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During a treatment was hold regularly (1 time in 15 days) clinical, laboratory researching checking for condition of the operative area was realized by way dynamic USD and KT each 3 month during 1 observations and each 6 months at the following years.
The frequency of reccurence of the patients without chemotherapy has formed 9.7 % (n = 20). Patients after prophylactic chemotherapy recurrences noted only in 3 (0.9 %) events. In rest observations (n = 303) after holding courses to postoperative chemotherapy at periods of the observation from 1 year till 5 years of the recurrence disease is not noted.
It was hold analyses interaction to localizations of recurrence's sac with revenge of the primary defeat beside 23 sick persons with repeated echinococcosis. Inthis case a localization of recurrence's sac only 26 % sicks has complied with segmentary localization primary sac, that has allowed to exclude absolute dominance in the role fibrous capsule of recurrence's genesis at the current diseases.
Probablity of the development of the recidivation, possibly is connected with that, that primary defeat of liver initially could
be plural, but development only one parasitical of the sac is connected with its dominance, competitive suppressing growing of the rest sacs.
Conclusion
The primary operation on cause of the liver echinococcosis without supporting phylactic chemotherapy, held on in condition of the modern high-tech surgical institution, does not guarantee from recidivation of the disease.
Using antirecidivation to chemotherapies at postoperative period derived benzimidazole carbamates (albendazole) allows to lead minimum frequency of recidivation to the diseases.
Reading to uses of curable isolated to chemotherapy by the liver echinococcosis, strictly connected with area of the primary localization parasitic sac, has formed 26.0 % from all recidivation of the forms. The big share echinococcosis recidivation of the sac in removed from primary centre segment (56.5 %) and even defeat of the other share (17.5 %) call in question role of the fiber capsule of the primary sac as the main factor of the relapse of the disease.
References:
1. Ahmedov I. G. Recidivation of echinococcosis disease: pathogenic aspects. Prophylaxis, early diagnostics and treatment//Surgery. Journals: N. I. Pirogova. - 2006, - № 4. - P. 52-57.
2. Nazirov F. G., Devyatov A. B., Akbarov M. M., Maxmudov U. M., Babadjanov A. X. Chemotherapy and problems recidivation of the liver echinococcosis//Annals of surgical hepatologist. - 2011. - Part 16, № 4. - P. 19-24.
3. Shamsiev A. M., Kurbaniyazov Z. B., Rakhmanov K. E., Davlatov S. S. Modern aspects of morphology, recidivation diagnostic of the liver echinococcosis//Problems of biology and medicine. - 2015. - № 3(84). - P. 191-196.
4. Shamsiev J. A. The ways of improvement results of surgical treatment and prophylaxy of recidivation echinococcosis in children. Diss. aspir. doc. med. sciences. - Tashkent, 2015. - P. 286.
5. Teggi A., Di Vico B. Treatment of human cystic echinococcosis with benzimidazole carbamates. XXth International Congress of Hy-datilogy. -2001, 4-8 June. - Kusadasi (Turkey), 2001. - P. 45-46.
Shukurov Esondavlat, Candidate of Medical Sciences, Scientific Research Institute of Traumatology and Orthopedic, Uzbekistan, senior researcher
E-mail: ludmilamedlib@mail.ru
Оsteosynthesis of external fixation of open fractures of the lower limbs
Abstract: It is proposed to improve the methodology of external fixation of long bones by optimizing layouts for different devices according to the nature and localization of open fractures of the lower limbs.
Application of the developed devices in patients with severe open fractures of long bones creates a convenience for those affected, significantly reduces the time of the operation, there is no alternative is unilateral arrangement of the device for combined injury.
Keywords: Fractures of the long bones femur, tibia, external fixation devices, early activation, less invasive osteosyn-thesis techniques.
Introduction
Treatment of open fractures of long bones in combined injury is very serious current problem of modern traumatology due to large damage such high mortality in the acute period of traumatic disease. Open fractures ofthe tibia is occupied by 54.3 to 78 % of all extremity fractures (Bialik E. I., 2002, Valiev E. Y., 2002).
To stabilize the bone fragments in such cases you should use the most simple design — monolateral rod apparatus with a support in the form of beams and brackets kit external osteosynthesis by Ilizarov (Beidik E. I., 2009, Gorodnichenko A. I., 2000).
When such injuries often arise suppurative complications, reaching 57.4 %, not great adhesions, false joints and bone defects resulting from the treatment and lead to disability (Martel I. I., 2012, Shved S. I., 2000).
Aim — improvement of results of treatment of patients with lower limb bone open fractures by improving methods of external
fixation by optimizing layouts for different devices according to the nature and location of lower limb fractures.
Materials and methods
We have developed a number of new arrangements of devices for osteosynthesis of long bones on the basis of common in many regions of the CIS structures Ilizarov.
I. The core unit (FAP № 200100007 from 15.01.2010)
Scheme of rod apparatus from parts of Ilizarov apparatus is shown in fig. 1.
Apparatus for the treatment of fractures of long bones comprising bone pins (1), nut (2), the threaded rods (3) arranged in parallel to each other and connected semi frames (4), wherein on the screw rods mounted plate 5 and semi frames with holes (4), which are fixed on the screw rods via clamping screws (2), moreover plate semi frames (5) and (4) are equipped with clamps for bone rods (6).
The role of chemotherapy in prophylaxis of the liver echinococcosis recurrence
A)
Fig. 1. Scheme of rod apparatus
Description of methods osteosynthesis with rod apparatus
Indications and contraindications
Indications: open and closed fractures of the long bones of the lower extremities. Open fractures with damage to the vascular nerve bundle.
Contraindications: generalized cancer; acute psychosis, senile dementia; decompensated state of the cardiovascular and respiratory systems (to the relief of these phenomena).
Preoperative preparation
Running radiography in two mutually projections: external osteosynthesis method should not be used in the absence of all the necessary for his organizational and technical conditions and trained personnel.
Anesthesia
The choice of method of anesthesia due to the weight of the affected state, view extraskeletal damage associated trauma, the presence and severity of the shock, the magnitude of blood loss and the state of anesthesia for hemodinamics. Optimal view external osteosynthesis of shin is block anesthesia. Patients in the compensated state. In more serious cases, including with severe concomitant injury, when along with the tibia osteosynthesis performed other surgical intervention is appropriate anesthesia with artificial lung ventilation.
The core unit for the treatment of long bone fractures is used as follows. surgery technique is fairly simple and safe in the sense that virtually no risk of damage to the neurovascular trunks.
B)
from parts of Ilizarov apparatus
The operation is performed as follows: after the removal of coarse mixings of bone fragments, the device is assembled is applied to the damaged segment, determine the area of administration of rods in the central and distal fragments. In each of the fragments ofbone threaded rods 1 to the anterior-internal surface of the tibia. The rods to reinforce the strips 5 and 4 with semiframes bone winding rods 6. screw nut 2 to 3 bars provide the necessary compression or distraction of bone fragments. Rotary mixing eliminates moving rods on holes 1 semiframes 4. Produce radiographs. The device is removed after 3 months. The device convenient and easy to use. It is recommended for wide use in practical medicine.
II. The core unit (FAP № 20011.0033 from 05.05.11) Scheme of rod apparatus from parts of Ilizarov apparatus is shown in fig. 2. Wire rod apparatus for treating fractures of long bones used contains 2 half-ring (1) and two Ilizarov apparatus strap from Ilizarov frame element (2) which is helical coupler (10) as the outer support. Transosseous retainers are spokes (3) and rods (4) of different diameters from 4 to 6 mm., each bone screw driving rod has a part (5) and the cylinder (6) with a key shank (7). Connecting element between the outer bearing, needle and rod are wire clamps (8) and rodclamps (9) to secure the hard core, which is free to move to the other strap hole. The means for relative movement between the rods and bone needles in the form of the turnbuckle. Bone pins (4) and spokes (3) and that serves to half-rings in the horizontal bar, and bone pins and half-rings ofradial spokes form an angle of approximately 90°.
A) B)
Fig. 2. Scheme of rod apparatus from parts of Ilizarov apparatus
Designed stem cell phones awarded the innovation and application of the grant of the State Committee of Science and Technology. And the number 36 from 02.01.2009, the number 23 from 02.01.2009 and of operative treatment for fractures of the long bones and the spine Manufacturing production batch of machines and devices, number of state. Registration — To-K-11-009 (2008-2010).
The work is based on the analysis of the results of treatment of 40 patients with open fractures of the lower limb between the ages of 15 and 80 years, who underwent surgical treatment by external osteosynthesis acute injury to the department Research Institute of Traumatology and Orthopaedics, Ministry of Health of the Republic of Uzbekistan.
From 2010 to 2014, in our clinic we made 84 operations in 40 patients with multiple and associated trauma. osteosynthesis of the femur and tibia by external osteosynthesis rod device.
Open fractures of the femur and tibia in road accidents occurred as a direct result of the mechanism of injury and damage accompanied by not only the bones but also soft tissues. According to the classification A. V. Kaplana and O. N. Markovoy majority (68-60.7 %) fractures consistent with the type B, preferably (100-89.3 %) lower leg fractures most often traumatic brain injury occurred among the collateral damage — in 78 (35.5 %) of 40 patients.
Spine fracture were 18 (8.2 %) patients, the fracture of the humerus — 16 (7.3 %), fracture of the heel bone — 14 (6.4), fractures of the pelvis — 12 (5.5 %), fracture of the forearm bones — 10 (4.5 % -8 multiple rib fractures (3.6 %), patellar fracture — 8 (3.6 %), fracture of the clavicle — 6 (2.7 %) patients.
Fixation of bone fragments rod apparatus with open fractures in patients with multiple trauma held in the acute period, and the final fixation in a delayed manner after removal from the victim of traumatic shock.
All patients were divided into 2 groups according to the method applied to them external osteosynthesis follows:
I — spoke osteosynthesis - 40;
II — rod osteosynthesis - 28.
Results
The results of treatment were observed in 28 patients during the follow-up period from 8 to 20 months. The sort-term results in all the operated patients were good, complications were not found. The development of movements in the contiguous joints began on the 4-5 days after operation. In the long-term period the union of the fractures with restoration of the extremity function was achieved in all the patients.
Clinical case 1 (fig. 3)
Patients: 48 years old.
Diagnosis: Open fractures of the middle third of the left tibial bone with a mix of bone fragments, the I-II degree of traumatic shock.
After performance of the anti-shock measures in the early posttraumatic shock period the osteosynthesis surgery with rod apparatus was made.
The patient was discharged from hospital on the 6 day after operation. The rod apparatus was removed three months later. The total term of hospital staying was 3 months.
Fig. 3. Radiographs of the patient before operation
Clinical case 2 (fig. 4)
Patient: 54 years old.
Diagnosis: Open fractures of the upper third in the left tibial bone with a mix of bone fragments, the I-II degre of traumatic shock.
The patient of 54 years old had open fracture of the shin bones in the upper third of diaphyseal part at home due to kick shin. AT admission to the clinic the osteosynthesis with wires and rods was performed. The patient was discharged on the 7 day after operation. The wound was healed by first intention. The rod apparatus was removed three months after operation. The total period of apparatus application was 3 months.
Conclusion
1. In cases of severe open fractures in the patients with multiple trauma in the acute period there is no alternative
2.
3.
4.
to the apparatus of the external fixation with use of rod and wires.
The constructures of the apparatus of external fixation with using of rod and wires allow wound examination and dressing requiring in severe open fractures. Mechanical strength equipment design allows early loading of the damaged segment and the early development of the joints can improve the functional and anatomical results.
The core devices described in this manual, it is enough available for specialized trauma care. For their application does not require the purchase of additional instruments, since only a set of parts used for osteosynthesis by Ilizarov, who are almost universally.
Role of oxidative process in pathogenesis of oral lichen planus
Fig. 4. Radiographs of the patient before operation
References:
1. Beidik O. V. Method of external rod osteosynthesis in the treatment of diaphyseal fractures of the tibia//Genius of Orthopaedics. -2009. - № 4. - S. 114-120.
2. Bialik E. I. Features of the treatment of open fractures of long bones in patients with polytrauma//Vest. travm. i Ortop.. - 2002. - 4: 3-8.
3. Valiev E. Y. The treatment of open fractures of long bones at combined multiple trauma//Journal of Emergency Medicine. - 2008. -№ 3. - S. 65.
4. Gorodnichenko A. I., Uskov O. N. Treatment of comminuted fractures of the tibia stem and wire rod devices//Vestn. trauma. and orthopedics. - 2000. - № 4. - P. 8-12.
5. Martel I. I. Chevardin. Transpozition of fibula fragments by Ilizarov method in the rehabilitation of victims of "sharp defects" tibial shaft//Genius Orthopedics. - 2012. - № 1. - S. 5-9.
6. Shved S., Sysenko Y. M., Beginners S. I., Maltse L. V. Role external osteosynthesis by Ilizarov system rehabilitation trauma patients with multiple bone fractures//Genius ortopedii. - 2000. - № 2. - S. 5-9.
Shukurova Umida Abdurasulovna, PhD, Tashkent State Dental Institute, Uzbekistan, Faculty Dental Therapeutics department E-mail: shua1981@mail.ru Bekjanova Olga Esenovna, PhD, MD, DDS, Faculty Dental Therapeutics department E-mail: bekjanovaolga@mail.ru
Role of oxidative process in pathogenesis of oral lichen planus
Abstract: Imbalance between free radical oxidation and anti-oxidant system is one of the key links of development of lichen planus on oral mucosa. Data on evaluation of anti-oxidant system (AOS) and peroxidation of lipids (POL), degree of imbalance between pro- and anti-oxidants in biological substratum (blood, oral liquid) are sensitive and objective indices of severity of pathologic processes on oral mucosa, that proves use of antioxidants in complex treatment of oral lichen planus (OLP) as local and system cure.
Keywords: lichen planus, oral liquid, lipid peroxidation, anti-oxidant system, diene conjugates, trienoic conjugates, malonic conjugates, catalase, superoxide dismutase, glutathione peroxidase.
Lichen planus (LP) is inflammatory, immune dependant disease of skin and oral mucosa, which is characterized by chronic polymorbid clinical current, torpidity to traditional therapy ad polymorphism of clinical manifestation [4, 3-4; 5, 267; 6, 57-58; 7, 11; 9, 55-57; 10, 7-8; 11, 300-301; 16, 683-684].
It should be noted, that OLP often has severe clinical current, at the same time one form could transform into another one, and malignancy frequency is equal to 6-7 % [13, 682; 15, 458-459].
Nowadays there is no doubt that pathogenesis of OLP is germane to development of oxidative stress, which can become the
reason of immune insufficiency and can cause chronic pathologic process [3, 106-107; 6, 58; 12, 355-357; 14, 311].
In spite of large number of studies in this field, questions of state of POL-AOS in patients with the different clinical forms of OLP remain uncertain, the importance of clinical research of state of this mechanisms on local "oral liquid" and system "blood" levels has not been established till the end.
In view of aforesaid the purpose of research is to study processes of free radical oxidation (FRO) of oral liquid and blood serum in patients with different clinical forms of OLP.
