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Section 6. Medical science
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Zakirkhodjayev Murod Asrorovich, Deputy chief of the adults' clinic of Tashkent Pediatric Medical Institute
E-mail: [email protected]
New approaches to diagnostics and conservative therapy methods of flat- footedness in children
Abstract: The efficacy of the application of electrophysiological tests, including computer planography, which reflect characteristics of flat-footedness in children, was determined. Conservative therapy methods applied at the early stages of flat-footedness formation provide correction of the anatomical integrity and mobility of foot. Keywords: flat-footedness, diagnostics, conservative therapy, children.
On the modern stage of orthopedics development sufficient tients. That specialists' interest promotes detalization of pathologic attention is paid to the problem of flat-footedness; new multifunc- manifestations and design of high quality diagnostic and therapeutic tional devices are designed for diagnostics and treatment of the pa- methods. Earlier used strategies are replaced by more physiological
New approaches to diagnostics and conservative therapy methods of flat- footedness in children
and effective ones [1, 4]. Among the various means and methods of improving of diagnostic and therapeutic efficiency one of the first places is taken by early detection of flat-footedness and coordination of the performed therapeutic activities by related specialists. The problem of the most perspective branch is principally important and crucial [2].
Bilaterality of the pathologic process, alterations of the functions of muscular-ligament apparatus, dysplastic impairments, changes of biomechanics of skeletal system have quite strict requirements of diagnostic and therapeutic character.
Analysis of target researches of the flat-footedness problem in children showed that that disease is represented by 12% in the total number of bone system pathologies and it demands targeted diagnostics and correction [3]. In relation with the versatility of flat-footedness problem and formation of various forms, the problem should be solved in young age [2; 4].
The objective of the study is improvement of the diagnostics of flat-footedness and methods of rehabilitation treatment.
Materials and methods: The study was held in 1427 children from 1 to 14 years old among which in 12.8% cases (182) we detected the symptoms ofvarious degrees flat-footedness. Prevalence of the pathology was observed mostly in boys — 100 children (54.9%), in comparison with girls -82 (45.0%). Frequency of the revealed flat-footedness was mostly revealed in 3-7 years old age (64.8%).
For the definition of flat-footedness degree we used method of computer plantography, myography (2-channel electromyography MGST-01, «Medicor», Russia), podometric (change of foot arch height, length, width, level ofpronation, abduction, adduction with further calculation of Friendler's index), roentgenography ("Unex" Denmark). Biochemical tests included the study of oxyprolin in urine (colorimetric) before and after the performed therapy.
Statistic processing was done in "Medstat" program with calculation of Student's coefficient.
Results and discussion: Dependently on the achieved clinical-diagnostic parameters we classified 3 degrees of deformation severity: severe, mild and slight.
In severe deformation in 49 children (68 feet) we determined sole prominence; equines-valgus position ofheel; anterior part was located in the extensor position, abduction to 75 ° and pronation to 35 °. Deformation was rigid and accompanied by expressed tension of extensor tendons of foot and triceps muscle of shin. In the children with severe deformation degree the load was given to the middle part offoot, and anterior and posterior parts performed just supporting function. Majority of children (62%) had lameness, instability and excessive swinging of the body while walking. Radio-logically in saggital plane we determined expressed equines position of astragalus and heel bones; astragalus-tibial angle varied from 150° to 190°, heel-sole from 16 ° to 35 °. In sole, astragalus-scaphoid and heel-cubiform joints there were drifts of bones such as dislocations (32%) and subluxations (37%). Longitudinal fornix was absent. On x-ray with load equines position of heel bone, retro reflexion of the anterior part increased, and correlation in sub-astragalus joint worsened. Position of astragalus, heel and first metatarsal bones in the frontal plane was evaluated by means of correlation of their axis to foot axis, which was lined through the middle of the distance between ankles and the center of the 2nd metatarsal bone basis. Angles formed by bone axis and foot axis (medial foot line) were called medial ones. Enlargement of medial-astragalus and diminishing of medial-heel angles as a result of valgus position of astragalus and heel bones was characteristic for congenital flat valgus deformation.
In the majority of the cases of mild degree deformation in 38 children (74 feet) there were symptoms of congenital vertical astragalus (CVA), both clinical and radiologic less expressed than in cases of severe deformation. Leading differential features were decrease of sole slope of astragalus (astragalus-tibial angle 130-150°), possibility of partial correction of the deformation and absence of expressed retro reflection of the anterior part of foot in children who start walking (29%).
Slight degree deformation in 14 children (23 feet) had no features of congenital vertical astragalus (CVA) and it was characterized by valgus position of foot completely correctable. Deviations in radiologic values were minimal and didn't involve all characteristics: there was moderate equines-valgus position of astragalus and decrease of sole slope of heel bone to 11.1±2.0 °. Longitudinal fornix was preserved. In astragalus-scaphoid joint ratio of bones in saggital plane was regular different from more severe deformations, and in the frontal plane there were noted lateral subluxations (14%), while in severe and mild degree deformations drifts in saggital plane were prevailing.
Electrophysiologic (EP) test of the functional status of neural-muscular system in 80% of the children revealed severe impairments such as disorder of reciprocal muscles-antagonists to shin, pathologic structure of electromyogram: decrease of the amplitude and frequency ofpotentials, decrease ofpolyphase, hyper synchronization, potential "volleys". Among the altered characteristics ofEP of manifestations of Achilles' reflex there was high amplitude and irregular form of it, irradiation to antagonist. There was notable decrease of the activity of gastrocnemius almost two fold — 281.9±29.2 mkV/s with normal 444.1±49.2 mlV/s., the level of electric activity of foot extensors was similar to healthy children.
In 96.8% patients with congenital flat-valgus deformation of feet we revealed symptoms of myelodysplastic organic lesion of neural system, including muscle hypotension, anisoreflexia, hypo and areflexia, pathologic reflexes. Symptoms of neurogenic pathology were associated with dysplastic development of lumbar-sacral part of vertebral column. Manifestation of bone and ligament vertebral dysplasia was longitudinal and transverse hypo genesis of vertebral arches, pathologic segmentation of sacrum, transient vertebra, congenital semi-vertebra, congenital concrescention and aplasia of vertebra, instability of vertebral bodies in relation to proximal part of vertebral column.
Plantographic test revealed not only change of the form of computer pattern, but also diminishing of both longitudinal and transverse sizes to 1/3 appearing as a result of equines position of heel bone and pronation position of the anterior part of foot. We detected impairment of the ratio between heel and toe. The values of sub-fornix space (according to Stritter) was 111.7±2.9%.
Originally the achieved data analysed in the aspect of dysfunctions of connective tissue testify increase of oxyprolin secretion in children with flat-footedness, which was motivated by alterations in exchange processes. Reliability of the results underlines direct correlation of the age and oxyprolinuria.
Performed studies provided design of the scheme of conservative therapy. In the younger age (1-3 years old) with compensated alterations in exchange processes with sufficiently correct therapeutic tactics, combination of correction bandages, massage, therapeutic coniferous-salty baths, correction ofposture, administration of vitamin complexes (complevit, oligovit, "Jungles", "Multitabs", Vit B6), methods of therapeutic physical training the involution of connective tissue was quite positive. Deformations in children, who underwent one-moment correction, were corrected with the help
Section б. Medical science
of stage plaster casts; foot was fixed (27%) for 3-4 months. In the middle position we performed selective and pressure point massage, correction gymnastics. When start walking correspondingly to the age children were trained exercises for strengthening of muscles of shin and they were prescribed to wear orthopedic shoes with straight last, fornix and heel arch supporter laying out, external hard tibia, bearing of the heel inside and prolongation of the inner crocle. In the elder age (4-14 years old) there is necessity of longer therapeutic courses and continuous wearing of arch supporter inner sole. Course (4 times a year) administration of multi vitamin agents, correction massage, and therapeutic physical training stimulating exchange processes have quite positive effect on the restoration of ligament apparatus of sole and back surfaces of foot.
Complex therapy performed in compliance with the proposed strategy provided significant correction of the anatomic integrity of the feet, improvement of its physiologic status and mobility. Besides
that, the study of oxyprolinuria revealed the tendency for decrease of its amount dependently on sex and age peculiarities.
Conclusion. Versatility of the flat-footedness problem and formation of various forms of it, therapeutic problem should be solved in young age. Prevalence of flat-footedness is greater in 3-7 years old age group. Electric physiologic test of flat-footed-ness determines decrease of gastrocnemius activity 2 fold, and activity of foot extensors stayed in the limits of normal values. in cases of flat-footedness in children the symptoms of neurogenic pathology combined with dysplastic development of lumbar-sacral part of vertebral column. In computer planography we revealed diminishing of longitudinal and transverse foot sizes to 1/3 as a result of equines of heel bone and pronation of the anterior part. Conservative therapeutic methods applied at early stages of flat-footedness formation provide correction of anatomical integrity and mobility of feet.
References:
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Zakirkhodjaev Sherzod, Department of Internal Medicine, Haematology, Tashkent Medical Academy, Republic of Uzbekistan Shamsutdinova Maksuda Ilyasovna, Department of Internal Medicine, Haematology, Tashkent Medical Academy, Republic of Uzbekistan Kamalov Zaynitdin Sayfutdinovich Iinstitute of Immunology Academy of Sciences of the Republic of Uzbekistan E-mail: [email protected]
Features the production of cytokines in chronic pancreatitis and pancreatic cancer
Abstract: With respect to the blood levels of pro- and anti-inflammatory cytokines in the 40 patients with chronic pancreatitis (CP), and pancreatic cancer (PC), there was a significant increase of interleukin-2 receptor (IL-2R) and interleukin-6 (IL-6) as compared to healthy controls. Clinical and laboratory analyses revealed an enlargement of the pancreas in 32 (80%), and of the spleen in 3 (7%) patients, respectively. Elevated bilirubin was present in 17 patients (41%), significantly elevated lipase, gamma-glutamyltrans peptidase and alkaline phosphatase activities were found in 24 (62%) patients. ALT and AST activities were significantly elevated in 20 (50%), moderately elevated (3-5 xULN) in 6 (15%) patients and slightly elevated (1.5-3 x ULN) in 14 (35%) patients. Serum albumin levels were reduced in 21 (51%) patients. The tumor markers CA 19-9 was elevated in 15 (38%) patients with a tumor in the head of the pancreas that was confirmed by computer tomography. The results indicate that cytokines are activated in patients with CP and PC respectively. This activation is accompanied by an increased levels of pro-inflammatory cytokines IL-2R, IL-6, TNF-a and INF-y, which closely correlate with the major pathological clinical and laboratory parameters in these patients.
Keywords: Chronic pancreatitis, cytokines, pancreas carcinoma, pathogenesis.
Introduction. In recent years, the interest of clinicians in of CP has increased due to the better understanding of the pathogenesis of CP and PC. The role of cytokines as an important link the
regulation of inflammation and pancreas regeneration in patients with CP remains unclear however. All pro-inflammatory cytokines examined in this study (IL-2R, IL-6, TNF-a) have been shown to be
