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Roentgenologic description of repeated fractures of forearm bones in children
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Kosimov Azam Azimovich, Ph.D in Medicine, Scientific Research Institute Traumatology and Orthopedics of the Republic of Uzbekistan, Tashkent city E-mail: azamrefracture@mail.ru
Roentgenologic description of repeated fractures of forearm bones in children
Аbstract: The successful development of traumatology orthopedics in the last decade has not solved some of the problems which, in particular, to repeat the treatment of bone fractures in children. Nonunion and refracture are a common complication of bone fractures and trauma require attention. The main method of diagnosis is X-ray examination, which not only allows us to determine the nature of the displacement of bone fragments, but also plays a major role in the evaluation of treatment results. Keywords: children, refracture, X-ray examination, forearm.
Introduction
According to the literature it is known that bone fractures in children ranged from 52 % to 58 % [2; 4; 5]. In 5.2 % of them concern to the refractures in children [1; 7; 8]. Repeated bone fractures in children are some of the serious injuries and at the same time, diagnosis and treatment are accompanied by some difficulties. The main diagnostic method of re-fracture is X-ray examination, which not only allows us to determine the nature of the displacement of bone fragments, but also plays a major role in the evaluation of the results of surgical treatment. Diagnosis of this pathology is challenging and misdiagnosis can lead to different consequences and complications.
Incomplete gathering of the anamnesis in children without finding-out of the reasons of occurrence of a trauma, an establishment of terms of occurrence concerning primary fractures ofbones with finding-out of a way of treatment after primary fractures can complicate a choice of an adequate way of treatment in case of re-fracturein the same place.
The only prevention of complications is a detailed description of these radiographs. According to available literature, complications ofvarious character such as re-refracture occur in cases of 1.4-1.7 % and pseudoarthrosis — in 2.4-2.6 % cases [3; 6; 8]. In the course of studying this problem, we realized that nowhere and in any literary source is not given x-ray data and defined refracture problems in children. The relation of the radiological signs of re-fracture by
osteoreparative processes is not defined and not demonstrated the status of callus during the re-fracture.
Based on the abovementioned, we have put the purpose as to explore and explain the radiological signs of refractures, depending on the stage of the regeneration of the primary fracture.
Materials and methods
In Children Traumatology Department of the Scientific Research Institute of Traumatology and Orthopedics of MH of the Republic of Uzbekistan, were examined and treated 109 children with refracture (without concomitant somatic diseases), during the period from 2000 to 2014. From them 77 (70.6 %) were boys and 32 (29.4 %) girls. The distribution of children according to the localization was as follows: with diaphyseal refracture were 91 (83.5 %), in the proximal part — 7 (6.4 %) cases and in the distal portion were 11 (10.1 %) children. Also, children are separated depending on the fracture frequency in the same segment, i. e. twice (refracture) in 91 (83.5 %), children, re-refracture or many times (more than three times) — in 18 (16.5 %) patients. Depending on the type of injury was observed the home injury — in 57 (52.3 %) children, street trauma — in 44 (40.3 %) and during sport activities — in 8 (7.4 %) children. 66 (60.5 %) patients treated conservatively and another 43 (39.5 %) patients by surgery way, from them. 43 (39.5 %) children in 24 (22.0 %) cases was used the combined method of osteosynthesis using the Ilizarov's apparatus, in 16 (14.7 %) — intramedullary
Section 5. Medical science
osteosynthesis with wires and in another 3 (2.8 %) cases was performed the intramedullary nailing.
All patients performed clinical, laboratory and instrumental (radiography, Doppler ultrasound, multislice computed tomography, roentgen densitometry) methods.
Results and discussion
Should be considered, it is necessary to assess the radiological signs and by the same way phased diagnosis of regenerative processes of refractures and to find out the period of occurrence of refracture with respect to the initial phase of primary fracture. Osteochondral regenerate in the area of the primary fracture in the period up to 3 months looks like cuff. In the case of re-fracture at the time and in the same place of cuff in the area of bone regenerate in the absence of careful attention on the chest X-ray can be diagnosed as a primary fracture. Maybe factor confirming the absence of the mechanism of injury in the study of life history of patients. Radiographic signs of refracture of cuff in area of bone regenerate after initial fracture depending on the stage of regeneration processes are characterized with different manifestations. Therefore, we decided to give some explanations of radiological manifestations of repeated fractures depending on the stage of reparative processes after the initial fracture. Thus, the shape of the fracture line and of bone fragments end surfaces undulating contours and rough and not smooth and sharp as primary fractures. The fracture line passes through the formed callus, dividing it into two parts, the ends of the calcification of bone fragments and through the fracture area passes blackish line than is characterized the repeated fracture.
Bone structure changes in refracture, the severity of which depends on the amount of periosteal callus forming, the state of the broken bones and pictures of the formed osteochondral regenerate after the primary fracture in segment. Form of callus is as cuff, in some cases, the secondary callus is located parallel to the cortex. If re-fracture occurs in the period of appearance of periosteal callus of reparation after the initial fracture and the radiological signs are distinctive, i. e. the cortex is flattened, thickened character and how verge towards to the fracture, the amount of cuff increases. In the area of primary fracture the periosteum is thickened as a "drawbridge" and the area after refracture has the character changes with the divergence of bone fragments from each other and diastasis between the fragments. In addition, to determine residual parts of callus (periosteal callus) under partitioned periosteal callus. Symptom "separation drawbridge" is mainly determined in the first phase (up to 3 months) of bone regeneration after the initial fracture, because in this period are already appeared as a full periosteal and paraossal callus. The callus layers are separated, the newly formed layer of callus is on top of the old callus and different plane with
unclear and irregular contours. The cortex is formed by the extension of the callus is smooth, as in the field of re-fracture cortical bone is filled with callus and cortical bone has lost its shape.
In children the difference of refracture from the primary concludes (by covering up) with callus of cortex. The appeared callus on the cortical surface have as partitioned form, which takes place in the period up to the third month of regenerative processes, i. e., in the stages of development periosteal callus. It is not difficult to put diagnosis for refracture in this period by X-ray data. On radiographs the callus in the field of the primary fracture reminds a conical shape and this shape is maintained in refracture, which is formed during periosteal callus.
Phasing regeneration is disturbed, it does not form a complete periosteal callus begins to dissolve periosteal callus and lost strength in the segment. On radiographs determined roughness of the fracture line.
Periosteal callus is white and had dissolving views, demonstrating due to resorption of the periosteal callus. The ends of the periosteal callus are obtuse and the ends of paraossal callus are acute. The cortex in the area of refracture thickened and hypertrophied due to paraossal and periosteal calluses.
In some cases, the phasing of regenerative processes is distributed, there is a early resorption ofparaossal callus, which leads to disruption weakness. In this the minor repeated trauma is available to occur the refracture. In this period the periosteal callus is hypertrophied.
On radiographs determined the absence of endosteal callus, the resorption of paraossal callus that leads to weakness in the area of the fracture. Due to the re-injury may occur the refracture. At normal physiological regeneration process the forming of the callus proceeds in stages, one formed at the expense of other resorption. In some cases, the phasing is distributed, there are one-time resolution parameters, peri- and endosteal calluses and reduces healing field strength.
In the second period of regenerative processes observed complete resorption of periosteal and paraossal calluses it begins to dissolve the endosteal callus while was not formed the intermediate callus. As a result of re trauma occurs refracture. Radiographic signs show such as cortex thickened, rough contour inaccurate and therefore, determine the edges of the cortical layer is very difficult. In the field of refracture of the bone marrow sclerotic, pale and medullary canal appear as closed. Due to the rough calluses bone ends are not consistent with each other. At primary fracture the cortex is accurate, smooth and as repeated the line of fracture.
Conclusions:
1. To study the radiological signs facilitates the installation of the diagnosis, choice of the treatment and evaluation of the results.
2. By studying radiologic manifestations can stop the possible postoperative complications and reduce disability.
References:
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Role of standard antibiotic therapy in Helicobacter pylori associated diseases of stomach...
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Yusupbekov Abrorbek Axmedjanovich, Doctor of Medical Sciences, Deputy director, National Cancer Research Center, Republic of Uzbekistan
Mallaev Makhsud Mukhammadievich, Tashkent medical academy, Oncology department, Assistant, Doctor-Oncologist
Ismailova Jadida Akhmedjanovna, National specialized scientific-practical medical center, Doctor
Abdusattorov Ravshan Abduraufovich, Tashkent Medical Academy, Department of General Oncology and Radiation diagnosis, Undergraduate student E-mail: Maqsud02@yahoo.co.uk
Role of standard antibiotic therapy in Helicobacter pylori associated diseases of stomach in development of stomach MALT lymphoma
Abstract: The discovery of H.pylori and the proof of its leading role in the development of most of gastrointestinal diseases has radically changed the approach to their treatment. Chronic gastritis, peptic ulcer disease, gastric lymphoma associated with H. pylori infection require therapy aimed at killing microbes.The main reason for the ineffectiveness of current treatment program is based on a point mutation of the genome HP and uncontrolled use of modern antimicrobial drugs. Moreover, the literature contains no information on the role of long-term use of ineffective drugs in the occurrence of gastric neoplasms. This fact is the reason for further research in this area. Aim of this research to determine efficiency of antibiotic therapy in antibiotic-resistant forms of Helicobacter pylori in the development of malignancy MALT tumors in gastrointestinal tract. After the study we concluded that long-term use of antibiotics for resistant forms of HP besides ineffective against the disease, contribute to the development of local and general disturbances of the immune status. Availability treatment-resistant forms of HP accelerates proliferation and dysplasia, which leads to the development of neoplasms. Keywords: MALT-lymphoma, helicobacter pylory, stomach neoplazms.
Helicobacter pylori — small, gram-negative, asporous, micro-aerophilic bacteria. Under the influence of the external environment, for example, a change in temperature or pH, long cultivation, Helicobacter pylori starts to change in coccal form. This may be due to the degenerative changes and the transition to an inactive phase, which favors its survival and could be an important factor in the epidemiology and spread of bacteria [1].
In coccal forms impaired enzymatic activity, and they lose their reproductive capacity, becoming resistant to antibacterial agents, they have created good conditions for preservation of bacteria in the bowels. Once in favorable conditions, such forms of H. pylori may be re-transformed into vegetative forms that can colonize in the gastric mucosa.
Helicobacter pylori has the ability to colonize, also it is able to protect themselves from the action of hydrochloric acid. It is equipped with a smooth cell wall — glycocalyx. Glycocalix makes bacteria non-susceptible to antibacterial agents and protects it from the host's immune response. Helicobacter pylori produce urease which neutralizes the hydrochloric acid in gastric juice that creates pH 7 environment around Helicobacter pylori.
In addition, the urease of H. pylori acts as a toxin that formed ammonium ion during the hydrolysis of urea. It damages epithelium which increases the inflammatory reaction by activation of monocytes and neutrophils, stimulation of cytokine secretion, formation of oxygen radicals and nitric oxide, moreover, large subunit urease (UreB) acts as an attractant for leukocytes [2].
There are two types of Helicobacter "stomach" — clinically important type is Helicobacter pylori (as well as H. acinonychis, H. baculiformis, H. bizzozeronii, H. cetorum, H. cynogastricus, H. felis, H. heilmannii, H. mustelae, H. salomonis, H. suis), «entero-hepatic» (H. anseris, H. bilis, H. brantae, H. canis, H. canadensis, H. cholecystus, H. cinaedi, H. equorum, H. fennelliae, H. ganmani, H. hepaticus, H. marmotae, H. mastomyrinus, H. mesocricetorum, H. muridarum, H. pametensis, H. pullorum, H. rodentium, H. salomonis, H. trogontum, H. typhlonius).
More than 10 types of helicobacter are pathogenic to human body (H. pylori, H. heilmannii, H. cinaedi, H. fennelliae, H. bilis, H. pullorum, H. hepaticus, etc.).
The most clinically important type for human is — Helico-bacter pylori, which according to modern ideas, related to many cases of stomach ulcers, gastritis, MALT tumors and gastric cancer.
The second most important type for human is H. Heilmannii. It usually causes antral gastritis.
According to many authors H.felis is a major factor in the development of gastric cancer. In particular, to address the conciliation meeting Maastricht IV (Part 3. "Preventing gastric cancer and other complications" statement № 1) "... Transgenic expression of IL-1ß of gastric parietal cells leads to the spontaneous development of gastritis, mobilization suppressor cells of myeloid origin and dysplasia. Helicobacter felis infection leads to the progression of neoplasms".
