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Section 6. Medical science
The appearance of effective anti-angiogenic agents such as monoclonal antibodies against vascular endothelial growth factor (VEGF) has made possible a direct effect on growth of abnormal blood vessels in the anterior segment. After ocular administration of these drugs is very rapid disappearance of the newly formed blood vessels visible iris and angle of the anterior chamber. This avoids the serious complications of cataract surgery and glaucoma patients with NVG.
To reduce IOP recommended to use ^ — blockers and carbonic anhydrase inhibitors which reduce intraocular pressure but not enough to efficiently. In the case of severe pain syndrome is recommended to use atropine, corticosteroids and diuretic drugs, which have a temporary analgesic and hypotensive effects are only effective as a preparatory stage for surgical treatment.
Laser treatment: The prerubeotic stage, preglaukomy stage, the stage of open-angle glaucoma and in the presence of clear eyes environments in vascular diseases of the retina we carried out short-term medical therapy (10-12 days), at the earliest stages of the disease, as a stage of preparation for the laser coagulation of the retina, given the the pathogenesis of vascular diseases of the eye. Drug therapy was conducted against the background of the correction included angioprotectors, absorbable, decongestants. Early laser retinal photocoagulation prevents the development of secondary glaucoma as prevents compression of posterior long ciliary arteries. Laser treatment of diabetic retinopathy begins with the appearance of the stromal edema, according to optical coherence tomography. The indication for laser treatment is the height of the stromal edema than 270 microns.
Laser treatment was conducted in a coagulation subthresh-old 2-3 OCT stage under control. At the same time requires the payment of blood sugar and blood pressure. In the case of focal or
diffuse retinal edema was performed subthreshold or threshold laser photocoagulation as a focal, sectoral, restrictive or "lattice".
When thrombosis retinal vein laser treatment started immediately after the medical therapy and was carried out in 2-3 stages. The first phase — careful coagulation multiple hemorrhages. The second stage (2 weeks), the threshold paravasal laser coagulation of the retina and macular area barrage. The third stage (one month after the second) restrictive retinal laser photocoagulation.
In the terminal stage of NVG in the absence ofvisual functions and expressed pain syndrome cyclophotocoagulation used.
Under open-and-closure NVG recommended antiglauco-matous operation — for our proposed original method — deep sclerectomy implantation xenokollagen drainage (GSE with ICD) (patent number 04336 issued by the IAP State Patent Office of the Republic of Uzbekistan in 2011), which allows to achieve the normalization of IOP.
To check the status of retina and pathogenetic treatment of patients with neovascular glaucoma is important to have transparency in the eyes of media, which makes it necessary to early cataract surgery in these patients, and therefore the presence of patients with complicated cataract at an early stage, phacoemulsification with intraocular lens implantation.
Conclusions
1. Taking into account the initial state of the eyes and the whole body approach to treatment of patients with neovascular glaucoma must be individualized.
2. Using the algorithm we developed rehabilitation treatment NVG allows you to select the optimal pathogenetically oriented approach to the treatment of NVG, depending on the stage of the disease, thereby increasing medical and social effect and improve the quality of life of patients.
References:
1. Еричев В. П. Дренажная хирургия глаукомы//Поле зрения. - 2012. - № 2.
2. Богумирский Б. С. Эффективная работа на IBM PC в сфере Windows. - Спб., 2007.
3. Карауловская Е. А. Комплексное лечение неоваскулярной глаукомы у пациентов с сахарным диабетом//Поле зрения. - 2012. - № 2.
4. Nesterov A. P. Glaukoma. - Moscow: MIA, 2008 (In Russian).
5. Робустова О. В., Бессмертный А. М. Современные представления об этиологии и патогенезе неоваскулярной глаукомы//Гла-укома. - 2003. - № 4.
6. Ambresin A., Saarawy T., Mermoud A. Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient//J. Glaucoma. - 2002. - Vol. 11.
7. Shaarawy T., Mermoud A. Deep sclerectomy in one eye versus deep sclerectomy with collagen implant in the contralateral eye of the same patient: long-term follow-up//Eye. - 2005. - Vol. 19.
8. Shields M. B.//Textbook ofglaucoma. - Baltimore, 1998.
Salakhiddinov Kamoliddin Zuhriddinovich, Andijan state medical institute, associate professor of faculty and hospital surgery, Uzbekistan Alekseev Andrey Anatolevich, Russian medical academy of post degree education,
professor, Moscow E-mail: [email protected]
Assessment of results of autodermoplastiks with application of biosynthetic wound coverings of "Biokol" and "Parapan" in patients with deep burns
Abstract: Authors analyse results of researches of 42 patients, with deep extensive ambustions III of stage. The comparative analysis of the complex approach in treatment of patients with application combined autodermoplastics — biosynthetic
Assessment of results of autodermoplastiks with application of biosynthetic wound coverings of "Biokol" and "Parapan"...
dressings for injuries of "Biokol" and "Parapranas" is carried out. Influence of dressings for injuries on a current process of injuries is rather studied. Efficiency of application dressings for injuries in complex treatment of the burn wounds, expressed creation of optimum comfortable conditions auto-regeneration is noted.
Keywords: combined autodermoplastics, dressings for injuries of Biokol, Parapranas.
Introduction
The great value in a during and in result of burn illness is in many times defined from a choice of resources of local and general treatment [1; 3; 4].
Despite numerous messages about modern methods of treatment of burn wounds [5; 2], application of dressings for injuries remains one of the important elements [2; 3; 5]. In this context of search of new resources and methods of the complex approach, the creation of comfortable and optimum conditions for auto-regeneration, in treatment of patients suffered from ambustions is in our opinion rather actual.
The work purpose: Perfection of methods of complex treatment of patients with deep ambustions.
Materials and methods
We had studied the possibilities of using combined autodermoplastics in a combination with modern dressings for injuries, in treatment of patients with extensive deep ambustions of III stage. As dressings for injuries we used a modern biosynthetic covering of "Biokol" and reticulated non-traumatic bandage of "Parapranas"
Total number of patients with deep ambustions in CFU treatment had used combined autodermoplastics (CADP) and dressings for injuries of "Biokol" and "Parapranas" included 42 persons. Patients have been divided into 2 groups. First group included 22 patients by whom has been made combined autodermoplastics with use of the reticulated perforated skin rag 1:4 and dressings for injuries of "Biokol". Second group was made by 20 patients by whom has been made combined autodermoplastcs with a skin rag perforated 1:4 and application dressings for injuries of "Parapranas".
The total area of ambustions of patients of the first group equaled from 1 to 65 % of the surface of the body. Deep ambustions have averaged 17.2 % of the surface of the body. Ambustions by a flame in 36.4 % of cases, a hot liquid of 54,5 % contact ambustions in 9.1 % of supervision. Among patients of the given group of the man made 16 (72. 8 %) women — 6 (27.2 %). The age of patients fluctuated from 26 to 83 years.
The area of affected patients of 2 groups has made from 2 to 63 % of a surface of a body. Deep ambustions have on the average made 23.9 % of the surface of the body. Men constituted 15 (75 %), women 5 (25 %). Etiologic factors of a burnt trauma were — at 12 (60 %) patients — a flame, at 5 (25 %) — a hot liquid and at 3 (15 %) contact ambustions. The age of patients from 24 to 79 years.
Terms of receipt of patients in a hospital were the following: 19 (86.3 %) patients have arrived in first three days after trauma reception, 3 (13.7 %) after 3 days.
The choice of tactics of local treatment depended on a number of reasons: the general condition of the patient, terms of reception of the trauma, depth of defeat etc.
The following surgical interventions on patients were implemented:
• Surgical necrectomy (SN) it was carried out on the average for 5-6 days after a trauma. In terms of performance SN was divided into primary and postponed. Primary necrectomy were carried out in the absence of inflammatory processes in the field of burn wounds for 2 days after a trauma.
• Postponed surgical necrectomy (PSN) were carried out 8 days after the trauma. At 16 patients (38.1 %) PSN had been implemented
for 8-14 days after a trauma, at 24 (57.2 %) for 15-27 days, and 2 (4.7 %) patients for 30 and 35 days. The heavy general condition, deepening ofambustions, later receipt in hospital were — the reasons of performance OSN after 14 days after a trauma.
The average area of one-ambustions removal necrotic tissues consists 5-10 % of the surface of body.
Autodermoplastics carried out in single-step ambustions CFU were under condition of certainty radical treatment of necrotized tissues. Doubtable in viability of tussues cases after the necrectomy carried out, postponed autodermoplastics.
For the better fixation and creation of favorable conditions for regeneration after the autodermoplastics are layed on a film of "Biokol" for the first group and a injury-covering "Parapran" for second group. Dressings for injuries were covered by sterile gauze bandages for some layers.
Bandagings in compared groups were performed for 2-3 days after operation. Only upper bandage was changed, and at presence of wound congestions under a film of Biokol or Parapran, it was replaced after processing of a wound by an antiseptic tank.
Results
The estimation of results of treatment was spent on the basis of the data of the received during clinical, cytologic and microbiological research of wounds, and also blood analyses in dynamics.
Clinically combination of use autodermoplastics and film dressings for injures of "Biokol" was marked good fixation of a transplant. In case of absence separated wound and appearence with cuticular-ization area, have been noticed drying of a covering and its dense fixation to the surface.
Crops from a surface of burn wounds of patients have shown that the initial picture in compared groups was almost identical. In 18 (42.8 %) cases from a wound were sowed strain P. aeruginosa, in 9 (21.4 %) — S. aureus, in other cases — S. epidermidis, and level microbic seedings has made 103 colony-formation units (CFU) microbic bodies on 1 sm 2 of a surface of wounds. After application dressings for injuries for 5-6 days, against more active cu-ticularization there was a reduction of quantity of microorganisms to 101 CFU on 1 sm 2, only in comparison to group some increase in frequency St was marked. aureus with 2 (5.7 %) to 3 (8.5 %) cases.
Antibacterial therapy were carried out depending on sensitivity of microflora to antibiotics.
Dabs-prints at all surveyed patients before the beginning of treatment were characterised as inflammatory, and in 15 % of cases — as inflammatory-regenerative. Further 12 (54 %) patients of the first group on 6-7 day has been registered regenerative type of cytograms, in 6 (27.2 %) cases the regenerative-inflammatory type, in 4 (18.2 %) — inflammatory type of cytograms is noted. In the second group indicators in these terms slightly differed: regenerative the type of cytograms is registered in 14 (70 %) cases, regenerative-inflammatory — in 5 (25 %), inflammatory — in 1 (5 %) a case.
For 12 days in dabs-print in group of patients with application of combination CADP + "Biokol" in most cases marked regenerative type of cytogram — 19 (86.3 %) cases, in 2 (9 %) cases — regenerative-inflammatory type and 1 (4.5 %) inflammatory type, and in group with application CADP + "Parapran" in 18 (90 %) a case — regenerative type cytograms, and in 2 (10 %) — regenerative-inflammatory. These days has been noted the sharp increase in
