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Section 8. Medical science
The study included anamnestic data, laboratory data, results of MRPChG and MSCTA, which allowed to determine ability to perform radical surgery.
Thus, in proportions equal to 15.7 points or above, and according to instrumental methods of diagnosing the case was resectable, it was the fulfillment of the GPDR.
If the amount is less than 15.7 (12.2 %) points, regardless of the extent of the State, from any interference should refrain with dynamic monitoring of the condition of the patient.
Based on these data, the original computer program « PPGPDR » (Program portability of gastropancreatoduode-nal resection) was developed — DGU 0384 d/d 14.08.2015.
Under this program, individual patient data shall be entered into a form with fixed parameters, each of which had its own specific weight, the sum of which allowed to determine the risk of complications and the tactics of the final treatment (Fig. 1).
So, in the control group of 24 radically operated patients, seven patients have died (29.1 %). Causes of deaths were from 4 patients — pancreatic fistula and three patients (24.5 %) —
underestimation of confounding factors. At the same time, in the main cause of the deaths of all three patients were pancreatic fistula.
The study showed the effectiveness of the proposed method, which has reduced the proportion of deaths from 29.1 % to 9 %.
Therefore, our proposed assessment program of GPDR identified the main factors that lead to unsatisfactory results of surgical treatment that helps you assess the effectiveness of the treatment and diagnostic activities and anticipated final treatments.
Conclusions:
1. Developed integrated program evaluation of the possible developments of complications and tolerance of radical surgical treatment allows to determine the potential risk of developing specific complications, deaths with the definition of accuracy of the method to the 84-86 %.
2. The proposed method of calculation is simple, can be supplemented by other factors and can be recommended for general use.
References:
1. Kubyshkin VA., Vishnevsky V. A. Pancreatic cancer. - M.: Medpraktika, 2003 - 386.
2. Patyutko Y. I., Kotelnikov A. G. Cancer surgery of the biliopankreatoduodenal zone organs. - М: Medicine, 2007
3. Kelemen D., Papp R., Baracs J., Kaposztas Z., Al-Farhat Y., Horvath O. P. Treatment of pancreatic and periampullary tumours in our department in the last 10 years.//Magy Seb. - 2009. - Vol. 62, № 5. - Р. 287-92.
4. Cieslak J. A. Cullen J. J. Treatment of Pancreatic Cancer with Pharmacological Ascorbate.//Curr Pharm Biotechnol. -2015. - Vol. 16, № 9. - Р. 759-70.
5. Lowery M. A., O’Reilly E. M. Novel Therapeutics for Pancreatic Adenocarcinoma.//Hematol Oncol Clin North Am. -2015. - Vol. 29, № 4. - Р. 777-87.
6. Mohammed A., Janakiram N. B., Pant S., Rao C. V. Molecular Targeted Intervention for Pancreatic Cancer.//Cancers (Basel). - 2015. - Vol. 7, № 3. - Р. 1499-542.
7. Oyasiji T., Ma W. W. Novel adjuvant therapies for pancreatic adenocarcinoma.//J Gastrointest Oncol. - 2015. - Vol. 6, № 4. - Р. 430-5.
8. Ponz-Sarvise M., Tuveson D. A., Yu K. H. Mouse Models of Pancreatic Ductal Adenocarcinoma.//Hematol Oncol Clin North Am. - 2015. - Vol. 29, № 4. - Р. 609-17.
9. Prakash L., Lee J. E., Yao J., Bhosale P., Balachandran A., Wang H., Fleming J. B., Katz M. H. Role and Operative Technique of Portal Venous Tumor Thrombectomy in Patients with Pancreatic Neuroendocrine Tumors.//J Gastrointest Surg. - 2015.
10. Sadowitz B. D., Luberice K., Bowman T. A., Viso A. M., Ayala D. E., Ross S. B., Rosemurgy A. S. A Single Institution’s First 100 Patients Undergoing Laparoscopic Anti-Reflux Fundoplications: Where Are They 20 Years Later?//Am Surg. - 2015. -Vol. 81, № 8. - Р. 791-7.
11. Strosberg J., Goldman J., Costa F., Pavel M. The Role of Chemotherapy in Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors.//Front Horm Res. - 2015. - Vol. 44. - Р. 239-47.
Shorustamov Mukhammad Todjalievich, Branch manager clinic of Tashkent Medical Academy, Republic Uzbekistan
E-mail: [email protected]
Dynamics of mineral density of the calcaneus by ultrasound densitometry at the patient in treatment of acetabular fractures
Abstract: Enhanced core compression-distraction device reduces the time of treatment and rehabilitation of patients with injuries of explosives, it contributes to a more rapid and complete recovery of function of the hip joint.
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Dynamics of mineral density of the calcaneus by ultrasound densitometry at the patient in treatment of acetabular fractures
Using the author device, allows to make an early activation of the patient on the 2nd day after the operation, which contributed to the recovery of BMD 22 (78.6 %) of the 28 studied.
Keywords: acetabular fractures, ultrasound densitometry.
The damage of the acetabulum is one of the most difficult types of injuries of the pelvis and consist of in their structure from 7 to 22 % [1; 3]. The aseptic necrosis of the femoral head after injuries hip joint develops in 30-40 % of the victims. Post-traumatic deformingarthrosis diagnosed in 20-40 % ofvictims [5]. Impaired microarchitectonicsof the trabecular and increased their fragility, characteristic for osteoporosis of the proximal part of femur, become a cause microfractures, which in turn leads to circulatory problems, necrotic changes and other processes characteristic of this disease [2; 4; 6].
A certain diagnostic value has bone densitometry method, that allows to detect changes in bone mineral density (BMD) of the affected area at different stages of the disease [4].
Objective: to study the heel bone mineral density in the dynamics by ultrasound densitometry in patients with injuries of the acetabulum, which used the author’s device.
Material and Methods: the Republican Specialized Surgery Center of joints and hands, as well as the second clinic
of the Tashkent Medical Academy from 2001 to the present, when damaged acetabulum preferred surgical treatment. During this period, we conducted clinical-radiological analysis of case histories of 189 patients with fractures of the acetabulum, of which 156 were men, 33 women, age ranged from 16 to 68 years. It was found that for the most common mechanisms of damage to the acetabulum include the direction of the impact of the greater trochanter — 89, in the knee joint — 77 on foot — in 18 and 5 patients history, because of the severity of the condition was unknown. Surgical treatment of injuries, of the posterior edge and the roof of the acetabulum (with subluxation or dislocation of the hip) in 64 cases, was to fix the bone fragments with screws or plates, of which 28 cases additionally imposed rod compression-distraction device with dynamic unloading. All this made it possible to load the limb on the second day after the surgery with preservation of motion in the joint in three planes: flexion — extension, adduction — abduction and rotary motion (Fig. 1).
Fig. 1. Scheme of device, dynamic unloading in the hip joint (1 - Rod, 2 - ball mechanism with two internal springs, 3 - clamps, 4 - pin, 4 c - sharpening rod, 5 - coupling, 6 - lock rod for acetabular region
Settingtechnique of the dynamic device was as follows: two rods — 4 a, 4 b — injected into supraacetabulararea parallel to each other, and then the rod 4 c introduced to the greater trochanter towards the head of the femur and two bars — 4 d, 4 e — in the thigh. 4 c rod inserted into the greater trochanter, had a sharpening in the middle part, which prevents back migration of stem and enable to dose dynamic unload of joint. The rods introduced into the femoral bone, are fixed with
latches on the rod with a swivel device giving the possibility of movement in the two planes, and the rods introduced in supra-acetabularportion fixed on the retainer rods acetabularregion which is connected to the femoral component. Rotary movements are due to the rotational movement of the bar inside.
All this made it possible to strengthen the patient and limb loading on the second day after the surgery with preservation of joint movement in three planes.
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Section 8. Medical science
In the firstdays after the injury for all patients on a healthy foot measured bone mineral density (BMD) by ultrasonic densitometer “SONOST 3000” (Korea). Further dynamics of BMD at the heel bone were measured at 3, 6 and 12 months, the results of which were compared with each other.
Results and discussion: UZDM — characterizes the state of bone mineral density in terms of the speed of passage of ultrasound (SOS — Speed of sound) and broadband attenuation (BUA — Broadband ultrasound attenuation) and reflects the number, size and spatial orientation of the trabeculars of bone.
After operation, setting rod compression-distraction device with dynamic unloading to the hip joint, UZDM conducted on healthy limb in 1-2 days and after 3 months in the affected limb after removal of the device, in order to avoid distortion of the results, because automatic program summarizes bone density and device, thus giving knowingly false results.
When surgical treatment with the use of dynamic unloading apparatus, we obtained the following results. A normal BMD came from these indicators BMD of healthy limbs. This group consisted of 28 patients. UZDM results in injuries of the acetabulum were: the first day was the norm — in 24 (85.7 %), osteopenia in 3 (10.7 %) and osteoporosis in 1 (3.6 %) patients. After 3 months of normal BMD have not been identified, all patients with acetabular
fractures observed: osteoporosis in 24 (85.7 %), and osteopenia in 4 (14.3 %).
After 6 months of normal BMD were observed: 14 (50.0 %), osteopenia in 8 (28.6 %), osteoporosis-6 (21.4 %) patients. These BMD at 18 months were as follows: normal values of bone mineral density in 22 (78.6 %), osteopenia in 4 (14.3 %) and osteoporosis in 2 (7.1 %) patients.
Changes in osteopenia and osteoporosis in healthy limb dynamics we have not obtained. In the group of patients with fractures of the acetabulum, who used the device of dynamic unloading device recovered of BMD in 22 (78.5 %) patients.
Thus, the dates UZDM shows, that — 22 (78.5 %) from 28 patients recovered with normal BMD, which was imposed author rod compression-distraction apparatus with dynamic unloading device, as a consequence, early static load on the limb was the prevention of osteoporosis.
Conclusions:
1. The use of traditional treatments (plaster cast, skeletal traction) and immobilization 3-4 months, leading to inactivity and loss of bone mineral density, thus reducing the quality of life of patients.
2. Using the author device, allows to make an early activation of the patient on the 2nd day after the operation, which contributed to the recovery of BMD 22 (78.6 %) of the 28 studied.
References:
1. Beletsky A. V, Varanovich A. I., Murzich A. E. Determine indications for surgery and the choice of surgical approaches for complex fractures of the acetabulum.//Journal of Traumatology and Orthopedics N. N. Pirogov. - 2010. - № 4. - P. 30-37.
2. Buachidze O. Sh., Onopriyenko G. A., Voloshin V. P., Zubikov V. S. Surgery of the hip joint. - M.: Medicina, 2002 - 136 p.
3. Landa VA., Bulibina T. I. To diagnosis and treatment of patients with fractures of the acetabulum.//J. Health and Medical Technology. - 2005. - № 8. - P. 22-23.
4. Rakhimzhanova R. I., Abdrakhmanov J. S., Spichak L. V. Radiological diagnosis of aseptic necrosis of the femoral head.//Consilium. - 2010. - № 6. - S. 26-28.
5. Berry D. J., Halasy M. Uncementedacetabular components for arthritis after acetabular fracture.//Clin Orthop Relat Res. -2002. - P. 164-167.
6. Gary J. L., Van Hal M., Gibbons S. D., Reinert C. M., Starr A. J. Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation.//J Orthop Trauma. - 2012. - P. 278-83.
Chembaev Bulat Renatovich, PhD student, Tashkent Institute of Postgraduate Medical Education E-mail: [email protected] Yeshimbetova Saida Zakirovna, Doctor of Medical Sciences, professor, Tashkent Institute of Postgraduate Medical Education
Characteristics of panss’s values and theirs dynamics among individuals with schizophrenia who have committed grave socially dangerous acts
Abstract: The paper attempts to evaluate values of the PANSS scale of positive and negative syndromes of schizophrenia among 157 individuals with schizophrenia who have committed grave socially dangerous acts according to psychopathological mechanisms. The PANSS scale confirmed the specificity and isolation of the identified
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