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The role of chemotherapy in prophylaxis of the liver echinococcosis recurrence
Shamsiyev Azamat, Samarkand State Medical Institute, doctor degree in medicine, department of pediatric surgery E-mail: azamat.shamsiev@mail.ru
Rakhmanov Kosim, Senior Research Fellow - Competitor, Department of surgical diseases № 1 E-mail: qosimmedik@mail.ru
Shamsiyev Jamshid, doctor degree in medicine, department of pediatric surgery E-mail: shamsievja@mail.ru
Kurbaniyazov Zafarjon, Samarkand State Medical Institute, PhD in medicine, Department of surgical diseases № 1 E-mail: dr.kurbaniyazov@inbox.ru
The role of chemotherapy in prophylaxis of the liver echinococcosis recurrence
Abstract: In analysis exposed the results of treatment 513 patients, operated in Samarkand State Medical Institution's clinic of surgical separation during for the 10 years (2006-2015).0n the occasion of primary the liver echinococcosis were operated 379 (73.9 %) sicks. From all the groups of operated patients, 207 patients were limited of limited of surgical operation, chemotherapy were not hold (2006-2008). And other 306 operated patients patients were hold chemotherapy in full content (2008-2015). 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.
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. Keywords: chemotherapy, liver echinococcosis, prophylaxis.
Introduction
Contemporary condition of the liver echinococcosis surgery can not be recognized as satisfactory, because after primary performed operation a considerable number of reccurent forms resulting in repeated operations is observed [2; 3].
On evidence different authors, frequency recurrence after surgical treatment of echinococcosis in different localization consist about 10 % and hesitant within 3-54 % [1; 5]. Most of complicated problem represent repeating and multiple recurrence of echinococ-cosis, in the time which may be lethal outcome.
Materials and Methods
In analysis exposed the results of treatment 513 patients, operated in Samarkand State Medical Institution's clinic of surgical separation during for the 10 years (2006-2015). On the occasion of primary the liver echinococcosis were operated 379 (73.9 %) sicks.
The portion of multifocal echinococcosis are consisted 26.9 % (n = 102). Repeatedly on the occasion ofthe liver echinococcosis and organs of abdominal cavities were operated 134 patients: about reccurent — 74 (55.2 %), residual — 13 (9.7 %), disseminated abdominal cavities of echinococcosis — 7 (5.2 %), about implantation of echinococcosiss — 39 (29.1 %), about reinfestation of echinococco-siss — 1 (0.7 %). From them 19 patients were operated in our separation, on 379 primary operation frequency of recurrent consisted 5.0 %.
The rest of115 patients, which income to repeating treatment, were operated to other surgical centres.
All admitting patients were effected a complex of clinical, laboratory and instrumental researching. Among the instrumental methods of researching are administered radiography, USD and KT.
According to sizes of the sac echinococcosis, its number and localization, the growth parasite of echinococcosis, the complication of character, the condition of fibrous capsule, the general condition of patients were applied to different methods of echinococcectomy and to the methods of liquidation leavings of cavity.
For intraoperative manipulation of Hydatid sac most safety and available for practical use were 80-100 % glycerin, which heated till 70 °C temperature. Glycerin is active even for significant delution, warrants of its most safety, that proved experimentally [4].
It was detected, that hot solution of glycerin causes death 100 % protoscolexes during 1 ± 0.2 min., and complete destroy of acephalo-cysts occurs on the average in 3 ± 0.5 minutes of exposition.
Results and its discussings
From all the groups of operated patients, 207 patients were limited of limited of surgical operation, chemotherapy were not hold (2006-2008). And other 306 operated patients patients were hold chemotherapy in full content (2008-2015).
Albendazole was used in dose 10-12 mg/cg/24 hours recommended WHO (1983). Preparations are assigned discontinuous courses (1 month treatment and 15 days — pause). Number of treatments courses in each observing were selected very seriously individually depending on its size, number and the disposition of sac.
Section 6. Medical science
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).
