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located at the upper boundary and Lm 5 years in a starting position lying adult at or above the upper boundary Ln. Tethered Cord (TC) is a common type neurospinal dysraphizm may occur when abnormalities of the spine and spinal cord, limiting the movement due to the fixation to the caudal situated fixed intra — or extradural structure. TC as an independent state, observed in 0,1% (Bademci G 2006) or in combination with the ARM can be asymptomatic in the neonatal period. In the subsequent spinal dysfunction manifested varying degrees, referred to as "the syndrome of fixed spinal cord" (TC) with progressive orthopedic, urological, proctological disorders. US sensitivity decreases after infancy as ossification begins in the spine. A more informative diagnostic method in TC is an MRI of the spine and spinal cord. Comparative analysis of the data of MSCT and MRI has shown that the MSCT is more informative for detection of pathology of the spine and MRI provides a structural change of the spinal cord. Perhaps this is due to the predominance in
our observations of changes in different parts of the spine, compared with myelodysplasia and TC.
Our observations suggest that, regardless of the anatomical shape ARM, high combination with spinal pathology extensive violation prevail in the lumbosacral region. Disorders of functional character and neurological disorders suggest involvement of the spinal structures in the area of their segmental innervation. Osteoneural anomalies often observed regardless of the severity and location of the forms of anorectal anomalies. Of the 51 surveyed only 5 with severe multiple disabilities Spine found such complex variations of anorectal abnormalities as cesspool and rectovaginal fistulas associated with such anomalies as a rectal pouch, a doubling of the vagina, the pathology of the US. The data indicate the feasibility of early detection osteoneural pathology of the spine and spinal cord, regardless ofAPM forms of treatment and preventive measures aimed at their aggravation.
References:
1. Di Cesare A. E., Leva F., Macchini L., Canazza G., Carrabba M., Fumagalli F., Mosca M., Torricelli. Anorectal malformations and neurospinal dysraphism: is this association a major risk for continence? Pediatr Surg Int - (2010) 26:1077-1081.
2. Holschneider A. J., Hutson. Anorectal Malformations in Children. Embryology, diagnosis, surgical treatment, follow-up. - Heidelberg: Springer, - 2006. P 280.
3. Bao Quan Qi - Spencer W. Beasley Dejan Arsic Abnormalities of the vertebral column and ribs associated with anorectal malformations Pediatr Sura Int - (2004) 20: 529-533.
4. Levitt M.A., Patel M., Rodriguez G. The tethered spinal cord in patients with anorectal malformations. J Pediatr Surg. Mar - 1997; 32 (3): 462-8.
5. M.WY. Leung, B.P.Y. Wong, T.W. Fan, N.S.Y. Chao, K.W. Chung, WK Kwok, KKW Liu Occult Spinal Dysraphism in Children with Anorectal Malformation HK J Paediatr (new series) - 2009; 14: 177-180.
6. Mirshemirani A., Ghoroubi J., Kouranloo J., et all. Spinal and vertebral anomalies associated with anorectal malformations. Iran J Child Neurology - 2008 - October, P. 51-54.
7. Schropp C., Sorensen N., Collmann H., Krauss J. Cutaneous lesions in occult spinal dysraphism correlation with intraspinal findings. Childs Nerv Syst - 2006. - 22: P. 125-131.
8. Seong Min Kim, Hye Kyung Chang, Mi Jung Lee, Kyu Won Shim, Jung Так 0h, Dong Seok Kim et al. Spinal dysraphism with anorectal malformation: lumbosacral magnetic resonance imaging evaluation of 120 patients Journal of Pediatric Surgery - (2010) 45, 769-776.
9. Warne S. A., Godley M. L., Owens C. M., Wilcox D. T. The validity of sacral ratios to identify sacral Abnormalities - 2003 BJU INTERNATIONAL | 91, 540-544.
10. Liu Y., Sugiyama К., Yagami К., Ohkawa H. Sharing of the same embryogenic pathway in anorectal malformations and anterior sacral myelomeningocele formation Pediatr Sura Int - (2003) - 19: 152-156.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-150-153
Yusupova Umida Masharipovna, Andijan Medical Institute, Inoyatova Firuza Khidoyatovna, Tashkent Medical Academy, Uzbekistan E-mail: medikdoctor@mail.ru
The relationship between development of inflammatory diseases of pelvic organs and expression of proinflammatory cytokines in women with intrauterine contraceptives
Abstract: We determined the level of proinflammatory cytokines in blood serum of women, wearing intrauterine contraceptives, and their relationship with the development of inflammatory processes in organs of small pelvis. Long wearing of intrauterine copper-containing contraceptives leads to the development of intrauterine inflammation and bleeding. When wearing intrauterine contraceptives, the levels of IL-1, IL-6 and TNF-a are increased, especially in patients with presence of inflammatory processes in organs of small pelvis. Activation of proinflammatory cytokines in blood serum coincides with histological pattern of local inflammation of the endometrium.
Keywords: intrauterine contraceptives, inflammatory processes in organs of small pelvis, women.
The relationship between development of inflammatory diseases of pelvic organs and expression.
Introduction. Among women of reproductive age intrauterine contraceptives (IUC) are the most popular in the developing countries ofAsia, Middle East and Latin America. Of them, China (49%), Tajikistan (68.9%) and Uzbekistan (46%) are the leaders by the absolute number of IUC users, while this rate is slightly lower in Russia (12.8-18%) [1; 4; 6; 7]. This method of protection is the choice option for breastfeeding women, who do not have contraindications to their use [3; 12; 13]. However, the use of IUC may develop side effects and complications such as expulsion, the development of inflammatory processes, and disorders of the menstrual cycle [2; 7; 9].
Local immune responses, which regulation mechanism is associated with the production of cytokines, have essential significance in the genesis of infectious lesion of the cervical epithelium [5; 12]. It was established that the system of cytokines, which includes interleukins, interferons, growth factors, plays the important role in the development of inflammatory reactions, intercellular interactions in a cervical biopsy, endocrine effects, and largely determines the nature, clinical manifestations and outcome of various pathological processes [7; 10]. Assessment of the levels of cytokines allows obtaining information about the severity of inflammatory process, its transition to a systemic level, and prognosis; about the functional activity of cells of the immune system that is very important in the differential diagnosis of numerous infectious and immunological processes. However, such studies in women with IUC that determined the purpose of the present study.
The purpose is to determine the level of proinflammatory cytokines in blood serum of women with IUC and their relationship with the development of inflammatory processes in organs of small pelvis.
Materials and methods
The studies were conducted at the maternity complex № 2 of Andijan city. Ninety one women of reproductive age (from 17 to 36 years), who were using copper IUC for 1 year (the main group), were surveyed. The control group consisted of 14 healthy women of reproductive age without IUC. Women had no contraindications for the use of IUC, according to the medical eligibility criteria of the WHO [3; 14; 15]. Of the observed women, 16 females used IUC after miscarriage, 8 — after abortion, 12 — after premature birth and 55 women — after timely delivery. Prior to admission or dispensary at the consulting polyclinics, before the use of IUC, 16 women received antibacterial and anti-inflammatory therapy. According to the recommendations, copper-containing T-shaped IUC (Cu T380A) were inserted not later than 48 hours after miscarriage, abortion or childbirth, considering the absence of infection and inflammation
[4].
The studies were conducted in the dynamics (at 40 days, 3 and 6 months after inserting IUC). Complete clinical examination was performed, the presence of pain, discomfort, volume, number, and intensity of excretes were identified. Determination of the levels
of proinflammatory cytokines in blood serum (interleukins IL- 1p, IL-6 and tumor necrosis factor TNF-a) was performed by ELISA using commercial test systems "Vector-Best" (Novosibirsk, Russia) [10]. Test systems are based on sandwich method of the solid-phase enzyme immunoassay using horseradish peroxidase as a tracer enzyme. Quantification of results was performed using the program Excel 2004, reflecting the dependence of optical density on the concentration of standard antigen. The sensitivity of the method at using the data of these test systems is 2-30 PG/ml. Materials obtained were processed by variation statistics.
Results and Discussion
There were different complications after IUC use: pain — in 12 (13.2%), bleeding of varying intensity — in 21 (23.1%), expulse — in 21 (23.1%), endometritis — in 5 (5,5%), adnexitis — in 12 (13.1%), erosion — in 13 (14.3%), the frequency ofwhich varied depending on the duration of IUC wear. So, expulse was mainly
noted in the early stages, while bleeding and especially inflammatory processes developed at 6-9 months. Later on, the rate of complications slightly decreased. Histological studies of the endometrium after removing IUC in connection with the occurrence of uterine bleedings, pain, inflammation of internal genital organs, desire to have a child, the onset of menopause or change of contraceptive method showed the presence of separate foci of superficial erosion of the endometrium and flattening of its stroma. In some patients, there was deeper endometrial erosions and stromal edema. They mostly occurred during the first 6 months of the use of contraceptive. Our findings correspond to literature data that demonstrate the development and severe course of acute inflammatory diseases of pelvic organs (IDPO) with distinct morphological changes [7; 9]. According to several researchers, they were due to the following factors: the presence of inflammatory diseases, fibroids, adenomyo-sis in the anamnesis was not considered; duration of IUC use in the majority of patients exceeded 5 years, etc. It was found that Th1-cells produce powerful cytokines with proinflammatory properties, such as IL-1p, TNF-a, etc. [7; 11]. Th2-cells secrete anti-inflammatory cytokines, such as IL-4 that stimulate mainly humoral immunity. The imbalance of cytokine production of Th1/Th2 is important in the immunopathogenesis of development of inflammatory processes. Based on the foregoing, we studied the cytokine content in blood serum of women with IUC in the dynamics.
Our studies have shown that the level of proinflammatory cytokines in blood serum was increased in 1.79; 1.31 and 1.49 times, in comparison with the control group. Later on, (at 3 and 6 months) after IUC insertion, the level of IL-6 in blood serum of women of the main group was reduced to values of the control group, the content of IL-1p was significantly higher than normal values in 1.53 and 1.49 times, and the level of TNF-a increased in 1.4 and 1.29 times, respectively to periods of wearing (Table 1). These changes coincided with the histological changes in the endometrium.
Table 1. - The levels of proinflammatory cytokines in blood serum of women with intrauterine contraceptives in the dynamics of wearing, M±m
Groups and study periods The levels of proinflammatory cytokines, pg/ml
IL-1ß IL-6 TNF-a
Control group, n=14 9.39±0.78 2.34±0.21 3.44±0.31
Main group, n=91, at:
40 days 16.83±0.77* 3.06±0.28* 6.63±0.34*
3 months 14.44±0.94* 2.18±0.17 4.83±0.28*
6 months 13.98±1.23* 2.07±0.18 4.44±0.31*
Note: * — significant differences between the indicators of main and control groups, P<0.05.
It should be noted that in the main group women noted a wide variability of the levels of interleukins. In this regard, the surveyed women were divided into 3 groups: 1st group — 61 women with IUC without IDPO; 2nd group — 14 women with IUC and IDPO, who have previously had no inflammation and did not receive treatment; 3rd group — 16 in women with IUC and IDPO, who have previously had inflammation and received treatment. The prospective analysis of the levels of interleukins in these groups showed significantly higher values of the studied cytokines in groups of women with IDPO (Table 2). Thus, at 40 day of the study, the levels of IL-1p in the 1st, 2nd and 3rd groups exceeded the control levels in 1.55; 1.9 and 2.1 times, respectively. Moreover, high values of interleukins maintained in subsequent periods of study, exceeding the values of control group in 1.39; 1.42 1.64 times at 6 month of the study. Along with this, they significantly differed from the values of a group of women, who have had no inflammatory processes.
According to the literature, IL-1p is a multifunctional cytokine with broad spectrum of activity, plays the key role in the development and regulation of non-specific defense and specific immunity, one of the first is included in the second protective reaction of or-
and regulates the inflammatory, immune processes, activates neutrophils, T- and B-lymphocytes, stimulates the synthesis of acute phase proteins, cytokines (IL-2, —3, —6, TNF-a), adhesion molecules (E-selectin), procoagulants, prostaglandins. We observed increase in the level of IL-1p in the examined by us patients. This is probably connected with stimulation with CD40 ligand processing of pre-ILp and release of the biologically active cytokine in endothelial cells.
At the same time, the values of IL-6 were changed to a lesser extent, and at 40 day were significantly higher than the control values, more significantly in the 2nd and 3rd groups. We should note that by 3 month, we noted significant increase in the content of this cytokine only in the 3rd group, and they significantly differed from the values of a group of women, who have had no inflammatory processes. By the end of follow-up (at 6 month) in all groups there were no differences from the control. We should note that IL-6 induces the synthesis of acute phase proteins, in this connection can be attributed to the cytokines of inflammation (like IL-1p and TNFa as well). According to the literature, IL-6 causes significant increase in the level of mRNA of c-sis gene in cultured endothelial cells that may mediate inflammatory vascular effects [11].
ganism against the action ofpathogenic factors [11]. IL- 1p initiates
Table 2. - The levels of proinflammatory cytokines in blood serum of different groups of women with intrauterine contracepytives in the dynamics of wearing, M±m
Группы и сроки исследования Содержание провоспалительных цитокинов, пг/мл
IL-1p IL-6 TNF-a
Control group, n=14 9.39±0.78 2.34±0.21 3.44±0.31
Main group, n=91, at:
40 days:
1st group, n=61 14.53±0.41 а 2.76±0.17 а 5.87±0.30 а
2nd group, n=14 17.85±0.77 а 3.51±0.26 а' b 6.76±0.47 а
3rd group, n=16 19.76±0.77 а' b 5.43±0.32 а> b 7.53±0.34 а- b
3 months
1st group, n=61 12.44±0.39 а 1.82±0.14 3.61±0.23
2nd group, n=14 14.01±0.94 а 2.43±0.22 4.36±0.28 а
3rd group, n=16 17.64±0.65 а- b 3.09±0.25 а- b 5.83±0.32 а> b
6 months
1st group, n=61 13.02±0.61 а 1.92±0.12 3.74±0.28
2nd group, n=14 13.37±0.49 а 2.16±0.12 4.36±0.29 а
3rd group, n=16 15.41±0.68 а 2.45±0.19 5.81±0.33 а' b
Note: a — significant differences between the indicators of main and control groups, P<0.05; b — significant differences to the 1st group, P<0.05.
The level of TNF-a significantly increased in all groups, especially in the 2nd and 3rd groups at 40 day of the study. The high values of this cytokine remained until the end of observations in the surveyed groups, and they differed significantly from values of a group of women, who have had no inflammatory processes. It is known that TNF-a and p (lymphotoxin) are factors of tumor necrosis. TNF-a is a product of monocytes/macrophages, endothelial, fat and myeloid cells, glial cells, and, in special cases, activated T-lympho-cytes. The release of TNF increases the permeability of capillaries, damages vascular endothelium, develops intravascular thrombosis. Namely TNF-a plays the important role in the development of inflammatory lesions of blood vessels. Excessive levels of proinflammatory cytokines, such as TNF-a, IL-1p and IL-6 contributes to the maintenance of the inflammatory process in the body as a whole.
Our results indicate the prognostic value of determination of cytokines in blood serum of women with IUC with the risk of development of inflammatory processes in organs of small pelvis.
Conclusions
1. Long wearing of intrauterine copper-containing contraceptives leads to the development of intrauterine inflammation and bleeding.
2. When wearing intrauterine contraceptives, the levels of IL-1, IL-6 and TNF-a are increased, especially in patients with presence of inflammatory processes in organs of small pelvis.
3. Activation of proinflammatory cytokines in blood serum coincides with histological pattern of local inflammation of the endometrium.
References:
1. Aliyeva D. A. Features of reproductive health of women using contraception//Bull. Doctors' Association. - 2001. - No. 1. - P. 29-31. [In Russian].
2. Ayupova F. M., Inoyatova F.Kh., Khamdamov M. T., Khamdamov I. B. Some biochemical parameters of erythrocytes in women with intrauterine devices//Bulletin of Tashkent Medical Academy. - 2012. - No. 1. - P. 62-64. [In Russian].
The remote results of the treatment of "pectus carinatum" of the thorax in children
3. World Health Organization: Medical eligibility criteria for contraceptive methods//Handbook. - 2008. - No. - 10. - P. 28-37. [In Russian].
4. Kuznetsova I. V. Intrauterine contraception//Gynecology. - 2008. - Vol. - 10, - No. 2. - P. 32-37. [In Russian].
5. Poletaev A. B. Clinical and laboratory immunology. - M., - 2007. - 180 p. [In Russian].
6. Prilepskaya V. N. New opportunities and prospects of modern contraception (clinical lecture)//Problems of reproduction. - No. 5. -2009. - P. 63-65. [In Russian].
7. Prilepskaya V. N., Kondrikov N. I., Revazova F. S. Effect of copper and levonorgestrelonly of intrauterine contraceptive devices on the endometrium, the cervix and the cervical canal microflora//Contraception and women's health. - 2001. - No. 1. - P. 3-13. [In Russian].
8. Saidkariyev B. K., Zakirova G.Yu, Yuldasheva S. Z. et al. Advantages of IUC as a highly reliable contraceptive method//Vestnik of the doctor. - 2009. - No. 3. - P. 334-335. [In Russian].
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13. FFRHC Guidance, - 2004.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-153-155
Yulchiev Karimjon Salimjonovitch, Andizhan State Medical Institute Senior researcher, the department of pediatric surgery E-mail: chtoubib@rambler.ru Akilov Habibullah Ataullaevitch, professor, MD, PhD, DS, Tashkent Institute of Advanced Medical Studies, Head of the Department, E-mail: akilovxa@mail.ru Mirzakarimov Bahrom Halimjonovitch, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: baxromjon73@gmail.com 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
The remote results of the treatment of "pectus carinatum" of the thorax in children
Abstract: Developmental anomalies of the thorax in children concern a serious illness representing big complexities for correction. In this work the developed author's methods of surgical treatment of children with various variants of "pectus carinatum" (PC) are presented. The results of the treatment in the remote postoperative period are analyzed. Keywords: thorax, children, thorax operations.
Malformation of the thorax in children are serious diseases that pose serious difficulties for the correction. PC occurs in 0,3-1,7% of children and to share it accounts for between 6-22% of all strains of the chest. It is characterized by symmetrical or asymmetrical anterior curvature of the sternum and the ribs articulate with it, includes several strain components at the same time defeat rib cartilage can be single- or double-sided, and the sternum stands in front in the
upper and lower section. At birth, says a third of patients with this pathology, and almost half of it appears only after the onset of puberty "leap" in growth. A characteristic feature of PC is a cosmetic defect. When evaluating the data of psychological survey found that dissatisfaction with the appearance of the chest, mainly manifested in patients older age. Currently, preference is minimally invasive, less traumatic at the same time more efficient surgical intervention
