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32Для повышения качества патологоанатомической диагностики необходимо:
- разработка стандартов проведения посмертных и прижизненных патологоанатомических исследований;
- разработка стандартов проведения клинико-анатомических сопоставлением с организацией разборов случаев не только на КИЛИ и ЛКК, но и на клинико-патологоанатомических конференциях;
- разработка стандартов оценки качества патологоанатомических исследований.
- разработка стандартов оформления и оценки медицинской документации в патологоанатомической службе.
ЛИТЕРАТУРА
1. Кактурский Л.В. Внедрение сертификации в патологоанатомическую службу // Актуальные проблемы управления качеством работ по специальности гистология: Материалы научно-практической конференции старших медицинских сестер, главных (старших) лаборантов патологоанатомических учреждений/подразделений Уральского Федерального округа. - Челябинск: Изд-во «Челябинская государственная медицинская академия», 2006. - С. 12-14
2. Мишнев О.Д., Трусов О.А., Щеглов А.И. Организационные задачи патологоанатомической службы страны // Актуальные вопросы патологической анатомии: Материалы областной научно-практической патологоанатомической конференции, посвященной 25-летию Областного государственного учреждения здравоохранения «Челябинское областное патологоанатомическое бюро». - Челябинск: Изд-во «Челябинская государственная медицинская академия», 2010. - С. 10-12.
3. Приказ Министра здравоохранения и социального развития Республики Казахстан от 25 февраля 2015 года № 97 «Об утверждении Положения о деятельности организаций и (или) структурных подразделений организаций здравоохранения, осуществляющих патологоанатомическую диагностику, и Правил проведения патологоанатомического вскрытия».
4. Приказ и.о. Министра здравоохранения Республики Казахстан от 23 ноября 2010 года № 907 «Об утверждении форм первичной медицинской документации организаций здравоохранения».
THE COPPER-CALCIUM HYDROXIDE DEPOPHORESIS AND SILVER NITRATE INTRACANAL ELECTROPHORESIS IN ENDODONTIC PRACTICE: COMPARISON, REASONABLE CHOICE
M. D. Professor Antonenko M.
Cand. Med, science Znachkova O.
Mayborodina D.
Ukraine, Kyiv, Bogomolets National Medical University, Dentistry department
The purpose: comparative analysis of the efficiency using intracanal 1% Sol. Silver Nitrate electrophoresis and the Copper-Calcium Hydroxide depophoresis in patients with destructive forms of periodontitis that are in multiroot teeth with impassable root canals.
Subjects and methods: We have made analysis of the modern scientific literature about frequency of using intracanal electrophoresis and the Copper-Calcium Hydroxide depophoresis endodontic treatment, pharmacological properties of the silver nitrate and Copper-Calcium Hydroxide .We have treated 48 patients with using therapeutic drugs and direct electric current.
Results: Using intracanal 1% Sol. Silver Nitrate electrophoresis and the Copper-Calcium Hydroxide depophoresis contributed the reduction of the heart of destruction according to X-ray after 6 months of observations. Comparative characteristics of the two different methods of exposure constant electric current did not show significant benefits fpr any of the methods (p> 0.05)
Conclusions.: In treatment of the teeth with impassable root canals it is advisable using intracanal Silver Nitrate electrophoresis and the Copper-Calcium Hydroxide depophoresis. This contributes the reducing of the destructive changes in the periapical tissues after long term treatment.
Modern endodontic science can be called the most dynamic part of the development in dentistry. Progress touched every level of this science, beginning from diagnosis and finishing by filling techniques for root canals. [2, 3, 13, 14].
However, till today, the percentage of deleted teeth and teeth that require endodontic reintervention is quite high [5, 9]. Analysis of the causes of the failures of endodontic treatment led to rethinking of the value of some of its stages. Also it led to looking for new opportunities to overcome the barriers [6, 8, 19].
There is a part of patients with limited mouth opening, narrow and curved root canals, channels of anatomic obstruction, other features of the internal morphology. They require the exceptional attention of a dentist. These features can be obstacles to a quality of implementation of the all phases of endodontic intervention even with the help of modern techniques [5, 15, 16].
Improving of the quality of dental treatment with impassable root canals is one of the most complex and totally unsolved problems of modern endodontics. One of the possibility for additional medical influence on the flora of the root canal, which is below the free access is intracanal electrophoresis of drugs and the Copper-Calcium Hydroxide depophoresis.
Materials and Methods:
The group of observation included 48 patients of working age with destructive forms of periodontitis. 48 multirooted teeth of the upper and lower jaws. Selection of patients was made according to the inability of the traditional physiological apex formation of root canals (Feature of the inner tooth morphology, patients with limited mouth opening).
The Treatment was conducted at the Dentistry Department of the Postgraduate Institute of Bogomolets Medical University and also in Dental Physiotherapy department of the medical center of Bogomolets Medical University.
Treatment began with traditional endodontic intervention with cone preparation with manual file system «ProTaper» (Dentsply, USA) . It was done on the possible length of up to ISO 30 and with the irrigation with 3% solution of sodium hypochlorite . Thereafter patients were divided into two groups. The first group included 26 patients (54.16%), which during endodontic intervention was conducted the intra-canal electrophoresis with 1% silver nitrate. 22 patients (45.84%) joined to the 2 groups. These patients were conducted the depoforez Copper-Calcium Hydroxide depophoresis. All the patients were examined on contraindications to using of electrotherapy methods. And the gave a consent to the proposed methods of treatment.
For the procedure of intra-canal electrophoresis endodontic file was used as an active electrode (anode). It was turning with a cotton swab with a 1% solution of Silver Nitrate, which placed in the cavity of the tooth. It is inappropriate to enter a file with a cotton turundas directly into the lumen of the makro-canal to avoid leaving microfibers of the wool in the lumen of the canal. Such residues are rather difficult to be removed from the canal. And instead of therapeutic effect the reinfection can be achieved And it will lead to further violation of adaptation of endohermetic to the walls of canal. According to its physical properties an electrical current flows through the lowest resistance. This is why it simultaneously impact on all micro-canals of multirooted tooth. Indifferent electrode was placed on the forearm of the right hand. An amperage during the procedure depended on the patient's feelings, but it was not more than 1 mA, exposure time- 10 minutes. The number of procedures per treatment - 3 (daily or every other day). Root canal obturation were held by endohermetic , which is based on epoxy resins «AH-Plus» (Dentsply, USA). It was used with guttapercha by lateral condensation technique.
The algorithm of depophorezis includes an additional extension of the root canal in coronary part to create the store of the Copper-Calcium Hydroxide.. Copper - Calcium hydroxide with a consistency of a thick cream was moved in the canal using the rotary paste filler. The negative electrode was immersed in the channel to a depth of 4-8 mm. The positive electrode was placed on the cheek and the current were supplying till the appearance of the patient's feeling of heat in the area of root apex. The current was constantly increasing during the procedure. . During the each session we should be ensured that the passage of 5 mA per channel were provided. It was controlled by a special device. In each channel the procedure is carried out separately. The treatment course consists of three sessions with an interval of 7 days.
After the last procedure canals were filled by atatsamit - an alkaline endohermetic that contains copper, which is a part of depophorezis
The procedures of intra-canal electrophoresis and depophorezis were conducted on a small physiotherapy complex «ScorpionDentalOptima» manufactured by «OpticaLaser» (Sofia, Bulgaria). The certificate of registration number is 5235/2006 of 18 July. . The presence of the counter of electric
current, which is a fundamental for a depophorezis complex «ScorpionDentalOptima» in comparison with other physiotherapy devices gives the privileges for using it.
The results of treatment was evaluated by the number of complaints of patients, presence of inflammation exacerbations, discoloration of a coronal part of tooth and X-ray signs of reducing the degradation of bone tissue immediately after root canal filling and after 6 months. The results of treatment were compared between the two groups of patients.
Results and Discussions:
The therapeutic effect of intra-canal electrophoresis is present due to, on the one hand, the field of direct electric current and on the other, the action of injected drug ions. The effect of DC field and pharmacological action of the drug are not limited only by macro-canals. It also spreads on the dentinal tubules,through which a current and the medicines with ions penetrate into the periodontal area , to the area of bifurcation and marginal periodontium. The beneficial physiological effect of the galvanic current on periapical tissues is shown in improving metabolism, acceleration of blood flow and lymph circulation, strengthening of tissue metabolism. The formation of high local concentration of the drug promotes a more rapid elimination of inflammation and stimulates a regeneration process [4, 11]. Thus the likelihood of an occurrence of adverse reactions and sensitization of the patient are significantly reduced.
In a case of electrophoresis with a solution of silver, the active electrode is an anode. During these procedures, the metal electrode which is places in the tooth undergoes by the electrochemical anodic dissolution. And as the resut of this is that metal compounds penetrate to surrounding tissues that provide antibacterial and curative effect. Besides this the anode electrode space formed an acid, which can cause dissolution of hydroxyapatite in tooth root dentine. It leads to the release of calcium ions. Insoluble, slightly soluble and poorly soluble compounds of silver and calcium appear as a result of electrochemical and chemical processes in the root of the tooth. Metal salt lining the walls of the root canal, filling the micro-canals, obturating them penetrate to the dentine of the tooth root.[7, 8].
The main drawback of the intra-canal electrophoresis is an absence of objective quality criterias of treatment. And the other is in the impossibility to provide a guarantee for a long-term endo-treatment and appearance of discoloration of the coronal tooth. The additional visits for electrophoresis increase the duration of treatment and increase the overall value of its.[4, 6 ].
Copper-calcium hydroxide, which is the basis of depophorezis, is a stable equilibrium system. The active substance is highly bactericidal ion of copper hydroxide [Cu (OH) 4] 2- ion and highly bactericidal colloidal copper hydroxide [Cu II (OH) 2] > 1000 [12].
Bactericidal activity of Copper-Calcium Hydroxide, is due to a combination of mechanisms, including proteolytic effect of OH-ions, destruction of microorganisms proteins by Hydroxo-Cuprate, by removing Sulfur from Amino-acids, disintegration of cell membranes and spores as a result of destruction of poly- and amino saccharides.[10, 18].
One of the important properties of Calcium-Copper Hydroxide is the ability to change the state of its components depending on the pH of the environment The content of the canal during depophorezis has a strong alkaline reaction, so Hydroxo-Cuprate ions are in dissolved form. The ion of Hydrokso-Cuprate is collapsing and fallouting in the sediment in the form of copper hydroxide-II -Cu (OH) by an electric current. It promotes the formation of so-called "copper plugs" that reliably obturate all the outputs on the root surface of the apical. Further there is the additional sealing entrances to the tubules as a result of the reossification that stimulate copper ions [1, 6, 12].
During the treatment an amount of copper that enters into the body, is below than the required daily dose of consumption and therefore there is no danger from the point of view of toxicity [4, 7].
The method of depophorezis is also not without any drawbacks that may limit its widespread. The technical difficulty of the procedure, a significant material cost of the starter kit for depophoresis, a clear depending on the endohermetic, duration of procedure in the dental chair lead to the increasing of the cost per treatment. A significant part of time between conducting the procedures reduces the motivation of the patient to this type of therapy. Also possible development of discoloration of coronal part of tooth [6].
The results of the first group of patients was done immediately after the treatment. It is that no complaints were registered in 24 patients (92.31%) and in 100% of patients a discoloration of the coronal tooth were recorded. The control X-ray after root canal filling showed a satisfactory obturation of the root canals. The results of clinical observation after 6 months of no complaints stated in 22 patients (84.61%), worsening of inflammation on clinical grounds- in 4 patients (15.38%). By the X-ray signs the reduced of the focus of destruction were found in 23 patients (88.46%).
Among the patients of the second clinical group after treatment no complaints registered in 20 patients (90.91%), 85% of patients marked discoloration of the tooth crown A control X-ray after root canal obturation showed a satisfactory obturation for accessible part of root canals. During the observations after 6 months no complaints were found in 19 patients (86.36%), a presence of the acute inflammation by the clinical signs were found in 4 patients (18.18%). By the X-ray signs a reduction of the area of destruction were found in 19 patients (86.36%). Comparative characteristics of treatment results using two different methods of exposure by a constant electric current did not show significant benefits of any method (p> 0.05).
Conclusions:
The expediency of combining the medications with the influence of physical factors during the treatment of multi-rooted teeth with destructive forms of periodontitis, with rugged root canals is due to the inability of high-quality implementation of all phases of endodontic intervention to physiological apex of the tooth root and the needs for additional medical effects on the flora of the root canal, that is located outside the area of free access.
The use of intra-canal electrophoresis with 1% solution of Silver Nitrate and Copper-Calcium Hydroxide depophorezis help to reduce destructive changes in peryapical tissues after long term treatment.
A rational using of therapeutic physical factors during endodontic intervention provides a strict differentiated choice of the type of physical energy and specific methods of its usage. No doubt that in the near future, the implementation of new methods of physiotherapy in endodontic will be continued, which is encouraged by the achievement of medicine, physics and technology.
REFERENCES
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ALGORITHM OF DIAGNOSIS EATING DISORDERS AND
NUTRITIONAL STATUS IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE, OBESITY AND
HYPERTENSION
Dm. G. D. Fadieienko Ya. V. Nikiforova
Ukraine, Kharkiv, SI «L.T. Mala National Therapy Institute of NAMS of Ukraine»
Abstract. Eating behaviour disturbance is the long-term process. Various factors can result in changes of EB and its disturbances. The study of the contribution of the EB in the etiopathogenesis of nutrition-related pandemics of the XXI century as non-alcoholic fatty liver disease, obesity, hypertension is relevant. At the present stage is being actively seeking screening methods timely diagnosis of EB and NS, that would constitute a non-invasive, inexpensive, with a minimum of contraindications and allow objectively and accurately assess the presence or absence of disturbances in the power supply and if available - to conduct timely and adequate their correction.
Keywords: eating behavior, nutritional status, non-alcoholic fatty liver disease, obesity, hypertension, Bioimpedance.
Introduction. Eating behaviour (EB), including a preference for the consumption of certain types of products, methods of their preparation, the mode and frequency of food intake plays a significant role in changing the nutritional status (NS) - a set of indicators that reflect the actual value of the preceding actual supply the body's needs. Long-term eating disorders lead to violations in the NS, which clinically manifested in the development of chronic non-communicable diseases (CHND). The study of the contribution of the EB in the etiopathogenesis of nutrition-related pandemics of the XXI century as non-alcoholic fatty liver disease (NAFLD), obesity, hypertension (H) is relevant, not only because of the medical, but also a socio-economic factor (marked increase in the population of diseases of working age). [4] Therefore, at the present stage is being actively seeking screening methods timely diagnosis of EB and NS, that would constitute a non-invasive, inexpensive, with a minimum of contraindications and allow objectively and accurately assess the presence or absence of disturbances in the power supply and if available - to conduct timely and adequate their correction.
Among the study NS methods are the most common measurement of anthropometric parameters (body mass index (BMI), waist circumference (WC), hip circumference (HC), the ratio of WC/HC), the measurement of subcutaneous fat folds. Determination of BMI to diagnose overweight (IMT>25kg/m2) or obese (IMT>30kg/m2), the definition of WC/HC allows you to diagnose abdominal obesity. This, in turn, allows you to determine the prognosis for an individual patient regarding CHND development risks (the ratio of WC/HC > 0.85 increased risk of insulin resistance
