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7SURGERY TREATMENT OF EDEMATIC EXOPHTHALMOS
D.m.s. Dolmatova I. A., D.m.s. Stepanova I. S., D.m.s. professor Utelbayeva Z. T., Berdisheva A. A., Ismailova S. K.
Kazakhstan, Almaty city, KazNMUafter S.D. Asfendiyarov
Abstract. Recently surgery methods of the endocrine ophthalmopathy (EOP) - orbit decompression have spread widely. Bone decompressions are accompanied with severe complications as during the operation so as in rehabilitation period. Developed by A.V. Brovkina (2002) inner transconjunctive orbit decompression at EOP decompensation promotes elimination of the orbit adipose tissue where T-lymphocytes accumulate, numerous cytokines that stimulate the cell proliferation, synthesis of glycosaminoglycans, lypocytes that is active cellular tissue is reduced, autoimmune aggression dicreases, the position of the eye in the orbit becomes better, exophthalmos reduces and skin scars formation is excluded.
The aim is to study efficiency of inner orbit decompression on the background of EOP complex treatment at the decompensation stage.
The material and methods.
The comparative analysis was done of the results of the inner orbit decompensation on the background of a complex medicine treatment of patients with edematic exophthalmos at the decompensation stage. There were 19 patients at the age from 26 to 65, among them 10 women and 9 men. The disease duration by the anamnesis data was from 6 months to 2 years, there was a relapse in two cases. At acceptance the patients complained of sharp or constant constricting pain in the orbit, of unclosing of the palpebral fissure, declining of eyesight keenness, absence or limited eye moving, reddening and periodical double vision. The objective clinical picture was characterized by a sharp edema of the periorbital tissue that was shown in the palpebra retraction, in 13 cases by a more expressed one-side exophthalmos with a difference from 5 to 12 mm, red conjunctiva chemosis (15), drastic reduction of eyeballs mobility in all directions (14), full ophthalmoplegia (3) and corneal-conjunctive xerosis of severe form in one case, keratopathy (9) and indications of optical neuropathy.
On the background of a complex traditional therapy (general and local glucocorticosteroids, diuretics that stimulate oxidative-recovering processes and improving of the microcirculation) inner orbit decompression was done during which the trans-conjunctiva orbitotomy and a little traumatic transect in the lower-outer part of the transitional conjunctiva fold. There was up to 10 ml of the fatty tissue. In 14 cases one-side decompression was done and in 5 cases - two-side one. In the after operation period physiotherapy was included into the complex treatment: magnet-therapy, infrared laser drainage on the paraorbital spots, He-Ne laser on a. carotis.
The control group constituted 9 patients with EOP, who received a pulse therapy, at the stage of decompensation.
The results and discussion.
As the result of the given treatment in the main group improving of the condition was registered in all cases. All mentioned complaints disappeared. Objectively it was observed disappearance of periorbital edema, retraction of the eyelids, conjunctiva chemosis, the mobility of the eyeballs returned, the full closing of the palpebral fissure, the full epithelization of the cornea, reduction of exophthalmos on average by 6,6 + 0,76 mm and improving the eyesight keenness by 0,15 ± 0,01. In the dynamics after 1, 3, 6 months it was noted a steady effect of the treatment in 15 cases, in two cases after 6 months exophthalmos grew by 2-3mm and in one case a disease relapse was observed after 3 months that was provoked by overcooling.
In the control group as the result of the given treatment the mentioned above complaints were reduced in all cases. Objectively it was observed a preserve of the moderate periorbital edema (8), moderate eyelids retraction (4), light conjunctiva chemosis (3), the full closing of the palpebral fissure
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was reached and the full epithelization of the cornea. Exophthalmos reduced on average by 3,1 ± 0,23mm, the eyesight keenness improved by 0,1 on average. Later in all cases because of absence of the full compensation process after 3 and 6 months anti relapse treatment was done: parabulbar injections, dexamethasone in combination with physiotherapy, diuretics and stimulating medicines.
Thus, performing of inner decompression of the patients at the stage of EOP decompensation on the background of a complex therapy with the use of physiotherapy allows obtaining significant reduction of exophthalmos and steady remission of the disease in prevailing number of cases.
Conclusions
1. Doing inner decompression of the orbit on the background of the complex therapy of EOP at the decompensation stage allows reducing exophthalmos by 6,6 ± 0,76 mm that twice exceeds the results of the pulse therapy with glucocorticosteroids.
2. The steady effect of the inner orbit decompression is preserved for a long time of most patients.
REFERENCES
1. Бровкина А.Ф. Внутренняя декомпрессия - реконструктивная операция при эндокринном экзофтальме.//Сборник научных трудов 3 Всероссийской школы офтальмологов, Москва 2004.- С 164-169.
2. Olivari N. Endocrine ophthalmopathy (surgical theatment). - Kaden Vergal. Heidelberg.-2001. - 120 p.
3. Бровкина А.Ф., Гусев Г.А. Способ хирургического лечения больных с эндокринной офтальмопатией в стадии декомпенсации, з. №2001108869/14 от 04.04.01; публ. 20.11.02.
STUDY OF LOCAL ANESTHETIC ACTIVITY OF NEW PYRIDINE DERIVATIVES
Kadirova. D. M., Smagulova G. S., Amirkulova М. K., students: Nagashibai A. K., Seitkamalova A. A
KazNMU named by S. D.Asfendiyarov, Almaty, Kazakhstan
Abstract. Despite certain achievements of domestic and foreign pharmacologists, chemists and clinicians in the field of creating of local anesthetics, one of the major problems of modern pharmacology are still searching and exploring new, more effective and less toxic substances with locally anesthetic properties. This is largely due to the fact that many of the traditional and modern local anesthetics are not without side effects, the phenomena of intolerance and often of low activity. Modern medicine highly requires such local anesthetics, which could ensure a sufficient depth of local anesthesia for a relatively long time. In connection with this the search for new compounds having advantages over the widely used anesthetics still remains relevant.
The purpose of this work. The search for compounds having certain advantages over existing local anesthetics in terms of duration of action, potency and toxicity on the model of conduction anesthesia.
Materials and methods of research. In the laboratory of chemistry of synthetic and natural medicinal substances JSC "Institute of Chemical Sciences" named A.B. Bekturov new compounds of piperidine derivatives under laboratory code MAV (local anesthetic substance): MAV-177, MAV-179, MAV-181, were synthesized. Experiments to study the conduction anesthesia been tested on rats by the modified method «tail flick». Determined: duration of total anesthesia and the total duration of the action. The activity of compounds and reference drugs was studied in a 1% solution. Each series of experiments carried out on animals. As a reference preparations were used novocaine, lidocaine and trimecaine.
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