., Lim M. V. The effectiveness of nebulizer inhalations of acetylcysteine in the therapy of acute bronchiolitis in in-fants.//Problems of Biology and Medicine. - 2016. - No 2 (87). - P. 116-119.
7. Shamsiev F. M., Mirsalikhova N.Kh. et al. Pathogenetic approach to the therapy of cough in children with inflammatory diseases of respiratory system.//Health of Uzbekistan. - No 4 (06) - 2016. - P. 42-47.
8. Shmeleva N. M. The use of mucoregulator ascoryl in the diseases ofrespiratory organs.//Therapeutic archive. - No 10. - 2012. - P. 86-90.
9. Gupta H. V., Gupta V. V., Kaur G. et al. Effectiveness of 3% hypertonic saline nebulization in acute bronchiolitisamong Indian children: A quasi-experimental study. Perspect Clin Res. - 2016. - Apr-Jun; - 7 (2):88-93.
10. Khalid Al-Ansari, Sakran M., Davidson B. L. et al. Nebulized 5% or 3% Hypertonic or 0,9% Saline for Treating Acute Bronchiolitis in in-fants.//The Journal of Pediatrics. - 2010. - Vol. 157. - No 4. - P. 630-634.
11. Zorc J. J. Inhaled epinephrine does not shorten hospital stay for infants with bronchiolitis destined to develop repeated bronchospasm. Lancet Respir Med. - 2015. - Sep; 3 (9):665-7.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-66-69
Mirzakarimov Bahrom Halimjonovitch, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: baxromjon73@gmail.com Yulchiev Karimjon Salimjonovitch, Andizhan State Medical Institute Senior researcher, the department of pediatric surgery E-mail: chtoubib@rambler.ru Djumaboev Jurakul Usmanovitch, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: djumabayevju@mail.ru Toshboev Sherzod Olimovich, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: shertoshboev@gmail.com Haydarov Nodir Sarviddinovich, graduate student of Andijan State Medical Institute
New technologies in the treatment of congenital chest deformities of in children
Abstract: Malformation of the thorax in children are serious diseases that pose serious difficulties for the correction. This paper presents the authors developed methods of surgical treatment of children with different variants of the funnel and keeled
New technologies in the treatment of congenital chest deformities of in children
chest deformation. The comparative aspect with traditional methods thoracoplasty analyzed the results of treatment and complications in the intraoperative, the near and distant postoperative periods. Keywords: congenital deformities of the chest, thoracoplasty children.
Congenital chest wall deformity (CCWD) is observed among children and adults, and estimated to have prevalence from 0.4 to 2.3% of the cases [1; 2; 3; 4; 5; 7]. Among EQAP more than 90% is funnel chest deformity (FCD) and about 8% is keeled deformation of chest wall (KDCW) [6; 9], the remaining 2% falls on Poland's syndrome, splitting and splitting the sternum, Kurrarino-Silverman syndrome [2; 4; 5]. The vast majority of surgeons are of the opinion that the treatment of chest deformities only operative [6; 10]. To date, there is no consensus on the indications for treatment and the choice of method of surgical correction.
Most of the proposed surgical correction methods have a common drawback — a large traumatic, with a relatively high risk of intra- and postoperative complications. Currently minimally invasive, less traumatic at the same time more efficient surgical interventions aimed at full correction of chest deformities with the maximum cosmetic effect are preferred by many. A wide range of interventions and the lack of a common approach in the selection of readings and the correction method in the treatment of EQAP demonstrate the relevance and complexity of the problem requires finding new ways of solving the problem of correction of chest deformations, taking into account the patient's aesthetic requirements, indicating the need for our research.
Aim of work. To improve the results of treatment in children with FCD and KDCW and through the development and application of minimally invasive methods of surgical correction.
Materials and methods. In Andijan regional children's diversified medical centers, at the Department of Pediatric Surgery in the period from 2012 to 2016 the author's procedures operated on 55 children and adolescents with EQAP. These children are the main group (MG).
Among patients with a congenital deformity of the chest 34 (75.6%) were children under 6 years with funnel chest deformity (FCD) and cor-costal form keeled chest deformation (KDCW) — 21 (24.4%). Of the 21 children with KDCW 18 were aged 8-15 years and older — 3 patients. KDCW met in 18 (85.7%) boys and 3 (14.3%) girls. 20 (58.8%) patients had FCD 2nd degree of deformation, and 14 (41.2%) — third degree. Symmetrical shape deformation were 22 (64.7%) patients, asymmetric — 12 (35.3%).
Performance indicators copyright transactions were compared with two comparison groups (CG). Clinical comparison group (CCG) 1 amounted to 28 previously operated on children with FCD Ravich traditional method over the period 2004 to 2006. The CCG 2 included 16 children with KDCW, also operated in the center of traditional methods thoracoplasty from 2006 to 2010. A total of CCG1 and CCG 2 it operated on 44 children with FCD and KDCW. The degree of deformation in the chest FCD evaluated by calculating the index J. Gizicka (1962) [8] on the profile X-ray is the ratio of the smallest distance to the largest sternovertebralnogo space. And when KDCW severity of the front chest wall deformation objectivized Lois by calculating the angle (the angle formed by the handle and the body of the sternum) on chest radiograph in lateral projection. All patients were from the II and III degree and FCD KDCW thoracoplasty performed by the author's methods. Follow-up care and scheduled scan after treatment were carried out in 3 months. 6 months., And then at 1 and 3 years. The statistical accuracy of the estimation of
observed variables clinical effect expressed by confidence intervals (95%). Statistical data processing was carried out on a PC using the «SPSS Pro» software package. The critical level of significance when testing statistical hypothesis was p = 0.05.
A method of treating funnel chest. The author's method of surgical treatment of funnel chest is as follows: on the chest wall of the cross-section of the skin is no longer than 4 cm in the joint area of the xiphoid process to the body of the sternum; skin mobilization, the subcutaneous tissue, ligaments and retrosternal dissection with removal of the xiphoid process; under the control of the finger in the retrosternal area determined resistance and rigidity sterno-costal complex (SCC); with sufficient ductility and resistance to Marshing bus traction SCC installed traction sutures to the sternum body with subsequent fixation to Marching bus; with the presence of resistance and greater rigidity SCC additionally perform vertical sternotomy followed by fixation to SCC Marching bus; mobilize rectus muscles followed them to the most in-depth section of the body of the sternum, which provides additional traction SCC in the act of inspiration, as in the age category of children type of breathing is mainly abdominal. The claimed method allows to reduce the duration of the operation, greatly reducing the amount of intraoperative blood loss during surgery, reducing trauma of surgery that helps out the use of analgesia and early mobilization of patients, respectively. On the way to obtain a certificate of the right to intellectual property of the Republic of Uzbekistan. "Minimally invasive techniques thoracoplasty when funnel chest in children" DGU 03579 of 08/02/2016.
A method of treating keeled chest deformity. The author's method of surgical treatment keeled chest deformation as follows: Performing on the chest wall of the vertical incision no longer than 8 cm; skin mobilization, the subcutaneous tissue and pectoral muscles one flap to provide minimally invasive access for thoracoplasty and thereby improves the aesthetic appearance of the patient, as well as significantly reduce blood loss during surgery and the likelihood of hematoma in the postoperative period; complete resection of the deformed costal cartilages (II-VIII ribs) on both sides and linking them end-to-end single interrupted sutures; transverse sternotomy at the top of the highest bending, shortening retrosternal ligament and suturing it to the lower third of the posterior surface of the sternum 3-5 cm above together with the rectus abdominis; layering stitching wounds with imposing cosmetic skin suture. The claimed method thoracoplasty simple to perform, available, not traumatic, but also makes it possible to shorten the duration of postoperative hospital stay. On the way to obtain a certificate of the right to intellectual property of the Republic of Uzbekistan: "Method thoracoplasty keeled chest deformation." DGU 03580 of 03/03/2016.
Results and discussion. Evaluation of long-term results in the exhaust gas was carried out according to the criteria: good, satisfactory, unsatisfactory. Based on these characteristics, the results of treatment recognized as good in 31 (93.1%) and 19 (90?5%) patients with FCD and KDCW main group versus 21 (58.8%) and 12 (80,0%) reference group of children, satisfactory in 2 (4, 54%) and 1 (4,8%) to 3 (14,7%) and 2 (12,5%) have unsatisfactory 1 (2,26%) and 1 (4,8%) to 4 (26.4%) and 1 (6,25%) patients, respectively (Fig. 1.).
Figure 1. Comparative evaluation of the surgical treatment of FCD and KDCW depending on the author and the traditional type of thoracoplasty
We have also analyzed the complications of surgical interven- erative nearest and late after thoracoplasty, which are presented in tions, which are conditionally divided into intraoperative, postop- table 1 and 2.
Table 1. - Feature intraoperative, the near and long-term complications of our and traditional options when thoracoplasty in FCD
№ Complications CCS 1 (n=28) CS (n=34) Up P9
aóc % aóc. %
Intraoperative complications
1 damage to the pleura, pneumothorax 2 7,1 - 2,9 2,21 <0,013
2 Intraoperative bleeding 3 10,7 1 5,9 2,66 <0,004
3 duration operation for more than 3 hours. 21 75,0 1 5,9 7,61 <0,001
Nearest postoperative complications
1 Hemodynamic disorders 7 25,0 1 2,9 3,54 <0,001
2 Festering wounds, secondary healing 6 21,4 - - 3,86 <0,001
Long-term postoperative results
1 Relapse strain 4 14,3 1 2,9 2,91 <0,001
2 overcorrection GRK 3 10,7 - - 2,68 <0,003
3 keloid scar 4 14,3 2 5,9 1,25 H. A-
Comparative analysis of complications thoracoplasty traditional version with the author's technique when FCD shown (Table 1) that intraoperative complications such as damage to the pleura and pneumothorax occurred was 7,1% (p9 <0,013) cases and intraoperative bleeding was in 10,7% (p9 < 0.04) and prolonged surgery observed (more than 3 hours.) in 75,0% (p9 <0,001) cases. In the immediate postoperative period were observed complications, such as hemodynamic disorders in 25,0% (p9 <0,001), secondaryhealing in 21,4% (p9 <0,001) cases and recurrence of deformation at 14,3% (p9 <0,001),
overcorrection sterno-costal complex at 10,7% (p9 <0,003) and keloid scarring wound surface at 14,3% (p9> 0,05) of sick children in the late postoperative period. The above-mentioned complications were observed much less frequently in the treatment and administered by our technique. They were observed in the form ofpneumothorax in 2,63% (p9 <0,013), intraoperative bleeding in 5,26% (p9 <0,004), long-term operation in 5,26% (p9 <0,001), hemodynamic disturbances at 2.63% (p9 <0,001), recurrent strains in 2,63% (p9 <0,001) and the formation ofkeloids at 5,26% (p9> 0,05) cases, respectively.
Table 2. - Feature intraoperative, the near and long-term complications of our and traditional options when thoracoplasty in KDCW
№ Complications CCS 2 (n=28) CS (n=34) Up P9
aóc % aóc. %
Intraoperative complications
1 damage to the pleura, pneumothorax 3 18,7 1 4,8 2,18 <0,011
2 Intraoperative bleeding 5 31,2 - - 1,46 <0,002
3 duration operation for more than 3 hours. 13 81,2 2 9,5 6,51 <0,001
Nearest postoperative complications
1 Hemodynamic disorders 4 25,0 1 4,8 2,45 h. a-
2 Festering wounds, secondary healing 3 18,7 - - 2,72 <0,008
Long-term postoperative results
1 Relapse strain 3 18,7 1 4,8 2,64 <0,001
3 Keloid scar 2 12,5 1 4,8 1,13 h. a-
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.
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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.
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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.
8. Kuhn M. A. Pectus Deformities/M. A. Kuhn, D. Nuss//Fund of Pediatric Surgery. - 2011. - Part 6. - P. 313-321.
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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
