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Section 4. Medical science
3. Kaijser M. Perinatal Risk Factors of Ishemic Disease: Disentagling Roles Birth Weight and preterm Birth. Circulation -2008, - 117: 405-410.
4. Guriev D. L., Okhapkin M. B., Karpov N., Blinov D. V. Course and outcome of pregnancy complicated by preeclampsia, depending on the type of maternal central hemodynamics. Obstetrics and Gynecology - 2011, - 7-2: 14-19.
5. Arzhanova O. N., Kapustin R. V., Komarov E. K. et al. The pathogenetic mechanisms of obstetric complications in gestational diabetes. Journal of Obstetrics and women’s diseases - 2011; - 5: 3-10.
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7. Tully L., Gates S., Brocklehurst P. et al. Surgical techniques used during caesarean section operations: results ofa national survey of practice in the UK. European Journal of Obstetrics & Gynecology and Reproductive Biology - 2002, - 102: 2: 120-126.
8. Kulakov V. I., Barashnev Y. I. High-risk newborns. - Moscow: GEOTAR Media, - 2006. - 528 p.
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10. Signore C., KlebanoffM. Neonatal morbidity and mortality after elective cesarean delivery. Clin Perinatol - 2008. - 35: 2: 361-371.
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Usmanov Shukhrat Urazalievich, senior scientific assistant, Research Institute of Traumatology and Ortopedics, Healthcare RUz
Djuraev Ahror Mahmudovich, Doctor of Medical Sciences, professor, Head of the department of pediatric orthopedics, Research Institute of Traumatology and Ortopedics, Healthcare RUz
E-mail: mbshakur@mail. Ru
Optimization of detection and treatment osteoporosis in children
Abstract: the combination of distal Us-densitometry and roentgenoabsorbtiometry is high informative method of diagnosis and monitoring for osteoporosis and osteopenia in pediatric practice. Timely pharmacotherapy correction osteoporosis and allows to prevent the decrease of bone mineral thickness and increase the given index. Keywords: osteoporosis, osteopenia, bone mineral thickness, children.
Topicality. Osteoporosis (OP) is the most often metabolic disease of human skeletone, being characterized with the decrease of bone mass to the unit of bone volume wih-tout changing it’s mineral and organic components’ ratio, being accompained with microarchitectural disorders of bone tissue, leading to increase of bones’ breaking and fractures’ risk [2; 5; 7]. Last decades carrying out epidemiologic studies convincingly proved, that OP problem is associated with the childhood (1). The disorder of bone formation process or chronic diseases lead to decrease of bone firmness already in the childhood, and, as sequense, to increase OP risk development, and, bones fractures in future [4].
Epidemiological data witness that maximum fractures in childhood cover from 5 to 7, and, from 13 to 14 years old people, and it can be caused with considerable inlargement ofbody length at that period on the background of age bone mass. Except that, last time the cases of osteoporosis in children became
more often as the symptom of different diseases, that allows to consider the children to have chronic pathology group with high risk of osteroporosis development [2]. Polyaetiologicity, polymorphism of clinical picture, small amount of diagnostic devices, allowing to reveal decrease of bone mineral thickness (BMT) at the early stages, make difficult the fight with OP. It leads to large material expenses at treatment the given patents and early disability in their working able age [1-4].
At the modern stage of orthopedics there is no possibility to work out algorythms combinations of ultrasound distal densitometry and reontgenoabsorbtiometry in ambulatory practice and program of complex treatment patients with given pathology, demanding further investigation.
The aim of study: evaluation of pilot introduction results in practice of ambulatory diagnosis for methods of distal Us-densitometry and reontgenoabsorbtiometry as the reviewer method.
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Optimization of detection and treatment osteoporosis in children
Materials and methods: The study was carried out in out-patient conditions at 78 children (5-14 years old), having chosen with random sampling from the number of adressing to pediatrician, surgeon, traumatologist, endocrinologist. Boys were 37 (48 %), girls were 41 (52 %). According to the methods of taking diagnosis the patients were divided into 3 equivalent groups by anthropometric indices: gpoup 1 (24) with taking standard diagnostic algorythm without Us-densitome-try; group2 (23) with Us-densitometry (Omnisens-7000) in children with osteopenia (OSP) and OP, when the treatment was performed only by the orthopedist; group 3 (31) with taking Us-densitometry at risk OSP and OP at joint treatment of orthopedist and specialist ofX-Ray diagnosis. The reontgeno-absorbtiometry (DTX-200, Denmark) of forearm bones was carried out as reviewer method of evaluation BMT.
At revealing OSP (T-criterion is from - 1 to 2, 5) in children of group 2 and 3 the preventive and dietary recommen-dationns were given. At revealing OP (T-criterion from - 2,
5 and lower) in children of groups 2 and 3 the continious course of calcitonin per 200 ME intranasally in combination with calcium (500-1000 mgl/daily) and VitD (400800 ME/dialy) were prescribed.
The children with revealed OSP and OP, on the back ground of treatment the control of Us-densitometry once per
6 months, were recomendead. The reontgenoabsorbtiometry was carried out once a year.
Results and discussion: There are presented data on age and sex contingent of examined children, being compared with the age criteria, marked with little overweight of the girls’ number, in table 1.
Table 1. - General age-sex characteristics of patients (%)
Groups Total Middle age Boys Girls
Abs % Abs %
Group 1 24 (30,7 %) 12,2 ± 1,3 11 14,1 13 16,6
Group 2 24(30,7 %) 13,1 ± 1,2 12 15,3 12 15,3
Group 3 30 (38,4 %) 12,3 ± 1,2 14 17,9 16 20,5
Total 78 (100%) 12,4 ± 1,3 37 47,4 41 52,5
The initial data patients for group 2, who were prescribed Us-densitometry, being observed by the orthopedist, OSP was revealed in 16 children, and by the data of reontgenoabsorbtiom-ety it was in 15 (one boy’s T-criterion was 0, 98). The number of patients with revealed OP by the data of Us-densitometry were 7 people, and, in control reongenoabsorbtiometry it was also 7.
In group 3 the initial number of patients with taken Us-densitometry were 30, number of persous with revealed OSP were 20 children, by the data of reontgenoabsorbtiometry they they were 20. Number of children wihn OP were 20, by the results of roentgenoabsorbtiometry they were 12.
The number of prescribed Us-densitometries at children in group 2 were by 1.84 times more than it was in group 3.
The analysis of taken of taken results in examined groups revealed, that in group 1 the standard diagnostic algorythm was used without Us-densitometry and reontgenoabsorb-tiomety. In group 2 from 24 children 15 revealed OSP, and 7 had OP. In group 3 the number of presriptions for Us-densitometry by the treating physician together with X-Ray doctor were 30 patents, from those 20 revealed OSP and 12 revealed OP.
Table 2. - Rate of primary revealing osteopenia and osteoporosis in examining groups (%), Number of patients (%)
Groups Us-densitometry Osteopenia Osteoporosis Fractures
Gr. 1 (n = 24) - - - 6
Gr. 2 (n = 24) 24 15 7 2
Gr. 3 (n = 30) 30 20 12 1
Total 4 (n = 78) 54 35 19 9
The analiysis of primary rate for revealing OSP and OP, coming from the ratio: the number of revealed osteo-penia/osteoporosis/the general number x 100 % in groups revealed, that the rate of ostopenia display in group3 was 66, 6 %, that is by 0.6 times higher than in group 2, where the given index was 62.5 %.
The rate of osteoporosis revealing in group 3 is 40 % that is in 1.8 times more than in group 2, where it was determined with 29.1 % index. The rate of osteopenia and osteoporosis revealing in the examined patients group 3 was higher than in group 2, that shows the more effective algorythm of revealing OSP and OP with the way of Us-densitometry, being coordinated between orthopedist and X-Ray doctor.
At analiysis of taken results for Us-densitometry in patients with osteoporosis, belonging to examining groups
2 and 3 on the background of trealtment with calciotonin in combination with calcium and Vit. D, the true statistic increase of BMT is abserved for 3 years of observation. The data, being taken with the method of roentgenoabsorbtiometry, prove the data of Us-densitometry (table 4).
By the data of roentgenoabsorbtiometry in patients with osteoporosis, belonging to groups 2 and 3, on the background of treatment with calciotonin in combination with calcium and Vit. D, it is observed the true increase of BMT for the next
3 years of observation. It can be marked the positive effect of treatment with calcitonin in children of groups 2 and 3, being proved with increase of BMT.
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Section 4. Medical science
Table 3. - Results of Us-densitometry (Laverage significances of T-criterion ± CKO)
Month of examination Patrents with osteoporosis (n = 19) T-criterion
March is primary examination -2.87 ± 0.41
November is control in 6 months -2.56 ± 0.26
May is control in 6 months -2.19 ± 0.18
December is control in 6 months -1.79 ± 0.31
March is control in 6 months -1.55 ± 0.22
December is control in 6 months -1.34 ± 0.19
March is control in 6 months -1.22 ± 0.21
December is control in 6 months -23 ± 0.36
Table 4. - The results of roentgenoabsorbtiometry (average) significanse of T-criterion ± CKO
Months of examination Patients with revealed osteopenia (n=35) T-criterion
March is primary examination -2.78 ± 0.37
May is secondary examination -2.21 ± 0.31
March is control examination -1.49 ± 0.24
March is control examination -1.25 ± 0.18
Conclusions: Putting into practice of children’s examination the method ofUs-densitometry with the aim of diagnostic algorythm on revealing OP and OSP in children allows to make timely diagnosis, and, to treat the given pathology, that leads to decrease the fractures’ number in the examining
contingent. The combination of distal Us-densitometry and roentgenoabsorbtiometry is high informative method of diagnosis and monitoring for OP and OSP in pediatric practice. Timely pharmacotherapy correction OP and allows to prevent the decrease of BMT and increase the given index.
References:
1. Benevolskaya L. I. Manual on osteoporosis. - M: Medicine, - 2007. - P. 23-28.
2. Kotelnikov G. P., Korolyuk I. P., Shehtman A. G, X-Ray diagnosis of osteoporosis: modern state and perspectives//Clinical medicine. - M., - 2008, - W3. - P. 66-70.
3. Radionova S. S., Morozov A. K., Lyaginskiy A. V. Evaluation of diagnostic significance of osteodensitometer DXL Cals-can-the first serial device, being found on three-component model of tissues.//Osteoporosis and osteopathy. - M, -2006. - W. - P. 12-17.
4. Rojinskaya L. Y. Part of calcium and Vit. D in phophylaxy and treatment osteoporosis.//Osteoporosis and osteopenia. -M, - 2009. - W2. - P. 37-40.
5. Borges J. L. C., Brandao C. M. A. Low bone mass in children and adolescents//Arq. Bras. Endocrinol. Metab. - 2006. -Vol. 50. - N. 4. - P. 775-82.
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Hamdamov Bahtiyor Zarifovich, Bukhara state medical institute, Uzbekistan, PhD, Associate professor of faculty and hospital surgery E-mail: Gavhar72@inbox.ru
Comparative evaluation of methods of amputation related to tibiotartus with severe forms of diabetic foot syndrome
Abstract: The results showed that the improvement of technology implementation in mioplastic amputation lead to a significant shortening of the surgery time, decrease the likelihood of infection of the wound surface during surgery and a dramatic reduction of postoperative wound infections from the amputation stump of the tibia from 15.4 % to 3.5 % of cases.
Keywords: mioplastic amputation, diabetic foot syndrome, critical limb ischemia.
The rise in the number of people suffering from diabe- tions such as diabetic foot syndrome (DFS). The develop-tes is triggering a proportional increase in severe complica- ment of necrotic suppurative process in diabetes mellitus
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