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Neurocorrection of the spina bifida complicate
As appears from the above, in comparison with thoracotomy atypical resection, videothoracoscopic operations have been preferred. Exudation from the pleural cavity and terms of drainage appeared to be significantly higher after atypical resections of the lung, performed by thoracotomy approach in comparison with videotho-racoscopy. On the average the terms of drainage of the pleural cavity after videothoracoscopic atypical lung resection appeared to be reliably shorter (3.16 ± 0.15 days) in comparison with thoracotomy operations (4.30 ± 0.31 days) in P < 0.01.
Conclusions
1. Introduction of videothoracoscopy into the clinical practice widens possibilities of the surgical treatment
of metastases. Association of the high informativity and small invasiveness of the intervention allowed to increase in the contingent of patients undergone to surgical treatment.
2. The long-term results of the surgical treatment of the solitary metastasis are satisfactory — 5-year survival are observed in the third of cases.
3. The active surgical tactics in single and multiple metastases is also confirmed in the complex treatment allowing achievement of 3- and 5-year survival in this group of patients. In the selective contingent of patients it is possible videothoracoscopic lung resection.
References:
1. Chissov V. I., Trakhtenberg A.Kh., Pikin O. V. et al. Metastatic lung tumors. - M.: Geotar-Media, 2009. - P. 101-109.
2. Atanasyan L. A., Ribakova N. I., Poddubniy B. K. Metastatic lung tumors. - M., 1977. - 182 p.
3. Trachtenberg A. Kh., Chissov V. I. Metastatic lung tumors. Clinical oncopulmonology - M., 2000. - P. 543-557.
4. Davidov M. I., Matveev V. B., Polockiy B. E., Matveev B. P., Nosov D. A. Syrgical treatment of cancer metastasis in the lung//Ross. Onkolog. Jurnal. - 2003. - № 4. - P. 15-19.
5. Potanin V. P., Konovnin O. I., Khalilov I. D., Khasin V. V., Potanin A. V., Sigal R. E. Surgical treatment of metastases into the lungs. Materials of IX of Republican Oncological Conference. - Kasan, 2002. - V. 6. - P. 85-89.
6. Eichfeld U., Dietrich A., Ott R., Kloeppel R. Video Assisted Thoracoscopic Surgery for pulmonary Nodules After Computed Tomography-Guided Marking With a spiral Wire//Ann. Thorac. Surg. - 2005. - Vol. 79, № 1. - P. 313-316.
7. Crow J., Slavin G., Kreel L. Pulmonary metastases: a pathologic and radiologic study//Cancer (Philac). - 1981. - Vol. 47. - P. 2592-2602.
8. Willis R. A. The spread of tumors ofthe human body 3rd ed. - London, Butterworth, 1973. - 170 p.
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10. Ribakova N. I. Metastatic tumors of the lungs In: Roentgenodiagnosis of diseases ofthe respiratory organs. - M.: Medicine, 1978. - 391 p.
11. Samsonov V. A. Metastases of kidney cancer (by autopsy data)//Voprosi onkologii. - 1986. - 32: 78-81.
12. Nielsen O. Role of systemic treatment in adult soft tissue sarcomas// Eur. J. Cancer. - 2003. - Suppl. 1(6): 249-259.
13. Matveev V. B., Stilidi I. S., Toygonbekov A. K. et al. Surgical treatment of the metastases of the kidney cancer into the lungs//Vestn Kirgiscko-Rossiskogo Slavanskogo Universiteta. - 2003. - 3(7)//[Electronic resource]. - Available from: http://www.krsu.edu. Kg/vestnik/2003/v7/a29.html
14. Starodubcev A. L., Kurilchik A. A., Kudravtseva G. T., et al. Combined treatment of the metastases of the bone and soft tissue sarcoma into the lungs//Sibirskiy onkologicheskiy jurnal. - 2010. - 5(41): 54-58.
15. Bezzi M., Forte A., Nasti G. et al. Surgical treatment of lung metastasis: experience with 108 cases//G. Chir. - 2003. - Vol. 24, № 1. - P. 351-356.
Usmankhanov Odilkhon Auybhanovish, Assistant at the Neurosurgery department of Tashkent Pediatric Medical Republican Scientific Center of Neurosurgery
E-mail: odilkhon@list.ru
Neurocorrection of the spina bifida complicate
Abstract: Of 25 patients with lipomyelocele underwent the surgical treatment. The essence of the operation was to conduct an additional laminocktomi with deficsation of a spinal cord. Keywords: lipomyelocele, spine bifida, tetring hord.
Congenital spinal hernia of the lumbosacral localization in children in mind a variety of morphological forms and severity of clinical manifestations is a complex problem of pediatric neurosurgery. The spina bifida complicate consist of 35 % of all the lumbosacral malformations [1; 3], and the fifth part of them belongs to lipomyelo-meningocele. Many aspects of the surgical treatment of spinal neural tube defects are well established. There are different opinions regards the tactics of the surgical treatment of lipomatous processes. Some authors believe it is necessary to undertake the surgery on the progression of the neurological symptoms; other researchers adhere to the earlier surgery [2; 4; 6]. In a standard situation the examination and surgical treatment algorithm of spina bifida is usually carried at the
average age of 6-7 years, and in some cases patients are operated in the age of 20-30 years old. In addition, the volume of surgical intervention is often limited to removal of only the part of extravertebral and extradural lipomas just with changing only the cosmetic appearance of the patient. In such cases the spinal cord is maintained to be fixed, and after the surgery the neurological symptoms progresses due to the growth and development of a child [5; 7; 8; 9; 10]. The aim of our work was to improve the results of surgical treatment of spina bifida complicate, by improving the diagnostic process and a rational, reasonable pathogenetic surgical tactics.
Material and methods. Our clinical observations are presented in 25 patients (17.8 %) of all patients with spina bifida complicated
Section 5. Medical science
by various lipomas, which are examined and treated from the period of 2004-2011 at the clinic of Tashkent Pediatric Medical Institute and Tashkent Regional Diversified Center. Individuals contained males were 7 and females 18. The main contingent of patients ranged from the age of 1 to 16 years. In 20 observations localization of lipoma was in lumbosacral, 3 in lumbar and 2 in thoracolumbar area. 19 observations of lipomyelocele localization were at a midline and 6 were more often lateralized at the left side. Patients underwent a comprehensive examinations: clinical, neurologic, MRI of the brain and spinal cord, neuroophthalmic inspection, medical and genetic screening, EEG, electro-neuromyography. Next invasive surveys were used: MSCT- hernia-, myelo and cisternography. There were 8 patients with transient form of lipomyelomeningocele, 12 patients with caudal and 5 cases with dorsal forms.
Table 1. - The combination of spina bifida complicate with other disorders
Disorders Number
of observations
Arnold Chiari malformation 12 (48 %)
Diastematomyelia 1 (4 %)
Syringomyelia 7 (28 %)
Dermal sinus 2 (8 %)
Scoliosis 6 (24 %)
Pseudo-dermoid 7 (30 %)
Shortening of limb 4(16 %)
Clubfoot 5 (20 %)
Violation of fusion of the vertebral bodies 4(16 %)
Pigment spot 7 (30 %)
Hypertrichosis 4(16 %)
Low hair growth 1 (4 %)
As it is seen from the above data, in 12 (48 %) cases lipoma is often combined with the Arnold-Chiari malformation syndrome. In 4 cases after the late access of the patients to a neurosurgeon there were observed the trophic disorders of the skin of the buttocks and the lower leg, in 1 case — osteomyelitis of the calcaneus, 1 observation of a gangrene of the foot and the lower third of the leg. The clinical manifestations of patients with diseases have been very diverse and reflected the overall status of disorders. Characteristics and frequency of these symptoms in patients with spinal lipoma is shown in Table 2.
Table 2. - Characteristics and frequency of the clinical symptoms in patients with lipoma
In our material there were patients under of one year of age who were accessed more frequently. There are the key neurological manifestations of this disease, which are: bladder dysfunction (54.5 %), violation of the movements of the extremities (59 %) and wasting of the lower limbs (63.6 %). The incidence of neuro-orthopedic anomalies amounted to — 50 % (scoliosis, clubfoot) cases among patients with lipoma.
Surgical treatment was performed in all 25 patients. Patients with a combination of lipoma and Arnold-Chiari malformation underwent the bone-dural decompression of the cervical-occipital region (12 cases) as the first stage of surgery, and at the second stage — excision of the lipoma. In the absence of progression of clinical manifestations of hydrocephalus and syringomyelia in relation to these anomalies the surgeries were not performed.
The strategy of spina bifida complicate surgery were regarded with the position of reconstruction of a vertebro-medullar anomalies which included the following key points: 1) adequate access, allowing to provide a surgical technique and direct visualization at all stages of the intervention; 2) mobilization and allocation ofhernial ring; 3) the possibility of radical resection of lipoma; 4) meningo-radikulomyelolysis; 5) plastic of the brain dura from the position of reconstruction of subdural space; 6) external drainage of the formed subdural cavity; 7) musculo-fascial plastic bone defect.
To achieve this aim the following methods of a surgical techniques were used: In 12 children were undertaken the additional resection of the non imperforated arches, laminectomy of the 1-2 vertebrae were performed in 9 children, radical resection of an adipomas were done in 2 patients, subtotal resection of lipomas is produced in 23, meningora-dikulomyelolisis were performed in 11 of patients. When there were considerable defects of the dura and stitching the edges of which led to a narrowing of the subdural space the plastic of the dura was done with artificial material, which was performed in 5 patients. Full defi-csation of the spinal cord was achieved in 1 patient, partial — at 24. Muscle — fascial hernia gate plastic were performed in 7 patients.
Results and discussion. After the osteo-dural decompression of the 12 patients only 7 of them observed various changes. After the first stage of surgical correction of the combined defect the following changes were found: 1) improvement of the sensitivity of the limbs and anogenital region that was observed in 1 patient; 2) 3 children appeared urge to urine and feces; 3) 2 observations recorded a decrease in feelings of heaviness in the legs; 4) In 2 cases the pain in the leg was gone. In addition, the consistency of the hernia sac became orthostatic dependent in two patients (horizontal protrusion was supple and soft, and vertically — acquired puffy shape). In two cases it was the observed transient dizziness and rare vomiting.
After reconstruction of the vertebro-medullary anomalies of 18 patients, 7 ofthem observed positive results and 2 patients suffered from worsening of the neurological status. Positive results were considered as: 1) sensitivity improvement observed in 2 cases; 2) increase in range of motion — in 3; 3) Improving the monitoring function of the pelvic organs — in 3; 4) normalized the spastic tonus of the toe finger flexors — 1; 5) improvement of the ream trophic — in 2; 6) cessation of a headache — in 1 patient. Postoperative negative effects were as follows, increase of motor deficit — in 3, in one case there was a wound liquor rhea and transient pseudomeningocele were observed in 2 cases.
Thus, the relatively small clinical material confirms the position that the diagnosis and treatment of the spina bifida complicate is quite complicate, multi-step and mixed process. Only adherence to the principles of meticulous specification and pedantic surgical strategy, supplemented by physiological permissibility and technically possibility, can ensure an acceptable result.
Characteristic symptoms Number of patients
Epileptic syndrome 1
Local pain in the bulge area 3
Lower flaccid paraparesis 6
Lower flaccid monoparesis 7
Hypoesthesia of both legs 6
Hypoesthesia of anogenital area 3
One leg hypotrophy 11
Both legs hypotrophy 3
Urinary incontinence 11
Bowel incontinence 12
Urinary retention 2
One leg hypotension 5
Both legs hypotension 8
Pasty legs 2
Ankle jerk 1
Bone deformation of the hernia 5
Study of the state of some cytokines in patients with urogenital ureaplasmosis and chlamydiosis
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Fattakhov Bobir Shavkatovich,
Porsokhonova Delya Fazilovna,
Ibragimova Gulnora Rustamovna,
Rakhmatullaeva Sevara Nodirbekovna, Republican Specialized scientific-practical medical Centre of Dermatology and Venereology of the Health Ministry of the Republic of Uzbekistan, Tashkent E-mail: fattahov_bob@mail.ru
Study of the state of some cytokines in patients with urogenital ureaplasmosis and chlamydiosis
Abstract: The state of some cytokines was studied in patients with urogenital ureaplasmosis and chlamydiosis in this scientific work. The analysis of the obtained data demonstrates that at urogenital ureaplasmosis, chlamydiosis and their association the disease proceeds against violation of development of cytokin in an organism. Keywords: ureaplasma, chlamydia, the immune system, cytokines.
The incidence of mixed infection (ureaplasma and chlamydia) increase the genitourinary system and causes serious complications in last years, both women and men [1; 4; 5; 11; 19]. Among human infectious diseases at a fraction of mixed infections account for up to 50 % of cases [13].
The peculiarity of the modern trend of urogenital infections is their frequent association with each other, with diseases caused by other microorganisms, multifocal lesions, few symptoms, severity of complications and the difficulty of therapy [1; 10].
The ubiquity of chlamydia, urea- and mycoplasma infection is due to the frequent persistence of agent reservoir with asymptomatic course of the disease [14]. However, despite the mostly torpid and subjectively asymptomatic course, urogenital chlamydiosis ureaplasmosis and can cause serious complications in patients on the part of the pelvic organs [2; 17].
In men, the incidence rate most of these diseases is higher than in women as in men clinically they proceed intensively, as a consequence, men are more likely to seek health care [8; 16].
In recent years, an increasing number of patients with sexually transmitted infections, with varying degrees of severity immmuno-defitsitnye of different genesis as asymptomatic, and with a variety of clinical manifested [9; 12].
This not only prevents the elimination of the pathogen and the complete rehabilitation of the body, but also creates conditions for the development of different immunopathological reactions. Against develop immunodeficiency current infectious process most of varying etiology can wear chronic, prolonged or frequently recurrent nature [6; 7; 18].
Among the most important factors of natural and adaptive immune system include interferon and other cytokines. STI different nature are accompanied by a series of production of proinflammatory and anti-inflammatory cytokines, which are monitored to judge the severity of these diseases, their course and outcome, as well as on the effectiveness of the therapy.
The largest informational value STI are cytokines such as IFN-a, IFN-y, IL-10, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18 and TNF-a. For example, IFN-y, IL-1p, TNF-a plays a decisive role in combating chlamydial infection, with the development of persistent chlamydial infection depends on the changes in the concentration of IFN-y [15].
The foregoing indicates that urogenital chlamydia and ureaplasmosis develops on the background certain immuno-logical changes that the correction allows for adequate and effective treatment.
