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0полости, и только на 20% - от антибактериальной и интенсивной терапии [4].
Тактические подходы к оперативному лечению распространенного перитонита разнообразны. Закрытый метод ведения брюшной полости применяется при низкой степени бактериальной контаминации брюшной полости и времени развития заболевания, не превышает 6-8 ч. Релапаротомия - наиболее часто используемый метод, заключающийся в повторной лапаротомии, устранении источника перитонита, санации и дренировании брюшной полости [3,6]. Основными критериями выбора метода хирургического лечения перитонита считаются его этиология, давность развития и распространенность, характер экссудата, определяется визуально, количественные и качественные бактериологические характеристики экссудата, степень выраженности пареза кишечника и органной дисфункции [1,6].
Решающее значение в успехе лечения распространенного перитонита имеет ранняя операция, задача которой сводятся к устранению источника перитонита и тщательной санации брюшной полости. Первая задача, как правило, решается однократно во время оперативного вмешательства. Вторая задача при высокой степени загрязнения брюшной полости при распространенном гнойном перитоните не всегда может быть решен одноразовой инт-раоперационной санацией. В 4,9-15,9% больных возникает необходимость в продленной или повторной санации брюшной полости [3,6]. По данным В.С.Савельева с соавт. (2006), каждый пятый пациент с распространенным гнойным перитонитом оперируется повторно.
Выводы. Перитонит остается актуальной проблемой в абдоминальной хирургии. Это обусловлено тем, что патогенетические механизмы, которые развиваются во время перитонита являются чрезвычайно сложными и не полностью изученными, а возникающие острые септические осложнения продолжают обусловливать высокий уровень летальности при данной патологии.
Хотя использование протоколов лечения перитонита остается общим и общепринятым, однако использование только такого лечения не всегда позволяет вылечить больного. Предложенные способы и подходы к решению этой задачи разные, и также не обеспечивают абсолютного достижения положительных результатов лечения. При этом существующие методы лечения перитонита недостаточно эффективными, поскольку не могут охватить весь спектр нарушений, иммунологических изменений, эндотоксикоза и способны влиять лишь на отдельные патогенетические звенья.
Список литературы
1. Butte J.M., Hameed M., Ball C.G. Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment. World Journal of Emergency Surgery. 2015. Vol. 10. № 1. С. 12-14.
2. Filippone A. CT findings in acute peritonitis: a pattern-based approach. Diagnostic and Interventional Radiology. 2015. Vol. 21. № 6. Р. 435436.
3. Gunasekaran G. Gallbladder perforation: a single center experience of 32 cases. Korean Journal of Hepato-Biliary-Pancreatic Surgery. 2015. Vol. 19. № 1. Р. 6-10.
4. Sista F. Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis. World journal of gastrointestinal surgery. 2013. Vol. 5. № 4. P. 73-82.
5. Макуров А.А., Касумьян С.А., Соловьов В.И., Абраменков И.В. Использование лапаро-лифта оригинальной конструкции в безгазовых эн-довидеохирургических вмешательствах. Эндоскопическая хирургия. 2009. № 1. С. 110.
6. Полянський 1.Ю., Гринчук Ф.В., Бшоокий В.В. Гострий перитошт на сучасному етат - про-блеми, здобутки i перспективи. Клшч. анатомiя та операт. хiрургiя. 2014. Т.13, №1 (47). С. 83-88.
ПОР1ВНЯЛЬНА ХАРАКТЕРИСТИКА ПОКАЗНИК1В КАР1ССУ ЗУБ1В У Д1ТЕЙ В ПЕРШИЙ
ПЕР1ОД ЗМ1ННОГО ПРИКУСУ
Мандзюк Т.Б.
ВДНЗУ «Буковинський державний медичний унгверситет» асистент кафедри стоматологИ' дитячого в1ку
Гончаренко В.А.
ВДНЗУ «Буковинський державний медичний унгверситет» асистент кафедри стоматологи дитячого в1ку
Каськова Л. Ф.
ВДНЗУ «Укратська медична стоматологгчна академгя»
COMPARATIVE CHARACTERISTICS OF DENTAL CARIES INDICES IN CHILDREN AT THE FIRST PERIOD OF CHANGEABLE OCCLUSION
Mandziuk T.B
HSEE of Ukraine «Bukovinian State Medical University», Department of Childhood Dentistry, Assistant Goncharenko V.A.
HSEE of Ukraine «Bukovinian State Medical University», Department of Childhood Dentistry, Assistant
Kaskova L.F.
HSEE of Ukraine « Ukrainian Medical Stomatological Academy»
Анотащя
В умовах розвитку сучасно! стоматологи можливють планування i проведения профшактичних захо-дiв з метою тдвищення резистентносп твердих тканин зубiв у дней обумовлюе необхвднють вивчення показнишв карiесу у дтгей рiзних вжових груп, порiвняння !х з плином часу i визначення факторiв, яш сприяють виникненню карiесу. За даними ВОЗ, близько 15% дiтей другого року життя мають ураженi карiесом зуби. Показник пiдвищуеться з вшэм i в перiод змiнного прикусу може сягати 90% в залежносп вщ мiсцевостi, де проживають дни.
Abstract
Caries is the most common dental disease originating from the ancient past and nowadays it is a considerable issue of pediatric dentistry (1,2). The WHO estimates approximately 15% of children in their second year of life are already afflicted with dental caries. This indicator increases with age and in the period of changeable occlusion it can reach 90% depending on the territory where children reside (3,4,5,6,7). Investigation of caries indicators in children during the period of changeable occlusion is an important issue since eruption of the first permanent molars occurs, which are poorly mineralized, and have a specific relief of the masticatory surface (8). At this period of age children are often ill and do not thoroughly take care of their oral cavities (9,10,12).
Ключов1 слова: показники карiесу, розповсюдженють, штенсивнють, прпофшактика, змшний прикус.
Keywords: сaries, occurrence, intensity, changeable occlusion.
Introduction. Investigation of caries indices in children during the period of changeable occlusion is an important issue, since the first permanent molars erupt that are poorly mineralized and have a specific relief of the masticatory surface. At this period of time children are often sick and do not take care of the oral cavity properly. There is an important fact that parents often do not pay their attention to permanent teeth erupting first, as they are not completely aware of hygienic rules affecting on the teeth development.
Objective: to study caries in children at the first period of changeable occlusion.
Materials and methods. The study was conducted on the basis of organized children groups in Poltava. In general 134 children aged from 7 to 9 during the 1st period of changeable occlusion were examined. The following indices were studied in all the children: caries intensity by decayed-missing-filled (DMFT+dmf) teeth index, where D - permanent decayed tooth afflicted with caries, M - permanent missing/extracted tooth, F - permanent filled tooth, d - temporary decayed tooth, m - temporary missing one, f -filled temporary tooth. Temporary extracted incisors and molars were not considered as they were in the process of changing into the permanent teeth. Other temporary teeth extracted due to caries were considered during examination of dmf index. Caries occurrence was calculated in percent. The comparative group included children examined in Poltava during the period of 1997-1998. The results obtained were processed by means of variation statistics method. The indices p<0,05 were considered to be reliable.
Results and discussion. 134 children with the first period of changeable occlusion were examined. Thus, only the teeth from the group of the frontal area (central and lateral incisors) and first permanent molars erupt in the oral cavity.
Comparative characteristics of caries indices was performed in the period of 1997-1998 (3,4) at the age periods of 7, 8 and 9 years which corresponds to the first period of changeable occlusion.
The analysis of the results of comparison with the period of 1997-1998 showed that the data concerning occurrence of caries in temporary teeth are different in children of 7 and 8 years of age (Table 1). Thus, the index of 7-year-old children in 2017 was reliably lower than that of 1997-1998. To our mind, it can be explained by the fact that today temporary incisors change into the permanent ones earlier, and especially in the upper jaw. Temporary incisors absent in this period of age and were afflicted by caries were not considered into the index.
Caries occurrence by df index in 8-year-old children differed reliably as well in the examined periods of time. In 82,22±5,76% of children examined in 2017 caries was found, while in 1997-1998 it was determined in 61,9±7,58% of children.
Thus, a reliable increase of the index is likely to be found at the expense of more substantial affliction of temporary molars, and especially the second temporary molars.
In 9-year-old children caries occurrence of temporary teeth possesses the identical indices irrespective of the time of the examination.
The age periods of examination determined reliable differences only in children in the period from 7 to 8 years of age in 2017.
Table 1
Caries occurrence of temporary teeth in children during the first period of changeable occlusion
Age in Number of children ex- Caries occurrence by df index, %
years amined
1997- 2017 1997-1998 2017 P
1998 abs. % abs. %
7 96 58 68 70,83±4,66 30 51,72±6,62 <0,05
8 42 45 26 61,9±7,58 37 82,22±5,76 <0,05
P7-8 >0,05 <0,05
9 43 31 29 67,44±7,14 21 67,74±8,93 >0,05
P7-9 >0,05 >0,05
P8-9 >0,05 >0,05
total 181 134 123 66,72±2,6 67,23±8,81 >0,05
Caries intensity of temporary teeth in 7-year-old children in the examined year of 2017 was reliably lower than that in children during 1997-1998 period of observation (Table 2). It is again explained by early change of incisors. In 8 and 9-year-old children this index was higher in 2017(<0,05), which requires more
detailed investigation of the causes of this phenomenon. The most intensive growth of temporary teeth caries during the period of changeable occlusion is found at the age from 7 to 8 years. In the period from 8 to 9 years of age this index decreases at the expense of extraction of the first temporary molars.
Table 2
Caries intensity of temporary teeth by df index
Age in years Number of children examined Caries intensity by df index
1997-1998 2017 1997-1998 2017 P
7 96 58 2,75+0,30 1,62±0,25 <0,05
8 42 45 2,02±0,31 3,22±0,50 <0,05
P7-8 >0,05 <0,05
9 43 31 1,51±0,25 2,42±0,44 <0,05
P7-9 <0,05 >0,05
P8-9 >0,05 >0,05
total 181 134 2,09±0,36 2,42±0,46 >0,05
similar ones in 1997-1998. The most considerable increase of the index was found in the period from 7 to 8 years of age - 17, 31% in 2017 and 4,01% in 2002, at the age from 8 to 9 - 14,06% and 11,46% respectively. From 7 to 9 years of age caries occurrence of permanent teeth increased in 3,3 times (the study of 2017) and in 5,94 times (the study of 1997-1998). Thus, a considerable increase of caries occurrence index is found during every period of the study, although lower indices were found in 1997-1998. In children at the age of 7-9 years caries occurrence of permanent teeth was 9,62±4,63% in 1997-1998 and 30,02±9,07% in 2017.
Table 3
Caries occurrence of permanent teeth in children during the first period of changeable occlusion
Age in years Number of children examined Caries occurrence by DMFT index,%
1997-1998 2017 1997-1998 2017 P
abs. % abs. %
7 96 58 3 3,13±1,8 8 13,79±4,57 <0,05
8 42 45 3 7,14±4,02 14 31,10±6,98 <0,05
P7-8 >0,05 <0,05
9 43 31 8 18,6±5,93 14 45,16±9,44 <0,05
P7-9 <0,05 <0,05
P8-9 >0,05 >0,05
total 181 134 14 9,62±4,63 36 30,02±9,07 <0,05
Examination of the permanent teeth condition in children during different periods demonstrated a considerable difference (Table 3). Thus, caries occurrence in 7-year-old children in 1997-1998 was 3,13±1,8%, and in 2017 -13,79±4,57% (<0,05). A reliable difference is found in every examined age period (at the age of 8 years it was 7,14±4,02% in 1997-1998 and 31,10±6,98% in 2017, at the age of 9 years -18,6±5,93% 45,16±9,44% respectively. Thus, a reliable increase of caries occurrence in permanent teeth is found in children at each age period as compared to the
To understand the situation concerning caries process in children at different age periods caries intensity by DMFT index should be examined. Our investigations and comparison of the results obtained today and 15 years ago demonstrated an unfavourable situation concerning caries of permanent teeth in children during the first years of their eruption (Table 4). Thus, in 19971998 caries intensity in 7-year-old children was 0,06±0,03 teeth, and in 2017 in children of the same age this index 3,5 times increasedy and was 0,21±0,05 teeth
per one examined individual. Similar tendency was found at the age from 8 to 9. The highest increase of caries intensity of permanent teeth both in 1997-1998 and 2017 was found at the age from 7 to 8. It is the time when a considerable attention should be paid to examination of factors influencing upon the condition of the dental hard tissues and initiation of preventive measures directed to the increase of resistance of the permanent teeth hard tissues.
Table 4
Caries intensity of permanent teeth by DMFT index
Age in years Number of children examined Caries intensity by DMFT index
1997-1998 2017 1997-1998 2017 P
7 96 58 0,06±0,03 0,21±0,05 <0,05
8 42 45 0,17±0,10 0,51±0,13 <0,05
P7-8 >0,05 <0,05
9 43 31 0,28±0,11 0,68±0,16 <0,05
P7-9 >0,05 <0,05
P8-9 >0,05 >0,05
total 181 134 0,17±0,06 0,47±0,13 <0,05
30 out of 58 examined children at the age of 7 years in 2017 were afflicted with caries of temporary teeth which constitutes 51,72±6,62%. The component «d» was found in 21 children out of 30, which is 70±8,51%. Therefore, 70,0% of children who suffered from caries of temporary teeth had to undergo sanitation, including 8 children whose permanent teeth were afflicted with caries which is 13,79±4,57%. Their temporary teeth were afflicted as well. At the same time, intensity of caries affliction of temporary teeth was inconsiderable (1-4 decayed teeth). In spite of the fact that it is inconsiderable percentage attention should be focused on it during the first years of eruption of the permanent teeth and these factors resulting in caries should be investigated.
82,22% of 8-year-old children were diagnosed to suffer from caries of temporary teeth. 14 examined children (31,11±6,98%) had caries of the permanent teeth, including 13 of them with caries of temporary teeth (92,86±7,14 %). An important fact was revealed that only in 2 (14,3±9,71%) children out of 14 permanent teeth were filled during preventive examination at the dentist. The rest 12 children were unaware of caries in their permanent teeth: carious cavities were small, toothache was absent; mastication surfaces were not accessible for careful examination by a child or parents; a dentist examination was more than half a year ago. All these factors should be considered while performing sanitary-educational and preventive work by a pediatric dentist.
Conclusions.
The analysis of caries index of the temporary and permanent teeth in children during the first period of changeable occlusion (7-9 years of age) in Poltava during the period of investigation in 1997-1998 and 20 later (2017) determined certain differences. A considerable attention should be paid to the indices of occurrence and intensity of caries in 8-year-old children. They are rather higher in 2017 as compared to1997-
1998. The data concerning the condition of the dental hard tissues of the permanent teeth in children nowadays are especially alarming. They appeared to be considerably higher than 20 years ago. It requires more detailed investigation of the affecting factors as well as the attitude of children and their parents to dental health care, since the system of work of dentists in Poltava schools is maintained which is an important thing from the point of view of prevention of dental diseases and timely oral sanitation (8,11).
References
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6. Kaskova L.F., Amosova L.I., Berezhna O.Y. et al. Caries morbidity of permanent teeth in children depending on fluorine content in drinking water and fluorosis availability. Herald of issues in biology and medicine. 2015. E. 2, V. 2 (119). 101-103 p.
7. Kaskova L.F., Soloshenko Yu.I., Amosova L.I. et al. Characteristics of caries affliction of the first permanent molars depending on their odontoglyphics in children from Poltava. World of medicine and biology. .№3(45). .2014. 62-64 p.
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ОБЗОР ВОЗМОЖНОСТЕЙ РЕГИОНАРНОЙ ИНТРА- АРТЕРИАЛЬНОЙ ХИМИОТЕРАПИИ В ЛЕЧЕНИИ ПЛОСКОКЛЕТОЧНОГО РАКА ПОЛОСТИ НОСА И ПРИДАТОЧНЫХ ПАЗУХ
Нариманов М.Н.
старший научный сотрудник отделения клинической фармакологии и химиотерапии НМИЦ онкологии им. Н.Н.Блохина Минздрава России), доктор медицинских наук, профессор кафедры онкологии и лучевой терапии РНИМУ им. Н.Н. Пирогова, области интересов: опухоли головы и шеи, опухоли желудочно-кишечного тракта,
REVIEW OF THE POSSIBILITIES OF REGIONAL INTRA-ARTERIAL CHEMOTHERAPY IN THE TREATMENT OF SQUAMOUS CELL CARCINOMA OF THE NASAL CAVITY AND PARANASAL
SINUSES
Narimanov M.N.
senior researcher of the Department of clinical pharmacology and chemotherapy of NMIC Oncology. N. N.
Blokhin Russian Ministry of health), doctor of medical Sciences, Professor, Department of Oncology and radiotherapy rnsmu. N. N. Pirogov, areas of interest: tumors of the head and neck, tumors
of the gastrointestinal tract
Аннотация
В структуре общей заболеваемости злокачественными опухолями в мире, рак головы и шеи занимает 7е место, причем 90% морфологических вариантов опухолей головы и шеи представлены плоскоклеточной карциномой (1). В частности, рак слизистой оболочки полости носа и придаточных пазух занимает 3% от всех опухолей головы и шеи(16), но, несмотря на значительный прогресс в лечении опухолей данной локализации, показатель общей 5-летней выживаемости пациентов существенно не изменились за последние 20 лет и составляет примерно- 45-50% (2).
В данном литературном обзоре мы провели анализ возможностей комбинированной терапии в лечении местно-распространенного плоскоклеточного рака полости носа и придаточных пазух, роль интра-артериальной химиотерапии в сравнении с другими методами комбинированного лечения, а также провели сравнение частоты и характера побочных эффектов при различных вариантах комбинированной терапии.
Abstract
In the structure of the total incidence of malignant tumors in the world, head and neck cancer occupies the 7th place, and 90% of the morphological variants of head and neck tumors are represented by squamous cell carcinoma (1). In particular, cancer of the nasal mucosa and sinuses occupies 3% of all head and neck tumors(16), but despite significant progress in the treatment of tumors of this localization, the overall 5-year survival rate of patients has not changed significantly over the past 20 years and is approximately - 45-50% (2).
In this literature review we conducted an analysis of the possibilities of combination therapy in the treatment of locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, the role of intra - arterial chemotherapy in comparison with other methods of combined treatment, and compared the frequency and nature of side effects in different variants of combination therapy.
Ключевые слова: _интра-артериальная химиотерапия, опухоли головы и шеи, плоскоклеточный рак головы и шеи
Keywords: intra-arterial chemotherapy, head and neck cancer, squamous cell head and neck cancer.
Обзор различных подходов комбинированной терапии в лечении распространенных форм плоскоклеточного рака полости носа и придаточных пазух
Долгое время золотым стандартом в терапии данной группы пациентов являлось хирургическое лечение, включающее массивные резекции с последующей лучевой терапией, что, зачастую, приводит
