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18
Вестник РГМУ, 2015, № 2
антибактериальная терапия с положительным эффектом. Эффективность лечения зависит от раннего обращения пациенток и своевременно начатой терапии современными антибактериальными средствами широкого спектра действия.
CONSERVATIVE TREATMENT OF INFLAMMATORY DISEASES OF THE MAMMARY GLANDS IN ADOLESCENT GIRLS
A.P. Danilova
Scientific Adviser — CandMedSci, Assoc. Prof. I. V. Karachentsova Pirogov Russian National Research Medical University, Moscow, Russia
Introduction. Not lactating mastitis - an inflammation of the mammary glands in girls, not associated with pregnancy and lactation. Often develops between the ages of 13-18 years, in menstruating girls in the second half of the cycle. Aim. To study the efficacy of conservative treatment of inflammatory diseases of the mammary glands in the prepubertal and pubertal period in girls. Materials and methods. We conducted our study in our hospital on the basis of pediatric gynecology, where 2010-2014, we observed 12 patients with acute mastitis. Age of the patients at the time of initial treatment ranged from 13-17 years. 12 All patients (100%) complained of pain in one, rarely two mammary glands. On examination, all patients 12 (100%) showed symmetrical development of mammary glands in accordance with the age, the breast volume in all patients was increased due to glandular tissue. It was also noted the presence of dense infiltrate hyperemic, painful on palpation. All patients were consulted by the specialist (otolaryngologist, pediatrician). Upon examination of the patients was identified chronic infection: chronic tonsillitis in 8 patients (66.7%), tracheobronchitis in 1 patient (8.3%), in 3 patients (25%) of chronic foci of infection have been identified. Patients were recommended rehabilitation of chronic foci of infection. All patients were performed pelvic ultrasound, abnormalities were found. When breast ultrasound in 4 patients (33.3%) revealed the formation of increased echogenicity with a liquid component, in 8 patients (66.7%) reveals the formation of a capsule surrounded by a heterogeneous content. All patients were conducted laboratory studies. In the clinical analysis of blood is drawn to the attention of all the patients 12 (100%) relative neytrofillez, the maximum values of the patients were as follows: segmented cells (74%), erythrocyte sedimentation rate was increased significantly in all patients 12 (100%). In the hormonal profile of patients significant changes were noted. One patient (8.3%) showed an increase in prolactin values to 12,35pmol/l. All patients were assigned to conservative antibiotic combination therapy group carbapenem aminoglycosides, cephalosporins II and III generations. At the 6 th of patients (50%) was appointed ertapenem therapy (Invanz), netilmicin (netromycin) and metronidazole (Metrogil), 4 patients (33.3%) received Cefoperazone (tsefobid) and cefixime (supraks), 2 patients (16 6%) were on therapy cefoperazone-sulbactam (Sulperazon) and metronidazole (Metrogil). Also, together with antibiotic therapy was appointed antifungal therapy -Fluconazole (Diflucan) 150 mg once. Locally, we used Chloramphenicol ointment (levomikol) and poluspirtovoy compress on the area of infiltration. Results. In 2 patients (16.6%) due to late treatment and ineffective antibiotic therapy there was a transition from the infiltrative form of mastitis in the abscess. Produced timely surgical opening of the abscess. In the remaining patients as a result of a combination antibiotic therapy was noted persistent positive trend. After 3 days of antibiotic treatment started after formation of reduced size on the average in all 12 patients (100%) of 5 mm. In 2 patients (16.6%) on day 3 of treatment there was a reduction of infiltration size. One patient education initial size 26-20-19 was reduced to 8-5-3. In another patient the initial size of the infiltrate 17-15-20 fell to 10-5-8. Conclusion. As a result of our research we have proved the effectiveness of conservative combination antibiotic therapy in the treatment of acute mastitis in girls. In all patients, 12 (100%) had persistent positive trend. In 2 patients (16.6%) after opening the abscess was also appointed as combination therapy with a positive effect. The effectiveness of treatment depends on early treatment of patients started therapy and timely modern antibacterials broad spectrum.
ОЦЕНКА ЭФФЕКТИВНОСТИ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ И КОМБИНИРОВАННОЙ ТЕРАПИИ ПАЦИЕНТОК С РАЗЛИЧНЫМИ ТИПАМИ ИСТИННОГО НЕДЕРЖАНИЯ МОЧИ
Е.А. Салтовская, О.М. Малкина Научный руководитель — к.м. н. Н.А. Шевченко Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, Москва, Россия
Введение. Недержание мочи представляет собой медико-социальную проблему, требующую комплексного подхода к диагностике и выбору рационального метода лечения данного заболевания. Цель исследования. Оценить эффективность хирургического лечения и комбинированной
терапии у пациенток трех групп в зависимости от типа истинного недержания мочи. Материалы и методы. За период 2014 г в ГКБ №31 были обследованы и пролечены 20 пациенток в возрасте от 45 до 75 лет с недержанием мочи. Все пациентки были разделены на 3 группы в зависимости от типа истинного недержания мочи. В первую группу вошли пациентки со стрессовым недержанием, во вторую - со смешанным недержанием мочи и в третью - с гиперактивным мочевым пузырем. На дооперационном этапе всем было выполнено комплексное уродинамическое исследование, а также сбор анамнеза, физикальное обследование, функциональные пробы. В качестве хирургического лечения пациенткам была выполнена операция TVT-O. Контролем качества лечения служили жалобы пациенток, оцениваемые с помощью специализированного опросника П. Абрамса и А. Вейна, а также функциональные пробы. Результаты. Эффективность лечения оценивалась в течение 6 месяцев. У пациенток со стрессовым недержанием и смешанным недержанием мочи после операции жалобы прекратились. Пациенткам со смешанной формой недержания мочи, а также с гиперактивным мочевым пузырем в послеоперационном периоде потребовалось назначение консервативной терапии М-холинолитиками с целью устранения расстройств мочеиспускания. Выводы. Всем пациенткам на дооперационном этапе должно проводиться комплексное уродинамическое обследование с целью выявления вида недержания мочи для определения дальнейшей тактики лечения. Пациенткам с гиперактивным мочевым пузырем на дооперационном этапе должна быть назначена терапия М-холинолитиками.
ASSESSMENT OF THE EFFICACY OF SURGERY AND COMBINED TREATMENT FOR DIFFERENT TYPES URINARY INCONTINENCE OF WOMEN
E.A. Saltovskaya, O.M. Malkina
Scientific Adviser - CandMedSci N.A. Shevchenko
Pirogov Russian National Research Medical University, Moscow, Russia
Introduction. Urinary incontinence is a medical and social problem, which needs a combined approach to diagnostics and choice of a rational method of treatment. Aim. To assess the efficacy of surgery and combined treatment for urinary incontinence of 3 groups depending on types of urinary incontinence. Materials and methods. 20 patients at the age range from 45 to 75 with urinary incontinence were examined and treated in the City Clinical Hospital N°31 during the year of 2014. The patients were divided into 3 groups depending on the type of their urinary incontinence . The first group consisted of the patients with the stress- related urinary incontinence, the second group consisted of the patients with combined urinary incontinence and the fird group of the patients had an overactive bladder. Integrated urinodynamic methods, anamnesis, physical diagnostics, functional methods were used to examine all the patients in the presurgical stage.The patients had surgical treatment in the form of the TVT-O operation. The patients complaints and Abrams and Vein's questionnaire were used to control the quality of the treatment. Results. The efficacy of the treatment was assessed during 6 months. The patients with the stress related urinary incontinence and the combined urinary incontinence had no complaints after the surgery. The patients with the combined type of urinary incontinence had to be conservatively treated with M-cholinolytics in order to cure the urinary incontinence. Conclusion. All patients should be examined using integradet urinodynamic methods in order to determine the type of urinary incontinence and the further way of treatment accordingly. The patients who have an overactive bladder should be treated with M-cholinolytics in the presurgical stage.
ПРОФИЛАКТИКА РЕСПИРАТОРНОГО ДИСТРЕСС-СИНДРОМА НОВОРОЖДЕННЫХ
Е.Р. Ким
Научный руководитель — д.м.н., проф. Д. К. Нажмутдинова Ташкентская медицинская академия, Ташкент, Узбекистан
Введение. Респираторный дистресс-синдром новорожденных (РДС) является одним из самых частых и тяжелых заболеваний раннего неонатального периода у недоношенных детей и основной причиной инвалидизации и ранней неонатальной смертности. На частоту развития РДС новорожденных сильно влияют методы пренатальной профилактики при преждевременных родах. На данное время существуют различные методы профилактики РДС новорожденных. Цель исследования. Целью нашего исследования явилось проведение сравнительного анализа эффективности профилактики РДС новорожденных с помощью дексаметазона и бензонала при преждевременных родах. Материалы и методы. Антенатальную профилактику РДС новорожденных получили 40 беременных в возрасте 19-36 лет (27,5±3,2) со сроком гестации
