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Section 7. Medical science
References:
1. Baek G. H., Chung M. S. The treatment of congenital brachymetatarsia by one-stage lengthening. J Bone Joint Surg Br. 1998; 80: 1040-1044.
2. Bartolomei F.J. Surgical correction ofbrachymetatarsia. J. Am Podiatr Med Assoc. 1990; 80: 76-82.
3. Choi I. H., Chung M. S., Baek G. H., et al. Metatarsal lengthening in congenital brachymetatarsia: one stage lengthening versus lengthening by callotasis. J. Pediatr Orthop. 1999; 19: 660-664.
4. Fox I. M. Treatment of brachymetatarsia by the callus distraction. J. Foot Surg 1998; 37: 391-395.
5. Kim H. T., Lee S H., Yoo CI, Kang J. H., Suh J. T. The management ofbrachymetatarsia. J. Bone Joint Surg Br. 2003 Jul; 85 (5): 683-90.
6. Magnan B., Bragantini A., Regis D., Bartolozzi P. Metatarsal lengthening by callotasis during the growth phase. J. Bone Joint Surg Br 1995; 77: 602-607.
7. Masada K., Fujita S., Fuji T., et al. Complications following metatarsal lengthening by callus distraction for brachymetatarsia. J. Pediatr Orthop. 1999; 19: 394-397.
8. Scher D. M., Blyakher A., Krantzow M. A modified surgical techniqwwue for lengthening of a metatarsal using an external fixator HSSJ (2010) 6: 235-239.
9. Takakura Y., Tanaka Y., Fujii T., Tamai S. Lengthening of short great toes by callus distraction.J. Bone Joint Surg Br 1997; 79 B: 955-958.
10. Urano Y., Kobayashi A. Bone lengthening for shortness of the fourth toe. J. Bone Joint Surg Am. 1978; 60:91 Y 93.
11. Wada A., Bensahel H., Takamura K., Fukii T., Yanagida H., Nakamura T. Metatarsal lengthening by callus distraction for brachymetatarsia. J. Pediatr Orthop B 2004; 13:206-210.
Rasulov Ulugbek Abdugafurovich, Central Military Hospital of the Ministry of Defense of the Republic of Uzbekistan, Head surgeon Ministry of Defense of the Republic of Uzbekistan.
E-mail: uli4-67@mail.ru
Oonservative treatment and rehabilitation of the patients with occlusive disease of femoropopliteal segment
Abstract: 48 patients who underwent reconstructive surgery in the femoral-popliteal-tibial segment are divided into 2 groups were under the watchful and received a course of rehabilitation therapy and have not received this treatment. After 2 years it noted that in one group the number of positive results for the treatment of above 45%, and the mortality rate is 25% lower than in group 2.
Keywords: antithrombotic prophylaxis, femoral-popliteal-tibial segment, rehabilitation, medical therapy.
The relevance of the research. The main site oflocalization of occlusive arterial lesions, leading to the loss of a limb, is the femoropopliteal segment — shin [1, 5-9; 2, 137-138; 4, 113; 5, 41-44]. Surgical treatment of such patients gives better results than conservative therapy. Nevertheless, conservative therapy is an essential complement to the adequate treatment of patients with obliterating vascular disorders of the lower limbs in the preoperative and in the postoperative period.
The debate continues on the choice of a rational conservative therapy and optimal antithrombotic prophylaxis in the complex postoperative rehabilitation of patients after revascularization of the limb [3,118-120; 6, 204; 7, 80-82].
Purpose of the study. Improved results of treatment of patients with occlusive-stenotic lesions in the infrainguinal segment targeted by antithrombotic prophylaxis and full rehabilitation of patients.
Materials and methods of research. We studied the role of the clinical examination of patients discharged from hospital after proximal femoral-popliteal bypass grafting, through a comparative analysis of two groups of patients in terms of mortality and the number of amputations, depending on the quality of post-operative rehabilitation and dispensary observation.
The first group included 26 patients who were successfully operated in the vascular suit. All patients in this group shortly after surgery were under outpatient observation of angiosurgeon. After 0.5, 1, 2 and 3 years, the patients were examined, including the ul-
trasound investigation, and haemorrheology indicators, lipid and carbohydrate spectrum. Twice a year, the patient went through a course of conservative therapy.
Basic principles of treatment of lower limb ischemia were as follows: 1. Correction of risk factors:
a) cessation of smoking,
b) strict control of plasma lipid levels,
c) control of blood pressure,
d) therapy, which reduces the level of lipids.
2. Exercise and training:
a) a special program of training,
b) walking on 45-60 min 3 times per week (12 weeks),
c) adding 6.5 min training walk every 6 months (before the pain).
3. Drug therapy:
a) intravenous infusion of reosorbilakt, latran, tivortin 10 days, twice a year. Subsequently, in the outpatient setting, patients received aspirin (100 mg per day) for two months, then along with aspirin sequentially sulodexide 250 LU twice a day for two months;
Further, in a month,
b) inhibitors of fosfodiesterazes- cilostazol 100 mg per day for a month.
c) physiotherapy — massage of the lower limbs, applications with paraffin wax (ozokerite) to pelvis and thigh.
The second group (control) consisted of 22 patients who, after discharge from the hospital for various reasons (mostly nonresident)
Differential diagnostics of the abnormalities of ureter-vesical segment development in children
in angio surgeon, were observed. 10 people did not receive any medical treatment, others did not regularly take aspirin. No rehabilitation was carried out to patients. By type of reconstructive surgery, and the original state at the time of hospital discharge, patients in both groups were comparable.
After 2 years, two patients from the first group of patients in 1 and 1.5 year went through reconstructive preventive intervention on the previously operated limbs due to stenosis in the zone of the distal vascular anastomosis. 5 patients within 2 years after a femo-ropopliteal bypass were performed surgery on the coronary arteries (2 — LAD stenting, 3 — aortocoronary bypass). One patient in 3 months after surgery underwent amputation at the thigh. Result of treatment: good — at 31.0%, satisfactory — at 50.0%, unsatisfactory — at 19.0% ofpatients. Mortality in the group was 10.0%.
In the second group, three patients underwent through amputation (2 — at the level of the hip, 1 — at the level of the lower leg). In general, the result of treatment in the group rated as good — at 11.0%, satisfactory — at 25.0% and unsatisfactory — at 64.0%. Mortality in the group amounted to 40.0%. The main cause of deaths in both groups were acute myocardial infarction (65%) and stroke (20%). Thus, in patients who have not received systematic monitoring and therapy, a positive outcome of the treatment after 2 years was produced only in 36.0% of patients. Meanwhile, in the group of
patients who were under medical supervision with adequate antithrombotic prophylaxis managed 2 years after femoropopliteal bypass got 45% increase in the number ofpositive results of treatment and 25% reduction in mortality compared to the control group. The findings confirm the need for a full and active postoperative rehabilitation of follow-up of patients after surgical revascularization of the lower limbs straight.
Conclusions. The leading role in the dispensary observation belongs to vascular surgeon who determines the tactics of the patient. It should be emphasized the need for timely detection and correction oflesions of coronary and brachiocephalic vessels, given that this comorbidity is the main reason of m ortality (90.0%).
Thus, in the late postoperative period for the prolongation of functioning grafts full antithrombotic prophylaxis and timely preventive repeated reconstructive surgeries are needed. And in order to increase the life expectancy ofpatients after successful revascularization of the lower limbs, an early detection and surgical correction in the first place, coronary and cerebrovascular disease is needed. Rational drug therapy combined with conventional rehabilitation patients is necessary constantly.
Active follow-up for 2 years after femoropopliteal bypass allowed to increase by 45% the number of positive results of treatment and 25% reduction in mortality.
References:
1. Bokeria L. A. et al. Actual problems of surgical treatment of patients with critical limb ischemia -solutions (state the problem).//An-nals of surgery. - № 1. - 2011. - P. 5-9.
2. Bokeria L. A. et al. The role of the rehabilitation of patients with atherothrombotic lesions of the lower extremities in an outpatient setting//Proceedings of the eleventh scientific conference outpatient surgeons Moscow and Moscow region, 2010. - P. 137-138.
3. Diveev V. A. et al. Correction of endothelial function in the complex treatment of patients with atherothrombotic lesions of the lower extremities//Proceedings of the eleventh scientific conference in Moscow clinics and surgeons Moscow region. - 2010. - P. 118-120.
4. Kovalenko V. I. et al. Comparative evaluation of the transplant in the femoropopliteal bypass surgery in patients with critical lower limb ischemia//Proceedings of the Seventeenth Congress of the All-Russia cardiovascular surgeons. - Moscow. - 2011. - P. 113.
5. Kalitko I. M. Repeated reconstructive surgery occlusion in femoropopliteal segment//Annals hirurgii. - 2011. - № 3. - P. 41-44.
6. Klimovich L. G. et al. The differentiated approach to the correction of hemostasis in patients with critical lower limb ischemia.//Pro-ceedings of the Seventeenth All-Russia congress of cardiovascular surgeons. - Moscow. - 2011. - P. 204.
7. Rasulov U. A. Surgical treatment of lower limb ischemia. - Tashkent: "TURON-IQBOL", 2016. - 192 p.
Rakhmatullayev Akmal Abadbekovich CMS, Senior lecturer of the Department of Faculty Children's Surgery, Tashkent Pediatric Medical Institute E-mail: mbshakur@mail.ru
Differential diagnostics of the abnormalities of ureter-vesical segment development in children
Abstract: In case of suspicion of ureter-vesical abnormality it is recommended to use ultra-sound diagnostics, transformation echopyeloscopy with diurrhetic load, impulse-wave Doppler-metering of uretral emission, excretory urography with catheterization of bladder for the time of the test, roentgenocinematography, hydro dilatation and prophylometering, which provide differentiation of the kinds of the pathology impairments in children.
Keywords: children, abnormality of ureter-vesical segment, differential diagnostic.
According to some authors' opinion majority of children with non-reflux form mega ureter widening disappears after some time and does not demand surgical treatment. Obstruction in these patients has functional character and it is conditioned by UVS immaturity [2; 3; 4].
Though many works note late diagnostics of vesical-ureter reflux. Consequently there is high percentage of chronic renal failure
and nephrogenic hypertension leading to invalidity and often death of patients in young age [1; 5].
Taking into account the aforesaid, the objective of this work was design of differential-diagnostic criteria of UVS obstruction in children.
Materials and methods. Retrospective and prospective studies were performed in 161 patients in the age from 3 months to 15 years
