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Surgical treatments herniated disc of the lumbar spine in elderly and senile
Bacteriological analysis of 20 patients of 1st group in 11 (55 %) patients sensitivity to claritromycin was not observed. To metroni-dazol we observed a low sensitivity (+), sensitivity to amoxicillin was medium (++). For Tetracycline and levofloxacin the sensitivity was high (+++).
6 (30 %) patients in the first group to the low sensitivity of clarithromycin (+). To metronidazol and amoxicillin no sensitivity (-). Tetracycline, we observed an average sensitivity (++) and to levofloxacin high sensitivity (+++).
In 3 (15 %) patients in the same group for metronidazol and claritromitsin sensitivity was not observed. For the rest of the antibiotics: amoxicillin, tetracycline and levofloxacin sensitivity was moderate (++).
2nd group — 20 patients with chronic atrophic gastritis. The average age of 46.5 ± 0.9 years. Patients in this group had a history of chronic hyperacid gastritis. The duration of clinical symptoms until diagnosis is 6-12 months.
In all (100 %) 20 patients by polymerase chain reaction for the detection of DNA of HP quality in real time is positive.
The history of all who had eradication HP treatment. They took antibiotics such as metronidazol, clarithromycin, amoxicillin by the standard of treatment.
By endoscopic study on the background of atrophic gastritis were identified erosive lesions of the mucous membrane. Erosion different polymorphisms in endoscopic picture.
Morphologic study were found degenerative changes in the cells and dysgenerator surface epithelium, continuous inflammatory infiltration of the gastric mucosa and a decrease in the number of normal glands. The epithelium appear fundal cancer among the main and parietal cells. Also found elements of the "restructuring" of the mucosa.
Bacteriological analysis of 20 patients in 9 (45 %) patients to claritromitsin and metronidazol has low sensitivity (+), no sen-sitibility for amoxicillin (-). Tetracycline medium sensitivity (++) and high sensitivity to levofloxacin (+++).
6 (30 %) patients of the second group no sensitivity to clar-ithromycin, metronidazol and amoxycillin (-). Tetracycline and to levofloxatcin we observed high sensitivity (+++).
In 5 (25 %) patients in this group to claritromitsin, metronidazol, amoxicillin and levofloxacin sensitivity was low (+) and tetracycline sensitivity was moderate (++).
3rd group — 20 patients with stomach ulcer. The average age of 46.5 ± 0.9 years. Patients in this group had a history of chronic hyperacid gastritis.
20 (100 %) of 20 patients by polymerase chain reaction for the detection of type DNA HP quality in real time is positive.
The history of all had eradication HP treatment, antibiotics such as metronidazol, clarithromycin, amoxicillin.
Morphologic study was a single ulcer, which has an oval or round in shape and size from a few millimeters to 5-6 cm. Ulcer penetrated the stomach wall at different depths reaching sometimes up to a serous layer. Edge sores facing the esophagus, some implied, and the mucous membrane hangs over the defect. The edge facing the gatekeeper, flat, looks like terraces, steps which are formed by layers of walls — mucosa, submucosal and muscular.
Bacteriological analysis of the 20 patients — 13 (65 %) patients to clarithromycin, metronidasol had an average sensitivity (++) to amoxicillin, tetracycline, and to levofloxacin observed high sensitivity (+++).
In 3 (15 %) patients of the third group to clarithromycin and metronidazol had a high sensitivity (+++). To amoxicillin, tetracycline and levofloxacin observed mild sensitivity (++).
In 4 (20 %) patients in this group to claritromicin, amoxicillin, tetracycline and levofloxacin has high sensitivity (+++). Metronidazol, we observed a low sensitivity (+).
Conclusions
1. 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.
2. Antibiotic-resistant form of HP, unlike other forms of family HP, a chemical mutation may increase the pathogenicity.
3. Antibiotic-resistant form of the HP continuously irritate lymphatic tissue and the use of eradication therapy in non-susceptible strains of HP causes an allergic reaction of the mucous membranes and lymph tissues of the gastrointestinal tract. This reduces the barrier protection of the stomach wall and HP directly stimulates lymphatic layer.
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Mamajonov Bakhodir Solijonovich, Assistant of the department of traumatology, orthopaedics, field surgery, neurosurgery and medicine of catastrophes Andijan state medical institute, Andijan E-mail: [email protected]
Surgical treatments herniated disc of the lumbar spine in elderly and senile
Abstract: The article presents the data of examination and surgical treatment of118 patients with herniated lumbar spine in elderly persons. The contingent of patients aged 60 to 85 years. In the preoperative period conducted clinical neurological and instrumental methods of research using X-ray, CT, MRI. The results of surgical interventions (arcotomy + discectomy —
Section 5. Medical science
13 patients hemilaminectomy + discectomy — 105 patients), good results were obtained in 83 (70.3 %), satisfactory 31 (26.2 %) and unsatisfactory in 4 (3.5 %) patients. The findings indicated that in elderly and senile pathological process is polysegmental character. Good results were achieved during hemilaminektomic access surgical procedures. Keywords: osteochondrosis, degeneration, arcotomy, hemilaminectomy, discectomy.
Introduction
Osteochondrosis of the lumbar spine are most frequent pathology and its main manifestations are considered various neurological disorders. Efforts orthopedists and neurosurgeons in the treatment of patients with lumbar osteochondrosis address the radicular disco, disco-Vascular conflicts [1; 4; 10; 11]. Although there are different ways of surgery, with herniated disc to date there is no common approach to the definition of indications and choice of interventions volume [2; 3; 9; 15]. In today's medical world problem of treatment of patients in elderly is of particular medical and social ethical significance [5; 6; 8; 13]. The urgency of this problem is an adequate assessment of the pathology, the complexity of its differentiation from natural ivolyutivnyh changes, and selecting the optimal method for the treatment of established diseases [7; 12; 14]. Please note that in the elderly the risk of surgery is much higher. So far there is no consensus in the choice of tactics of treatment of degenerative diseases of the lumbar spine, particularly in elderly individuals. There are currently a large number of surgical treatment of degenerative spine lesions methods [4; 7; 10; 15].
According to Simanovich's information, the patients with lumbar vertebral osteochondrosis compose 16 % of all patients who addressed medical staffs. Most of them had complications. Clinic of lumbar vertebral osteochondrosis, its course of neurologic complications are a little different in patients old and advanced ages. There were not much spoken about diagnostics and surgical treatment of old and advanced patients in literature and is considered as one of the most vital problems nowadays.
The aim of the research work — to treat lumbar vertebral osteochondrosis of old and advanced aged patients surgically and to determine the basic properties of preparing it for the operation and to prevent possible problems that can be met during the operation and post operation time.
Age-related changes in the lumbar spine degenerative are accompanied by changes that may lead to the development of pathological conditions requiring an adequate surgical treatment [1; 7].
Materials and Methods
We observed in the neurosurgical clinics of ASMI department from 2008 to 2012. there were 118 patients of elderly and senile patients with lumbar osteochondrosis complicated by herniated intervertebral discs. The patients' age from 60 to 87 years. The greatest number of patients were between the ages of 60 to 75 years — 85 (72.0 %). The allocation of the men on the floor — 66 (55.9 %) and women — 52 (44.1 %).
The disease duration from 3 months to 15 years. Of the 118 patients examined the occurrence of disease and its first symptoms associated with heavy physical labor 69 (58.4 %) and one-off physical overload 26 (22.4 %) patients. The remaining 23 (19.4 %) patients the occurrence of disease associated with inflammatory processes.
Neurological examination of patients with the disco-radicular conflict manifested itself in the form monoradikulyarnogo syndrome in 75 (63.5 %) patients, biradikulyarny syndrome in 43 (36.4 %) patients. Most often they suffered L4 - L5 - S1 roots. From the roots of tension symptoms symptoms Lassega investigated, spondylitis, and Neri. Thus Lassega symptom was noted in 85 (72.0 %) patients, ankylosing symptom in 56 (47.4 %) patients and Neri symptom in 68 (57.6 %) patients. Violations of the sensitivity is
usually observed in the area of pain — hypoesthesia. Almost all observations have been marked changes in tendon reflexes — knee and Achilles. The phenomena of paresis of the foot on the affected side were noted in 23 (19.4 %) patients and dysfunction of the pelvic organs in 7 (5.9 %) patients.
X-ray examination of all 118 patients were identified spondylograms signs of osteochondrosis in various stages of development, the triad Bar. Ofthe 118 patients 109 (92.3 %) patients were performed MRI and CT studies. MRI and CT studies revealed the characteristic signs ofherniation of intervertebral discs in the sagittal and axial planes T1 and T2 mode, the state of the epidural space, the size and the direction of deposition of the intervertebral disc, the degree of compression of the dural sac and the spine. Dimensions of hernias of intervertebral disks were from 8 mm. to 15 mm. In 76 (64.4 %) cases were left-sided hernia in 28 (23.7 %) cases, the right-handed and 14 (11.6 %) cases were located mid hernia. Polysegmental herniation on MRI study were identified in 98 (83.0 %) cases on 2 levels — 69 patients (58.4 %) and 3 levels of 29 patients (24.5 %). In identifying MRI polysegmental hernias of intervertebral discs, the removal was performed if their size is greater than 8 mm.
After diagnosis, the patients were subjected to surgical treatment. Minimally invasive surgical interventions were carried out by arcotomy and hemilaminectomy. At the same time we take into account the size of the disk has fallen, its relationship surrounding nerve structures, the severity of degenerative changes of the spine and the age of patients. In addition, the presence of lesions polysegmental adjacent disks as used by hemilaminectomy access.
Of the 118 patients surveyed arcotomy was performed in 13 (11.0 %) cases and 105 (88.9 %) cases hemilaminectomy. In all cases, it was noted hypertrophy of the yellow ligament and economical removal after the last audit made of the spinal canal. After hernia detection produced the mobilization of the dural sac, spine and proceeded to discectomy. Technical difficulties with discectomy appeared at larger sizes hernias (12 to 15 mm.), due to the presence of scars between the dural sac, spine and hernia. In these cases, discectomy was performed 2-stage — first made the removal of herniated disc between the dural sac and the spine, and then made the mobilization of these entities, and the complete removal of a hernia. In 97 (82.2 %) cases, discectomy was completed foraminotomy due to narrowing of the places of the spine bone formations — osteophytes.
Results and discussion
Evaluation of surgical procedures performed on the basis of the results of orthopedic and neurological criteria. At the same time we take into account the regression of neurological symptoms and the restoration of the biomechanics of the damaged segment of the spinal column.
Good results — the disappearance ofpain, restoration of sensitivity, motor activity and disturbed functions of the pelvic organs — were noted in 83 (70.3 %) patients.
Satisfactory results — saving blurred pain in the spine during movement and physical activity, slow regression of neurological symptoms — in 31 (26.2 %) patients.
Unsatisfactory results — saving motor and pelvic disorders in the pre-operative level, although there is a decrease of pain due to decompression of nerve structures — 4 (3.3 %) patients.
Evaluation of the results of treatment in patients with locally common forms of ovarian cancer.
Conclusions:
1. According to the X-ray, CT and MRI studies indicated that patients with middle and old age is a characteristic type of lesion polysegmental vertebrae and intervertebral discs;
2. The correct choice of surgical approach based on neurological disorders and on the basis of MRI studies of
patients with herniated discs promotes earlier restoration of the biomechanics of the spine and the regression of neurological symptoms.
3. We believe that patients elderly optimal surgical approach to the vertebral canal is hemilaminectomy that gives complete decompression of the dural sac and the spine.
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Mamarasulova Dilfuzahon Zakirjanova, Head of the Department of Oncology, Radiology and Phtiziatry, Andijan State Medical Institute, Andijan, Uzbekistan
Ergasheva Zumrad Abdukaumovna, Head of the Department of Pharmocology
Ziyaeva Surayo Tahirovna, Doctor-intern of Andijan Region Oncologycal Dispancery
Yakubbekova Sohiba Sadikovna, Master degree Andijan State Medical Institute E-mail: [email protected]
Evaluation of the results of treatment in patients with locally common forms of ovarian cancer in Andijan Regional Oncological Dispensery
Abstract: The article deals with the treatment and the results of a locally common forms of ovarian cancer. The study included registered in Andijan Regional Oncological Dispensery histologically verified patients with ovarian cancer. The purpose of this section of our study is to evaluate the effectiveness of various schemes of neoadjuvant chemotherapy in combined treatment of patients with locally advanced ovarian cancer. Also, long-term treatment results are obtained depending on the different schemes poliochemotherapy.
Keywords: ovarian cancer, locally common forms of ovarian cancer, neoadjuvant chemotherapy, adjuvant chemotherapy, drug, treatment.
