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The remote results of the treatment of "pectus carinatum" of the thorax in children
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-153-155
Yulchiev Karimjon Salimjonovitch, Andizhan State Medical Institute Senior researcher, the department of pediatric surgery E-mail: [email protected] Akilov Habibullah Ataullaevitch, professor, MD, PhD, DS, Tashkent Institute of Advanced Medical Studies, Head of the Department, E-mail: [email protected] Mirzakarimov Bahrom Halimjonovitch, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: [email protected] Djumaboev Jurakul Usmanovitch, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: [email protected] Toshboev Sherzod Olimovich, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: [email protected]
The remote results of the treatment of "pectus carinatum" of the thorax in children
Abstract: Developmental anomalies of the thorax in children concern a serious illness representing big complexities for correction. In this work the developed author's methods of surgical treatment of children with various variants of "pectus carinatum" (PC) are presented. The results of the treatment in the remote postoperative period are analyzed. Keywords: thorax, children, thorax operations.
Malformation of the thorax in children are serious diseases that pose serious difficulties for the correction. PC occurs in 0,3-1,7% of children and to share it accounts for between 6-22% of all strains of the chest. It is characterized by symmetrical or asymmetrical anterior curvature of the sternum and the ribs articulate with it, includes several strain components at the same time defeat rib cartilage can be single- or double-sided, and the sternum stands in front in the
upper and lower section. At birth, says a third of patients with this pathology, and almost half of it appears only after the onset of puberty "leap" in growth. A characteristic feature of PC is a cosmetic defect. When evaluating the data of psychological survey found that dissatisfaction with the appearance of the chest, mainly manifested in patients older age. Currently, preference is minimally invasive, less traumatic at the same time more efficient surgical intervention
Sectiom 6. Medical science
aimed at full correction of chest deformities, with the maximum cosmetic effect.
Aim ofwork. To evaluate the effectiveness ofnewly developed minimally invasive methods thoracoplasty various kinds PC in children.
Materials and methods. This paper analyzes the results of surgical treatment of children with PC based on the Department of Thoracic Surgery ofAndizhan regional multi-profile children's Medical Center and the Department of Pediatric Surgery of Andizhan State Medical Institute. During the period from 2012 to 2016 by the author's method operated on 59 children with different variants PC in the age group of 6 to 18 years. These children are the main group (MG). The boys were 50 (84.7%), girls-9 (15.3%). The largest number of children with PC between the ages of 12-16 years. This is due to the fact that the progression of the maximum deformation begins in puberty — the age of the most active growth of the child. Performance indicators copyright transactions compared with the control group (CG). CG were children, operated during the period 2007-2011, which were carried out in various modifications Ravich's thoracoplasty operations — 32 children. Just CG holds the predominance of boys over girls -23 (71.8%) boys and 9 (28.2%) girls in the age group 6-16 years. The average age of children in the comparison group was 13,4±0,1 years, in the exhaust gas 13,9±0,2 years. Statistically significant differences in the age structure and sex groups were found (p>0.05). This allowed to consider them equivalent samples and used for further comparison. In our study, all patients were from the II and III century. Of PC and underwent surgical correction. Patients with first degree PC owing just noticeable cosmetic defects, were under the supervision of a dynamic, not to operate in our study are not included. All patients underwent thoracoplasty on the author's methods. During the development
and implementation of complex technology thoracoplasty received the certificate of the right to intellectual property of the Republic of Uzbekistan: DGU 03580 "Method thoracoplasty keeled chest deformation." on 03.03.2016., registered in the State Register.
The author's method of surgical treatment of PC providing surgery and correction of distortion with transverse sternotomy, wedge resection of the sternum and bilateral resection of ribs, characterized in that it produced a vertical section through the skin on the chest wall is no longer than 8 cm, the skin mobilization, the subcutaneous tissue and pectoral muscles one flap, made complete resection of deformed costal cartilages on both sides and stitched them end-to-end single interrupted sutures, transverse sternotomy at the top most of the bending, the complete removal of the xiphoid process and shortening retrosternal ligament suturing it to the back surface of the lower third of the sternum 3-5 cm higher.
The statistical accuracy of the estimation of observed variables clinical effect expressed by confidence intervals (95%). Statistical data processing was carried out on a PC using the «SPSS Pro» software package. The critical level of significance when testing statistical hypothesis was p=0,05.
Results and discussion. Evaluation oflong-term results in the exhaust gas was carried out according to the criteria: good, satisfactory, unsatisfactory. These results are evaluated in terms of up to 1 year to 3 years over 3 years. Timing estimation results of treatment groups in clinical treatment comparisons and statistically significant differences are not. To assess the effectiveness of long-term outcome of treatment by copyright thoracoplasty comparative evaluation of results in the MG in 30 (87,5%) in the CG 23 (87,5%) of sick children. The analysis results showed that good results in the MG obtained in 95,2%, and satisfactory and unsatisfactory results were obtained in two children, 2,38%, respectively (Fig. 1).
i good results
satisfactory results
i unsatisfactory results
Control groop
Main groop
Fig.1. Comparative indicators of long-term results of treatment KGDK in children, depending on the operations performed For good clinical results we assigned patients with complete correction of deformation, with the absence of hypertrophic scars and overcorrection anterior chest wall. For satisfactory results included patients with recurrent partial deformation of the sternum to the I-th degree, as well as patients with a complete correction of the deformity, but with the presence of overcorrection of the sternum, and the combination of one of these changes with hypertrophic or keloid scars. Unsatisfactory postoperative results we assigned patients with relapsed complete deformation.
Table 1. - The results of treatment in the control and the study group in the late postoperative period
№ Outcomes number of treatment Control groop (n=23) M±SE Main groop (n=30) M±SE
abs % abs %
1 Good 18 78,26±8,68 28 93,3±4,7
2 Satisfaction 2 8,69±3,54 1 3,33±3,14
3 Unsatisfaction 3 13,04±4,32 1 3,33±3,14
As the table shows, the positive outcomes of treatment in kg is 78,26 ± 8,68%, and satisfactory — 8,69 ± 3,54%, which is quite a
low figure. Satisfactory results were obtained in 3 children (13,04 ± 4,32). When comparing the percentage of good outcomes in
Review on prediction of results of dental implantation at patients with the accompanying pathology
the CG relative to the MG where the proportion of good results is 93,3±4,7%, figures are statistically significant, because Student's t-test=3,41, (p<0,05), which is the result of using a more effective method of surgical treatment PC. Satisfactory and unsatisfactory outcomes in the MG and the same number was on 3,33±3,14%. Satisfactory results referred a patient who after 8 months of the postoperative period developed local bone deformation due to the 7th costal cartilage, which required repeated surgery. Resection of cartilage 6-7 ribs on the right and the left rib cartilage 7, led to the complete elimination of the deformation. Unsatisfactory results in the exhaust gas carried with the patient's connective tissue dysplasia
syndrome. The patient had in addition PC morphologic appearance, scoliosis of the spine, joint hypermobility. We believe that the presence of this disease in the patient contributed to the development of relapse keeled deformation in a year.
Finally, summarizing all the results of our study, it is clear that we have developed a method thoracoplasty at PC are minimally invasive and very effective methods of treatment allows us to reduce the trauma of surgery, reduce the operation and, thus, anesthetic time, accelerate the activation time ofpatients and reduce the duration of pain, minimize operating and postoperative complications, improve cosmetic results.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-155-156
Yarmukhamedov Bekhzod, Tashkent state dental institute, Uzbekistan Department of oral surgery and dental implantology Associated professor, PhD, E-mail: [email protected]
Review on prediction of results of dental implantation at patients with the accompanying pathology
Abstract: Dental implantation is actively introduced into everyday practice of maxillofacial surgeons and dental surgeons. Despite its high results achieved during the last decades, there is a number of unsolved issues associated with implants rejection. The number of such complications according to different authors varies from 3 to of 10%.
Keywords: dental implantation, prognostication, clinical and laboratory results, oral fluid.
At the present stage the method of dental implantation took the worthy place among other dental interventions and plays one of the leading roles in system of complex rehabilitation of patients with defects of dentitions [1; 2; 3]. Revived in the middle of the 20th century, he thanks to the scientific capacity and integrative potential endures rapid development. Perfecting of implants and techniques of their statement is carried out in various directions for the purpose of increase in their quality and elimination of the shortcomings revealed during clinical operation [1; 4; 5]. The modern achievements of scientific and technical progress in metallurgy, chemistry, physics, materials science, biology and toxicology are involved in this process [2; 3; 6; 7].
The listed above facts convince that dental implantation continues to take root actively into daily practice of maxillofacial surgeons and stomatologists — surgeons that emphasizes relevance of the submitted publication.
The work purpose — based on the analysis and synthesis of data of domestic and foreign express literature to provide theoretical justification of carrying out researches on development of the system of prediction of result of dental implantation.
Now particular progress in introduction of the composite and productive techniques for optimization of provision of implants and achievement not only the adequate functional, but also cosmetic results is observed [3; 4; 8; 9; 10]. Overwhelming number of ex-
press sources of information are devoted to surgical technology of statement of implants [1; 5; 9], the characteristic of a bone tissue and to requirements imposed to an alveolar shoot, a jaw bone when carrying out the specified AND operations contain, generally given beam research techniques, results of pathomorphologic, is more rare — biochemical characteristics of processes of osteointegration [4; 6; 7; 10].
Long-term success of implantation depends as from medical (the exact selection of patients, ensuring stable primary fixing of an implant), and on efficiency factors (optimum material, the production technology, reactivity of a surface of an implant, its macrostructure) [9]. It is known that at optimum osteointegration the dental implant has to: to have clinical stability, to function not less than 5 years, not to damage fabrics, adjacent to it; not to cause at the patient of negative symptoms and feelings, to satisfy the patient both in the functional, and in esthetic aspects.
The detailed analysis of express literature specifies that failures when using a method, unfortunately, are very widespread and meet more often than it is accepted to speak about them and furthermore to consider them at assessment of results of treatment [2; 7].
In most of the basic managements and monographs [1; 5; 6] in sections of absolute contraindications to performing dental implantation such states as are specified: pathology of immune system and dysfunction ofleukocytes; the diseases demanding periodic applica-
