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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-148-150
Ergashev Nasriddin Shamsiddinovich, Head of the Department of Hospital Pediatric Surgery and Oncology TashPMI Otamuradov Furkat Abdukarimovich, Senior Research Fellow-Competitor of the Department of Hospital Pediatric Surgery and Oncology TashPMI. Ergashev Nargiza Nasriddinovna, Senior Research Fellow-Competitor of the Department of Neurology of child neurology TashPMI, 1 Tashkent Pediatric Medical Institute, Republic of Uzbekistan, Tashkent E-mail: [email protected]
Anomalies of spine and spinal cord in children with anorectal malformations
Abstract: Associated malformations with anorectal malformations (ARM) are observed in various combinations, in 1060,7% of combined anomalies of the spine and spinal cord. Objective: to determine the nature of concomitant pathology of the spine, spinal cord and related disorders in children workstation. Results: We included 51 children after surgery for various forms ofARM carried out in the clinic 2004-2015year. The prevalence of functional disorders (60.8%) in normal and satisfactory anatomical structure (76.5%) of the surveyed data prompted us to study after surgery. The results showed that neurospinal cord anomalies/dysraphism (ND) or sacrovertebral anomalies/dysraphism (SD) are widespread at the workstation, which confirms the need for a focused examination of each patient for diseases of the spine and spinal cord, the observation and treatment of co pediatric surgeon and a neurologist.
Keywords: anorectal malformations, Associated anomalies of the spine and spinal cord, diagnostics, children.
Anorectal malformations (ARM) — one of the many groups Objective: to determine the nature of concomitant pathology
proctologic pathology, requiring surgical treatment. The high mor- of the spine, spinal cord and related disorders in children undergoing
tality rate is not typical for this group of anomalies, but after surgical surgery for anorectal malformations.
correction offunctional disorders observed in 30-60% of cases. The Materials and methods. The study included 51 children
situation is compounded by the presence of associated anomalies (35 girls with, boys — 16) aged from 1 day to 15 years after sur-
that the risk ofviolations of social adaptation of patients. Associated gery for ARM performed in the clinic in 2004-2015. Preoperative
malformations observed at the workstation in a variety of combina- diagnostic measures were aimed at establishing forms of anomalies,
tions in 10-60.7% of the combined anomalies of the spine and spinal evaluation of anatomical and functional condition of the perineum
cord [1; 2; 4; 6; 7; 8]. Although the pathogenesis ofARM remains and sphincter apparatus of the rectum (contrast irgography, ultra-
completely obscure their superior combination of them with the sound of internal organs). Related osteoneural spine abnormalities,
pathology of the spine associated distal common embryogenesis [3; spinal cord and spinal hidden dysraphism installed on the results
10]. A more informative methods of diagnosis of these anomalies of the inspection and consultation neurologist, additional studies
are ultrasound and MRI of the lumbosacral spine [5; 9]. of the spine spondylography digital (Siemens) or MSCT (before
Anomalies of spine and spinal cord in children with anorectal malformations
surgery — 15 patients after treatment for long-term results — 36). In 5 cases performed MRI of the spinal cord. The patients' age at the time of investigation: 3 months. up to 1 year — 8 (15.7%); from 1 year to 3 years — 12 (23.5%); 3 to 7 years — 19 (37.3%); from 7 to 15 years — 12 (23.5%).
Distribution of patients according to nosological forms in accordance with the International Classification adopted in Kriken-bek: rectovestibular fistula — 15 (29.4%); rectourethral fistula — 12 (23.5%); rectovesical fistula — 1 (2%); rectoperineum fistula — 3 (5.8%); rectovaginal fistula — 7 (13.7%); rectovestibular fistula with normal anus — 1 (2%); without fistula — 2 (3,9%); cloaca — 7 (13.7%); ectopic anus — 1 (2%); stenosis anus — 1 (2%); mixed forms — 1 (2%). Patients performed the relevant operations ARM correction recommended by the expert group in congress Kriken-bek [2].
Results and its discussion. normal anatomical structure and functional state of the anorectal area — 20 (39.2%): In a clinical examination of children operated on different anatomical and functional status were identified. In normal (19) and satisfactory (7) anatomical structure of functional disorders of the anorectal area — 26 (51%) (persistent constipation — 10, fecal incontinence — 9, urinary and fecal incontinence — urinary 5 urine — 2). In case ofviolation of the anatomical structure in 5 (9.8%) without sphincter relegation rectum — 2; stenosis of the anus — 1; lack of sphincter muscles — 1; dropping out rectum mucosa — 1, proceed with functional disorders (fecal incontinence — 2, chronic constipation with paradoxical incontinence — 2, chronic constipation — 1).
The prevalence of functional disorders 26 (51%) in normal and satisfactory anatomical structure of the surveyed after surgery prompted us to conduct targeted research to identify the pathology of the spine and spinal cord.
In assessing neurological status in 20 (39.2%) of this group of disorders have been identified; aggravation of neurological signs or anorectal dysfunction is not marked. In 26 (51%) were observed moderate violations of motor activity, the weakness of the lower limbs and sphincter apparatus of the rectum. In 5 (9.8%) patients had evidence of CNS lesions, associated with undergoing intrapartum asphyxia and lesions at delivery: a clear neurological disorders spinal nature, including dysfunction of the pelvic organs.
In 31 (60.8%) marked decline in child ahilov and anal reflexes, asymmetry of reflexes, sensory disorders, wasting of muscles of the lower extremities. sensory disturbances (4-12,9%) were shown segmental, radicular and conduction changes from the lower extremities and perineum as gipoestezi, in rare cases — anesthesia. Severity of motor impairment (1-3,2%) ranged from minor to plegia reflex disorders in long lesions. In 26 (83,9%)children in this group were observed constipation, periodic incontinence signs of neurogen bladder dysfunction in the form of delays or urinary incontinence. In6 (11.8%) of 51 patients had cutaneous stigma disembriogeneza (hypertrichosis skin, nevus, capillary hemangioma, coccygeal traction, lipoma), located along the spine, in the perineum; asymmetry of the gluteal folds characteristic of occult SD.
22 (43.1%) patients underwent digital spondylography: in 17 (77.3%) failed determine different vertebral pathologies (hypoplasia and agenesis of the coccyx -12, —5 sacral malformation). In 14 patients the violations combined with spina bifida mainly lumbosacral localization coverage of (2) two or more vertebrae (12). However, this method proved sensitive enough to detect certain types of occult SD.
All patients underwent MSCT for the detection of spinal pathology. In 6 (11,8%) change is not detected in 45 (88,2%) set as-
sociated with a predominance of spinal abnormalities sacroverte-bral dysraphizm — 33 (73.3%) over neurospinal dysraphizm — 12 (26.7%). Changes in the spinal column in 6 (11,8%) patients were shown scoliosis, 5 of them are due to the presence of curvature in the thoracic spine of the wedge (ThXI — 4) and lumbar (L -1) sections. In 4 (7,8%) change at the same time the children were observed in the thoracic-lumbar and sacral spine. In 2 patients there has been a fusion of ribs from 1 — no one edge, is a variant ofverte-bral anomalies. 2 patients in the presence of these strains and other anomalies detected cleft posterior arch of the spine with preferential localization in the lumbosacral region. When MSCT data and thread localization terminal structure spinal cord were shown in 6 (11,8%) cases. In 4 patients ascertained tetring syndrome, in 2 — with intradural lipoma.
Spina bifida okkulta in isolation, identified in 13 patients was the most common type of spinal dysraphizm hidden. Cleft arches a vertebra (mainly lumbar — 2; sacral — 0) was observed only in 2 cases; two vertebrae — in 4 of 7 patients have cleft arches observed over several vertebrae in the lumbar localization — 0, sacral — 4 at the same time within the specified locations — 3.
In 19 (37,2%) surveyed revealed isolated anomalies of the coccyx and sacrum. This is usually expressed by the absence of one or more sacral vertebrae — 6; asymmetric hypoplasia — gemisak-rum — 4; sacred hemivertebrae — 3; coalescence their abnormal — 8 and coccyx agenesis — 6. As a rule, malformations of the spine sacrococcygeal department suffers from the development of the sacral plexus, whose branches innervate the sphincter apparatus of the bladder and rectum, which may account for decrease in tactile sensitivity of the perineum and functional disorders of different dynamics after operative correction of ARM. Violations of pelvic organs, alone or combined (persistent constipation — 11, chronic constipation with paradoxical incontinence — 2, fecal incontinence — 11, fecal incontinence and urine — 5, incontinence — 2) without marked anatomical abnormalities of the anorectal area and the predominance of long cleft arches in the lumbosacral region, covering "interested zones» — SI and SII does not exclude a role neurospinal and lumbosacral dysraphizm their genesis violations. Orthopedic disorders as manifestations of NSD and SVD as hip dysplasia and asymmetry of the gluteal folds were found in 6 patients.
14 (27.5%) patients with diagnosed before surgery ultrasound pathology of the urinary system is further configured with MSCT urography, will provide information about anatomical and functional condition of the kidneys and urinary system. Agenesis of the right kidney is set in 4 patients, ureterohydronephrosis — 8 (one of them on both sides); y 2 — partial doubling (one of them in the right ureter ectopia crotch).
In 22 (43,1%) patients with persistent constipation MSCT with contrast irrigography allowed to assess the condition of the colon. Revealed the following changes: dolihokolon — 11 megarektum — 8, —3 dolichosigma. These anomalies of the urinary system and the colon indirectly constitutes a violation of organogenesis in the zone of segmental innervation of organs, which can be explained by common ARM embryogenesis and pathology spine distal [1, 10].
The study showed that NSD or efficiency are widespread at ARM, which confirms the need for a focused examination of each patient for diseases of the spine and spinal cord, the observation and treatment of co pediatric surgeon and a neurologist.
According to the literature, ultrasound may be screened — by comorbidity diagnosis of the spine and urinary system in infants with ARM in the neonatal period to determine the indications for targeted screening. At neurosonography neonatal spinal cord
located at the upper boundary and Lm 5 years in a starting position lying adult at or above the upper boundary LII. 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.
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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: [email protected]
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.
