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References:
1. Хайдарова М. М., Шамсиев Ф. М., Мусажанова Р. А., Мирзамухамедов Д. М. Применение иммуномодулина при лечении обструк-тивного бронхита у детей раннего возраста//Материалы Республиканской научно-практической конференции «Проблемы иммуннопатологии детского возраста. - 1998. - С. 107-110.
2. Шамсиев Ф. М., Хайдарова М. М., Мусажанова Р. А., Якубова О. Ш. Клинико-иммунологические особенности острой осложненной пневмонии у часто болеющих детей дошкольного возраста//Актуальные проблемы содействия нормальному росту и развитию детей. - Ташкент, 2006. - С. 185-186.
3. Хайдарова М. М., Шамсиев Ф. М., Асадова Г. У, Мусажанова Р. А., Нигматуллаева М. Х. Психологические особенности детей с бронхо-легочной патологией//Материалы Республиканской научно-практической конференции «Организационные и научные проблемы снижения младенческой и детской смертности». - Ташкент, 28 ноября 2006. - С. 143-146.
Khakimov Sherali Kuzievich, PhD in Medicine, Scientific Research Institute Traumatology and Orthopedics of the Republic of Uzbekistan, Tashkent city
E-mail: [email protected]
The improvement of pectus excavatum repair results using differentiated tactics in children
Abstract: This report presents the results of the operative correction of the PE in 54 children aged from 5 to 15 years. In relation to the SCC elasticity degree and age of the patient there was performed the PE repair by D. Nuss procedure and in modification with application of a metal plate of the own construction. The obtained results show that thoracoplasty by D. Nuss due to PE is required when the sternocostal complex is still elastic. PE with worsening SCC elasticity required the thoracoplasty in modification.
Keywords: children, chest, pectus excavatum elasticity, D. Nuss procedure.
Background
The deformation of the chest has various forms, the overwhelming majority of them is the pectus excavatum (PE) (90 %) [1; 2]. The treatment of children with PE remains to be significant and not to be resolved completely problem of the children orthopedics. This is confirmed by the high percent of unsatisfactory results of operative correction of PE, which are found in more than 30 % [1; 3]. While having diversity ofvarious methods for operative correction of PE the cosmetic effect seems not to be resolved problem completely.
Though the majority of the authors use the method of thoracoplasty by D. Nuss with the purpose of elimination of the PE, the orthopedic features of treatment remain without appropriate attention. It is quite logical, that the performance of the same method of thoracoplasty at different types and severity of the PE in the patients ofvarious age groups leads to the predispositions for occurrence of various postoperative complications which quite often result in unsatisfactory results of treatment at the long-term period [4].
The purpose of work was to improve results of operative correction of PE in children.
Materials and methods. In the Clinic of Scientific Research In-sttitute of Traumatology and orthopedics of the Ministry of Health 54 patients with PE at the age from 5 to 15 y. were operated during the period from 2009 to 2013. All patients were known about their cosmetic impairment and so, they had moral degradation. Because, patients and their parents were given their consent to perform the operative intervention, notably, they completed out the act about occurrence of any complaints during the operation.
These children were divided into three groups in relation to the degree of sternocostal complex elasticity (SCC). All patient was performed treatment with use of the SCC elasticity criteria (patent № DGU 02466) including the following parameters: the test of autocorrection, difference of chest excursion at a deep inspiration and expiration, "torsion" of the breast bone and the angle of steepness of the deformed ribs. On the basis of SCC elasticity degree there were formed groups of the patients, according to which the choice of a method of operative correction was made. For operative correction of the SCC we used our developed (2010) and made by firm ChM (Poland) metal plate (patent № FAP 00825).
The results of the study are devoted to research of all parameters data of SCC elasticity degree, which are shown in table 1.
Table 1. - Distribution of the children with PE by the SCC criteria elasticity degree (n = 54)
Criteria Elasticity degree Totally
Light degree of elasticity of the chest n = 27 Moderate degree of elasticity n = 15 Severe degree of hypoelastic chest n = 12
(TA) Test of autocorrection 27 (50.0 %) 17 (31.5 %) 10 (18.5 %) 54(100 %)
(CE) Excursion of the chest 28 (51.8 %) 15 (27.8 %) 11 (20.4 %) 54 (100 %)
(BBT) Breast bone torsion 27 (50.0 %) 15 (27.8 %) 12 (22.2 %) 54 (100 %)
Angle of the steepness of the deformed ribs 24(44.4 %) 20 (37.0 %) 10 (18.6 %) 54(100 %)
The improvement of pectus excavatum repair results using differentiated tactics in children
The table 1 shows, that summarizing all parameters of criteria of deformation of the sternocostal complex in 27 (50.0 %) children we establish elastic thorax, in 15 (27.8 %) moderate elasticity was determined, and in 12 (22.2 %) the hypoelastic thorax is established.
Depending on a degree of SCC elasticity the method of operative correction was choosen. In 27 (50.0 %) patients with normal elasticity of sternocomplex (as a rule they are children in the age under 10 years), there was carried out the D. Nuss procedure with application of a metal plate. At the moderate degree of elasticity in 15 (27.8 %) children PE repair was performed by chondrotomy of the deformed ribs with stabilization with plate. In the third group of the patients the PE was corrected by «T»-shaped or transversal sternotomy and cartlages resection and stabilization with plate too. The duration of immobilization period was 3.2 ± 0.9 y. in relation to character and rate of growth of the patient.
The long-term results of the operated patients were investigated in 37 (68.5 %) out of common number of operated children during the period offollow-up from 2 till 4 years. In the other 17 (31.5 %) patients there were studied nearest postoperative results.
The results of operative correction we have estimated as good, satisfactory and unsatisfactory:
- The good result is considered when the patient does not show the complaints and the good cosmetic effect, complete restoration of the functions of pulmonary-cardiovascular system;
- The satisfactory result is considered when there is a periodic pain sensation in the field of operative intervention, intercostals pain, and light inflammatory reaction
in the area postoperative wound on the basis of good cosmetic result.
- The unsatisfactory result is when there is noted the deeping of SCC looking-like PE 1 degree, that is, the relapse of deformation is of mild degree.
In 27 (50.0 %) children with sufficient SCC elasticity there was performed D. Nuss procedure. The good result was obtained in 26 (96.3 %) children, thus PE was eliminated with a good relief without a relapse and complaints of the patient. In one (3.7 %) patient the satisfactory result was achived.
In 15 (27.8 %) patients with moderate degree of elasticity with the purpose of reduction of resistans of the SCC the D. Nuss operation was performed with modification. The good result was obtained in 13 (86.7 %) children, they h ave good relief in the are of SCC, recurrences were absent. In 2 (13.3 %) cases there were received satisfactory results, that associated with periodic pain sensations in the area of surgery and the forming of rough celoid scars. The unsatisfactory results were not found.
The hypoelastic chest was established in 12 (22.2 %) patients, them were performed thoracoplasty in modification with "T"-shaped or transversal sternotomy and cartilages resection, then the plate of D. Nuss was inserted under sternum. The good result was obtained in 9 (75 %) children.The satisfactory result was noted in 1 (8.3 %) case. The unsatisfactory results were received in 2 (16.7 %) cases with occurring of the mild relapse of deformation. These patients underwent repeated operative intervention.
Intra- and postoperative results of the operative correction of the patients with pectus excavatum are presented in table 2.
Table 2. - Results of the operative correction in the patients with pectus excavatum deformity in the comparative groups (n = 54)
Group 1 Group 2 Group 3
Criteria Normal elasticity Moderate degree of elasticity Hypoelastic Totally
n = 27 n = 15 n = 12
Good 26 (96.3 %) 13 (86.7 %) 9 (75 %) 48 (88.9)
Satisfactory 1 (3.7 %) 2 (13.3 %) 1 (8.3 %) 4(7.4 %)
Unsatisfactory 0 (0 %) 0 (0 %) 2 (16.7 %) 2 (3.7 %)
Totally 27 (50 %) 15 (27.8 %) 12 (22.2 %) 54(100 %)
The table 2 shows the results of operative intervention depend on SCC elasticity degree. The rate ofrestoration and improvement ofthe patient state was directly proportional to volume of operative intervention. The duration of D. Nuss procedure (group 1 of the patients) was 25 ± 2.5 minutes, at modified method of D. Nuss, (groups 2-3) was more than an hour — 72 ± 9.4 minutes (p < 0.001).
Because of strong pain syndrome in the postoperative period in the patients from groups 2-3 the ventilation function of the lungs was limited and worsened, the need of the body in oxygen was not supplied, this was expressed by slowing ofphysical activization of the patient, as a result the patiets received treatment in the department of resuscitation and intensive therapy for a longer period, 3.4 ± 0.8 days.
At an easy degree of elasticity the pectus excavatum deformity is easily corrected without negative effect on the internal organs of the thorax. And at the moderate and hypoelastic thorax the elimination of deformation is carried out with the certain difficulties and with additional interventions. In these cases the possibility of the occurrence of intraoperative complications is increased. We believe that presence of breast bone torsion and marked steepness of the
deformed ribs are the contributing factors to occurrence of the secondary deformations.
Conclusion
As our results shoun, that with the growth ofpatients their SCC is became as a rigid. So, in such moment the correction of the PE deformity without sternotomy or cartilages resection is impossible.
The results of the performed operative interventions and their comparative analysis show that thoracoplasty by D. Nuss due to PE is required when the sternocostal complex is still elastic. The worse elasticity of the sternocostal complex there are more and more often complications and relapses of the deformation after the thoracoplasty.
The results obtained of the comparative characteristic in three groups of the patients indicate that "with age" the SCC elasticity in PE loses, that is difficult for correction and with some complications.
Thus, the operative intervention at PE should be performed with taking into account SCC elasticity that contributes to the easy performance of the correction and provides good cosmetic and functional results.
References:
1. Abdrachmanov A. J., Tajin K. B., Anashev T. S. Congenital deformity of the chest and their treatment//Travm. and Ortop. - 2010. - № 1.
2. Hebra A. et all. Outcome Analysis ofMinimally Invasive Repair of Pectus Excavatum : review of 251 cases//J Pediatr Surg. - 2000. - № 35.
3. Nuss D., Kelly R. E. Jr., Croitoru D. P. et all. A 10 Year Review of a Minimally Invasive Technique for the Correction of Pectus Excavatum//J Pediatr Surg. - 1998. - № 33.
4. Nuss D., Croitoru D. P., Kelly R. E. Jr. et al. Review and discussion of the complications of minimally invasive pectus excavatum repair// Eur. J. Pediatr. Surg. - 2002. - № 12.
Khodjaeva Nodira Vakhidovna, Republican Specialized Scientific and Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan, external degree candidate E-mail: [email protected] Khaidarova Feruza Alimovna, M. D., Republican Specialized Scientific and Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan, therapeutic work director E-mail: [email protected]
Assessment of emotional psychological status and quality of life at women with premenstrual syndrome under therapy with drospirenone
Abstract: The analysis of the conducted researches has shown that after 6 months of therapy with drospirenone more than at a half of women symptoms of PMS have completely disappeared, essential decrease in cases of subclinical anxiety and depression and improvement of quality of life were noted.
Keywords: premenstrual syndrome, emotional psychological status, quality of life.
Premenstrual syndrome (PMS) is characterized by the repeating, affective, physical and behavioural symptoms that develop during luteal phase of menstrual cycle and vanish within several days after the beginning of menstruation. The symptoms arising in luteal phase of cycle can significantly influence social relationship, quality of life and working capacity, changing and worsening a habitual way of life of the woman and her relation with people around [3; 14; 15; 17].
Though the exact etiology of PMS is unknown, there is a wide range of tested medications, for treatment of premenstrual symptoms (for example, change of the way of life, pharmacological interventions, and non-pharmacological methods oftreatment) [11].
Pathogenically a reasonable method of treatment of PMS is suppression of cyclic activity of ovaries. For the purpose of suppression of ovulation a number of medications is used: combined oral contraceptives (COC), danazol, agonists of gonadoliberin. Interest in use the COCs as a method of treatment of PMS has revived with the advent of a new gestagenic component — drospirenone (DRSP) similar in its effects to a spironolactone [1; 2; 16].
Drospirenone is the only gestagen that is synthesized on the basis of a molecule of a spironolactone. The unique mechanism of action of drospirenone besides influence on receptors of progesterone is also caused by its powerful anti-aldosterone and anti-andro-genic potential. At the same time drospirenone is void of estrogenic and glucocorticoid activity, it is as high-selective as gestagen due to activation of only progesterone receptors [4; 7; 9].
Objective: to estimate influence of drospirenone on the level of anxiety, depression and quality of life of women with PMS.
Materials and methods of research
Researchers examined 89 women of fertile age (from 18 to 40 years) with PMS (average age of 31.0 ± 6.59 years) who have addressed to advisory policlinic of Republican Specialized Scientific and Practical Medical Center of Endocrinology. The control group included 33 women (average age of 30.0 ± 5,30 years) with no PMS symptoms.
For confirmation of PMS the assessment of symptoms was carried out by filling out of a "calendar of premenstrual supervision" during 6 cycles including 12 most widespread psycho-emotional and 10 somatic symptoms of PMS [5; 8; 10]. Each patient estimates the severity of each symptom daily on a 4-mark scale, proceeding from extent of violation of a habitual way of life due to this symptom.
Existence and intensity of anxiodepressive distress were estimated by means of the Hospital scale of anxiety and depression [19]. At interpretation a total indicator on each subscale was considered, allocating three areas of its values: 0-7 — norm (no significant expressed symptoms of anxiety and depression); 8-10 — subclinically expressed anxiety/depression; 11 and more — clinically expressed anxiety/depression.
For the purpose of determination of QOL parameters ofpatients the standard version of questionnaire SF-36 was used [18], allowing to estimate the QOL within past 4 weeks. Prior to the beginning of pharmacotherapy it was recommended to all women to change lifestyle (observance of diet, change of work-rest schedule, sports).
The combined medication drospirenone/ethinylestradiol was assigned to all patients from the first day of menstrual cycle — 1 pill for 21 days. After a 7-day break the next course was assigned. Duration of therapy made 6 months. All patients have signed the informed consent to participation in research.
The obtained data was processed by means of the computer programs: Microsoft Excel, STATISTICA 6 and Biostat. The relation of chances (RC) and 95 % of confidence interval (95 % of CI) were counted with application of logistic regression. Reliability of differences of indicators was estimated by means of nonparamet-ric criterion x2 (Pearson's criterion). Quantitative indicators are presented in form M ± m, median (Me) and 25 and 75 percentiles (IQR). Distinctions between groups were considered statistically significant at P < 0.05.
Results and discussion
At the first stage of work the careful analysis of two menstrual calendars of patients carried out that allowed to reveal dependence
