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Clinical course and tactics of treatment of tuberculous lesions of the thoracic spine with spinal disorders
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Usmonov Isomiddin Haydarovich, Republican Specialized Scientific Practical Medical Center of Tuberculosis and Pulmonology, Cenior scientific fellow of bone and joint tuberculosis department, Tashkent,
E-mail: uisamiddin@bk.ru Tillyashayhov Mirzagolib Nigmatovich, Republican Specialized Scientific Practical Medical Center of Tuberculosis and Pulmonology, Director of theRSSPMCT&P Tashkent, E-mail: tmirza58@mail.ru Nazirov Primkul Khudjamovich, Republican Specialized Scientific Practical Medical Center of Tuberculosis and Pulmonology, leading scientific fellow of bone and joint tuberculosis department, Tashkent, E-mail: nazirov.primkul@bk.ru
Clinical course and tactics of treatment of tuberculous lesions of the thoracic spine with spinal disorders
Abstract: It is analyzed case records of 57 patients with tubercular spondylitis which have received hospitalization in branch ofbone-articulate tuberculosis the republican specialized scientifically-practical medical centre of Phthisiology and Pulmonology in 2012-2015 years, from them men was — 31 (54, 4%), and women — 26 (45.6%). At 41 (71,9%) the patient are spent considerably-regenerative operation by an is traditional-classical method with application autograft for spondylodesis, and at 16 (28,1%) by means of titanic mesh cage — Piramesh. At application titanic mesh cage the patient the postoperative period the pastel mode was observed for 27-30 days, 28-31 days to the patient it is authorised to rise, and goes, and is traditional-classical to a technique this period has lasted on the average 55 days.
Keywords: tubercular spondylitis, diagnostics, surgical treatment, spinal infringement, results.
Actuality: The specific tubercular lesions of the spine, spondylitis, has always occupied an important place in the problem of os-teoarticular tuberculosis, attracting the attention of researchers and physicians particular severity of the disease and the difficulty of their treatment. Currently, interest in spinal cord injuries has increased significantly due to the introduction of radical surgical treatment, which radically changed for the better, our therapeutic and preventive capabilities in the fight against these resistant diseases [4]. In most cases, the cause ofpsoas abscess is purulent-destructive defeat thoracic or lumbar spine (spondylitis). Such processes often provide a detailed clinical picture, primarily in the form of a pronounced vertebral pain, pulling pain on the inside of the thigh, mainly from the psoas abscess, the development of gross neurological deficits and expressed radicular pain due to spinal cord compression sequestration of bone and cartilage tissue combined with a relative stenosis of the channel [2; 3; 5]. In tuberculous lesions of the spine is especially important to have data as a process, developing bone (the level of destruction, the number of vertebrae, the nature of the destruction, and others.) And complete understanding of the complicated spondylitis abscesses (their location, extent, relation to other bodies
and tissues). Are very important information about the state of the spinal canal and its contents [6; 7; 8; 9]. Long-term course of the disease increases the risk of postoperative complications. In order to prevent early postoperative complications are shown in the amount of surgery radically reducing operations in the period of 6 months from the onset of the disease [1].
Objective: to study the clinical course and to evaluate the effectiveness of surgical treatment of spinal disorders of tuberculosis of the spine.
Material and methods: analyzed 57 case histories of patients with tuberculous lesions of the thoracic and thoracolumbar spine who received inpatient treatment in the department of osteoarticular tuberculosis RSNPMTsFiP in 2012-2015., Of them were men — 31 (54.4%), and -26 women (45.6%). The age of patients ranged from 19 to 64 years, average 45.3 years. The defeat of the spine was observed in the thoracic region — in 35 (61.4%) and in the thoracolumbar — in 22 (38.6%) patients. Complex diagnostic study: clinical and laboratory (blood count, biochemical blood, coagulation of blood, urinalysis), ECG, respiratory function, ultrasound of internal organs (liver, kidney, pancreas, pelvic, retroperitoneal, psoas
Section 6. Medical science
abscess), X-ray examination of the chest. In 48 (84.2%) patients underwent magnetic resonance imaging (MRI), and 9 (15.8%) patients underwent MRI and multislice computed tomography (CT) of the spine. Complaints of patients were as follows: to increase body temperature to 38,20S — at 44.3%; sweating — at 27.6%; weight loss — at 54.3%; Spinal disorders: pain in the affected area with radiation — at 98.7%; increased pain when walking — at 40.7%; lower paraparesis, lower paraplegia, dysfunction of the pelvic organs (signs neurogenic bladder: dysuria, ischuria, constipation) — in 44.8% of patients. In the X-ray, MRI, MSCT study revealed kyphosis — at 35.4%, paravertebral and prevertebral abscesses — at 64.4%, epidural abscess — at 38.3%, destructive changes in the vertebral bodies and infiltration of surrounding soft tissue found in all patients. In 7 (12.3%) patients showed Generalized form of tuberculosis that lesions observed in the lung and spine, ofwhom 1 (14.3%) patients stood out mycobacteria tuberculosis with sputum. All patients underwent sputum microscopy at BC, surgical material studied bacteriology in the reference laboratory apparatus Gene/Xpert. Sowing was carried out on pathological material liquid medium — MGite and solid Lowenstein-Jensen medium, with the definition of the sensitivity of the ILO (Mycobacterium tuberculosis) to antibiotics. Obtained results of bacteriological research: ILO negative — 75.7%, the Office Rif positive sensitivity — 13.2%, the Office Rif positive steady — 6.3%, the Office Rif undefined positive — 1.4%, and the result is not defined — 3, 5%. In 27 (47.4%) patients met concomitant diseases: cardiovascular disease — in 17 (63.0%) patients, diseases of the hepatobiliary system — in 5 (18.5%); urinary and genital organs — in 2 (7.4%); diabetes — in 2 (7.4%); Infected HIV — 1 (3.7%). Patients received chemotherapy DOTS program before and after the operating period. Side effects of anti-TB drugs imagined a toxic-allergic reactions: mainly nausea, loss of appetite, in the form of itching and red rash in patients. These patients underwent a course of treatment of individual traditional method using first-line drugs on the background of antihistamines and desensitizing therapy. In 3 (5.3%) patients diagnosed with MDR (multidrug) form of tuberculosis that is resistant to the ILO the first row of TB drugs. Neurological status was assessed by the system, and on a scale ISCSCI Frankel following categories: grade A (patients with anesthesia and plegia below the lesion) — in 2 (3.5%), grade B (patients with incomplete violation of the sensitivity below the level of injury, no movement) — in 5 (8.7%), grade C (with partial violation of the sensitivity, there is little traffic, but the muscle strength is insufficient for walking) — 12 (21.1%), the degree of D (part-time violation of the sensitivity below the level of injury, there is a movement, muscle strength enough to walk with assistance) — 14 (24.6%), the degree of E (patients without sensory disturbances and movement below the level of injury) — 24 (42.1%) patients. All patients were treated with complex orthopedic treatment, chemotherapy, pathogenetic therapy, restorative therapy. All patients underwent radical reconstructive surgery, 41 (71.9%) patients traditionally classical method using autologous bone for spinal fusion, and in 16 (28.1%) using a titanium mesh Cage — Piramesh. Patients who have a epidural abscesses, rough kyphosis often met lower paraparesis, lower paraplegia, dysfunction of the pelvic organs (signs neurogenic bladder: dysuria, ischuria, constipation). Patients paravertebral, prevertebral abscess and spinal instability neurological symptoms appeared a pain of varying intensity, below the level of injury. In these patients underwent radical reconstructive surgery with abstsessonekrektomiey, and with compression of the spinal cord decompression. Duration of operations 1.5-2.5 hours, an average of 2 hours.
Results and discussion: to enroll in clinical and laboratory studies of observed changes in the overall analysis of blood hemoglobin 110,0-90,0 mmol/l — 28.7%; 90,0-70,0 mmol/l — 8.4%, less than 70.0 mmol/l — 1.2%; ESR acceleration 22-33 mm/h — 37.1%; 34-45mm/h — 14.7%; 46-58 mm/h — 6.8%, in the biochemical analysis of blood: elevated levels of ALT, AST, bili-rubin up to 3.5% of the total analysis of urine: the reaction of the acid — 60.9%, alkaline — 30.1%, leukocyturia — 5.2%, red blood cell — 3.1%, protein — 1.4% salt — 82.6%, bacteriuria — 0.8%, fungi — 1.2%. Patients with preoperative period was performed 1.0-1.5 month course of antibiotic (4 anti-TB drugs of first-line) on the DOTS program against the background of pathogenic (detoxification, vitamin, hepatotropic, cardiotropic, osteotrophic, symptomatic therapy is indicated) and orthopedic therapy. ILO noted resistant forms of TB in the first-line therapy (rifampicin, isoniazid, ethambutol, pyrazinamide, streptomycin) — 3 (5.3%) patients. When such cases were treated by DOTS + program, with the use of anti-TB second-line drugs (aminoglycosides: capreomycin, kanamy-cin, amikacin, cycloserine, PASK, protionamid; fluoroquinolones: levofloxacin). Patients after 1-1.5 months of conservative therapy performed MRI of the spine control. The results of antibacterial, pathogenetic and orthopedic treatment: all patients normalized the body temperature, sweating is not observed, the intensity of pain symptoms significantly decreased to — 28.7%, lower paraparesis, lower paraplegia, dysfunction of the pelvic organs — without positive dynamics. Kyphosis and spinal instability persisted, abscesses decreased small size — from 30.8% of patients, destructive changes in the vertebral bodies remain the same, but in 10.2% of patients with predominant symptoms of osteosclerosis, and in 89.2% cases of osteolysis, infiltration of surrounding soft tissue decreased in 54.2% of patients. The clinical and laboratory studies have survived the following changes: In the overall analysis of the blood drop in hemoglobin level — at 45.7%; ESR acceleration normalized — from 86.8% in the biochemical analysis of blood had elevated levels of ALT, AST, bilirubin — 15.5% of the total analysis ofurine acid reaction prevailed — to 89.9%, alkaline — 11.1% reduction leykotsitu-rii — eritrotsiturii 1.2% — 1.1%, protein — 3.4% salt — 86.6%, bacteriuria — 0%, fungi — 4.2%). Antibacterial, pathogenetic therapy and orthopedic treatment helped in part. In 41 (71.9%) patients underwent radical reconstructive surgery traditionally classical method using autologous (patient's own rib) for fusion, and in 16 (28.1%) using a titanium mesh Cage — Piramesh. After 6 months of surgery in neurological status was a significant improvement in the evaluation system ISCSCI and Frankel scale in the following categories: grade A (patients with anesthesia and plegia below the lesion) — in 1 (1.7%), grade B (Patients with partial violation of the sensitivity below the level of injury, no movement) — in 2 (3.5%), grade C (with partial violation of the sensitivity, there is little traffic, but the muscle strength is insufficient for walking) — 4 (7.0%) the degree of D (part-time violation of the sensitivity below the level of injury, there is movement, muscle strength enough to walk with assistance) — in 7 (12.3%), the degree of E (patients without sensory disturbances and movement below the level of injury) — 43 (75.4%) patients. After the implementation of the operations of classical pastel mode observed 55-60 days, and the application of titanium mesh Cage 27-30 days, 28-31 days, the patient is allowed to walk and was discharged home.
Conclusions:
1. TB defeat thoracic and thoracolumbar spine with compression of the spinal cord is a direct indication drastically reducing operations with decompression of the spinal cord.
The influence of gastroesophageal reflux disease comorbidity on biochemical markers, data of ambulatory blood...
2. When plegia and violations of the pelvic conducted early 3. The use of titanium mesh Cage — piramesh provides
surgery to decompress the spinal cord holds the best results. good immobilisation of the operated segment and enables early
activation of patients.
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Fadieienko Galyna Dmytrivna, SE «National Institute for Therapy named after LT Malaya NAMS of Ukraine», D. med.sci., Professor, E-mail: info@therapy.gov.ua Gridnyev Oleksiy Ievgeniovych, SE «National Institute for Therapy named after LT Malaya NAMS of Ukraine», PhD, Senior Researcher, E-mail: alex-gridnev@yandex.ru
The influence of gastroesophageal reflux disease comorbidity on biochemical markers, data of ambulatory blood pressure monitoring and echocardioscopy in patients with hypertension
Abstract: The article presents the characteristics of biochemical parameters, data of daily profile of blood pressure and echocardioscopy in patients with comorbidity of gastroesophageal reflux disease and hypertension. Particular attention is paid to the characteristics of the "lipid peroxidation-antioxidant protection."
Keywords: gastroesophageal reflux disease, hypertension, ambulatory blood pressure monitoring, echocardioscopy, lipid profile, lipid peroxidation, apelin.
The features of the disease in case of comorbid pathologies are in the epicenter of the problems in modern medicine [1, 102107]. Hypertension is one of the most common non-communicable diseases in countries with high economic level, and one of the major risk factors for cardiovascular diseases [2, 5-7].
In addition, special attention is paid to the study of gastroesophageal reflux disease (GERD). In 1998 GERD has been included in the «five» diseases with the greatest degree of reducing of the quality of life in patients. According to recent reports 40% of US adults and up to 10-25% in Europe suffer from the primary symptom of GERD — heartburn [3, 323-331]. According to numerous population-based studies, GERD is common with prevalence also in developed countries (10-20%) [4, 1-37].
The combination of hypertension and GERD is a frequent situation [5, 155-162], first of all, it is explained by not only their prevalence, but also by common risk factors of these diseases:
psycho-emotional stress, smoking, alcohol abuse, irrational eating with increased consumption of saturated fats, refined carbohydrates, insufficient consumption of micronutrients, obesity, physical inactivity, etc. Thus, the study Moraes-Filho JP et al. (2009) hypertension was detected in 29% of patients from non-erosive reflux disease group and 20.6% of patients with erosive reflux disease [6, 785790]. In connection with the above the study of pathogenetic links and features of the mutual influence of these two diseases is very topical.
The purpose of research is to study the effect of concomitant GERD on data of blood pressure profile, echocardioscopy, lipid profile, apelin level and condition of the system "lipid peroxidation-antioxidant protection" for persons suffering from hypertension.
The study was performed at the GI "The National Institute of Therapy named after LT Malaya of National Academy of Medical Sciences of Ukraine".
