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were reported to be in their progression stage. The fatality occurred resulting from multiple organ failure with symptoms of severe intoxication. It should be noted that 5 (55.6%) patients were diagnosed with pulmonary tuberculosis and 3 (33.3%) patients — with Hepatitis C.
Thus, based on the obtained results we suggest on the apparent exacerbation of TL in case of HIV infection.
Thereat, symptoms changed along with the rapid development of HIV terminal stage. The clinical signs of TL in HIV-infected patients include a great variety of symptoms of local and general origin. TL course as compared with that in non-HIV patients especially in the progression stage is far severer and contributes to the mortality in patients reported with such comorbidity.
The clinical pattern features of concurrent TL and HIV-infection have been associated with the progressive formation of infectious and toxic syndrome.
Conclusion:
1. Significant differences in clinical and laboratory signs and stages of tuberculous lymphadenopathy have been identified in HIV-infected patients. Tuberculous lymphadenopathy in HIV-infected patients is much severer with concomitant diseases that
develop much more frequently and aggravate the underlying disease than those in non-HIV patients.
2. The progressive stage of tuberculous lymphadenopathy with generalization and lethality is reported in 15.8% cases.
3. TL in absence of HIV infection as compared with TL with HIV infection is clinically more favorable, it is known for limited lesions and, most importantly, for limited caseous-necrotic changes.
4. Having analyzed the histologic pattern of lymph nodes removed in HIV-infected patients, we identified three types of tuberculous lymphadenopathy activity: inactive phase (with prevalence of productive cell response) in 3 patients (5.3%), active phase (predominantly with productive-necrotic tissue reaction) in 11 patients (19.3%), pathology progression phase (mostly necrotic lesions, suppuration and fistula formation) in 43 patients (75.4%).
5. It is found that the inactive phase is 5.5 times more commonly reported in non-HIV patients as compared with that in HIV patients (29.3% and 5.3% accordingly, P<0.001), whereas the active phase and progression phase were 1.5 and 1.3 times more commonly reported in HIV patients as compared with that in non-HIV patients (19.3% and 13.1, accordingly, P>0.5; 75,4% and 57.6%, accordingly, P<0.02).
References:
1. Erokhin V. V. et al. Peculiarities of clinical sign identification and TB therapy in HIV-infected patients//Probl. Tub. - 2005. - No. 10. -P. 20-27.
2. Zimina V. N., Batyrov F. A., Kravchenko A. V. and et al. Clinical and radiological features of the incident case of TB development in HIV-infected patients depending on the original account of CD4 + lymphocytes//Tub. - 2011. - No. 12. - P. 35-41.
3. Frolova O. P. TB development features in HIV-infected and prevention measures: Author's abstract...Doctor ofMedical Science. - Spb., - 1998.
4. Chulochnikova M. V. Clinical and morphological characteristics of the peripheral lymph node tuberculosis in different phases of activity: Author's abstract .Candidate of Medical Science. - M., - 2005.
5. Demisse M. et al.//Int. J. Tuberc. And Lung Dis. - 2001. - Vol. 5, - No. 11. - P. 85.
6. Mu A.//Zhonghua Jie He He Hu Xi Za Zhi. - 1998. - Sep; - Vol. 21, - No. 9. - P. 526-527.
7. Richter C. et al.//Intern. J. Tuberc. And Lung Dis. - 1995. - Vol. 77, - No. 6. - P. 510-517.
8. Sepkowitz K. A. et al. Tuberculosis in the AIDS era//Clin. Microbiol. Rev. - 1995. Vol. 8, - No. 2. - P. 180-199.
9. Sharma S. K. Mohan A. Extrapulmonary tuberculosis//Indian J. Med. Res. - 2004. - Vol. 120. - P. 316-353.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-136-137
Halikov Shavkatbek, Andijan state medical instate Science researcher Abduhalikov Alimjon Karimjanovich Andijan state medical institute Doktor of chair traumatology and vertebrology E-mail: Vertebrolog-shavkatbek@yandex.ru
Surgical treatment of foraminal herniated disc of the lumbar spine
Absrtact: Herniated lumbar intervertebral disc have a significant impact on both the patient's life as well, and because of the high prevalence and economic impact on society as a whole. Designed scheduling algorithm foraminal hernia surgical treatment of lumbar intervertebral disc, based on the preoperative detection of compressing factors allows to define differentiated indications for decompressive or decompressive-stabilizing surgery. Keywords: herniated disc, foraminal foraminal.
The urgency of the problem of hernias of lumbar interverte- The prevalence of disease in the population is 58-84%, and the in-bral disc is made up of a number of reasons. First and foremost, cidence is 4-33% [9; 10].
the fact that the world is suffering from this disease a huge number The incidence of "low back pain" (low back pain) in the Neth-
of people — more than 80% of the world's population [1; 2]. And erlands amounted to 28 cases per 1000 population per year, and more often herniation of lumbar intervertebral disc found in de- for low back pain with sciatica — 11.6 cases per 1,000 persons per veloped countries where widespread sedentary, sedentary lifestyle. year. Herniated disks are a common cause of back pain. This pain,
Surgical treatment of foramina! herniated disc of the lumbar spine
«low back pain», defined as pain localized in the back, the twelfth rib bounded above and below — the inferior gluteal folds [8]. In Russia, the prevalence of chronic back pain is estimated 26-33% of the adult population [1]. The incidence of "low back pain" (low back pain) in the Netherlands amounted to 28 cases per 1000 population per year, and for low back pain with sciatica — 11.6 cases per 1,000 persons per year. Herniated disks are a common cause ofback pain. This pain, "low back pain", defined as pain localized in the back, the twelfth rib bounded above and below — the inferior gluteal folds [8]. In Russia, the prevalence of chronic back pain is estimated 26-33% of the adult population [1].
Most herniated discs occur in the lumbar level (about 65%), at least — on the neck (30%), very rare (5%) — on the thoracic level. This is due to the fact that the formation of the herniated disc in most cases is the ultimate manifestation of a degenerative process. Moreover, different parts of the spine in varying degrees susceptible to degenerative changes and the formation of hernias.
Men suffer slightly more often than women [4]. Most of the patients are people ofworking age: 25-55 years. Often the disease is associated with their professional activities [2; 11].
Herniated lumbar intervertebral disc have a significant impact on both the patient's life as well, and because of the high prevalence and economic impact on society as a whole. This disease causes suffering — pain, neurological damage or make it impossible to minimize the ability to fully work up to 70% of patients. Given the high incidence in the state scale, this leads to temporary disability significant number of people, which inevitably leads to huge losses. In addition, the state spends huge amounts of money on the treatment and rehabilitation of such patients. Vertebral pathology in the general structure of morbidity with temporary disability ranked second, second only to respiratory infections, and up to 20-30% [4].
Each year the incidence is increasing. For example, Palmer et al. revealed an increased incidence in the UK from 1980 to 2000 [7].
In 2004, the American Academy of Orthopedic Medicine estimates that the average loss of the US budget caused by lumbar pain "low back pain" in most cases due to the herniation of lumbar intervertebral disc, is $ 100 billion annually., Including $ 20 billion. As paying medical bills [4].
The first reports of reoperation after failed discectomy performed in the lumbar spine appeared in the 50s of the last century. Surgical treatment neyrokompression forms of degenerative disc disease of the lumbar spine in most cases leads to an objective improvement of the patients. However, the pain after surgery is not always completely removed and, in some cases, there is worsening of neurological symptoms, leading to a deterioration in the quality of life of patients, reducing their efficiency and the need to further conduct a long rehabilitation treatment. According to the generalized data of world literature, the number of unsatisfactory results after discectomy performed various surgical procedures is 8-23% [5; 10]. Frequency conducted reoperation 5-18% [6].The most common causes of failure is the formation microdiskectomy disc hernia recurrence, appearance of segmental instability, scar formation, adhesions, the remains of unidentified foraminal disc herniation, etc. Unsatisfac-
tory results after lumbar discectomy in foreign literature combined in FBSS term (failed back surgery syndrome). FBSS or LES (failed back surgery syndrome) — is the clinical condition of the patient, who despite holding one or more operations in the lumbar spine is marked resistant radikulopatichesky syndrome [5; 6; 11].
Depending on the location distinguish: median, paramedian and lateral herniated discs.
Lateral herniated discs — team group uniting hernia, located in mezhpozvonkovogo hole or laterally beyond (or foraminal and extrafo-raminal). Their rate is 4-20% ofall hernias ofthe lumbar spine. Laterally raspolozhennye herniated discs differ from other vidov herniated discs diagnostic difficulty and operativnogo access, even with modern methods neyrovizualizuyuschih, unsatisfactory results of surgical intervention.
Foraminal hernia of intervertebral holes located in that at the level of L4-L5 and L5-S1 disks are radicular channel length of 1.52 cm. Because of the massive articular processes and long radicular channel at these levels access to foraminal hernia is difficult, they often go unnoticed.
Nerve root ganglion and displaced cranially and dorsally compressed and the lower edge of the arc root. Migrations down as the hernia and prevents root sequester bottom arc. With this in mind, find foraminal hernia without appropriate preoperative diagnosis and specific surgical approach difficult.
Objective: To develop a surgical treatment of foraminal hernia of intervertebral discs of the lumbar spine.
Material and Methods:
We analyzed the results of treatment of 750 patients with herniated intervertebral discs, which were treated in the clinic Spine ASMI office in the period from 2012 to 2016. All the patients underwent CT and MRI studies. Of these, 90 patients were found to foraminal hernia. Men were 42 (46%) and 48 women (54%). The average age of patients sostavlyal- 40±2,7 years.
Results and discussion:
On the L5-S1 level foraminal hernia occurred in 41 patients (45.7%), the L4-L5 level in 38 patients (42.8%). In 10% of patients foraminal hernia found in the L3-L4 level. In 52% of patients later-ilizatsiya foraminal hernia was left-handed, right-sided in 48%. The degree of pain was assessed by visual analovogo scale — VAS. Patients to Your operation was 7,5±0,7.
Patients under endotracheal anesthesia was performed surgery: arkotomiya, medial facetectomy, discectomy and Foraminotomy with partial preservation of the yellow ligament. Operations were carried out under the operating microscope using microsurgical instruments.
In the early postoperative period, a decrease of pain according to VAS to 2,1±0.5, 6 months after the operation marked pain relief to 1.1±0.2 VAS.
Long-term results of microsurgical treatment were as follows: -74% excellent, 22% good and mediocre — 4%.
Conclusions:
Designed scheduling algorithm foraminal hernia surgical treatment of lumbar intervertebral disc, based on the preoperative detection of compressing factors allows to define differentiated indications for decompressive or decompressive-stabilizing surgery.
References:
1. Belova A. N. Neurorehabilitation: a guide for physicians. - 2nd ed. Revised. and ext. - M.: antidoron, - 2002. - 736 p.
2. Belova A. N. Scales, tests and questionnaires in neurology and neyrohirurgii. - M., - 2004. - 432 p.
3. Waldman A.V, Ignatov Y. D. Central mechanisms of pain. - L.: Nauka, - 1976. - 191 p.
4. Krylov V. V., Lebedev V. V., Grin A. A. Status of neurosurgical care to patients with injuries and diseases of the spine and spinal cord in Moscow (according to neurosurgical hospital zdravoohraneniya Committee for - 1997-1999.)//Neurosurgery. - 2001. - No. 1. - P. 60-66.
5. The international congress dedicated to the treatment of chronic pain after surgery 1for lumbar pozvonochnika «painmanagement 98» (FAILID BACK SURGERY SYNDROM)//M. S. Gel'fenbeyn/Neurosurgery - 2000. - No. 1-2 - P. 65.
6. Zozulya Y. A., PedachenkoE.G, Slin'ko EI Surgical treatment neyrokompressionnyh lumbosacral pain syndromes//Kiev. - 2006.
7. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years/KT. Palmer [et al.]//BMJ. - 2000. - Vol. 320. - P. 1577-1578.
8. Greenough C. G., Fraser R. D. Assessment of outcome in patients with low-back pain//Spine. - 1992. - Vol. 17. - P. 36-41.
9. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration/Y. Ahn [et a!.]//Acta Neurochir (Wien). - 2009. - Vol. 151. - P. 199-206.
10. What comprises a good outcome in spinal surgery? A preliminary survey among spine surgeons of the SSE and European spine patients/M. Haefeli [et al.]//Eur. Spine J. - 2008. - Vol. 17. - P. 104-116.
11. Wolf A. D., Pfeger B. Burden ofmajor musculoskeletal conditions//Bulletin ofWorld Health Organization. - 2003. - Vol. 81. - P. 646-656.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-138-140
Hodzhimuratova G. A., The Health Ministry of Republic of Uzbekistan specialized scientific-practical medical center of obstetrics and gynecology joint-stock company E-mail: mexriban85@mail.ru
The clinical morphological characteristic normal premature placental separation at thrombophilia
Abstract: It is executed comparative complex clinical-morphological probe engaging studying of structural violations in 11 placentas, received at the premature birth which has advanced against a typical clinical picture premature placental separation Key words: Thrombophilia, PPS, morphological of placenta, pregnant.
Introduction. Last achievements in the field of clinical immunology, endocrinology, haemastology, microbiology, virology have allowed to look at problem PPS at pregnancy as result haemoctologic violations in system "mother-placenta-fetus" [1; 4]. Congenital and got external factors (the antiphospholipiding syndrome, virus infections) potential in pregnancy various thrombophilia violations owing to damage endothelium vessels. Gears of development of such conditions depending on acting causation the factor are not studied enough and represent doubtless scientifically-practical interest.
The special place is retracted hereditary thrombophilia which is one of the major factors contributing to violations of coagulation, since a stage of implantation and formation of a placenta [2; 5].
Correction of violations in system of a hemostasis at pregnant women with thrombophilia in formation of a placenta before end инвазии throphoblastes is necessary for prolongation of pregnancy and preventive maintenance of the remote complications, such as heavy forms gestosis, placentary insufficiency, a delay of prenatal development of a fetal PPS [3; 7; 8].
Development of placentary insufficiency with blockade of formation new villus or angiogenesis calls violations of development of bodies and fabrics, especially kidneys, a brain, heart [6].
In connection with the above-stated there was a probe particular purpose:
Aim: To carry out the clinical-morphological analysis of placentas at the died fruits and newborns at PPS.
Research problems included the analysis of risk factors and definition of morphological criteria of chronic placentary insufficiency at thrombophilia.
Materials and methods research: At probe of placentas the microscopy and a semiquantitative estimation in comparison group (4 women with normal pregnancy and sorts) and in the main group ofll women with premature отслойкой normally disposed placen-
ta (PPS) which term of pregnancy has made 28 weeks (3 woman), 30 weeks (2 women), 36 weeks (1 woman), 37 weeks (3 women), 38 weeks (1 woman), 40 weeks (1 woman) have been used macros-copy. At histologic probe of placentae, considering different terms of pregnancy, various morphological changes were observed. In comparison group placentae of healthy women with not burdened obstetrical the anamnesis were investigated.
At macroscopical probe of placentae of healthy women with term pregnancy (comparison group) uniform drop of a thickness of a placenta from the centre to periphery was marked. The mean thickness of placentae in the centre made 23,7±0,5 mm. Mantles fetal eggs had brilliant grey colour. The number of segments in placentae fluctuated from 12 to 18. Vessels on a fruit surface of placentae are sanguineous. On a placenta sectional view had dark red colour. The mean weight of placentae made — 409,5±1,9 rp. Placenta-fetal the index (PFI) was a parametre of pot-life of a fruit. At the adverse forecast parametres PFI were above 0,18 or more low 0,1) and made 0,123±0,006.
The macroscopical characteristic of placentae of the main group with PPS indicated the significant changes shown in a kind circulation of frustration and changes of microcirculation, destructive changes, presence of heart attacks, hematomas and the centres calcification. The mean thickness of placentae in the centre made 22,3±1,8 mm. Mean weight of placentae — 332,1± 72 rp., placental-fetus the index made — 0,166 ±0,05.
For a visual estimation of placentae clinical-anatomic classification PPS on which is used revealed:
- Subhorialnaja a hematoma (a hemorrhage under mantles) — in the given group — 3 supervision;
- The Regional hematoma (a hemorrhage on placenta bottom edge)-2 supervision;
- Retoroplatsentarnaja a hematoma (a hemorrhage under a placenta) — 2 supervision.
