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Estimation a condition of blood cytokine profile at performing a conservative myomectomy
Results and discussion: Innovation aspects of rehabilitation methods of treatment of acetabulum damage (AD) is, first of all, in fixation of fragments with screws in 46 cases and additively in applying apparatus of dynamic unloading on joint in 22 cases. All that gave a possibility to load an extremity on the second day after operation with preservation of motion in joint in three planes: flexion — deflexion, adduction — abduction and rotation motions. The method of applying apparatus of dynamical unloading is based on innovation construction worked out by us. For this construction we received a positive decision of the Agency of Intellectual Property of the Republic of Uzbekistan.
Apparatus of dynamical unloading allowed sufficiently reduce a stay of patients in hospital. If skeletal traction through femoral epicondyles was put after osteosynthesis patients with acetabulum damage for 4-6 weeks, then after using of the worked out by us apparatus patients were activated on the second day after surgical treatment that permitted to load the injured extremity and accomplish functional motions in joint.
Summarizing it may be noted that a possibility of an early activation and reduction of a number of stay days in hospital occurred in 22 patients that additively were underwent applying of authors’ apparatus of dynamical unloading. An early static loading on extremity resulted in prevention of osteoporosis and increased a level of quality of life of patient.
How is given on Figure 1, algorithm of rehabilitation includes blocks of conservative (including blocks ambulatory, treatment at a health resort, medicamentous) and other methods of treatment of acetabulum damage as well as control
block. Block of endo-prosthetics of coxofemoral joint is also provided for in case of detection of signs of coxarthrosis.
According to algorithm elaborated by us, after surgical rehabilitation treatment we provided for block with using of innovation apparatus and block without its application. Algorithm of rehabilitation also includes block of detection of coxarthrosis signs that provides for analysis of results of rehabilitation treatment of injuries of cotyloid cavity. Medicamentous methods of treatment with optimization of dosage, multiplication factor and prolongation of application of preparation aimed at prevention of thromboembolic complications in accordance with generally conventional international standards were also used by us in accomplishment of innovation rehabilitation methods of AD treatment. With that end of view the physiotherapeutic methods in postoperative period of rehabilitation starting from the third day have been used in our Center. Therapeutic physical training in regime of forced loading optimizing an intensity of loading in dependence on type of acetabulum damage aimed at improvement of rehabilitation methods of treatment of AD was used. All that allowed shorten terms of unloading of extremity, perfect self-help service and recurrence of patients to functional motor activity.
Innovation algorithm of perfecting rehabilitation methods of treatment of AD contributes to expansion of an implementation sphere in traumatic surgery and orthopedics practice. It allows practical physicians to build a clear algorithm of postoperative rehabilitation for this complicated cohort of patients with AD.
References:
1. Rakhimzhanova R. I., Abdrakhmanov J. S., Spichak L. V. Radiological diagnosis of aseptic necrosis of the femoral head.//Consilium. - 2010. - № 6. - S. 26-28.
2. Berry D. J., Halasy M. Uncementedacetabular components for arthritis after acetabular fracture.//Clin Orthop Relat Res. -2002. - P. 164-167.
3. 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.
Yuldashev Sanjar Keldiyarovich, Republican specialized scientific-practice medical centre of obstetrics and gynecology Uzbekistan, junior scientific employee E-mail: yuldashev_s@inbox.ru
Estimation a condition of blood cytokine profile at performing a conservative myomectomy
Abstract: In purpose on to studying of influence of operative techniques of conservative method of myomectomy at women of reproductive age on a cytokine state of blood profile in aspect of reduction of intraoperation surgical trauma of the tissue there have been made conservative myomectomy (CME) by laparatomy at 46 women with a uterine myoma on developed by us technique. Efficiency of a technique on the 3rd and 5th days of the postoperative period estimated with definition in dynamics of Interleukin 1, 6 and TNF-a level in blood. For 3rd days after the operational period in group ofwomen with which it has been made conservative myomectomy
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by a traditional method marked authentically sharp increases in level of maintenance of IL-1; IL-6 and TNF. Results showed high efficiency of new technique CME in comparison with a traditional method in preservation of reproductive to function of women.
Keywords: a uterus myoma, myomectomia, cytokine.
Introduction. Studying of results of surgical treatment shows, that the current of the postoperative period is in many respects connected as with volume of surgical intervention in a abdominal cavity, and with localisation and the sizes of an operational wound [3; 6; 9]. In reply to any damage, whether it be the trauma, surgical operation, an infection, etc., in an organism develops a complex of the physiological reactions directed on localisation of the centre of damage and restoration of disturbed functions [1; 2; 3; 5].
This difficult process, directed on preservation of a homeostasis, is known as an inflammation, and a complex local and system changes, originating after damage, makes concept of an acute phase of an inflammation. Cytokines play basic role in realisation of the inflammatory answer to the surgical trauma. Cytokine production reflects a traumatizing of surgical intervention. The strengthened synthesis of cytokines begins in reply to penetration into organism a microorganisms or damage of fabrics. After extensive surgical interventions a cytokine concentration reaches a maximum by 24 o’clock and remains increased throughout 48-72 hours of the postoperative period.
Last years, because of development of methods of quantitative definition of levels of cytokines production, it has been reached considerable progress on understanding of the role of some cytokines in norm and in pathology [2; 4]. The high level of studied cytokines testifies to development of a local and general inflammation. So, IL-1 in consequence of the ability to increase of body temperature it is established as endogen pirogene. The tumor necrosis factor-a (TNF-a) stimulates a local inflammation, and in system — causes a syndrome of a septic shock, activates and damages cells, operating on cells of hypothalamus, causes a fever, secretion of IL-1, IL-6, fibers of acute phase [2; 3; 5]. At studying of results of operative interventions it is necessary to note the traumatizing factor or “surgical stress”.
It is known, that blood cytokine level reflect a current condition of work of immune system and development of protective reactions, gravity of inflammatory process and its transition to system level. Cytokine production reflects on traumatizing of surgical intervention [3; 7; 8; 9].
Purpose of this work was to studying of influence of operative technics of conservative myomectomy (CME) method at women of reproductive age on a condition of blood cytokine profile in aspect of reduction of intra operative surgical trauma of tissue.
Material and methods. Research and treatment was conducted in department of operative gynecology of the Republican specialised scientifically-practical medical centre of obstetrics and gynecology (RSSPMC O&G), Tashkent. In total there have operated 66 women at the reproductive age,
suffering with uterine myoma of various localisation and the sizes. All patients have been divided on two groups depending on a technique of performed CME method. The basic group was made by 46 patients by whom it has been performed CME by the technique which developed by us; and the comparison group included 20 women at whom CME was made by a traditional method. The age of patients varied from 20 up to 42 years (in average 33.51 ± 2.4 years) in both groups. Research the maintenance of interleykin-1 (IL-1), interleykin-6 (IL-6), The tumor necrosis factor (TNF-a) in blood plasma of women determined by immune enzyme analyzing on commercial test systems of firm “Vector-best” by means of IFA analyzer “Anthos-2010” (Austria) in dynamics before operation and on the 3rd, 5th days of the postoperative period.
Results and discussion
As a result of the carried out researches it is established some features of change of cytokine status in blood plasma in women with uterine myoma, depending on a performed method of CME.
As a presented datas from table show, preoperative initial levels of IL-1 in both groups essentially did not differ among themselves and have made 1.84 pg/ml in the basic group and 1.48 pg/ml in comparison group (p > 0.05). On the 3rd days after operation there has been noted sharp increase of maintenance of IL-1 up to 135.74 pg/ml in comparison group, that on 90 times exceeded its initial level. In the main group a maintenance of IL-1 essentially has not changed and has made 1.98 pg/ml. On the 5th day of postoperative period a level of IL-1 in main group has decreased nearer to its initial level though in group of comparison with its initial level did not reach initial sizes. Although, IL-1 is endogen pirogen, owing to the ability to increase of body temperature, we can explain temperature reaction at 16 patients in comparison group. In the main group subfebrile temperature was registered only in 3 patients.
Results of research of IL-6 levels at women in compared groups were given by following data. In patients from comparison group the level of IL-6 has made — 6.15 pg/ml, in main group patients — 4.88 pg/ml, and significant distinctions between them is not revealed. However, on the 3rd day at the postoperative period in women who have being performed CME by traditional method the level of IL-6 has made the maximum value — 585.11 pg/ml against 5.46 pg/ml in main group. And in comparison with its preoperative level (p < 0.001), on the 5th day we observed decreasing in level of IL-6 to 7.94 pg/ml in comparison group, that came nearer to data before operation on 2 times exceeded similar indicators of the main group which by the end of 5th day have made — 3.82 pg/ml in comparison with its initial data.
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Estimation a condition of blood cytokine profile at performing a conservative myomectomy
Table 1. - Pre-inflammatory cytokines in dynamics prior to and on the 3rd, 5th days after conservative myomectomy (M ± m)
Parameters Prior to operation On the 3rd day after operation On the 5th day after operation
Main group (n = 46)
IL-1 1.84 ± 0.21 1.98 ± 0.03 1.53 ± 0.32
IL-6 4.87 ± 0.24 5.45 ± 0.39 3.8 ± 0.39
TNF-a 2.046 ± 0.63 2.29 ± 0.54 1.93 ± 0.36
Comparison group (n = 20)
IL-1 1.48 ± 0.25 135.74 ± 0.31* 2.08 ± 0.25
IL-6 6.1 ± 0.24 585.11 ± 0.30** 7.94 ± 0.34
TNF-a 2.3 ± 0.31 27.59 ± 0.29* 2.99 ± 0.36
Note: * — statistical authentic in comparison with its initial level on p > 0.05; ** — statistical authentic in comparison with its initial level on p > 0.01
As a received result from the analysis of the condition of TNF-a observed a similar pattern of change of its maintenance in dynamics on the postoperative period (table 1). So, on the 3rd day after performing of CME by a traditional method the level of TNF-a has made 27.59 pg/ml, that on 11 times has exceeded than its initial level (before operation) — 2.3 pg/ml and (Р < 0.005), on the 5th days it has made — 2.99 pg/ml, coming nearer to its initial data. In the main group at all investigation phases the level of TNF-a was stable and made: 2.05 pg/ml before operation, 2.29 pg/ml — on the 3 days and 1.93 pg/ml on the 5th day accordingly.
Analyzing the received data as a result of our research, we marked authentically sharp increases in level of maintenance of IL-1, IL-6 and TNF-a on the 3rd day after operation period in group of women which has been made CME by traditional method.
It is known, that IL-1, IL-6 and TFN-a are proinflammatory cytokines, so any damages or the microbic agent are named as «mediators» of local inflammatory reaction and acute phase answer of an organism. In a sharp phase of an inflammation at the expense of tissue damage to occur activation of macrophages which synthesize a cytokines, thereof to what there will occur a changes of vascular endothelium, leading to increase in its permeability, expression increase adhesive molecules and infringements in coagulation system of blood.
Thus there is occurring an release of an inflammation mediators, such as histamine, glandins and other, responsible for developments of inflammatory reaction. And it in turn, promotes on stasis ofblood in capillaries, venule, leading to strengthening of pre-coagulation link and development of edema [3; 7; 9].
Hyperproduction of cytokines — IL-1, IL-6, TNF-a at women in comparison group is explained by longer and extensive surgical interventions at performing a CME by traditional method. It is unfavorable factor of the postoperative period causing early postoperative complications (pain syndrome, early temperature reaction, tissue swelling).
Summarising the above-stated, it is possible to conclude, that during operative interventions it is necessary to consider so-called “surgical stress”, i. e., the factor of traumatizing, which its degree depends on the level of maintenance of proinflammatory cytokines (IL-1, IL-6, TNF-a) in blood.
Conclusion. Thus, it is possible to conclude, that the new method of CME applied by us is less traumatic, which not causing a “surgical stress”, that it is proved by not changeable levels of the maintenance of markers of a condition of work of immune system and development of protective reactions — proinflammatory cytokines IL-1, IL-6 and TNF-a in women from main group. Hence, our results showed high efficiency of new technique CME in comparison with a traditional method in preservation of reproductive to function ofwomen.
References:
1. Vlasova G. V., Egorov L. V., Kotov A.J., etc. Pre-inflammatory cytokines.//Cytokines and an inflammation. - 2005. - 4: 39-44.
2. Demj anov A. V., Kotov A. J., Simbirsev A. S. Diagnostic value of research of cytokine levels in clinical practice.//Cytokines and inflammation - 2005. - T. 2. - № 3. - P. 20-35.
3. Karobekova D. A., Rahmatulloeva S. H., Safarov CH. B. Surgical treatment of patients with a uterus myoma.//Bulletin Avisenni - 2014. - № 2 (59). - P. 79-83.
4. Luneva S. N., Popova A. H., Tkachuk E. A. Biochemical indicators in an estimation of efficiency of treatment of a myoma of a uterus.//Basic researches. - 2013. - № 9. - P. 847-851.
5. Pekarev O. G, Majborodin I. V., Pekareva E. O. Experience spontaneous delivery at women with a scare on a uterus after myomectomy.//Obstetrics and gynecology. - 2012. - № 5. - P. 88-92.
6. Plehanov A. N., Tatarova N. A., Ryabinin G. B, Shishkin Ju. A. Restoration of reproductive function at women after conservative myomectomy.//Effective pharmacotherapy. - 2013. - № 18. - P. 42-46.
7. Ushakov J. E., Pruglo A. K., Budak V. S, Kosolapowa N. V. Case of rupture of a uterus during pregnancy after conservative myomectomy without suturing of uterus in anamnesis.//the Taurian medical and biologic bulletin. - 2013. - Vol. 16. -№ 2. - T. 2 (62). - P. 166-168.
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8. Kondratovich L., Kozachenko A., Adamyan L., Kogan E. Clinical and morphological features of pelvic adhesions in patients with uterine leiomyoma.//The 20th World Congress on Controversies in Obstetrics, Gynecology AND Infertility (COGI). - 2014. - P. 63.
Yuldasheva Nasiba Alisherovna, Tashkent State Stomatology Institute, Department of Orthopedical stomatology E-mail: bonusha-uz@list.ru
Dependence of the periodontal state on the gestation period in the pregnant women
Abstract: The stomatological diseases in women during pregnancy present great social problem. Under stomatological examination there were 132 women in the different periods of pregnancy and control group included 50 women without events of inflammatory periodontium diseases. The research showed that the pregnancy results in occurrence and progressing of the parodontium diseases, and the severity of damage achieved maximum in the III trimester, the damage of parodontium induced by pregnancy does not stop in the early postpartum period, remaining statistically significant above the appropriate meanings of control group and index parameters of the I trimester.
Keywords: chronic polypoid rhinosinusitis, morphological study, immunohistochemical study, reticular fibers.
The high prevalence rate and increasing intensity of the main stomatological diseases in women during pregnancy present great social problem [1; 7]. In the meta-analytical systemic review the authors identified statistic clear association between periodontium and unfavourable outcomes of pregnancy [7]; and in the gram negative bacteria in the oral cavity connected with increase of levels of prostaglandin E2, tumor necrosis factor-а, retardation of the embryo growth and lowering weight in newborns [5], The absence of defensive antibodies due to systemic distribution of mother periodontal infection initiate preterm labor [3; 7].
In the pathogenesis of the periodontium lesions in pregnancy the change of balance between sexual hormones, pregnancy pathology, exacerbation of somatic pathology and others are of special attention [1; 6; 7].
In this connection the purpose was to determine prevalence and severity degree of the inflammatory periodontium diseases by CPITN index in the various periods of pregnancy and early postpartum period.
Material and methods. Under examination there were 132 women in the different periods of pregnancy: 132 (trimester I); 110 (trimester II) and 95 (trimester III of pregnancy); and control group included 50 women without events of inflammatory periodontium diseases.
In order to obtain representative data in all trimesters of pregnancy there were preserved identical age ratio. The average age of women in groups fluctuated from 26.3 ± 0.81 to 28.82 ± 1.13 years. The number of pregnant women in groups was comparable in relation to percentage rate.
The frequency of the basic somatic pathology, pregnancy complications in the comparative periods, social-economic status of the pregnant women and control group were equal.
The state of periodontium tissue was evaluated with use of municipal-paradontium.
Index (CPITN), developed by exerts of the WHO Working Group/FDI for population epidemiological examinations. This index allows evaluation of the prevalence and intensity of the indicators of periodontium tissue lesions (stomatorrhagis ant probe taking, presence of perigingival calculus, parodontal pockets of various deep) based on the sextant examination of the oral cavity (4).
The results of stomatological examinations were recorded in the special cards. The statistic processes of the results were performed with use of program Microsoft Excell. The level of reliability between parameters of stomatological status was measured according to Fisher’s t-criteria.
Results and discussion. The results of study of pregnant women showed sharp increase in the quantity of sextants reflecting severe inflammatory-destructive periodontium lesion: sextant number with stomatorrhagis (code 1) (21.67 ± 5.82 %) increased by 5.38 % (22.83 ± 4.30 %) (P < 0.05); with dental calculus (code 2) (21.83 ± 5.84 %) — even by 38.1 % (30.17 ± 4.71 %) (P < 0.01); and with pocket > 6 mm. — by 1600.0 % (8.5 ± 2.86 %) in comparison with 0.50 ± 0.99 % (P < 0.01); and in these pregnant women the uncounted sextants appeared (code X) (1.67 ± 1.31 %), being absent in the control group. Thus, in pregnant women there is registered sharp increase in the of periodontal lesions of the highest degree corresponding to high codes of CPITN index.
The receiving of the most objective data is possible only on the basis of the results of dynamic observation of the evolution of separate nosological forms of the periodontal pathology in the same group of pregnant women during all postpartum period, as well as in the first months of the postpartum period.
On the basis of the evaluation of the periodontal status in the homogenous group of pregnant women in the different period of pregnancy there was established progressing of the
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