CC BY
13
KoHrpecu, cMMno3iyMM, WKonu / Congresses, Symposiums, Schools
GNIDENKO J., BOBRO V.
Kharkiv National Medical University, Kharkiv, Ukraine
Some Problems оf Early Diagnostics оf Diabetic Arthropathy
Introduction. With such complication of diabetes mel-litus (DM), as diabetic osteoartropathy (DOA or Charcot foot), there are doctors of different specialties, but far not always it in time is recognized. Prevalence of this complication among patients on (DM) folds less than 1 %, although in literature there are data about the defeat of bone fabric feet in 0.1—55 % of patients. Such large divergence of data, probably, related to the differences in methodology of inspection and different criteria of diagnostics of DOA. Consider now, that DOA causes any not form of neuropathy, its «subspecieses» are but only certain. In this connection to foresee development of DOA difficult, and late diagnostics and inadequate treatment of patient result in invalidi-sation.
Aim of work: to investigate frequency and character of clinico-instrumental signs of defeat of bones' tissue for patients on DFS.
Materials and methods. The analysis of results of inspection is conducted 62 patients on DM 2 to the type, complicated SFS. Men it was 36 (58.1 %), women 26 (41.9 %). Middle age of patients presented 56.90 ± 1.02. Experience of DM laid down 12.90 ± 1.02. A questionnaire was used by means of minute test of estimation of risk of osteoporosis, method of ultrasonic densitometry and radiography.
Results and their discussions. Distribution of the investigated patients depending on the clinico-pathoge-netic form of DFS was such: 14 patients (22.6 %) had neuropathic form, 18 (29.0 %) — ischemic and 30 patients (48.4 %) — mixed. From data of anamnesis, from 62 patients on DM the diagnosis of DOA was first set
KINASH M.I., LOBODA V.F., DZYUBAN L.V.
Ternopil State Medical University
named after. I.Ya. Horbachevsky, Ternopil, Ukraine
Diagnostic Criteria of the Bone Mineral Density Reduction in Children with Hepatobiliary Pathology
Introduction. Preclinical diagnostics of metabolic bone pathology in children is of great importance for the prevention of osteoporosis (OP), its timely correction and formation groups of high risk for osteopenic syndrome.
Aim: To develop methods of predicting the osteopenic syndrome in children with disorders of hepatobiliary system with the following development of forecasting algorithm.
Materials and methods. Comparative analysis of risk factors for OP development based on the history of life, results of clinical and laboratory investigation and den-sitometrical examination allowed to select 9 signs which were considered as informative diagnostic criteria of pre-clinical OP development.
Results. Results of a consecutive detection procedure, based on the review of ordered series of signs in the com-
88
to 47 (75.8 %) patients, from them 92.2 % — at presence of III—IV of the stage of DOA. A questionnaire by means of minute test and analysis of anthropometric data of patients allowed to distinguish patients (35 persons — 56.4 %) with the high risk of presence of osteoporosis. From data of anamnesis, 34 (54.8 %) patients had an episode of manifestation of DOA as an one-sided sharp edema of foot. Mostly (in 37.5 % cases) patients saw a doctor of general practice or surgeon of policlinic, but manifestation of the sharp stage of Charcot foot was not diagnosed. At radiography research of bones' of foot of sign of osteoporosis educed in 9 (14.5 %) patients from the number of inspected (mainly with the neuropathy form of DFS); in 27 (43.5 %) patients from all cases the educed phenomena of ossifluence, presence of bone sequestra, osteomyelitis (mainly at the ischemic and mixed forms of DFS). Conducted inspection of patients with the high risk of osteoporosis educed the presence of os-teopenia the method of ultrasonic densitometry in 30 patients (48.3 %), from them in 12 (19.3 %) is an osteoporosis, that folded 34.3 % from the group of high risk.
Conclusions. The presence of sharp phase of DOA is necessary to be assumed for all patients with the one-sided edema of foot, taking into account duration of motion of DM, expressed of diabetic neuropathy, trauma or surgical interference on a foot, that preceded to the edema. A radiography inspection of patients is the late method of diagnostics of defeat of bone fabric, that does not allow effectively to conduct the prophylaxis of osteopenia and timely treatment of osteoporosis. For stratification of risk of os-teopenia for patients from DFS it is necessary to use a minute test with verification of degree of defeats of bone fabric by means of densitometry. Patients with suspicion on DOA most rationally to send in the specialized podiatric separations (centers).
parison groups and the sequential analysis of selected pairs of distribution, are presented in the table 1.
The process of forecasting is as follows: in every patient we have determined the value of each risk factor, which corresponds to a specific diagnostic factor, in the order they are presented in the table. Then diagnostic factors were added until one of the thresholds has not been reached. If the threshold A2 = +13 was achieved or exceeded, then with a probability of 95 % the risk of reduced bone mineralization in a child can be predicted. If the threshold is A1 = —13, with the same probability the risk of pathology can be denied. If the threshold of ±13 was not reached the next decision was made: there was not enough diagnostic information for resolving the issue with the planned reliability level and it is necessary to continue to study risk factors (undefined response).
Conclusion. Retrospective analysis of risk factors for the osteoporosis development in examined children has demonstrated a relatively high accuracy (87.9 %) of osteoporosis prediction using the presented table, so that allows to recommend it for revealing the probability of bone mineral density reduction in certain patients with hepatobiliary disorders.
№ 2 (18), 2015
Brnb. CyMo6u. Xpe6eT, ISSN 2224-1507
