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atypical forms play a great role in the epidemiology of this disease, which prevail over the symptomatic cases [3].
The treatment of epidemic encephalitis at any stage is inefficient and very difficult. There are no specific drugs today. If the disease is identified in the acute form, anti-viral medicine is prescribed, usually Interferon Gamma Globulin. The treatment in the chronic stage of epidemic encephalitis is done with drugs of the cholino-lytic range, mostly synthetic compounds Cyclodol or Tropatsin. It is prescribed 1 mg or 2 mg of Cyclodol 2-3 times a day. In the case of side effects such as dryness in the mouth, accommodation disorder, palpitations, dizziness the dose should be reduced. They prescribe 10-12.5 mg Tropatsin 1-2 times a day, it is possible to increase the medicine up to 20 mg if there are no side effects; the daily dose can be 20-50 or even 75 mg.
A more effective method of treatment in many cases of Parkinson's disease is taking L-Dopa, a dopamine predecessor. The drug gets into the blood-brain barrier and compensates for the lack of dopamine in the basal ganglia. The effect of L-Dopa treatment does not depend on the etiology of the disease, its duration, age or sex of patients and the severity of symptoms. The most effective treatment is using L-Dopa in combination with the previously used antiparkinsonian medicine — Cyclodol and its analogs, as well as some of the antisensitizers such as Dimedrolom, Suprastin.
L-Dopa treatment is used in a certain pattern, which provides a gradual increase in dosage, and amount of drug within a few weeks. It starts with the initial dose of 0,125 g per day with gradual increase up to 0.25 g. A good therapeutic effect is reached when using different dosages, generally starting with 2g per day and increasing the dose up to 5-6 g. per day. The drug effectiveness is
reduced when it is used long term, a patient may experience the on-off effect, when the state of stiffness is immediately replaced by the state of hypotension and hyperkinesis and vice versa. Positive results of L-DOPA treatment and its derivatives is observed in approximately 70% of patients. Some of them return to their normal life, even restart working.
In recent years a number of drugs such as Midantan and some other antidepressants are used for the treatment of patients with Parkinson's disease. But they are less effective than L-DOPA, though they can be successfully applied in a complex treatment in combination with L-Dopa, especially Midantan. For some patients, especially those suffering from hyperkinetic forms, a surgical treatment is necessary. It consists of stereotactic operations aimed at destroying mainly the ventrolateral nucleus thalamus [1; 2].
There are also different methods of surgical treatment of Parkinson's disease, in which the chemicals (Novocaine and Alcohol) destroy thalamo subcortical connections. This leads to a decrease in muscle tone and disappearance of hyperkinesis.
Conclusion: Sporadic cases of epidemic encephalitis exist nowadays. Potentially they can cause an epidemic. The causative agent of epidemic encephalitis is transmitted by droplet infection. This disease is contagious, and in each case the patient must be isolated. The treatment is symptomatic. Antiviral drugs such as De-oxyribonuclease, dehydrating agents, B vitamins and ascorbic acid are the most effective forms of the therapy in the acute phase of the disease today. Neurotrophic and neuroprotective drugs are used in the chronic form of the disease, they are also effective for the treatment of the secondary parkinsonism, symptomatic epilepsy, the correction of the endocrine and autonomic disorders.
References:
1. Bogadelnikov I. V., Prokudina L. I. Zdyrko E. V. Bezdolny T. N. Differential diagnosis of acute stroke and viral encephalitis. Crimean State Medical University named after S. I. Georgievskogo. Guidelines for doctors. - Simferopol, - 2009. - 690 p.
2. Gusev E. I., Konovalov A. N., Skvortsova V. I. Neurology and Neurosurgery: - M: GEOTAR - Media, - 2007. - 608 p.
3. Karpov I. A., Kachanko E. F., Vasilenko A. I., Gorbich J. L. Nightingale I. V. Encephalitis in clinical practice. Is it simple? (Review of practical recommendations for the treatment of patients with encephalitis of the American Society of Infectious Diseases) - 2011.
4. Karpov S. M., Baturin V. A., Telbuh V. P., Frantseva A. P., Belyakov N. A., Ciechanowski L. V. Autoantibodies to myelin basic protein and its role in demyelinating processes. Clinical Neurology. - 2013. - No 3. - P. 28-31.
5. Schneider N. A., Dmitrienko D. V. Late diagnosis of the chronic form of epidemic encephalitis. Siberian medical review. - 2007, - No 333, - P. 12-49.
6. Yarosh A. A., Krivoruchko I. F., Dracheva Z. I. Nerve diseases textbook. - 1985. - 463 p.
7. Arvind K., Deepti Sh., Rashmi K., Mohammad Z. I., Usha K. Misra, Tapan N. Dhole. An epidemic of encephalitis associated with human enterovirus B in Uttar Pradesh, India. Journal of Clinical Virology, - 2011-06-01, - Volume 51, - Issue 2, - P. 142-145.
8. Karpov S. M., Dolgova I. N., Vyshlova I. A. The main issues of topical diagnosis of nervous system diseases. Stavropol - 2015.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-84-88
Okhunov Аlisher Оripovich, Bozaripov Soyib Jonibekovich, Sattarov Оybek Тokhirovich, Tashkent Medical Academy E-mail: doctoroybek84@mail.ru
The condition of endothelial system under nephropathy genesis
Abstract:
The aim: to define interchange condition of nitrogen oxide components in blood within different variants of nephropathy. Methods: there were used 40 rabbits of both sexes by weight 1500-2500 gr. Animals were divided into 4 groups: 1) control group — 10 intacted rabbits; 2) the first group — rabbits with chronic nephropathy; 3) the second group — rabbits with
nephropathy under diabetic angiopathy 4) the third group — rabbits with chronic kidney disease under diabetic nephropathy. Results: analysis testified difference between arterial and mixed venous blood in NO systems of intacted animals while under diabetic nephropathy activity NOS of arterial blood declined. Depending on disease severity reproduction of different kinds of nephropathy differed by increasing NADPH dependent on HP in expired breath condensate. The lowest meaning we observed in animals with chronic toxic nephropathy. Conclusion: conducted impact analysis of concentration in blood and in expired breath condensate among animals with chronic toxic nephropathy indicated predominance of productivity in anatomical airway.
Keywords: nephropathy, endothelial system, lung barrier function.
The chronic kidney disease takes particular place among chronic non-communicable disease, because it spread widely, it leads to worse life quality, death and it demands expensive therapy — dialysis, kidney transplantation.
Many years the problem of chronic kidney disease was not paid attention much. Flurry of interest appeared in the beginning of XXI century, when data from epidemiological researches (NHANES and others.), showed high frequency of decreased kidney function and dialysis service did poor job, in spite of opening new dialysis centers, with great number of patients. In 2005 USA 6,4% of Medicare budget. Spending goes up 7,7% annually. In the EU spending goes up 2% from budget of public health service.
The pathogenesis of ChKD under vascular events of diabetes is not investigated thoroughly. The main role takes endothelium dysfunction and breach of vascular system in ChKD under diabetic angiopathy. Nitrogen oxide — free radical brings about endothelium — dependent vasodilation, abscopal trombocyte aggregation leukocyte adhesion to endolethelium and proliferation of smooth muscle sell V. W.
Formation of NO hails from L-arginine by synthesis NO [1; 2; 6; 8]. Statical express of ferment which catalyze formation of nitro oxide is in endothelium and thrombocyte [7; 10]. In macrophage, neu-trophil, hepatocytes mesangeal and smooth muscle cells fusion determines inducible synthesis (iNOS), that activate production ofnitrogen oxide to 10 times, herewith NO acquired cellulotoxic properties [4; 9].
During learning NO in pathogenesis of ChKD under diabetic nephropathy we got discrepant data, that connects with differences of clinical profiles and different methodological approaches to synthesis NO. some authors judging by activity of cells in particular, thrombocytes; other researchers found its reduction, another fixed increasing [2; 6; 7].
Alternate approach based on level NO integral estimate by content stable products, its oxidation of nitrates (NO3) and nitrites (NO2) in blood and urina. There were discovered normal, increased exponents of nitrogen oxides metabolites in patients' blood plasma [2; 10].
In view of the above, the aim of our research is assessment of interchange nitrogen oxide in blood over time with different kinds of nephropathy.
Material and research methods. there were used 40 rabbits of both sexes by weight 1500-2500 gr. Animals were divided into 4 groups: 1) control group — 10 intacted rabbits; 2) the first group — rabbits with chronic nephropathy; 3) the second group — rabbits
with nephropathy under diabetic angiopathy 4) the third group — rabbits with chronic kidney disease under diabetic nephropathy.
Experimental chronic nephropathy was reproduced via A. K. Mitciev's method by using lead acetate. Experimental model of chronic kidney disease under diabetic nephropathy we carried out by our own method [5].
Division of animals according to several types of nephropa-thy in relation to glomerular filtration rate, which is identified by creatinine clearance method [1; 8].
Endothelial system investigated by nitrates indicators, nitrites, and the enzymatic activity of NO-synthase in blood, which was determined by the Griss method in the modification of A.P Solodko. [6]. In this study we were taken for various tests of mixed venous and arterial blood at fixed endovasal catheters and of expired breath condensate. For condensate collection of expired air we used corresponding device generated by S. V. Fedotov in auth [2; 4; 9].
Attained results and its discussion. Research includes: in control group mixed venous blood contains in average 17,51±1,54 umol/l. In arterial blood sample the level climbs to 26,61±3,45 umol/l. Herewith veno-arterial difference is composed of «+» 9,1±0,54 umol/l was basic to all animals from this experience. This tendency confirms common record of predominant content in arterial blood in comparison with venal blood, on the other side our experience identifies importance of endothelial system of lung in these transformations.
Attained analysis results showed that there is great difference between arterial and mixed venous blood in activity of NO-system intacted animals. In arterial blood sample the level of stable metabolites transcended NO significantly the meaning of mixed venous blood on 55,5%, activity NOS — to 99,6%, activity ofNADPH- dependent on NR (mark iNOS) was onferior to 56,5%, and ONO- — to 60,3% (table 1).
Consequently, obtained data proclaim that depending on en-dothelial system of lung the activity level NO is changed in arterial and mixed venous blood. Arterial blood is more impregnated by concentration of NOS. The low level ONO2, can be related to doldrums activity of NADPH- HP.
Such relationships among level of main stable metabolites NO, NOS, NADPH- HP and ONO- support stable level in arterial, mixed venous blood, resistibility of endothelial system RES and low rate of reactive connections, that conditioned by ferment strength NADPH- HP and concentration. Resistibility rate in arterial blood exceed in mixed venous blood to 2,84 times, but reactive connections were beneath of level to 1,15 times.
Table 1. - Control rates of NO-system in mixed venous and arterial samples of intacted animals, M±m
Exponents of NO-systems Blood samples Venous arterial difference
Mixed venous blood Arterial blood
NO (umol/l) 17,51±1,54 26,61±3,45* «+» 9,1±0,54
NOS (umol/min/l) 3,92±0,11 6,73±0,19* «+» 2,8±0,09
NADPH — dependent HP (umol/min/l) 0,33±0,04 0,2±0,09* «-» 0,13±0,01
ONO- (umol/l) 2,61±0,08 1,7±0,2* «-» 0,91±0,02
Factor ofVillibrant (umol/l) 0,65±0,06 0,1±0,01* «-» 0,55±0,05
* significant difference of arterial blood samples from mixed venous p<0,0S
Obtained data proclaim that limiting factor of resistibility in endothelial system is venous blood inflow with high in content of cellulotoxic connection in particular ONO2. Within development of different variants of nephropathy, these resistance relations of endothelial system and reactive connections can be changed.
Among animals with chronic toxic nephropathy on the 10th day of pathological process the level of NO in mixed venous blood increased to 24,61±1,74 umol/l (p<0,05), whereas in arterial sample this level declines to 19,22±1,23 umol/l (p<0,05). The next 20-th and 30-th days discovered tendency to normalization ofcontent ofNO in mixed venous (19,35±2,32 umol/l; p<0,05 and 18,04±1,24 umol/l; p<0,05 correspondingly), the same in arterial (29,62±1,47 umol/l; p<0,05 and 27,41±2,14 umol/l; p<0,05 correspondingly) in blood samples, however their meaning were higher than control meaning.
Venous arterial difference on 20-th day of experimental research was increasing to «+» 10,27±1,24 umol/l (p<0,05), and on 30-th day it included «+» 9,37±1,4 umol/l (p<0,05).
In all learning cases the identified character was identical. Animals with experimental model of nephropathy under diabetic angiopathy on 10th and 20th day were characterized by maximal content ofNO in mixed venous blood got 38,81±5,21 umol/l (p<0,05) and 30,63±4,85 umol/l (p<0,05) correspondigly. This increase in comparison with control series of experiments was 2.2-fold on 10th day and 1.6 times at the 30th day studies.
The increased content of NO in mixed venous sample may be connected with importance of peripheral endothelial system and the general trend of development of diabetic angiopathy. Although level of NO in the mixed venous blood sample at the entrance to the lungs by the 30th day of the experiment decreased in relation to the 10 th day of 1.85 times (p <0.05), and in relation to the 20 th day of 1 46 times (p <0.05), respectively, however, compared with the control group given indicator experiments was 1.19 times higher (p <0.05). This in turn indicated that the level of NO in the mixed venous blood sample testified preserving transformations in organic endothelial system during diabetic angiopathy.
At the same time arterial sample of animals with nephropathy under diabetic angiopathy was characterized by the lowest meaning of NO in comparison with control group (p<0,05). In consideration of minimal meaning NO in arterial sample came to 20 th and 30 th day of experimental research (less than control meaning in 1,7 an 1,4 times).
The 30-th day of experimental research characterized by increased level of NO in comparison with experience period of 1,3 (p<0,05) and 1,1 times (p<0,05) correspondently, but less than control meanings in 1,24 times (p<0,05).
The great changes were discovered in relation to venous arterial difference. On 10th and 20th day under increased meanings of NO in mixed venous sample, difference was changed, getting proportional to the value. A negative meaning of indicator at the outlet from lung endothelial system was due to the vasodilatation of the capillary vascular system with the development of stasis and dysfunction of microcirculation in lungs that was stated by us during the morphological studies of lung tissue.
30-th day there was appeared low venous arterial difference in average from 0,3 to 0,8 during experimental research.
Analysis result of research discovered that under diabetic nephropathy in arterial blood activity of NOS declines. Similarly, reduced activity of this enzyme in the mixed venous blood. Thus, the dynamics of NOS activity in the mixed venous blood in patients with diabetic nephropathy was below the benchmark data — by 39.4% (p <0.05); 28.4% (p <0.05) and 17.7% (p <0.05)accordingly the terms of observation.
The similar changes of ferment NOS activity appeared under toxic nephropathy. Consequently, Consequently among the possible causes of decline in main stable NO metabolites, NOS activity is inhibition of arterial and mixed venous blood at various etiologies nephropathy.
NADPH — dependent HP takes part in normal physiological condition of oxide NO in NO2 and vice versa: — NO2 ions are reduced to NO. In condition of endoxemia and hypoxia web arises excess that can become cause of oxidation NO into nitrites (NO2) and nitrates (NO2). In this case, NADPH- dependent on HP, and also iNOS, promotes biotransformation on nitrates (NO3) nitrites (NO2), after to NO, which over distress grows in web in 100 or 1000 times more, than during reaction with NOS. in view of the above, special place takes learning NADPH dependenton HP in arterial and mixed venous blood analysis of animals with different types of nephropathy.
Obtained analysis of research demonstrated that after nephropathy model under diabetic angiopathy activity of NADPH dependent on HP grew after 10 days in arterial blood to 50%, 20the and 30-th day kept remain arisen among intacted animals (p<0,05).
In mixed venous blood tendency is saved the same. After 10th day activity of NADPH dependent on HP exceeded data marked in intacted animals, on 88,7%, through 20-th and 30-th day — to 49,6 u 24,8%% accordingly (p<0,05). Venous arterial difference exceeded the main meaning in all periods of experience to 2,15 times to 10-th, in 1,8 times to 20-th and 30-th day of experimental researches (p<0,05).
Consequently, animals with nephropathy in diabetic angiopathy background of arterial and mixed venous blood samples have a high activity of NADPH — dependent on HP.
Similar in character and focus on results is registered over analysis ofNADPH dependent HP in mixed venous and arterial samples among animals with toxic nephropathy. Activity of this ferment in arterial blood among intacted animals after experimental research exceeded on 10th day to 25%, then to 20th u 30th day data from animals did not differ.
Thus, the animals on the background diabetic nephropathy, angiopathy activity NADPH — dependent on HP in the mixed venous blood was higher than in the arterial blood; on the 10th day of the simulation by 51.7% (p <0.05), 20 th and 30 th day — 53.6 and 56.1% (p <0.05), but after playing a toxic nephropathy, according to these periods of experience — by 58.5% (p <0.05), 65.6% (p <0.05) and 61.3% (p <0.05).
So, the analysis of the results showed that after the modeling of different variants of nephropathy in the arterial and mixed venous blood samples increases the activity of NADPH — dependent HP whose level of activity is significantly higher in the mixed venous blood, arterial than. These data suggest that the animals in the blood should be increased NO content. In our experiments the level of arterial blood in animals with various embodiments nephropathy reduced, and mixed venous, increased conversely.
Among possible reasons of NO, NOS, NADPH — dependent on HP in arterial and mixed venous blood over animals with different types of nephropathy can be process of formation peroxyni-trites (ONO2). Intense formation ONO" can be result of hyper expression NO and high level in blood of superoxide-radical (O2), which oxidize from NO to ONO2.
Investigations have shown that after the modeling background nephropathy of diabetic angiopathy in arterial and mixed venous blood level exceeds ONO2" data identified in intact animals after 10th day experience 1.4 times and 1.74 times through 20-th day — 1.3 times and 1.5 times, after the 30 days — the same 1.1 times in the respective blood samples.
Consequently, after a reproducing nephropathy, as well as against the background of diabetic angiopathy, there is a significant increase in blood ONO2. It should be noted that in figure ONO2 mixed venous blood was significantly higher than in the arterial blood as in animals with background nephropathy of diabetic angiopathy, and without it.
Thus, studies have shown that the type of nephropathy model dependent changes in NO-system activity in arterial and mixed venous blood.
Analyzing obtained data of condition NO — system in arterial and mixed venous blood it should be pointed out that after experimental reproduction of nephropathy under diabetic angiopathy, particularly with ChKD exponents NO, NOS, and iNOS were more affected than among animals with chronic toxic nephropathy.
In such in manner, conducted researches demonstrated that activity of NO-system in arterial and mixed venous blood depended on presence of angiopathy and ChKD development. At the same time, it's necessary to mark that activity of NO-system in our researches limited with characteristic as hyperexpression NADPH — dependent on HP and ONO-. NADPH — dependent on NR provided increasing NO, тогда when level of ONO- depended on O- and NO".
Researches of expired breath condensate among animals with different kinds of nephropathy detected ambiguous dynamics in relation to NO concentration change. Concentration of expired breath condensate on 10th day in all experiences of pathologic behavior descending in relation to control group of experience.
Concentration NO in condensate of expired breath on the 10-th day of toxic nephropathy reduced in relation to control group of experience in 1,2 times, when the nephropathy under diabetic angiopathy, the level of condensate was less than control meaning in 1,4 times. In the next periods of experiences on the 20-th and 30-th days concentration of expired breath condensate were increasing in comparison with 10 th day of experience where variant of chronic toxic nephropathy from 0,154±0,09 umol/l (р<0,05) to 0,168±0,07 umol/l (р<0,05) и 0,195±0,10 umol/l accordingly (р<0,05).
The same picture was in relation to concentration of expired breath condensate NO among animals with nephropathy under diabetic angiopathy, where given exponent was also increasing gradually in regard to 10-th day of experience; on 20-th и 30-th day from 0,133±0,09 umol/l (р<0,05) to 0,141±0,05 umol/l (р<0,05) and 0,172±0,04 umol/l accordingly (р<0,05).
Consequently, development of different kinds of nephropathy was accompanied by undulating changes in concentration of expired breath condensate NO. The foundation of this changes was increment of their levels to pathologic behavior. At the same time, progressive azotemia was accompanied by scalling-down concentration in expired breath condensate NO.
Investigation of NOS activity in exhaled breath condensate in animals with various embodiments nephropathy also revealed mixed trend towards its change.
The similar situation was marked in regard NOS activity in expired breath condensate over animals with chronic ne-phropathy under diabetic angiopathy, where givent exponent was growing gradually to 10-th day on 20-th and 30-th day from 0,349±0,084 umol/min/l (р<0,05) to 0,402±0,074 umol/min/l (р<0,05) and 0,516±0,046 umol/min/l accordingly (р<0,05).
Consequently, development of various types of nephropathy, as in case of NO, was accompanied with undulating changes in activity NOS in expired breath condensate, the base was growing of levels over development of pathologic behavior.
Activity of NADPH — dependent on HP in expired breath condensate over various types of nephropathy was on 10-th day of modeling pathologic process, it was growing in comparison with previous experiences among animals with chronic toxic nephropathy in 1,4 times, while the nephropathy under diabetic angiopathy — in 1,54 times. The tendency to growing of NADPH activity — dependent on HP in expired breath condensate among animals with nephropathy on 20-th and 30-th day after researches was pointed out the nephropathy under diabetic angiopathy.
Thus, the reproduction of of different variants differ nephropathy certain regularity in the increase in the activity of NADPH — dependent HP in expired breath condensate, depending on the severity of the disease. The lowest values (almost at the level of control) have been observed in animals with chronic toxic nephropathy.
At the same time, growing of DADPH — dependent on HP in expired breath condensate among animals with nephropathy under diabetic angiopathy was higher than among animals with chronic toxic nephropathy in 1,83 times.
In comparison with diabetic nephropathy, these changes were 2.2 times more. In other words, the activity level of NADPH — dependent HP in expired breath condensate in animals with various embodiments nephropathy entirely depends on the severity of the pathological process. The harder the course of the pathological process, the higher the activity of NADPH — dependent HP in expired breath condensate, and vice versa.
ONO2-content of expiredd breath condensate on the 10th day of modeling of different variants nephropathy was increased in all cases. When toxic chronic nephropathy compared to the control series of experiments ONO2-increase in expired breath condensate was 1.3 times greater. When background diabetic nephropathy, angiopathy on this figure in expired breath condensate was 1.6 times greater in animals with a manifestation of chronic renal failure — 1.7 times greater than in intacted animals.
The dispersion of concentration-response curve showed that on 10-th and 20-th day of diabetic nephropathy the 2nd type dominant, and on 30-th day — 3-rd type, characterized by high productivity in respiratory ways and in outlet of lungs.
Key indicators of NO-system (NO, NOS) passed on the 30th day of development of diabetic nephropathy from the third group concentration curves with low productivity in exhaled breath condensate in the first (1 and 3 type of concentration curves).
Conclusion. Conducted analysis in concentration changes of blood and expired breath condensate among animals with chronic toxic nephropathy showed dominance of productivity in respiratory ways. But the tendency was saved. Such value among animals with nephropathy under diabetic angiopathy showed dominant of high level of productivity among learned exponents into expired breath condensate. On the back of opportunity reduction in influence on growing exponents in vascular system owing to angiopathy manifestation this function takes respiratory ways. This hypothesis can be morphostructural, associated with changes in lungs (in blood barrier) under diabetic angiopathy and growing azotemia.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-88-90
Karimov Shavkat Ibragimovich, Khakimov Murad Shavkatovich, Berkinov Ulugbek Bazarbaevich, Sattarov Oybek Tokhirovich (Tashkent Medical Academy) E-mail: doctoroybek84@mail.ru
Improvements to the selection of minimally invasive techniques in laparoscopic elimination diastasis rectal muscle of abdomen
Abstract: Objective. Assess the feasibility of laparoscopic elimination of diastasis recti and improve the results of treatment of such patients. Material and Methods. In 2 clinical TMA for the period from 2015 to 2016 performed 21 laparoscopic operations for diastasis recti II-III degree. Patients with diastase II degree was 9 (42.8%), with III — 12 (57.2%). The age of patients ranged from 36 to 62 years. 58% of patients were older than 50 years. Men were 7 women — 14 patients. In 7 patients had a concomitant pathology requires simultaneous operations: 4 — cholelithiasis, 3 — inguinal hernia. Results. Laparoscopic elimination of diastasis sheathe made under anesthesia. When laparoscopy determined the boundaries of diastasis recti. The operation was carried out with the help of endoscope developed by us, "the hook-needle" Mean operative time was 52,5 ± 5,3 m. When simultaneous operations the figure was 73,5 ± 13,7 minutes. There were no intraoperative complications. The mean time of hospital stay was 4,1 ± 1,3 bed-days. After surgery, patients have 7-8 hours back to normal pre-operative activities. The need for daily dressings, surgeon visits was not. The average number of visits to the surgeon on an outpatient basis was 5,2 ± 1,3 times. Relapse during the observation was not for 1 year. The patients had no complaints, physical activity does not cause discomfort, strain in the anterior abdominal wall was not, rectus abdominis edges abut one another. Conclusion. our first experience with laparoscopic elimination of diastasis recti showed that it is a highly effective method of treatment less traumatic and has a number of health and social benefits.
Keywords: diastasis of rectal muscle of abdomen, laparoscopic liquidation, endo-needle.
Today surgery lets discuss about the selection methods of mini-invasive interventions in different areas of the abdomen. Aging and constant physical activity leads to disruption ofthe anterior abdominal wall soft tissue blood circulation that stimulates the development of discrepancies musculo-fascial layer of the stomach. Thus, the rectus abdominis is one ofthe more yields in a given situation, the differences which called diastase. Among the strains of soft tissue of the anterior abdominal wall diastasis recti is 40%. The combination of diastasis recti with umbilical hernia reaches 60%, which is often ignored by surgeons during surgery, thus, recurrence of hernia. The recurrence rate in the late postoperative period ranging from 45 to 80% [1; 2; 3; 5].
More than 35 surgical methods of elimination and their modifications proposed for the treatment of diastasis. Despite this variety of correction methods, the question of choosing the most effective among them remains controversial [1; 4; 6]. It is well known that the traditional methods of surgical correction, such as plastic or Shampi-noneru by Voznesensky to eliminate diastasis of the rectus muscles of the anterior abdominal wall to the far more often used. The frequency of relapses and the development of postoperative ventral hernias up to 11.3% [2; 4].
The introduction of new technologies in surgery allowed to perform different minimally invasive surgical procedures in the
