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7
Рисунок №4.
На данном слайде представлен планшет с раскладкой удаленных лимфоузлов по группам и сам препарат-удаленная верхняя доля легкого с циркулярно резецированным участком левого главного бронха.
Гистологическое исследование материала установило: опухоль- плоскоклеточный рак, низкодифференци-рованная форма. В 3 субаортальных, 4 трахеобронхиаль-ных, л/узлах НДБ (№2) и ВДБ (№2)- метастазы рака, граница резекции бронха- без особенностей. Единственная группа удаленных лимфоузлов в которых не было найдены метастазы это группа бифуркационных лимфоузлов. Таким образом установлена окончательная стадия заболевания: T2N2M0.
Дренажи из плевральной полости были удалены на 3-ий день послеоперационного периода. В послеоперационном периоде длительная гипертермия, что потребовало проведение 2 линий антибиотикотерапии: медацеф + про-ципро в течении 10 дней, затем замена на инванз+ванко-мицин. После 4 дней антибиотикотерапии 2-ой линии гипертермия купирована. На контрольной рентгенографии ОГК- без осложнений.
Выписка пациента - на 20 день послеоперационного периода.
Учитывая стадию процесса пациенту назначена адьювантная ПХТ с препаратами платины- 3 курса с последующей лучевой терапией. Явка на контроль после проведения полихимиотерапии.
Таким образом бронхопластические операции позволяют, с одной стороны, сохранить функциональную паренхиму легких у пациентов с относительной операбель-ностью, с другой стороны, достигнуть необходимого радикализма оперативного вмешательства.
Литература
1) Руководство по медицинской профилактике / Под ред. Р.Г. Оганова, Р.А. Хальфина. - М.: ГЭОТАР-Медиа, 2007.- 464 с.
2) 1. Авилова ОМ. Резекция и пластика бронхов и ме-диастинальной трахеи. [Автореф дис ... докт мед наук]. Киев, 1971. 25 с.
3) Бисенков ЛН, Шанин ЮН, Замятин МН и др. Бронхоскопический мониторинг при операциях на легких. Грудная сердечно-сосуд хирургия 2000; (1): 43-7.
4) Марченко ВП, Чхиквидзе ВД. Резекция легкого с иссечением устья бронха. Вестн хирургии 1984; (1): 21-6.
5) Маслов ВИ, Малышев ВЕ, Куликов МВ и др. Лоб-эктомии с клиновидной резекцией главного и промежуточного бронхов. Грудная сердечно-сосуд хирургия 2000; (5): 62-5.
6) Перельман МИ, Бирюков ЮВ, Гудовский ЛМ и др. Хирургия трахеи и бронхов. Анн хирургии 2001; (1): 30-4.
7) Опубликовано в сборнике Новое в терапии рака легкого (Москва, 2003) Современные принципы выбора лечебной тактики и возможности хирургического лечения немелкоклеточного рака легкого. М. И. Давыдов, Б. Е. Полоцкий
8) Рамазанов Эльбрус Наврузбекович. Клинико-функ-циональное обоснование экономных и бронхопла-стических операций на легких у больных пожилого и старческого возраста14.00.27 - хирургия Автореферат диссертации на соискание ученой степени кандидата медицинских наук Саратов - 2006
9) Хвастунов Р.А., Коновалов Э.Г. Редкий случай хирургического лечения первично-множественного синхронного рака легкого и культи желудка. Волгоградский научно медицинский журнал.
HEMORHOELOGICAL STATUS DURING PERIODONTITIS WITH AND WITHOUT THYROID DYSFUNCTION BETWEEN CHILDREN THE AGE OF 11-15
Beriashvili Sesili Davidovna
Postdoc; Georgian David the Builder University Mantskava Maia Mikhailovna Associate Prof.; Beritashvili Biomedical Experimental Center, Tbilisi
Momtselidze Nana Gogievna Associate Prof.; Beritashvili Biomedical Experimental Center, Tbilisi
Nikolaishvuli Marina Indikoevna Associate Prof.; Beritashvili Biomedical Experimental Center, Tbilisi
Tupinashvili Tamar Nodarovna Postdoc; Georgian David the Builder University, Tbilisi
Tamasidze Nino Archilovna Postdoc; Georgian David the Builder University, Tbilisi
We were interested in how the homorheological status has been changing in adults during the dysfunction of thyroid, the second stage of periodontitis and the parallel development of the thyroid gland and periodontitis. The following rheological status were examined erythrocytes aggregability, which represents aggregated erythrocytes area ratio against whole area of the erythrocytes. We investigated 75 patients (30 boys and 45 girls) 11-15 years old. Group I - patients with thyroid dysfunction, n=25, maen age =11,9±2,0 with out treatment; group II - patients with II stage parodontitis, n=25, mean age =12,5±1,6 with out treatment; group III - patients with nozological, wheare parallel development of thyroid dysfunction and periodontitis n=25, mean age =12,8±1,3 with out treatment; group IV - control subjects group, n=10, mean age =12,4±2,0. According to the obtained results it turned out that during periodontitis the rheological features are disordered compared to the control (status deteriorated by 15%). The rheological features are far more disordered during dysfunction of thyroid (status deteriorated by 30%). The children who had periodontitis and the dysfunction of thyroid at the same time have been examined. In the given case the rheological status was far from the normal rheological situation for 40% (the targets of our research were the primary patients who weren't provided with hormonal treatment). The issue is very relevant, having a practical applied side. It was concluded that one of the reasons of the development ofperiodontitis in the adults is the changes in the functional state of the thyroid.
Key words: Hemorheological status, Periodontitis, Thyroid dysfunction
Blood is not a homogeneous (Newtonian) liquid and it is a suspension having suspended particles, it has exceptional features and it is studied by hemorheology. Blood hemorheology plays a significant role in blood circulation and ensuring its trophic function. Changes in rheological properties of blood may cause a slowdown in the flow, establishment of stasis, therefore tissue hypoxia, which is accompanied by a multi-disease and vice versa, the particular structure of blood depends on a local hematocrit, axial flow of erythrocytes and the existence of plasma layer, blood flow structure changes leads to a disorders of its rheological properties. The rheological features of blood are mainly determined by the erythrocytes, as the volume of leukocytes is much smaller (800 times), than the number of erythrocytes and platelet (however they are numerous than erythrocytes, they are of a significantly small size). The volume of the platelet composes only 1/10 of the volume of erythrocytes. Therefore, the rheological properties of blood is determined by erythrocytes and the features of its actions (resilience, agglutination, movement,etc.) [9].
According to the concept of our research group, erythrocytes value the microcirculation and hemorheologic condition, so called hemorhelogical status.
We were interested in how the hemorheological status has been changing in adults during the dysfunction of thyroid, the second stage of periodontitis and the parallel development of the thyroid gland and periodontitis. If we take into consideration that according to the epidemiplogical data in children and adults throughout the world the thyroid disease is spreading and increasing from 10 to 15 years of age, the changes in characteristic of periodontitis is far more common in children [15,16].
Our research is very important for fundamental research as well as for practical biomedicine. This approach is gaining more relevance in research, as it is for the first time that we are connecting these two pathologies and estimate rheological status.
Materials and Methods. We investigated 75 patients (30 boys and 45 girls) 11 - 15 years old. Group I - patients with thyroid dysfunction, n=25, maen age =11,9±2,0 without treatment; group II - patients with II stage periodontitis, n=25, mean age =12,5±1,6 with out treatment; group III - patients with nozological, wheare parallel development of hyroid dysfunction and periodontitis n=25, mean age =12,8±1,3 with out treatment; group IV - control subjects group, n=10, mean age =12,4±2,0.
The following rheological status were examined erythrocytes aggregability, which represents aggregated erythrocytes area ratio against whole area of the erythrocytes [7]. Erythrocyte aggregation was evaluated with the recently developed "Georgian technique" [8,10] providing us with
direct and quantitative data. Blood samples (4ml) from the cubital veins were centrifuged and about 0.1 ml blood was diluted 1:200 in own plasma in the Thoma pipettes preliminary rinsed with 5% sodium citrate solution without addition of any other anticoagulants to the blood under study. Following standard mixing the diluted blood was placed into a glass chamber 0.1 mm high. The quantitative index of erythrocyte aggregation, which was assessed with a special program at the Texture Analysis System (TAS-plus, "Leitz, Germany), represented itself the relationship of the aggregated and unaggregated red cells.
Data are presented as mean ±SD. Comparison of data were evaluated by Student's paired t-test, while data from the patients' study were evaluated by Student's unpaired t-test. Differences between groups were considered statistically if P<0.001.
Studies conducted charges according the Declaration of Helsinki [14].
Results. Rheologiocal status in Group I 30,0±2,5. Rheological status in Group II 25,8±2,6. Rheologiocal status in Group III 32,2±2,0. Rheologiocal status in control -22,4±2,0.
Discussion. According to the obtained results it turned out that during periodontitis the rheological features are disordered compared to the control (status deteriorated by 15%). The rheological features are far more disordered during dysfunction of thyroid (status deteriorated by 30%). The children who had periodontitis and the dysfunction of thyroid at the same time have been examined. In the given case the rheological status was far from the normal rheological situation for 40% (the targets of our research were the primary patients who weren't provided with hormonal treatment).
From our point of view periodontitis and the dysfunction of the thyroid developed in parallel. It is known that without an adequate blood supply the normal functioning of the tissue and organ is impossible. The provision of the abovementioned is made by the normal flow of microcirculation network, which itself depends on the rheological features of the blood. Microcirculation is important during each physiological process and far more important during the development of pathological processes. Pathology causes the disorder of microcirculation, hemorhelogical changes and the latter strengthens the pathological processes [8,9].
Thus we can conclude that thyroid disorders are contributing factors to the development of periodontitis. Despite the lack of works [1,4,5], where hemorhelogical, the dysfunction unity of calcium and phosphorus homeostasis gland, are discussed, our data also confirms the truth of this statement. We believe that the microcirculation disorder is caused by the mineralization imbalance as a result of
parathormonis not only locally, but also in every organ and tissue. The development of periodontitis, cardiovascular problems and risks, as well as memory and other neuro and neurogenic risk factors are derived from the above mentioned [1,2,3].
Local trans capillary metabolism cause hemorhelogical changes. On one hand hemorhelogical disorders cause illness and on the other hand microcirculation disorder develops pathologies. The more microcirculation is damaged the more actively the rheological status is changed and the more heavily organs and tissues are damaged, which in turn do not function normally and even more damage the microcirculation network by excess or small amounts of a hormone excretion or exudation of other substances [6].
The issue is very relevant, having a practical applied side. It was concluded that one of the reasons of the development of periodontitis in the adults is the changes in the functional state of the thyroid.
The enlargement of the thyroid gland is promoted by some harmful social and cultural habits, poor living conditions, lack of micronutrients in food, but the main role is implemented by the iodine deficiency. Compensatory response to exogenous lack of iodine in the thyroid gland is that: hyperplasia provides the secretion of the required amount of the thyroid hormone. It is also noteworthy that during the 1st and 2nd degrees of periodontitis more often hygiene, viral effects, mineral misbalance of the tooth paste and etc. are named as a main causing factors [11,12,13]. Only in the long term or in rare cases, children are prescribed thyroid test. Based on this work the adults are recommended to be provided with the thyroid examination and/or examination of rheological status, which indicates clinicians on a treatment and choosing the tactics for management. Our data will assist in the correct classification of the 1st and 2nd degrees of periodontitis, which has a fundamental significance for physiology and pathophysiology apart from the practical meaning.
All the planning and performance of the research, which will promote the reduction of the ratio of periodontitis and the monitoring of thyroid function is very important. All the above mentioned allow us to broaden our research.
Reference
1. Carallo C., Franceschi M., Tripolino C. et al. Common carotid and bronhial artery hemodinamic alterations in periodontal disease. J. Clin. Periodontal. 2013. 40 (5), p. 431-436.
2. Chekmareva S.E. Prognostic an assessment of a functional condition of the blood circulatory system at
diseases of a thyroid gland. Avtoreferat. Krasnodar, 2003. - 48 p.
3. Jaftha A., Holmes H. Periodontitis and cardiovascular disease. SADJ 2013, 68(2), p.62-63.
4. Konoplia E.E., Danilova L.I., Kremko L.M. Stomatologic status in exchanges tireoidny and calcium at the people with an autoimmune thyreoid living on it is radioactive the polluted territories. J. Stomat. 2000. 1, p.35-8.
5. Latypova V. N. A state of health of children and teenagers with thyreopathya. Children's health care of Russia: development strategy: materials IX of congress of pediatricians of Russia. 2000. p.342-343.
6. Machill K., Scholz G. Dependence of hemodynamic changes in hypothyroidism on age of patients and etiology of hyperthyroidism. Book: Heart and thyroid. Ed L.E. Braverman. O. Eber, W. Langsteger.-Wien. 1994. p.203-211.
7. Mantskava M.M., Momtselidze N.G., Davlianidze L.Sh. D0I:http://dx.doi.org/10.15360/1813-9779-2014-5-27-32.
8. Mchedlishvili G. Basic factors determining the hemorheological disorders in the microcirculation. Clin. Hemorheol. Microcirc. 2004. 30, p.179-80.
9. Mchedlishvili G. Local RBC aggregation disturbing blood fluidity and causing stasis in microvessels. Clin. Hemorheol. Microcirc. 2002. 26, p.99-106.
10. Mchedlishvili, G., Beritashvili N., Lominadze D., and Tsinamdzvrishvili B. Technique for Direct and Quantitative-Evaluation of Erythrocyte Aggregability. J. Biorheology. 1993. 30, p.153-161.
11. Nikolaishvili M., Beriashvili S., Franchuk K., Tupinashvili T., Vashakidze I., Zenaishvili S. Crystallization of a saliva at teenagers at dysfunction of a thyroid gland. J. Experimental and clinical Medicine. 2014. 4, p.29-33.
12. Pestov A. Regularities of relationship of a biocenosis and physical and chemical properties of oral liquid at caries. Avtoreferat. Volgograd: 2012. p.29.
13. Sovtsova K.E. Clinic-biochemistry researches of oral liquid at patients with a periodontal disease, Congress of health and education in the XXI century. Moscow: 2008. 460-461.
14. http://www.ub.edu/recerca/Bioetica/doc/Declaracio_H elsinki_2013.pdf.
15. http://www.who. int/entity/bulletin/volumes/90/8/12-040812.
16. http://www.who.int/mediacentre/factsheets/fs318.
ПОВЫШЕННАЯ ЧУВСТВИТЕЛЬНОСТЬ ЗУБОВ В СТОМАТОЛОГИИ,
ПУТИ ЕЕ РЕШЕНИЯ
Журбенко Вероника Александровна
Ассистент кафедры терапевтической стоматологии ГБОУ ВПО Курский государственный медицинский университет МЗ РФ, г. Курск
Саакян Эльмира Сефтеровна Ассистент кафедры терапевтической стоматологии ГБОУ ВПО Курский государственный медицинский университет МЗ РФ, г. Курск
Повышенная чувствительность зубов имеет более популяции планеты [11;18]. Результаты эпидемиологиче-чем полувековую историю [3;4]. По данным мировой ли- ского обследования в Российской Федерации свидетель-тературы гиперчувствительностью зубов страдает до 57 % ствуют о том, что данной патологией страдает около 3057,0 % взрослого населения с приростом в возрастных
