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infection, improves hygienic in-dex by 43%, reduces up to complete reduction of inflammation, enhances the non-specific protective functions of the mucous membranes and upper respiratory
tract was pronounced posi-tive effect on mucosiliartion transport the mucous membrane of the nasal cavity and sinuses.
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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-88-93
Niyazov Shukhrat Tashmorovich, Samarkand State Medical Institute Assistant Professor of the Department of Neurology, Neurosurgery,
Traumatology and Orthopedics, PhD.
E-mail: shucrat@mail.ru Djurabekova Aziza Takhirovna, Samarkand State Medical Institute Professor, Chief of the Department of Neurology, Neurosurgery, Traumatology and Orthopedics, PhD.
E-mail: shucrat@mail.ru Igamova Saodat Suratovna, Samarkand State Medical Institute Assistant Professor of the Department of Neurology, Neurosurgery,
Traumatology and Orthopedics E-mail: saodat-igamova@mail.ru
Morphological structure of encephalomyelitis and myelitis using several treatments (experimental research)
Abstract: A special place among the infectious diseases of the central nervous system (CNS) occupy encephalitis (brain inflammation), and myelitis (segmental spinal cord injury caused by acute inflammation) in children. One of the treatments, the use of which is possible in the acute stage and the recovery stage is ozone.
Thus, the proposed scientific research is devoted to solving problems identifying of morphopathogenesis CNS lesions, early morfodi-agnostik comprehensive, effective treatment, reduce disability and mortality myelitis and encephalomyelits.
Keywords: encephalitis, myelitis, perivascular and pericellular edema, ozone, glial cell, microcirculation, pathogenetic therapy.
Introduction. A special place among the infectious diseases cent years there has been a significant increase in the incidence of of the CNS occupies encephalitis and myelitis in children. In re- encephalitis and myelitis, with the number ofpatients with compli-
cated forms and subsequent disability reaches 30-45%. The mortality rate is 20-35% [1; 3; 6].
Modern methods of investigation such as MRI have high diagnostic value in the study of myelitis and encephalomyelitis, but revealing their neuroimaging features, depending on the etiology in children is practically unknown. As there is no differentiated approach to the treatment, while traditional treatment includes patho-genetics and causal treatment, symptomatic agents, as well as remediation activities. As for the causal treatment, it often turns out to be impossible, as is not always possible to specify the leading etiopathogenic factor. All the more so, specific treatments for viral encephalitis and myelitis (which take 45-55% of all lesions of the central nervous system) are not yet exist [2; 4; 10].
One of the methods of treatments, the use of which is possible in the acute stage, and the recovery stage is ozone therapy [7].
In our opinion OT must take place in the treatment of encephalomyelitis, myelitis, which is dictated by a number of positive properties of ozone: germicide, viral (antiviral) and fungicidal (antifungal) activities, immunomodulation (small doses stimulate the immune system, long — suppressed), the effect on the oxygen budget and metabolism, homeostasis system restore, restore blood oxygen, the optimization of pro- and antioxidant systems, restore microcirculation and peripheral circulation, optimization of homeostasis, stimulation of hematopoi-esis, the activation ofproduction ofbiologically active substances, the optimization of the metabolism of biological substrates of carbohydrates, proteins, lipids (bioenergetic, biosynthetic effects), analgesic, anti-inflammatory, detoxification, fibrolitic action [7; 8; 9].
The proposed scientific research is devoted to solving problems identifying morphopatogenesis of CNS lesions, early complex
morphodiagnostic, effective treatment, reduce disability and mortality from myelitis and encephalomyelitis.
Aim. To study pathologic changes in the brain and spinal cord in the experiment with the subsequent development on the basis of data obtained by new approaches to complex pathogenetic therapy.
Materials and methods. To study the morphological picture of the origin and development of inflammation (myelitis and en-cephalomyelitis), an experimental study on 110 laboratory rats weighing 150-200 g Under thiopental sodium anesthesia in a dose of 50 mg/kg 20 animals lumbar puncture will be made with the introduction of CSF from patients infected children. In this part of rats (n = 10) remains intact and is used as a control group.
The model of acute myelitis and encephalomyelitis were reproduced on a modified procedure Nozdracheva AD (year 2001). The first series (I group, n = 40) — the processes studied inflammatory reactions in animals with experimental encephalomyelitis and myelitis, which will be packed with 5 pieces on 2, 5, 9, 14 hours. The second series (II group, n = 20) — animals receiving the conventional treatment for 10 days will be scored on the 14th day. The third series (III group, n = 20) — animals treated with conventional treatment and intravenous ozonoids, scored on day 14. The fourth series (IV group, n = 20) — animals receiving only intravenous ozonoids, scored on day 14.
Results and discussion. The results of morphological brain studies in the early period (3-5 days) after the inflammatory process modeling showed that in the affected hemisphere is determined by the focus of inflammation, exciting the deep layers of the cortex, periventricular white area of the hemisphere. Directly around the inflammatory focus brain tissue is loosened, and the vacuolated cells depleted due to swelling of the brain substance.
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Figure 1.
Figure 2.
In 6-12 days after the inflammation in the affected areas of the brain are neurons, mainly in the state of swelling, lyses and disintegration. Inflammatory focus around glial cells, unlike neurons are located in the activation state, proliferation and hyperchromasia,
although also vacuolated cytoplasm. In the center of inflammation observed decrease the volume ofbrain tissue, hemolysis, on the periphery of the macrophage reaction (Figure 2).
Figure 3.
On inflammation initially reacted arterioles affected area immediately adj acent to the site ofdestruction pronounced vasodilation with an increase in capillary blood flow that is morphologically manifested expansion of the lumen of arterioles, breaking some of them to form secondary foci ofhemorrhage, as well as thinning and straightening of the structural elements of all layers ofthe wall (Figure 3).
In remote areas of the brain hemorrhage from the hearth to the experimental period are also stored swollen and minor destructive changes. On the day of the experiment 15-17 nerve fibers are subjected to focal and diffuse disintegration of places. This distal branching of nerve fibers completely lysed with the development pattern of diffuse swelling and lysis of myelin structures (Figure 4).
Figure 4. After 31 hours from the beginning of the infection. At the site of inflammation play, formed coarse-fibered connective scar tissue. Coloring: hematoxylin-eosin. X: ok.10, ob.20 (increase - 200 times).
Changes are expressed in glial cells, and propagation of its advent among these degenerative forms. Proliferative processes by glia have the focal or diffuse nature. With long-term course of the disease is observed decay and encephalomalacia brain tis-
sue in inflammation, leukocyte infiltration with perivascular and pericellular edema surrounding nerve tissue. These changes occur at 20-21 hours post-infection the experimental animals.
Figure 5.
At 55-60 hours around the source of inflammation in the brain tissue of developing common and intracerebral perivascular inflammatory infiltrates of macrophages, microglial origin. These changes are completed with the development of secondary complications such as focal and diffuse gliosis nervous tissue. In some parts of the glial tissue adhesions are formed passing into coarse fiber scars (glio-sis, neuroglial sclerosis) (Figure 5).
The results of morphological examination of the spinal cord in the early period (10-12 days) after the simulation of the inflammatory process showed that in the affected area formed the focus of inflammation, spectacular gray and white matter of the spinal cord. On inflammation initially reacted arterioles damaged area. Around the vascular tissue ofthe spinal cord loosened and swollen, there is the proliferation of glial cells and isolated lymphocytes and
monocytes. In remote areas of the brain from inflammation focus on the 13-14 day of the experiment are also saved swollen and minor destructive changes (Figure 6).
At 15-17 hours after inflammation in the affected area of the spinal cord neurons are located primarily in the state of swelling, lysis and disintegration. With this in the art neurons present with varying degrees of structural and functional changes, the severity of which decreases from the central to the peripheral zones of necrosis hearth.
On day 30 of inflammation revealed uneven plethora of vessels, a slight perivascular edema pericellular and spinal cord material. As in the brain and spinal cord develop secondary complication as diffusely — focal gliosis nervous tissue. In some parts of the nervous tissue of the spinal cord is formed by the adhesive process (Figure 7).
Figure 6. Irregularly full-blooded little vessels and perivascular edema pericellular spinal cord material. Determined by fibrotic scar
In the experimental group I were treated at different times from the onset of the disease in the traditional way by 15-17 days and continued until day 31 of the disease. In these terms against the background of positive clinical dynamics in the morphological pic-
ture is also observed positive changes: reduce the size of perivascular edema and peritselyulyarnyh nervous tissue. In the vasculature it has been a slight expansion of the lumen of blood vessels. Can not find the glial cells and scar process cortex of the brain (Figure 8).
Figure 7. After 19 hours from the start of treatment. On gistopreparate determined by the expansion of micro, small and perivascular edema peritselyulyarny nervous tissue. Colouring: hematoxylin-eosin. X: ok.10, ob.20 (increase — 200 times)
In 45-46 hours (15-16 hours of treatment) microscopically detected in brain tissue following morphological pattern: in the cortex and glial cells of the brain are found on the small size of vascular and perivascular cell infiltrates vascular connective apparatus hematogenous and local origin. The glia sections occur as a loosening and negligible intensity proliferative processes, which leads to the formation of small
adhesions. Reduces the size ofperitselyulyarnyh swelling ofnerve tissue. Formation of a large number of small adhesions leads on the border of the frontal, parietal and temporal lobes to individual scars small density.
Research traditional therapy started at 10-12 days of the disease showed that in the affected area to reduce inflammation focus in the gray and white matter of the spinal cord.
On day 30 of treatment unit vessels microvasculature in a state of irregular blood supply. In the matter of the spinal cord on a background of mild proliferation of glial cells and isolated lymphocytes
and monocytes are soft spikes, identified areas with smaller and perivascular edema peritselyulyarnymi (Figure. 9).
Figure 8. Nerovnomerno full-blooded little vessels and perivascular edema pericellular spinal cord material. Determined by fibrotic scar
Smears of the brain when traditional therapy in combination with ozone therapy. It gives more ranneyu positive clinical and morphological dynamics for 45 hours in the cortex and glial brain there are isolated vascular and perivascular cell infiltrates hematogenous and local origin. In the nervous tissue peritselyulyarnye edema are rare and
have small sizes. The vasculature vascular lumen extended slightly. In comparison with the morphological pattern after conventional therapy reduced the number of vessels in which endothelial wall has desquamation. Against the background of the use of ozone therapy are observed proliferative processes in the crust and glia (Figure 10).
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Figure 9. In the 15 hours since the beginning of the treatment. On histopreparate determined microvascular expansion, migration of leukocytes, macrophages and the formation of weakly expressed perivascular edema and pericellular nervous tissue. Colouring: hematoxylin-eosin. X: ok.10, ob.20 (increase — 200 times)
For 50 days in the cortex and the brain glial cells reduces the number of vascular and perivascular cell infiltrates vascular connective apparatus hematogenous and local origin. Pericel-lular nervous tissue edema is also significantly reduced in size. The blood vessel lumen glia slightly expanded in areas adjacent to the cortex. In the cortex, and brain matter after this treatment is not detected scar process. This suggests that our
proposed method of treatment more effective, even in the later stages of treatment.
It is also noted the positive dynamics in the spinal cord substance occurs 2-3 days earlier. Identifies individual capillaries lumen which is not completely filled with the blood formed elements, and around them there was a slight perivascular edema and peritselyu-lyarny spinal cord substance (Figure 11).
Figure
In the matter of the spinal cord is not detected the proliferation of glial cells and lymphocytes and monocytes are no spikes. However, in the white and gray matter of the spinal cord there are areas with low and perivascular edema pericellular.
In order to determine the effect of ozonoids on the structure of rat brain and spinal cord material. In the control group of five rats was administered intravenously ozonoids. The study of morphological picture of the introduction ozonoids revealed no differences in the structures of the substance of the brain and the spinal cord of rats compared to control animals not treated with ozonoids.
Conclusions. In the middle of inflammation in the damaged brain tissue react glial cells and the cell walls of the microvasculature. When playing an inflammation in the brain tissue in the early stages of developing the original edematous phenomena associated with the activation and generation of factors damage glial cells and vascular wall cells. Following this fast-destructively joined predominance of necrotic changes in neuronal and glial cells. These destructive-necrotic changes in inflammation and in the circle are developing regenerative response of inflammatory reactions in the form of expan-
sion vessels, the migration of leukocytes, monocytes in the hearth of destruction, proliferation of microglia to the transformation on macrophages, the formation of inflammatory cell necrosis demarcation around the shaft. When inflammation of the spinal cord at the early stages of developing primary edematous effects associated with damage to glial cells and vascular wall cells. Thereupon rapidly predominate destructive-necrotic changes in neuronal and glial cells.
Against the background of traditional therapy started in the early stages in the morphological changes found in the picture better than treatment, started in the later periods.
Against the background of traditional therapy for myeloma, a positive trend in clinical and morphological picture is earlier than when conventional therapy encephalomyelitis.
Traditional therapy started even later date in conjunction with ozone therapy provides a positive morphological dynamics in the nervous tissue of the brain is already 21 days of treatment.
In conventional therapy combined with ozonoids of myelitis, positive morphological dynamics occurs earlier than when conventional therapy myelitis.
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