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4. Huynh, Nelly T., and Fernanda R. Almeida. "Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis." Sleep medicine reviews 25 (2016): 84-94.
5. Hermann N.V., Darvann T.A., Kreiborg S. Early post-natal development of the mandibular permanent first molar in infants with unilateral complete cleft lip and palate. Orthodontics & craniofacial research, 2017; 20(4): 196-201.
6. Liang C., Liu S., Liu Q., Zhang B., Li Z. Norms of McNamara's Cephalometric Analysis on Lateral View of 3D CT Imaging in Adults from Northeast China. Journal of Hard Tissue Biology, 2014; 23(2): 249-254.
7. Nazarali N., Altalibi M., Nazarali S., Major M.P., Flores-Mir C., Major P.W. Mandibular advancement appliances for the treatment of paediatric obstructive sleep apnea: a systematic review. European journal of orthodontics, 2015; 37(6): 618-626.
8. Olate S., Zaror C., Blythe J.N., Mommaerts M.Y. A systematic review of soft-to-hard tissue ratios in orthognathic surgery. Part III: Double jaw surgery procedures. Journal of Cranio-Maxillofacial Surgery, 2016; 44(10): 1599-1606.
9. Orlovskyj V.O. Osoblyvosti linijnyh kompyuterno-tomografichnyh rozmiriv malyh kutnix zubiv ta yix koreniv u praktychno zdorovyh cholovikiv centralnogo regionu Ukrayiny z riznymy typamy oblychchya. Visnyk morfologiyi, 2017; 23(2): 311-314. (in Ukraine)
10. Proffit U.R. (per. s angl.; pod red. L.S. Persina) Sovremennaya ortodontiya. 2006; M. : MEDpress-inform. (in Russian)
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13. Shinkaruk-Dikovitska M.M., Kotsyura O.O., Cherkasova O.V. Features linear computed tomography sizes of large molar teeth and their roots in practically healthy men from Ukraine with different types of faces. Visny'k morfologiyi, 2017; 23(2): 323-327.
14. Urbizu A., Ferré A., Poca M.A., Rovira A., Sahuquillo J., Martin B.A., Macaya A. Cephalometric oropharynx and oral cavity analysis in Chiari malformation Type I: a retrospective case-control study. Journal of neurosurgery, 2017; 126(2): 626-633.
В1ДМШНОСП Л1Н1ИНИХ КОМП'ЮТЕРНО-ТОМОГРАФ1ЧНИХ РОЗМ1Р1В ВЕЛИКИХ КУТН1Х ЗУБ1В У ПРАКТИЧНО ЗДОРОВИХ ЧОЛОВ1К1В ЦЕНТРАЛЬНОГО РЕПОНУ УКРА1НИ Шшкарук-Шинкарук-Диковицька М.М., Коцюра О. О., Тепла Т.О., Мельник М.П., Чайка В., Шештько К.В., Лiхiцький О.М.
У 64 практично здорових чоловшв вком вщ 19 до 35 роюв iз центрального репону Украши встановлеш особливост вщмшностей комп'ютерно-томографiчних розмiрiв великих кутшх зубiв та 1х корешв в залежиосп вщ типу обличчя. Найбшьш виражеш вщмшносп розмiрiв великих кутнiх зубiв встановлеш на нижнш щелепi для висоти, висоти коронки, мезiо-дистальних розмiрiв коронки i шийки, а також довжини ближнього i дальнього кореня правого i лiвого перших та лiвого другого зубiв.
Ключовi слова: одонтометрiя, комп'ютерна томографiя, великi кутнi зуби, практично здоровi чоловiки.
Стаття надшшла 2.11.2017 р.
DOI 10.26724 / 2079-8334-2018-1-63-93-95 UDC 616-089: 612[51+563]
ОТЛИЧИЯ ЛИНЕИНЫХ КОМПЬЮТЕРНО-ТОМОГРАФИЧЕСКИХ РАЗМЕРОВ БОЛЬШИХ КОРЕННЫХ ЗУБОВ У ПРАКТИЧЕСКИ ЗДОРОВЫХ МУЖЧИН ЦЕНТРАЛЬНОГО РЕГИОНА УКРАИНЫ Шинкарук-Диковицкая М. М., Коцюра О. А., Тепла Т. А., Мельник М. П., Чайка В., Шепитько К. В., Лихицкий А. М.
У 64 практически здоровых мужчин в возрасте от 19 до 35 лет из центрального региона Украины установлены особенности отличий компьютерно-томографических размеров больших коренных зубов и их корней в зависимости от типа лица. Наиболее выраженные отличия размеров больших коренных зубов установлены на нижней челюсти для высоты, высоты коронки, мезио-дистальных размеров коронки и шейки, а также длины ближнего и дальнего корня правого и левого первых и левого второго зубов.
Ключевые слова: одонтометрия, компьютерная томография, большие коренные зубы, практически здоровые мужчины.
Рецензент Гунас 1.В.
DEVELOPMENT OF INADVERTENT INTRAOPERATIVE HYPOTHERMIA: THE POSSIBILITIES OF CLINICAL PROGNOSIS
e-mail: [email protected]
Inadvertent intraoperative hypothermia is known to increase the risk of intra- and postoperative complications. Its prediction and subsequent prevention is an acute and clinically meaningful problem. The aim of research is to determine the predictors of inadvertent intraoperative hypothermia development. Ascertaining prospective open-label study of temperature homeostasis in 100 surgical patients has been carried out. During the study, patients were divided into two groups, depending on the presence or absence of inadvertent intraoperative hypothermia. In processing of the study results was indicated the method of normalization of intense values and risk of sign realization by E. N. Shyhan. It was found out the occurrence rate of inadvertent intraoperative hypothermia that makes up 62%, identified its prognostic criteria including time-urgent operations, midline laparotomy, duration of the operation over 60 min, medication with barbiturates, myorelaxants, artificial lung ventilation, female sex, elderly age over 60 years, body mass index below 18.5 kg/m2.
Keywords: inadvertent intraoperative hypothermia, prognosis.
The paper is a part of RSW "Optimizing the quality of anaesthesia and intensive care patients based on age and gender dimorphism clinical and functional, immune and metabolic changes", state registration number 0114U006326.
Humans are homoiothermic organisms, i.e. they are able to maintain their own stable internal body temperature regardless of external influence. However, anesthesia, even local, results in partial loss of the human body to maintain constant temperature by itself, thus, making it poikilothermic, i.e. when body
ISSN2079-8334. Ceim Meduuuuu ma ôio^iï. 2018. № 1(63)
temperature fluctuates according to that of the surroundings. During the time of surgical operations and being under anaesthesia human's ability to homoiothermy is, in particular, impaired due to alteration in the structure of heat lost and the action of narcosis drugs.
All general anaesthesia medications considerably influence on the thermoregulation by changing thresholds of compensatory cardiovascular reactions, reducing heat production, perspiration and muscle thermogenesis [4]. In clinical practice, unplanned drop of core body temperature of the patient below 36°C in the perioperative period (including 1 hour before and 24 hours after exposure) is known as inadvertent intraoperative hypothermia (IIH).
The ranges of its registration are from 40 to 90% [6]. IIH is known to increase the risk of intra- and postoperative complications [5], therefore, its prediction and subsequent prevention is an acute and clinically meaningful problem.
The purpose of paper was determining the predictors of IIH development.
Material and methods. The study was carried out for the period from August, 2015, to October, 2016, in surgical units of Poltava and included ascertaining prospective open-label study of temperature homeostasis in 100 patients operated on for surgical pathology of abdominal organs, aged from 18 to 83 years old, whom have been measured the changes in basal body and internal body temperature during the surgical operation in such conditions of operating room: air temperature was 230C and relative humidity of the air equalled 55%. Before the study, the patients or their legal representatives have provided written consents for participation in the study.
The study has been approved by the local committee for bioethics and coincided to the principles set forth in the Helsinki Declaration as amended. Type of anaesthesia medication, the need for artificial lung ventilation, the urgency, the type and duration of the operation, the sex, age and weight of the patient was registered. Measuring of core body temperature was performed upon the tympanic membrane by using an infrared thermometer «UT-101» («A & D Company, Ltd.», Japan). After them, IIH frequency was determined.
The frequency of IIH development was determined for which the fact of its development was fixed. During the study, patients were divided into two groups, depending on the presence or absence of IIH. In describing the results of the study we indicated the number of observations (n) and percent (%). To determine the risk of IIH occurrence we used the method of normalization of intense values (NIV) with calculation of the average detection frequency of in signs in the groups under the observation (ADFS) and risk of sign realization (RSR) by E. N. Shyhan (1986) [3].
Results and their discussion. We revealed the IIH occurrence rate, which made up 62%; this corresponds to the data of other authors [2]. Identified NIV prediction criteria were determined. For this purposes we divided the patients into two groups based on the presence of IIH (Table 1).
The Table shows that prediction criteria for IIH include time-urgent operations, midline laparotomy, surgical procedures lasted over 60 min, medication with barbiturates, myorelaxants, artificial lung ventilation, female sex, elderly age (over 60), body mass index up to 18.5 kg/m2. We hypothesize that they are connected to a change in heat generation by means for anaesthesia and an increase in heat loss through the operating field in under-trained patients in urgent conditions [1].
Table 1
Indicators Patients studied (n=100) Patients with hypothermia (n=62) Patients without hypothermia (n=38)
n (%) ADFS, % n (%) NIV 1 n (%) NIV 2
Time-urgent surgical operation 78 (78%) 74 56 (90%) 1,2 22 (58%) 0,8
Median laparotomy 52 (52%) 47 42 (68%) 1,4 10 (26%) 0,6
Duration of the operation more than 60 min. 58 (58%) 53 46 (74%) 1,4 12 (32%) 0,6
Barbiturates 98 (98%) 97,5 62 (100) 1 36 (95%) 1
Sedatives 100 (100%) 100 100 (100%) 1 100 (100%) 1
Dysleptics 70 (70%) 75 34 (55%) 0,7 36 (95%) 1,3
Myorelaxants 54 (54%) 53 46 (74%) 1,4 12 (32%) 0,6
Artificial lung ventilation 54 (54%) 53 46 (74%) 1,4 12 (32%) 0,6
Female sex 59 (59%) 55,5 43 (69%) 1,2 16 (42%) 0,9
Elderly age (over 60) 64 (64%) 56,5 54 (87%) 1,5 10 (26%) 0,5
Body mass index over 30 kg/m2 38 (38%) 38,5 23 (37%) 1 15 (40%) 1
Body mass index below 18,5 kg/m2 16 (16%) 14,5 12 (19%) 1,3 4 (10%) 0,7
These prognostic criteria based on the patient's data, type of elective or semi-elective surgical intervention and type of anaesthesia enable health care workers to calculate risks of IIH occurrence for a curtain patient before the surgery begins. Here is an example of the implementation of IIH prediction criteria.
Female (NIV = 1.2), aged 47 years old (NIV = 0.5) is being prepared for an urgent surgical operation (NIV = 1.2) for acute intestinal obstruction.
The surgical procedure will approximately last more than 60 min (NIV = 1.4) under total intravenous anaesthesia with sodium thiopental (NIV = 1), diazepam (NIV = 1), (ketamine (HIV = 0.7), myorelaxants (NIV = 1.4), supported by artificial lung ventilation (NIV = 1.4). The body mass index is 32 (NIV = 1). To calculate the risk of IIH we should multiply average group rate of frequency (62%) by NIV of each of these factors.
Thus, the risk of IIH occurrence for this patient by the RSR calculated is following: RSR =62% x 1,2 x 0,5 x 1,4 x 1,2 x 1 x 1 x 0,7 x 1,4 x 1,4 x 0,7 = 62% x 1,38= 85,7%.
It was found out the occurrence rate of inadvertent intraoperative hypothermia that makes up 62%, identified its prognostic criteria including time-urgent operations, midline laparotomy, duration of the operation over 60 min, medication with barbiturates, myorelaxants, artificial lung ventilation, female sex, elderly age over 60 years, body mass index below 18.5 kg/m2. To prevent inadvertent intraoperative hypothermia based on our data of its prediction it is appropriate to try to limit the use of myorelaxants, artificial lung ventilation during the surgical operation, as well as to try to reduce the duration of the operation.
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2. Moola S. Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. Int J Evid Based Healthc. 2011; 9(4): 337-345.
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4. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008; 109(2): 318-338.
5. Seamon MJ, Wobb J, Gaughan JP, Kulp H, Kamel I, Dempsey DT. The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies. Ann Surg. 2012; 255(4): 789-795.
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РОЗВИТОК НЕНАВМИСНО1 ШТРАОШРАЦШНО1 ГШОТЕРМП: МОЖЛИВОСТ1 КЛ1Н1ЧНОГО ПРОГНОЗУВАННЯ Шкурупш Д.
Вщомо, що ненавмисна штраоперацшна riпотермiя тдвищуе ризик внутршньо- i шсляоперацшних ускладнень. II передбачення i подальша профшактика е построю i клшчно значущою проблемою. Метою дослщжену7 е визначення предиюх^в розвитку ненавмисно! штраоперацшно! гшотермй. Проведено перспективне вщкрите дослщження температурного гомеостазу у 100 хiрургiчних пащен™. Пщ час дослщження пащенти були подшеш на двi групи в залежност вщ наявносп, або вщсутносп ненавмисно! штраоперацшно! гшотермп. При обробщ результата дослщження був використаний метод нормайзацй штенсивних показниюв i ризик реалiзацi! ознаки за С. Н. Шиганом. Було встановлено, що частота виникнення ненавмисно! штрао-перацшно! гшотермй становить 62%, визначеш !! прогностичш критерй, яю включали ургентш опера-цп, серединну лапаротомш, тривалють операцп бшьше 60 хв, призначення барб^ураив, мюрелаксанив, штучна вентилящя легень, жшоча стать, вк старше 60 роюв, шдекс маси тша нижче 18,5 кг/м2.
Ключовi слова: ненавмисна штраоперацшна гiпотермiя, прогнозування.
Стаття надшшла 9.11.12017 р.
РАЗВИТИЕ НЕПРЕДНАМЕРЕННОЙ ИНТРАОПЕРАЦИОННОЙ ГИПОТЕРМИИ: ВОЗМОЖНОСТИ КЛИНИЧЕСКОГО ПРОГНОЗИРОВАНИЯ Шкурупий Д.
Известно, что непреднамеренная интраоперационная гипотермия повышает риск внутри- и послеоперационных осложнений. Его предсказание и последующая профилактика являются острой и клинически значимой проблемой. Целью исследований является определение предикторов развития непреднамеренной интраоперационной гипотермии. Проведено перспективное открытое исследование температурного гомеостаза у 100 хирургических пациентов. Во время исследования пациенты были рандомизированы на две группы в зависимости от наличия или отсутствия непреднамеренной интраоперационной гипотермии. При обработке результатов исследования был использован метод нормализации интенсивных показателей и риск реализации признака по Е. Н. Шигану. Было установлено, что частота возникновения непреднамеренной интраоперационной гипотермии составляет 62%, определены ее прогностические критерии, которые включали ургентные операции, срединную лапаротомию, продолжительность операции более 60 мин, назначение барбитуратов, миорелаксантов, искусственная вентиляция легких, женский пол, возраст старше 60 лет, индекс массы тела ниже 18,5 кг/м2.
Ключевые слова: непреднамеренная интраоперационная гипотермия, прогнозирование.
Рецензент Ксьонз 1.В.
