CC BY
41
Section 1. Clinical medicine
Conclusions: In Uzbekistan, implementation of screening programme on breast cancer early detection was started in 2013. With a goal to improve the quality of its implementation the work has been carried out in two main directions: increase of the coverage of prophylactic medical examinations and correction of the report form for getting more information on the programme. Monthly reports are received in paper and electronic versions in the National Cancer Center of Uzbekistan, where they are treated.
To date, in all regions of the Republic the creation of an electronic database for data collection on screening has been started. Information of screening on breast cancer cases is recorded in the impersonal form with the date of birth and number of the registration form. The organization of breast cancer screening and its broad implementation in the form
of ongoing programme will help to reduce mortality from breast cancer, which is especially important for fertile and younger age women. This minimum of criteria will help to assess the quality of implemented preventive and screening activities for the whole country.
Regulating more organization requirements of diagnostic services, the resolution allows the regions to determine independently the screening algorithm, the hospitals participating in the programme, the routing at-risk population at all steps of preventive screening. Organized breast cancer screening programme and its broad implementation in the form of permanent programme will help to reduce breast cancer incidence and mortality. These minimum criteria are effective to assess the quality of practicable preventive measures.
References:
1. Davydov M. I. (Acad.) and Axel E. M. (PhD) Malignant neoplasms in Russia and the CIS. - Vol. 1 - 2012.
2. Zakharova N. A, Semiglazov V. F. Breast cancer screening: problems and solutions. - GEOTAR Media, 2011, - Volume 1, - 176 p.
3. Berry D. A. Effect of Screening and Adjuvant Therapy on Mortality from Breast Cancer.//New Engl. J. of Medicine. - 2009. - Volume 8. - Р. 1784-1792.
4. Wang Z. NCI Cancer Spectrum, Mammography and Beyond. - 2003. - Volume 5. - Р. 344-346.
Kolenko Yulia Gennadievna, Sanaz Akbari National Medical university of the name of A. A. Bogomolesch, Conservative Dentistry Department E-mail: kolenko@i.ua
Estimation of the state of the tissues of periodontium in patients with the cardiovascular diseases
Abstract: In all patients with cardio-vascular pathology is noted one or another degree of the lesion of the tissues of periodontium therefore into the complex treatment of the diseases of periodontium with the development CVD it is necessary to addition of antiosteoporetic therapy.
Keywords: cardiovascular diseases, diseases of periodontium, atherosclerosis of coronary vessels, ischemic disease of heart, tissues of periodontium.
In the recent decades the problem of the connection between the status of the health of the oral cavity in patients with the cardiovascular pathology is considered as extremely urgent. The influence of the centers of the chronic infection of oral cavity on the development of general diseases is
recognized as that meant in all countries of world. Thus, according to the data of the World Health Organization, based on the Dentistry examination of the population of 53 countries, the diseases of periodontium are encountered in 68-98 % (Petersen P. E., 2005). A quantity of people, which suffer
28
Estimation of the state of the tissues of periodontium in patients with the cardiovascular diseases
the cardiovascular diseases (CVD), is also great in the entire world. In the developed countries cardiovascular diseases remain the main reason of death of people. According to the information WHO (World Health Organization), from CVD yearly dies 14 million people.
The diseases of periodontium, are important medico-social problem, are characterized by a constant increase and wide prevalence in the persons not only of elderly, but also young age [9, 59; 11, 23]. The inflammatory diseases of periodontium are the initial stage of the destructive process, which leads to the loss of teeth and the disturbance of the communicative function of man, which determines the social significance of problem. Manifestation and progression of the signs of periodontitis depends on many circumstances, which include the presence of somatic diseases, social, behavioral, systemic, genetic factors, the microbial composition of dental plaque and other indicators, and the factors of risk [5, 6; 6, 295].
The important circumstance, which influences on gravity of the course of generalized periodontitis, are the growth of general somatic pathology, in particular the pathology of cardiovascular system, the presence in patient in anamnesis of atherosclerosis ofcor-onary vessels and ischemic disease of heart [1, 697; 2, 52; 3, 56; 4, 74; 7, 398; 8, 93; 10, 1128; 12, 545].
Based on this, the purpose of the study — to study the state of the tissues of periodontium in patients with the cardiovascular diseases.
Materials and the methods of study Group I included of 36 patients: 24 with of arterial hypertension and 12 with of ischemic of heart of disease. Among them there were 25 women (69,4 %) and 11 men (30.6 %) at the age of 61.6 ± 9.4 of year. Group II — comparisons included 10 (6 women and 4 man) patients without somatic pathology, whose average age 52.6 ± 4.3. Further, patients groups I and II for the analysis of the prevalence of risk factors for osteoporosis, we used international minute test of risk factors of osteoporosis (WHO, 1999).
Table 1. - Clinical characteristics of patients
Indicators I group, n=36 II group, n=10
The average age years 61,6 ± 9,4 52,6 ± 4,3
Women 25 (69,4 %) 6 (60 %)
Men 11 (30,6 %) 4 (40 %)
Arterial hypertension 24 0
Coronary heart disease 12 0
Menopause+Andropause Frequent diarrtiea Smo king Alcohol abuse Reduction of height more than 3 sm Taking the medicine as corticosteroids inanamnesis Atraumatic fractures in anamnesis Fractures in geneticrelatives
0 10 20 30 40 50 60 70
Fig.1. Prevalence of risk factors of osteoporosis
Dental examination included the definition of the status of periodontal tissues by estimating the specific complaints, the depth of periodontal pockets and indexes: CPITN, ОШ-S, PI.
From the additional tests, we used orthopantomography and intraoral radiography.
Results of a study
The prevalence of osteoporosis in patients with CVD
Risk factors of osteoporosis are common enough in all patients (Fig. 1).
In group I (patients with CVD) in 32 patients (88.9 %) are revealed risk factors. In group II (comparison) risk factors occurred in 7 (70 %) patients. In this case, approximately with the identical frequency such factors of risk as the deficiency of sexual hormones, alcohol abuse, taking the corticosteroids more than 3 mon., fractures in genetic relatives, frequent diarrheas were encountered. However, the transferred atraumatic fractures and reduction of height more than on 3 cm. more frequently are diagnosed in the
29
Section 1. Clinical medicine
patients ofthe I group. Thus, the transferred atraumatic fractures are diagnosed in 22.3 % of patients of the I group and in 8.8 % in the II group (p < 0.05). Reduction of height is more than to 3 cm. (as the manifestation of the compression of the vertebrae bodies) in 38.3 % of the patients of the I group is noted, and in the II group — in 22.7 % (p < 0.05).
We revealed with the analysis of the prevalence of osteoporosis in patients with CVD in comparison
Table 2. - Compl
with the comparison group, that the prevalence of osteoporosis increased with the age; however, in patients with CVD osteoporosis was encountered considerably more frequent.
Estimation of the state of the tissues ofthe periodontium
The majorities of patients with CVD complained of bleeding of gum (spontaneous, during food intake and cleaning of teeth) — 77.8 % (table. 2). its of the patients
I group (n=36) II group (n=10)
Gum bleeding 28 (77.8 %) 3 (30 %)
Pain (at a food chewing, tooth cleaning) 25 (69.4 %) 2 (20 %)
Mobility of teeth 23 (63.9 %) 2 (20 %)
Dryness in the oral cavity 29 (80.6 %) 4(40 %)
Burning of tongue 13 (36.1 %) 2(20 %)
Smell from the mouth 30 (83.3 %) 5 (50 %)
Note: p < 0.001
At patients of the II group bleeding of a gum was noted only at 30 %. Pain at a chewing of food and tooth cleaning was more often noted at patients of the I group — 69.4 %, the II groups — 20 %. Not less characteristic complain at a generalized periodontitis is mobility of teeth, so patients of the I group noted this symptom in 63.9 % of cases, against 20 % of patients of the II group.
Table 3. - Depth of
Thus, all patients with CVD had the complaints, connected with the lesion of periodontium.
Examination of parodontal pockets is revealed, that in the patients of the I group average value of the depth of pockets composed 4.7 ± 1.5 mm., in the patients of the II group — 2.1 ± 0.3 mm.
To all patients was carried out a X-ray examination of jaws, results were represented into tabl. 4. parodontal pockets
The I group of patients (n=36) The II group of patients (n=10)
The average depth of the parodontal pockets 4.7 ± 1.5 2.1 ± 0.3
to 4 mm. 6 (16.7 %) 7(70 %)
to 5 mm. 13 (36.1 %) 3 (30 %)
more than 5 mm. 17(47.2 %) -
Note: p < 0.001
Table 4. - Results of X-ray examination
The I group of patients (n=36) The II group of patients (n=10)
Degree of the resorption of the interalveolar septa to 1/3 9 (25 %) 7(70 %)
to 1/2 16(44.4 %) 2(20 %)
to 2/3 11 (30.6 %) —
There is no resorption — 1 (10 %)
Quantity of patients with the pathologic bone pockets 14(38.9 %) 1 (10 %)
Note: p < 0.001
As follows from table 4, in 25 % of cases of the I group of patients the resorption of the interalveolar septa to 1/3 lengths of root was noted, in 44.4 % — to 1/2, also, in 30.6 % of cases — to 2/3. In this case
in the II group of patients the resorption more than 1/2 the depth of root was not noted. And in the II group of patients bone resorption was not revealed in 10 % of patients. Considerably the frequency
30
Estimation of the state of the tissues of periodontium in patients with the cardiovascular diseases
of the development of pathologic bone pockets was differed, so in patients of the I group they were discovered in 38.9 % of cases, and in patients of the II group — only in 10 %.
For evaluating the state of periodontium the calculation of index CPITN was conducted. Data of table 5 demonstrate, that more severe lesion of periodontium is observed in the I group, the high values Table 5. - Index of hygiene CPI
of index CPITN are shown this. Thus, in patients with the combination pathology of CVD it corresponds to the values of index 4 in 16 observations (61.5 %), which indicate the necessity for the complex treatment of the diseases of periodontium (p < 0.001). In the patients of the II group the value of index 4 is noted in 1 case (10 %), 3 in 5 cases (50 %), 2 in 4 observations (40 %), differences are reliable (p < 0.001). J in patients of different groups
CPITN The I group of patients The II group of patients
(n=36) (n=10)
2 0 4(40 %)
3 10(38.5 %) 5 (50 %)
4 16(61.5 %) 1 (10 %)
Note: p < 0.001
The analysis of an index of hygiene of OHI-S (G&V) shows that higher values also in the I group are noted. By comparison of dependence of a resorption of a bone tissue of an alveolar process of a jaw on an index ofhygiene of OHI-S it is established that the hygiene index is higher, when the resorption of a bone tissue is more considerable. By results of examination of patients with GP against the combined pathology individual hygiene of an oral cavity is estimated at 83 % ofcases as bad (OHI-S > 2.8) whereas in 50 % (OHI-S > 1.9) (p > 0.01), supervision in the II group hygiene was estimated as unsatisfactory.
Index PI, which reflects gravity of the lesion of periodontium, in the I group is equal 4.2 ± 0.5, and in the II group — 3.4 ± 0.4 (p > 0.001). In this case the maximum value of index PI is noted with GP against the background of ischemic of heart disease. It composes 4.6, which corresponds to the third degree of generalized periodontitis.
The analysis of gravity of the lesion of periodontium showed that generalized periodontitis the III degree the most frequently was diagnosed in patients with GVD, while of the I degree most frequently it was noted in the patients of the II group.
It is possible to establish that in all patients with cardio-vascular pathology is noted one or another degree of the lesion of the tissues of periodontium.
Conclusion. In all patients with cardio-vascular pathology it is necessary to carry out the search of the factors of risk and clinical markers of osteoporosis. During the detection of the clinical markers of osteoporosis should be assumed the heavier degree of the lesion of periodontium. Furthermore, in all patients with cardio-vascular pathology is noted one or another degree of the lesion of the tissues of periodontium therefore into the complex treatment of the diseases ofperiodontium with the development CVD it is necessary to addition of antiosteoporetic therapy.
References:
1. Dental infections and serum inflammatory markers in patients with and without severe heart disease/J. H. Meurman, S. J. Janket, M. Ovarnström, P. Nuutinen//Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. - 2003. - Vol. 96, № 6. - P. 695-700.
2. Fong I. W. Emerging relations between infectious diseases and coronary artery disease and atheroscle-rosis./I. W. Fong//CMAJ. - 2000. - Vol. 163, № 1. - P. 49-56.
3. Gender differences in the relationship between periodontal disease, tooth loss and atherosclerosis./ M. Desvarieux, C. Schwahn, H. Völzke, R. T. Demmer.
4. Interactions of oral pathogens with toll-like receptors: possible role in atherosclerosis./G. Hajishengallis, A. Sharma, M. W. Russell, R. J. Genco//Ann. Periodontol. - 2002. - Vol. 7, № 1. - P. 72-78.
5. Kinane D. F. Periodontal manifestations of systemic disease./D. F. Kinane, G.J. Marshall//Aust. Dent. J. -2001. - Vol. 46, № 1. - P. 2-12.
31
Section 1. Clinical medicine
6. Lagervall M. Systemic disorders in patients with periodontal disease./M. Lagervall, L. Jansson, J. Bergstrom//}. Clin. Periodontol. - 2003. - Vol. 30, № 4. - P. 293-299.
7. Muhlestein J. B. Bacterial infections and atherosclerosis./J. B. Muhlestein//J. Investig. Med. - 1998. -Vol. 46, № 8. - P. 396-402.
8. Müller H. P. [Does chronic periodontitis play a role in the pathogenesis of cardiovascular and cerebrovascular diseases?]/H. P. Müller//Gesundheitswesen. - 2002. - Bd. 64, № 2. - S. 89-98.
9. Periodontal Disease; 2nd ed./S. Schluger, R. Yuodelis, C. Page, R. H. Johnson. - Philadelphia: Lea and Farbiger, 1990. - 349 p.
10. Periodontal disease and cardiovascular disease./J. D. Beck, R. G. Garsia, G. Heiss, P. S. Vokonas, S. Offen-bacher//J. Periodontol. - 1996. - Vol. 67, № 10, Suppl. - P. 1123-1137.
11. Preus H. R. Periodontal Disease./H. R. Preus, L. Lavrell. - London: Quintessence, 2003. - 89 p.
12. Risk factors for atherosclerosis in cases with severe periodontitis./K. Buhlin, M. Hultin, O. Norderyd, L. Persson, A. G. Pockley, P. Rabe, B. Klinge, A. Gustafsson//J. Clin. Periodontol. - 2009. - Vol. 36, № 7. - P. 541-549.
Norbert Torma, PhD, vascular chirurg, IMEA CC -angiochirurgical ambulance, Kosice, Slovakrepublic E-mail: norkotorko@gmail.com Kopolovets Ivan, PhD, vascular chirurg, Clinic of vascular surgery of Medical faculty of University of Pavol Jozef Safarik and VÜSCH, Kosice, Slovakrepublic E-mail: i.kopolovets@gmail.com Sihotsky Vladimir,
PhD, vascular chirurg, Clinic of vascular surgery of Medical faculty of University of Pavol Jozef Safarik and VÜSCH E-mail: sihotsky.v@seznam.cz Kubikova Maria,
PhD, vascular chirurg, Clinic of vascular surgery of Medical faculty of University of Pavol Jozef Safarik and VÜSCH
E-mail: mfrankovicova@vusch.sk Frankovicova Maria, prof., PhD, vascular chirurg, Clinic of vascular surgery of Medical faculty of University of Pavol Jozef Safarik and VÜSCH E-mail: mfrankovicova@vusch.sk
Paragangliomas in the area of carotid bifurcation - case reports
Abstract: Tumor glomus caroticum in the area of carotid bifurcation represents a very rare disease. The aim of this work is to describe this rare disease and experience with surgical treatment at our workplace. Tumour extirpation was successful at all the patients, without necessity to perform resection of the carotid arteries.
Keywords: carotid surgery, Tumor glomus caroticum, paraganglioma.
32
