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1. Akhmedov F. K., Tuksonova D. I., Negmatullaeva M. N., Dustova N. K. Cardiac and kidney hemodynamic in pregnant women with preeclampsia against the background of obesity.//International journal of applied and fundamental investigations. Moscow. - 2013. - № 11 - P. 18-20.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-108-110
Makhmudova Zulfiya Primkulova, Senior Researcher Republican Specialized Scientific Practical Medical Center Phthisiology and Pulmonology
E-mail: [email protected]
Evaluation of the results of surgical treatment of tuberculous spondylitis
Abstract: Using titanium autografts has high strength and plastic properties, wear resistance, quickly assimilated through ingrowth into the pores of the bone at the radical reconstruction operations in patients with spinal tuberculosis significantly improve the results of surgical interventions.
Keywords: tuberculosis spondylitis, anterior spinal fusion, extra pulmonary tuberculosis.
Currently, spinal tuberculosis is detected in the fuzzy and complicated stages of the disease and at the same time, the use of hightech operations in the surgical treatment of complicated forms of tuberculosis spondylitis improve the results of therapy, will reduce the period of hospitalization [1; 3; 5].
The effectiveness of the treatment of tuberculosis of the spine is not high: healing observed in 36,5-69,5%; remission process — in 29,0-52,8%; disability — in 67-88,8% of cases [2]. In complicated forms of tuberculosis spondylitis celebrated the destruction of a large number ofvertebral bodies with the emergence of large defects of the spine, filled sequester, cheesy masses, and spinal disorders with severe disorders of the spine stability and development of kyphotic de formation [2; 6].
At present various options anterior fusion with autograft and non-biological implant in complicated forms of tuberculosis spon-
dylitis can not completely solve the problem of the effective stabilization of the affected spine, which began to attach the recent important [4].
Objective: To study the effectiveness of the stability of the affected spine in the surgical treatment of patients with complicated forms of tuberculosis of the spine.
Methods and scope of the study: Spend analysis of data from 162 patients were treated Republican Specialized Scientific Practical Medical Center Phthisiology and Pulmonology complicated forms of tuberculosis of the spine. The disease — from 1 month to 1.5 years. The specific process is localized in the cervical region in 23 (14.1%) patients, the thoracic region in 44 (27.1%), lumbar spine in 60 (37.0%), the lumbosacral region in 31 (19.1%) patients. The diagnosis of complex clinical laboratory, bacteriological, histological and rentgenotomo-raficmethods. Methods of radiation survey in-
Evaluation of the results of surgical treatment of tuberculous spondylitis
eluded: plain film all 100% ofpatients, 5 (14.2%) cases, the thoracic spine is made defeat contrast myelography, MRI performed in all patients with a magnetic field strength of 0.3 to 1.5 Tesla. Tuberculosis of the spine was diagnosed at later stages, which leads to serious complications. Destructive changes were extensive vertebral bodies until fracture of the vertebral bodies to form kyphosis (35.5%).
Preoperative preparation of 1 to 1.5 months, had a set of conservative, antibacterial, pathogenetic therapy in orthopedic operation. Depending on the timing of surgical interventions the patients were divided into 2 groups: group 1, 86 (53.1%) patients who underwent surgery performed within the first 3 months after the detection of the disease, 2-group 76 (46.9%) who underwent surgery performed in the later stages, for up to 1.5 years after the detection of the disease. The specific process of the spine in all cases was in the active stage. Men were 80 (49.3%), 76 women (46.9%). The isolated spinal lesion was observed. Defeat 2 or more vertebrae found 1 group — in 9 (62.9%), more than 3 vertebrae — in 4 (37.3%) and 2 patients — group — in 6 (60.0%) and 4 (40.0%), respectively. Kyphotic deformity of the spine is set in 7 (53.8%) patients in the 1 — group and 6 (60.0%) of 2-group paravertebral abscesses and sinter-sided — in 7 (53.8%) patients in the 1 — group and 6 (60.0%) of 2-group, double-sided — y. When lesions of the cervical spine preoperative preparation of 1 to 1.5 months, had a range of antibacterial, pathogenetic therapy in orthopedic operation.
In patients with lesions of the cervical spine 2 or more vertebrae found 1 group — in 9 (62.9%), more than 3 vertebrae — in 4 (37.3%) and 2 patients — group — 6 (60.0%) and 4 (40.0%), respectively. Kyphotic deformity of the spine is set in 7 (53.8%) patients in the 1 — group and 6 (60.0%) of 2-group.
Upon successful resolution of the problems of radical remedial treatment of complicated forms of tuberculosis spondylitis may contribute to the development and Applications, wide surgical approaches to the spine, allowing to expose the vertebral body to a considerable extent and under visual control to make all optionally-sary surgical manipulation. When lesions of the cervical vertebrae was performed front-side access to the cervical spine. The main 1 group 13 (56.5%) patients with the aim of the affected spine plastics used titanium cage. 2-group, 10 (43.4%) autobone (ribs have — 25, from the wing of the ilium — 5 patients), taken during surgery.
In patients with lesions of the thoracic spine neurological disorders of radicular syndrome to profound paresis and plegia in violation ofthe pelvic organs were observed — in 30 (85.7%) patients. MRI examinations characteristic feature was an increased signal in the affected areas with the presence ofpre, paravertebral and epidural abscess.
In 35 patients in whom the defeat thoracic department — in 15 (42.8%), mid-thoracic in 13 (37.1%), lower thoracic spine — in 7 (20.0%) patients. The specific process of the spine in all cases was in active stage. Related pulmonary tuberculosis in 4 (11.4%), pleural — in 3 (8.5%), and the ribs were 3 (8.5%) patients. surgical access transtorokal. At the same time, transtorokal access has created an opportunity to carry out under the supervision ofvisual manipulation throughout the thoracic spine, removal of purulent necrotic masses, resection of the affected spinal decompression of the spinal cord at the level of injury to the spinal fixation.
When lesions of the lumbar and sacral spine lumbar surgery departments carried out the conventional method. Front side, taking into account the localization of the abscess: the main group: surgical access for the purpose of abstsessotomy (from m.psoas), necrectomy affected vertebrae with spinal cord decompression and revision of the dura mater, the elimination of kyphosis with fixation of the vertebrae. To gain access to the upper lumbar vertebrae perform
resection XII and, in some cases, XI rib. Preoperative preparation of
1 to 1.5 months, had a range of antibacterial, pathogenetic therapy in orthopedic operation. 1 groups 13 (56.5%) patients with the aim of the affected spine plasticity is-to use a titanium cage, the control group, 10 (43.4%) using autobone (wing of the ilium), taken during surgery. Defeat 2 or more vertebrae found 1 group — in 9 (62.9%), more than 3 vertebrae — in 4 (37.3%) and 2 patients — group — in 6 (60.0%) and 4 (40.0%), respectively. Unstable kyphotic deformity of the spine is set in 7 (53.8%) patients in the 1 — group and 6 (60.0%) of 2-group, sinter abscesses (m.psoas) unilateral — in 7 (53.8%) patients of 1 — and the group of 6 (60.0%) of 2-group. All patients were operational data are compared with the results of MRI.
Postoperative material studied Reference Laboratory of Republican Specialized Scientific Practical Medical Center Phthisi-ology and Pulmonology (caseation, pus) in 23 (100%) patients. Pure cultures were obtained using a solid medium Lowenstein-Jensen, followed by the study of drug sensitivity to a liquid medi-um-MGIT-960. In all patients, 35 (100%) histological diagnosis was verified, which is confirmed by a specific process in the spine.
Results: The analysis of the literature led to the conclusion about the presence of unresolved problems in the treatment of complicated forms of tuberculosis of the spine, such as: the absence of clear indications for surgical treatment techniques specific spondylitis with retaining structures and tactics developed their application in different phases of tuberculous spondylitis. The postoperative orthopedic operation on the background of anti-TB therapy was carried out immobilization of the affected card cervical collar soft (Schantz type) for 2-4 weeks. The range of treatments include massage and physiotherapy up to 3 weeks. After the operation, the formation of X-ray of the bone block in the affected vertebral level at 6 months in 11 patients (84.6%) of group 1, and 6 (60.0%) of the 2 groups. After 2 months at 10 (15.3%) of 1-group and (40.0%) of the 2 groups. Fixation of the cervical spine x-ray was carried out before the detection of bone block. All patients had relief of neurological symptoms.
Increasing variability ofMycobacterium tuberculosis has led to an increase in atypical forms and pathomorphosis clinical symptoms and rentgenotomografic thoracic spine tuberculosis, which is associated with the widespread use of antibacterial drugs. However, not always the X-ray and MRI picture of tuberculosis and tuberculosis of the spine is so pathognomonic to her in conjunction with clinical findings could build a proper diagnosis.
MRI in these cases allowed to find in different parts of the spine different in nature and degree of destructive changes, ranging from barely visible under X-ray foci research centers and to large bone cavities.
The postoperative orthopedic operation on the background of anti-TB therapy, taking into account the DST conducted immobilization of the affected department of the lumbar spine for 1.5 months. in group 1, two months in two patients. In both groups of patients assigned to pathogenetic therapy in the treatment of the complex include massage and physiotherapy up to 3 weeks. After surgery rentgenotomografic noted eliminate instability and the formation of the bone block in the affected vertebral level at 6 months in 11 patients (84.6%) of 1-group and 6 (60.0%) of the
2 groups. After 2 months at 10 (15.3%) of 1 — group, and (40.0%) of the 2 groups. Fixing a orthopedic splint of the lumbar spine was performed before the X-ray detection of bone block. All patients had relief of neurological symptoms.
Thus, currently the plastic compensation for defects, resulting in bone tissue after removal of the pathological focus, still remains a major problem and continue the study of the transplant,
the aim of the use of plastic material for specific lesions of the spinal column in the surgical treatment. Different versions of anterior fusion with allograft and autologous or non-biological implant in complicated forms of tuberculosis spondylitis can not completely solve the problem of stabilization of the spinal column.
Conclusions: 1. The bone graft is a biological material widely used plastic material purpose, but the drawback is that often by the
sword, with all their nonunion bed, festering, under axial load are more susceptible to deformation and reduces its stability.
2. The non-biological material, (Titanium mesh) have high strength and plastic characteristics, wear resistance has rapidly assimilated due to ingrowths into the pores of the bone tissue in radical — recovery operations in patients with spinal tuberculosis.
References:
1. Беляков М. В., Бурлаков С. В., Гусева В. Н., Мушкин А. Ю., Олейник В. В., Сердобинцев М. С., Куклин Д. В., Виноградова Т. И., Вишневский А. А., Гордеев С. К. Клиническое применения углеродных имплантатов при радикально-восстановительных операциях у больных спондилитами//Туберкулез и болезни легких. - 2011. - № 4. - C. 54.
2. Куклин Д. В., Мушкин А. Ю., Сердобинцев М. С., Дорофеев Л. А., Беляков М. В., Роднова И. Г. Хирургические лечение многоуровневых туберкулезных спондилитов, осложненных грубой деформацией позвоночника//Туберкулез и болезни легких. - 2011. - № 4. - C. 222.
3. Фахртдинова А. Р. Современная комплексная лучевая диагностика туберкулезного спондилита и оценка результатов его хирургического лечения: дисс... канд.мед. наук. - 2012. -С. 12.
4. Anastasios G., Chistodoulou., MD, PhD; Panagiotis G., MD, PhD; Dimitros K., MD; Panagiotis D., Symeonidis, MD; and John Pour-naras, MD, PhD. Treatment of tuberculosis spondilitis with anterior stabilization and titanium cage//Clinical ortopaed. and related research. - 2006. - P. 60-65.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-110-112
Mirsalihova Firuza Lukmonovna, PhD, Assistant to chair, Tashkent State Dental Institute, Department Of children's therapeutic stomatology E-mail: [email protected]
Upgraded approach and methods of use of modern theory comprehensive prevention programs dental caries in children
Abstract: Dental caries in children is a significant problem in all countries of the world, due to the trend towards an increase in the severity and frequency of disease. It should be noted that the widely used prevention programs have the potential to achieve positive changes in matters of dental caries prevention It is necessary to note that the implementation of the prevention program involves reduction of both dental caries and periodontal disease, reduce the incidence of tooth loss at a young age, which in turn implies an increase in the number of children and adolescents with intact teeth.
Keywords: dental caries, early childhood, prevention program.
Dental caries is currently the most common disease of mankind. As is well known problem of tooth decay and diseases it has a long history, which is due to the trend towards an increase in the severity and frequency of disease.
Widespread dental caries in children necessitates further improvement of effective and accessible public means of prevention of this disease, which is one of the urgent problems of modern dentistry.
Despite some progress caries prevention, recorded a high prevalence and intensity of dental caries, especially among children. Currently, there are many works on the prevention of dental caries in children. Despite the fact that gained a lot of positive experience in implementing advanced caries preventive measures, the level of dental disease according to WHO, is not reduced. The relevance of the development of prevention methods is also associated with a decrease in the volume of medical activities and as a consequence of material costs, as the cost of preventive methods is 20 times lower than the cost of treatment of diseases already developed.
Dental caries in children is a significant problem in all countries of the world, such an interest and the constant attention of the experts associated with the high prevalence of these diseases among the population. At the same time, the global dental practice
convincingly shows that preserve intact teeth and periodontal tissues is only possible through the introduction into the daily practice of the methods of prevention of dental diseases. However, many scientific works point to the low level of informativeness in prevention of dental diseases.
It is known that dental caries — a multifactorial disease characterized by pockets of enamel demineralization. The leading factor in the development of dental caries is the cariogenic microflora of the oral cavity, although the broader consideration of dental caries is a chronic infectious disease resulting from an imbalance of multiple risk and protective factors.
Another important factor in the pathogenesis of dental caries is a frequent use of carbohydrate. Rapid break down of these products to the final oral metabolites — lactic acid, acetic acid, propionic acid and others, is an important part in the occurrence of caries. Since they initiate demineralization of enamel.
In the etiology of dental caries Saliva plays an important role, which has a mineralizing, washing, cleansing and protective functions. Important for the mineralization of the enamel has a speed of salivation, saliva remineralization capacity and features of the mineral composition of dental hard tissues. It is known that dental caries is a result of imbalance in the system "tooth enamel — sa-
