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gene and formation ofAD. The point to be emphasized is that, when comparing Gln/Gln healthy genotype in patients with AD as compared to healthy individuals, it was found more than 5-fold valid reduction in the frequency of occurrence ofhealthy genotypes (OR = 0.54; 95% CI 0.26-1.12). These data confirm the validity of our results, showing that allele IL4RA- Gln551 is a marker of reduced risk of AD progression in patients. Thus, in the result of the study on IL4RA. gene's Gln551Arg polymorphism was found that the
DNA locus associated with AD in Uzbekistan. In the initial stages of defining diagnosis on atopic dermatitis it is recommended to conduct genotyping assay of studied gene polymorphisms of cytokines and their receptors for the establishment of further variants of its clinical course and nasty disease-forms-susceptibility. Treatment of atopic dermatitis is recommended to conduct taking into account the genetic data on the dominating nature of its clinical course and evidence of immune status disorders.
References:
1. Sandford A. J., Chagani T., Zhu S., Weir T. D., Bai T. R., Spinelli JJ, et al.Polymorphisms in the IL4, IL4RA, and FCERIB genes and asthma severity. J Allergy Clin Immunol. - 2000. - 106:135-140.
2. Kauppi P., Lindblad-Toh K., Sevon P., Toivonen H. T., Rioux J. D., Villapakkam A., et al. A second-generation association study of the 5q31 cytokine gene cluster and the interleukin-4 receptor in asthma. Genomics - 2001, - 77:35-42.
3. Wjst, Kruse S., Illig T., Deichmann K.: Asthma and IL-4 receptor alpha gene variants. Eur J. Immunogenet - 2002, - 29:263-268.
4. Bottini N., Borgiani P., Otsu A., Saccucci P., Stefanini L., Greco E., et al. IL-4 receptor alpha chain genetic polymorphism and total IgE levels in the English population: two-locus haplotypes are more informative than individual SNPs. Clin Genet - 2002, - 61:288-292.
5. Cui T., Wang L., Wu J., Hu L., Xie J. Polymorphisms of IL-4, IL-4R alpha, and AICDA genes in adult allergic asthma. J Huazhong Univ Sci Technolog Med Sci - 2003, - 23:134-137.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-75-78
Nazirov Feruz Gafurovich, doctor of medical sciences, Republican Specialized Center of Surgery named after ac. V. Vakhidov, Tashkent, Uzbekistan Ibadov Ravshan Alievich, doctor of medical sciences Republican Specialized Center of Surgery named after ac. V. Vakhidov, Tashkent, Uzbekistan Abralov Hakimjon Kabuljonovich, doctor of medical sciences, Republican Specialized Center of Surgery named after ac. V. Vakhidov, Tashkent, Uzbekistan Julamanova Dono Ikramovna, doctor, Republican Specialized Center of Surgery named after ac. V. Vakhidov, Tashkent, Uzbekistan Ibragimov Sardor Khamdamovich, doctor, Republican Specialized Center of Surgery named after academician V. Vakhidov, Tashkent, Uzbekistan Republican Specialized Center of Surgery named after academician V. Vakhidov, Tashkent, Uzbekistan)
E- mail: [email protected]
Experience and comparative analysis of application results of regulated subclavian-pulmonary artery anastomosis in patients with tetralogy of Fallot
Abstract: The article summed up the consolidated analysis of close results of classical subclavian-pulmonary artery anastomosis (Blalock-Taussig shunt) and modified via a vascular Fogarty catheter for patients with Tetralogy of Fallot. It was noted that the major complications in the early postoperative period are hypervolemia of pulmonary circulation, postoperative bleeding and the development of acute heart failure. It is proved that the active application of the author's method for managing cardiopulmonary hemodynamics using Fogarty catheter allows significantly reduce the mortality rate of 1.6% and avoid anastomosis hyperfunction and the development of cardio-pulmonary insufficiency.
Keywords: Tetralogy of Fallot subclavian-pulmonary artery anastomosis hypervolemia of pulmonary circulation.
Introduction
In infants and young children with strong cyanosis and frequent episodes of acute respiratory failure, as well as in elderly patients with severe hypoplasia of the pulmonary artery and the left ventricle the most common type of surgical treatment is the subclavian-pulmonary anastomosis (SPA) [2]. The increased pulmonary blood flow lead to certain changes in the patient's condition — disappear cyanotic episodes, there are the conditions for cancellation of beta-blockers [1]. However, the increased blood flow through SPA to the left heart can be the cause of such vital complications, such as pulmonary edema and acute left ventricular failure. Postoperative mortality increased to 7.5 during the development of these complications — 15.6% [3].
Until recently in the literature is almost no information about the possible regulating ways ofbypassed (shunted) blood volume through the established vascular anastomosis. The RSCS named after ac. V. Vakh-idov proposed an original way allowing to adjust the shunt volume through the SPA. However, the authors mainly consider the surgical aspects of the tactical and technical parts of SPA performance.
700 600 500 400 300 200 100 0
Since 2009 in RSCS the using of authorial method was started (patent RU number FAP 00560) of regulation ofblood flow via SPA.
Materials and methods.
We conducted a consolidated analysis of 930 results of SPA, which made in RSCS named after ac. V. Vakhidov for 33-year period (1976-2013). Classical anastomosis by Blalock-Taussig was performed for 79 and modified anastomosis — for 790 patients. In 61 cases SPA was supplemented by copyright controlling methods of cardio-pulmonary hemodynamics. Of these the ligature were using in 7 patients and for 54 them — Fogarty catheter.
The age of patients ranged from 3 months to 32 years (mean age 13,34 ± 0,04 years). There were 512 male and 425 female. In order to objectively assess the effectiveness of new methodological approaches and developed tactical and technical aspects by using SPA we made comparing of three periods of using SPA in our Center: 1976-1980 years — the period of development and introduction of SPA (93 patients), 1981-1999 — the period of active use of SPA (610) and the period 2000-2013 years — the period of overview the methods of managed SPA (227) (Fig. 1).
1976-1980
1981-1999
2000-2009
Figure 1. The number of completed SPA by periods (n = 930)
Results and Discussion postoperative mortality that can be objectively related to the im-
Retrospective analysis showed that in the first period was a high provement of methods and surgical techniques (Fig. 2).
100%-80%-60%-40%-20%-0%
92,5%
91,6%
1976-1980
1981-1999
2000-2009
Figure 2. Structure of the SPA results Part of postoperative patients from 1976 to 1980 was significantly represented in the group with fatality (12.9%), compared with appropriate (87.1%) outcomes (u- 2.66, p <0.001 9* — 3.75 p <0,01; x2-27,43, p < 0.001, T 5.78, p < 0.001). The risk of death for this period of operation was 6.8 times higher. Contingency factor of death causes and these periods (1976-1980 and 1981 -1985 years) was equal to KA — 0.751 and KA — 0.709, respectively.
by period (%) in patients with TOF
Correlated tendency that noted in the incidence of a advantageous outcome of the stages of formation of surgical techniques, was in reducing mortality and increasing the portion of positive results. So, for the period from 1981-99, the amount of patients with adequate (positive) outcomes was 92.5% compared to 7.5% with a mortality (u — 2.43, p <0.05 9* — 1.6, p < 0.05). KA was respectively equal to 0.769 and 0.719.
In comparison, between 2000 and 2013 year, these values were 91.6% and 8.4% respectively. However, it should be noted that such an increase of mortality compared with the second period was associated with the expansion shown in the particular type of surgery in patients with a single (common) ventricle of the heart. The most favorable results of these operations in this period marked in the last three years (2007-2013 years), so the amount consist of
Table 1. - Causes of deaths in the early
98.4% and 1.6%, respectively (u — 2.42, p < 0.01, 9*- 2.71, p <0,01; X2-3,75, p < 0.05, T — 2.32, p < 0.05). KA was respectively equal to 0.757 and 0.729.
The major complications of early postoperative period were:
1. Hypervolemia of pulmonary circulation;
2. Postoperative bleeding;
3. Severe congestive heart failure.
postoperative period in studied groups
Causes of death I group II group III group
Hyperfunction of anastomosis 4 (0,43%) 11 (1,18%) 3 (0,32%)
Postoperative bleeding; 3 (0,32%) 5 (0,54%) 4 (0,43%)
Severe congestive heart failure; 5 (0,54%) 30 (3,22%) 12 (1,29%)
Sum (abs.) 12 46 19
Note:% - of the total number of operated patients
Thus, in the early postoperative period in 60 (6.4%) patients were noted hyperfunction of anastomosis with the development ofhyper-volemia of pulmonary circulation that leading to pulmonary edema. In all cases, this complication request the reoperation and elimination of the shunt. Fatal outcome was observed in 18 (30% of the total number ofpatients with hypervolemia ofpulmonary circulation) patients, and all of them, according to the scale «Aristotle» the result were not more than 18 units. Among the 42 survivors in the early stages, 20 of them needed the prolonged ALV for more than 5 days.
Total rethoracotomy were 86 (9.2%), most of them (60) were associated, as noted above, with hyperfunction of the anastomosis with a mortality rate of 30% (18 patients). In 26 (20.2% of the total rethoracotomy) patients with rethoracotomy were conducted because ofpostoperative bleeding, with mortality rates of 42.3% (11 patients).
Overall mortality was 8.3% (77 patients), of which 37.7% (29 patients) accounted for reoperations and 62.3% (47 patients) was associated with the progression of cardiovascular disease.
From beginning of2009 year, we started to use method or technic that regulate or controlled anastomosis that located between arteries, which allows to control the volume of blood flow through the shunt SPA on the pulmonary circulation, which leads to a restriction of the blood flow (excretion) in the shunt to side of installed anastomosis. By measuring the gradient between the subclavian and pulmonary arterial system the dosage system of excretion blood into the pulmonary circulation can be regulated. Thus, it avoids the hyperfunction of anastomosis and eludes high pressure in the pulmonary artery, which can lead to cardiovascular diseases.
Figure 3. Adjustable subclavian-pulmonary artery
Conclusions.
1. The clinical material collected in RSCS named after ac. V. Vakh-idov during the 33-year period, the introduced unified methodology of improved surgical tactics of patients with TOF proves its high efficiency in the preparatory stage of a radical correction.
2. Analysis of the preoperative examination of studied patients in chronological periods showed that the distribution of pa-
anastomosis by using intravascular Fogarty catheter
tients within the groups, depending on the basic clinical and anamnestic data, objective status, and based on of diagnostic monitoring was equal, as evidence by the magnitude criteria of matching are equal to 1.523 (p <0.05).
3. Satisfactory results of SPA noted for the 2000-2013 period give the motivation to apply and active use of method that manage of cardio-pulmonary hemodynamics.
References:
1. Matsuyama K., Matsumoto M., Matsuo T. Slowly developing perigraft seroma after a modified Blalock-Taussing shunt.//Pediatr. Cardiol. - 2003. Jun-Aug; - 24 (4):412-4/Epub - 2003. - Jan 15.
2. Sivakumar K. Catheter closure of an atrial septal defect in anatomically corrected malposition with left juxtaposition of atrial appendages. Cardiol Young. - 2009. - Sep;19 (5):534-6. Epub - 2009. - Aug 13.
3. Williams J. A., Collardey K. R., Treadwell M. C., Owens S. T. Prenatally diagnosed right ventricular outpouchings: a case series and review of the literature. Pediatr Cardiol. - 2009 Aug; - 30 (6):840-5. Epub -2009. - May 27. - PMID: - 1947-1995.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-78-79
Rabbimova Dilfuza, Samarkand State Medical Institute, PhD in medicine, department of pediatric disease E-mail: [email protected]
Risk factors and features of septic course in infants
Abstract: In this paper we present the data from clinical observations and special studies of246 children aged from 1 month to 1 year with purulent inflammatory diseases. Clinical monitoring of sick children were held in the branch of Samarkand Pediatric Surgery. In addition, when analyzing septic risk in young children it has been established that the main predictors of the generalization of bacterial infections in early childhood are the causes that lead to the development of acute and chronic hypoxia of the fetus and newborn, as well as the presence of persisting infection in mothers.
Keywords: septic course, children, purulent inflammatory diseases.
According to the modern concept of PIRO (Predisposition, Infection, Reaction, Organ disfunction) the diagnosis of sepsis predetermines identification of predictors, i. e. predisposing factors of the disease, clarification of infectious agent and its localization, assessment of the response of the organism to the infectious agent, and the identification of organ dysfunction.
In this paper we present the data from clinical observations and special studies of 246 children aged from 1 month to 1 year with purulent inflammatory diseases. Clinical monitoring of sick children were held in the branch of Samarkand Pediatric Surgery (director — prof. A. M. Shamsiev).
Patients were divided into groups: I group with sepsis (generalized infection) — is basic 163 patients (of them 109 patients with septicemic form and 54 patients with septikopiemic form). II group — the group of local infection comparisons -83 patients.
In assessing the flow, acuteness, severity of inflammation in sepsis, we used clinical criteria and laboratory parameters were compared with those of a localized infection. Children in this group underwent the smallest period of severe condition and the period of fover, and had a shorter total duration of the disease.
For a detailed analysis of the contributing factors of the disease associated with the development of sepsis were comparison with frequency of these factors at a local infection was carried out. This approach allowed us to build a logical chain in predicting the possible development of sepsis and in the selection of appropriate measures to reduce the adverse outcomes. In this work, a thorough analysis of the psycho-social and medical-biological factors of high septic risk in infants was carried out.
Of psychosocial factors on the frequency of septic group mothers low medical culture was leading: so 84% of mothers showed ignorance and failure to comply with hygiene items, not timely appealed for medical aid, about 59.3% of mothers showed reduced attention to the child: wrong feeding, care, walkings and etc. The contingent of patients, as in sepsis, so at the local infection, was mainly from rural areas: 79.4% and 76%, respectively. It was found that the average age of mothers of the studied was higher group
than in the control: 65,7 ± 3,2% of mothers in the control group were between the age of 19-28 years, i. e. during the period of the most active reproductive function. The maximum number of mothers of children with sepsis are located in a range of less than 19 and older than 30 years, which increases the risk of sepsis in infants in 1.5 and 1.8 times respectively. There were no significant differences in nulliparous women over multiparous ones in both groups: the first birth was in 58 (54.2%) women in the group with sepsis and in 14 (48.2%) women in the group with a local infection.
From medical and biological factors we analyzed the factors of perinatal period with peculiarities of pregnancy and childbirth and maternal health during pregnancy.
Comparative analysis of perinatal factors associated with the development of sepsis in infants revealed that the frequency of pathology of pregnancy in mothers of septic children is over 4 times higher than that of mothers of children with local infection.
The structure of the complicated pregnancy. In particular, in toxicosis in 42 (25.7%), in sepsis threat of termination of pregnancy — 54 (33.1%), preeclampsia was observed in 25 (15.3%), polyhydramnios — 21 (12.8%) women. In some cases, there is a combination of complications of pregnancy in a woman.
Complications during childbirth and with significantly greater frequency occurred in the groups with sepsis and made 68% of cases, which is 5 times more likely than in mothers of children with localized infections. Among the complications there were: entanglement of umbilical cord around the neck, premature detachment of normally situated placenta, powerless labor, precipitated labor and they were the cause of neonatal asphyxia during labor.
In the structure of extragenital diseases in mothers of the studied children anemia had a leading position. Anemia of moderate and severe degree in mothers is 4 times more common in the group with sepsis than in the mothers in the group of children with local infection (74.8% — in sepsis, against 18.1% — by local infection).
Also, when carrying out a retrospective analysis of the results of interviews with the mothers of the studied children, it was revealed that they had a high infection index, confirmed by the high frequency
