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Section 7. Medical science
Kadyrov Shavkat Nomonovich, Andijan state medical institute The chair general surgery Science researcher Jalilov Muhammadjan Alijanivich, Andijan region Urgent Medical centre Physician the abdominal department E-mail: 87akademik@mail.ru
Prevention of complications following operating Adhesive Peritonitis
Abstract: Most inta-adhesive complications require repeated surgery, which is much more traumatic and dangerous than the primary operation. Defining the phenotype of acetylation was carried out in 36 patients with peritonitis and 42 patients with OSKN aged 16 to 84 years admitted to hospital Andijan Medical Institute from 2007 to 2012.Used method for determining free and acetylated sulfosalazina 6 hour urine sample after of test dose per os. The amount of free and acetylated sulfosalazina determined by Prebstinga and Gavrilov in modification Timofeeva (1971). To significantly reduce the incidence of postoperative complications in the adhesive early and late periods after the most frequent primary surgical operations on the abdominal organs to the wider use of the techniques of modern videolaparoscopic sparing surgery.After operating the wound east rated with medication "Dermobacter" undiluted. After operating for a conference run smoothly, the stitches removed for 6-7 day, with the wound healed by first intention.
Keywords: peritonitis, acetylation, rapid acetylators
Introduction.
Prevention of adhesion formation after operations on the abdominal organs is traditionally the most difficult section of abdominal surgery [1-3].
Conventional methods of clinical diagnosis of adhesions does not allow us to estimate the direction and intensity of the process of restructuring the connective tissue (collagen) in the abdomen after surgery. Consequently, it is not possible to objectively assess the disease, predict complications and effectiveness of their treatment. To date, none of the existing methods of preventing postoperative adhesions do not reliably prevent the formation of adhesions in the abdominal cavity. In this regard, an important focus is to find new, more effective ways to prevent pathogenetic adhesive postoperative complications.
The causes of abdominal adhesions, most researchers consider a mechanical failure of the peritoneum during the operation, the presence of abdominal infection and prolonged intestinal paresis. Also important to give the individual predisposition adhesions.
In recent years has been associated with postoperative complications adhesive type of acetylation. Found that after surgery for peritonitis different genesis of pathological process occurs only in patients with the fastest type of acetylation [2; 4; 5; 6].
The aim of the study was to determine the phenotype of acetylation in patients with various forms of peritonitis and acute adhesive intestinal obstruction (OSKN) to study its relation to the incidence of adhesive complications.
Materials and Methods.
Defining the phenotype of acetylation was carried out in 36 patients with peritonitis and 42 patients with OSKN aged 16 to 84 years admitted to hospital Andijan Medical Institute from 2007 to 2012.
Used method for determining free and acetylated sulfosalazina 6 hour urine sample after of test dose per os. The amount of free and acetylated sulfosalazina determined by Prebstinga and Gavrilov in modification Timofeeva (1971).
By "rapid acetylators" patients were referred to the level of acetylation of more than 76%. Found that in these patients the inflammatory process is productive as before surgery and in the postoperative period, which leads to the formation of adhesions and complications infiltrates.
In contrast to this "slow acetylators" (less than 76 percent acetylation) on mild otgranichitelnye repair processes, they were more typical complications associated with poor wound healing.
Therefore, the phenotype may acetylator life used as a screening test to select patients at risk for the development of adhesive surgical complications.
Studies were performed in patients with peritonitis of various origins and OSKN operated traditional (open) and laparoscopic. In the postoperative period, patients received drugs that slow down the collagen and accelerate its utilization. Along with their usual therapy administered per os Kuprino with 7-10 days after the operation, 1 time a day for 10-15 days. This drug is able to cleave the unstable cross-links and thus contribute to the accumulation of soluble collagen and inhibit the formation of insoluble collagen.
For the purpose of destruction and recycling of collagen fibers at the same time held 10-15 sessions electrophoresis contratubksom and vitreous body 64 units. After discharge from the hospital, all patients were places on the dispensary registration with regular inspection at least 2 times a year. If necessary, repeat the treatment.
Results and Discussion.
After verifying the effectiveness of the definition of the phenotype of acetylation in predicting adhesive complications, we performed phenotyping in 36 patients with peritonitis of various origins. Slow "acetylators" were 24 (66.6%) patients, a "fast" — 12 (33.4%).
To evaluate the effectiveness of treatment protivospaech-nogo 36 operated patients with peritonitis were divided into 3 subgroups. 14 patients the main group in the postoperative period than conventional treatment (infusion and antibiotic therapy, topical treatment) treated with a course of therapy pro-tivospaechnoy. 10 patients the operation was performed with laparoscopic protivospaechnoy subsequent course of therapy. 12 patients of the control group did not receive protivospaech-nuyu therapy and treatment for the rest of than did not differ from that of the main group.
Relative frequency of adhesive complications in three groups depending on the phenotype of acetylation is presented in Table. Number 1.
Immunological markers of juvenile Rheumatoid Arthritis in children
Table 1.
Group Complications of adhesions The total number of patients
«Slow acetylator» «Fast acetylator» Abs.
Summary (n=14) 1 (7.1) 2 (14.2) 3 (21.4)
Laparoscopic (n=10) 0 1 (10) 1 (10)
Control (n=12) 1 (8.3) 4 (33.3) 5 (41.6)
Total. 2 (5.5) 7 (9.4) 9 (25)
The frequency of complications in patients with adhesive peritonitis,
As can be seen from Table 1 in three groups of commissural complications occurred mainly in patients with rapid acetylation phenotype. At the same time, the frequency of these complications was significantly lower in the intervention group than in the control, where the anti-inflammatory treatment was carried out.
Analysis of the results of different treatments peritonitis showed convincingly that developed a new set of clinical interventions for the treatment of this severe disease reduces the likelihood of the formation ofadhesions in the abdominal cavity. Accounting acetylation phenotype and preventive measures provide an opportunity to reduce the frequency of the formation ofintra-abdominal adhesions in this group ofpatients.
Conclusion.
However, these measures do not fully address this complex problem of abdominal surgery.
depending on the method of treatment and acetylation phenotype (n=36)
Most of the traditional open trauma laparotomic access violation of the integrity ofthe skin, muscle, arrays, aponeurosis, parietal peritoneum and removing intestinal loops from the abdominal cavity causing intestinal paresis and contribute to the strengthening of adhesions.
To significantly reduce the incidence of postoperative complications in the adhesive early and late periods after the most frequent primary surgical operations on the abdominal organs to the wider use of the techniques of modern videolaparoscopic sparing surgery.
After operating the wound east rated with medication "Der-mobacter" undiluted. After operating for a conference run smoothly, the stitches removed for 6-7 day, with the wound healed by first intention.
References:
1. Babajanov B.D., Beketov G.I. Teshaev O.R./New approaches to the treatment of postoperative peritonitis. Journal of Surgery - 2002. T. 161. Number 4. 25-28.
2. Biryaltsev V.N., et al/Laparoscopic abdominal rehabilitation in treatment of peritonitis. Surgery. - 2002 - № 6. from 30-33.
3. Karimov S.I., Babajanov B.D., O.P. Teshaev/Modern aspects of the treatment of acute purulent peritonitis. Surgery - Uzbekistan. -2005. - № 3. 12-14.
4. Rozanov V./Using videolaparoscopic technology for the treatment of posttraumatic peritonitis. Military Medical Journal. - 2006. T327. Number 12. with 32-33.
5. CHernov V./Videolaparoscopic role in the diagnosis and treatment of complex rasprastranennogo peritonitis. Endoscopic surgery. -2005. Number 1. with 163.
6. Gies W. P., Kim H. C. Use oflaparoscopy in the diagnosis and treatment ofpatients with surgical abdominal sepsis. SurgEndosc - 1995, 9, 2 178-182.
Kaipbekova Gulbaxar Konisbaevna, Senior scientific assistant, applicant of the Department of ambulatory Medicine of the Tashkent Pediatric Medical Institute
E-mail: mbshakur@mail.r
Immunological markers of juvenile Rheumatoid Arthritis in children
Abstract: It was proven that high level ofACCP had an impact on clinical progress ofJRA in children. The obtained results can serve for the assessment of the therapy efficiency.
Keywords: juvenile rheumatoid arthritis, diagnosis, children.
There is a groups of diseases the development of which occurs due to the immune system secretion of antibodies against some proper proteins, as if these were alien ones. In other words, protective system of organism plays a role of aggressor against its own organism. These diseases are called autoimmune ones, and juvenile rheumatoid arthritis (JRA) is one of them [1; 2].
In JRA, especially its early stages, there is a significant diversity of immunological disorders. It is related both to rheumatoid factor [4; 7] and its isotypes [6], and new immunological markers such as anti citrullin antibodies [5]. Antibodies to citrullin peptides, and, particularly, to cyclic citrullin peptide (ACCP) should be considered
to be one of the most perspective (diagnostically and prognostically) markers nowadays [3].
In case of JRA. in synovial membrane of a joint there is an inflammatory process, as a result of which arginin amino acid is converted to citrullin. In other words, in a pathologic joint there is a process of citrullination of proteins considered alien by immune system. For the struggle with the assemble of citrullinated proteins an organism secrets specific antibodies, by these means promoting auto immune inflammation. The exact pathogenic role of auto antibodies is not studied well yet [4; 7].
