CC BY
6The study shows that pregravid preparation is of great importance in prevention of PB. Pregravid preparation decreases the number of PB and pregnancy complications among women with burdened obstetrical history significantly.
Thus, the ways of settling the PB problem and improving the perinatal results can be stated as follows.
At the outpatient stage the main factors are:
- timely diagnosis of preterm birth and preterm amniorrhea;
- finding the risk group in pregravid period;
- pregravid preparation;
- decreasing harm from medications among the women patients with subjective signs of the risk of PB and the normal length of uterus by using ultrasound examinations.
At the maternity hospital it is important to:
- take the women with the risk of PB to a third-class stationary or a perinatal centre;
- administer adequate therapy for the risk of preterm delivery;
- apply proper methods of delivery;
- keep and treat the premature babies in the intensive therapy and neonatal resuscitation departments.
DOI: 10.22448/AMJ.2016.15-16.53-54
UDC 617.735-007.23
THE RESULTS OF TREATMENT OF ATHEROSCLEROTIC MACULODYSTROPHIES WITH THE USE OF RETINALA-
MIN
Gusev A.N., Krasnogorskaya V.N., Vikhreva D.V., Moiseyenko G.A., Petrenko M.A.
Amur State Medical Academy, Blagoveshchensk, Russia
Abstract The central chorioretinal dystrophy (CCRD) is one of the most common diseases in people over the age of 50 years. [10]. According to different authors frequency of macular lesions in old age as high as 40% [6, 7]. The pathogenesis of central chorioretinal dystrophies are circulatory disorders, metabolic dysfunction in the retina and pigment epithelium. Degenerative changes in the retina are caused by various factors, including the disorder of lipid peroxidation as a result of hypoxia. Activity of the antioxidant system reduced under conditions of hypoxia. is leads to activation of free-radical processes, oxidation of lipids and proteins, destruction of cell membranes, the membranes and in severe cases - to cell death. ATP deficit is accompanied by an increase in the concentration of calcium ions in hyaloplasm cells, which reduces the efficiency of autoregulation of blood circulation, contributes to the vascular spasm, an increase of ischemia and the energy deficit [9].
Key words: Central chorioretinaldystrophy, Retinalamin.
Currently, the treatment of CCRD widely used the medications of vasodilators, vitamins, and biostimula-tors [2, 3, 4, 5, 8]. Despite the wide variety of drugs, the disease progresses steadily. Pathogeneticallydirec-tions in the treatment of central chorioretinal dystrophy is the application of peptide bioregulators. The use of peptide bioregulators contributes to regulation of intracellular protein synthesis in cells of the retina, pigment epithelium preservation, activation of reparative processes and functional interaction of cells, metabolism correction and prevention of oxidative stress, preventing cell death. In this connection, in the combined treatment CCRD, we used the preparation - Retinalamin.
The purpose of work - assessment the effectiveness of the treatment of patients with central chorioretinal dystrophies with the use product Retinalamin.
Material and methods. The study involved 38 patients with central chorioretinal dystrophy with initial and advanced stages of the disease between the ages of 52-76 years. In order to increase the effectiveness of pharmacological retinalamine, the drug was administered to the posterior pole of the eye under the conjunctiva (0.5 ml.) With a preliminary implementation of the food sclerectomy in the lower outer segment of the eyeball. The course of treatment was 10 days. The drug was administered daily in the lower conjunctival outer segment of the eyeball.
All patients before and after treatment were carried out a comprehensive examination: visual acuity, of the visual field. From the objective research methods we used reography and electroretinography (ERG). Given the localization of pathological changes in the retina we performed ERG in local area of retina. Rheography eye was performed using reopletizmografy RPG-2-02 and writing device H-327-5.
Results. After a course of treatment of visual acuity in the group average change from 0,49 ± 0,07 to 0,71 ± 0,08 (p <0.001), the peripheral border of the field have expanded by an average of 70.1 degrees in the amount of 8 meridians ( p <0.05). As a result of the treatment the increase in visual acuity, 25 patients on average 0.10.3, 8 patients below 0.1 and 5 unchanged. Peripheral sight borders expanded at 78%, significantly reduced the relative scotoma. Rheographic ratio increased on average by 34.5% from baseline (p <0.001). Increasing
AMypcKMM Meg^MHCKMM wypHa^ №3 - 4 (15 - 16)
53
the ratio observed in 34 patients.
With a total amplitude of the ERG a-wave was 16,3 ± 1,7 mkA, b-wave - 87,4 ± 8,4 mkA. After a course of treatment of common indicators ERG increased significantly: a-wave up to 27,1 ± 3,3 mkA, b-wave up to 137,3 ± 9,2 mkA (p <0.05).
When the local ERG before treatment, the amplitude of a-wave to red stimulus was 1,4 ± 0,5 mkA, b-wave -13,2 ± 0,4 mkA. Upon completion of the course of treatment also observed a significant increase in the a-wave up to 3,6 ± 0,8 mkA, and less significant b-wave up to 15,2 ± 1,3 mkA. After treatment, the amplitude of a-wave under the influence of green stimulus increased by 3.1 uA, b-wave - 13.9 mkA (p <0.05).
Discussion. In contrast to the visual function index improved blood flow is registered in more patients. In our view, improvement of blood circulation in back department structures of the eye and is the most important pathogenetic confirms the effectiveness of histochrome.
The resulting increase in the local ERG parameters in 28 patients shows a significant improvement of metabolic and metabolic processes in the retina and the pigment epithelium. Fundus examination, we observed a positive trend in the form of absorption of point hemorrhages, increasing the caliber of the arteries, reducing the amount of soft drusen, in 2 patients had complete absence of macular edema Thus, the use of peptide bioregulators Retinalamin in the treatment of central atherosclerotic-related macular degeneration is pathogenetically substantiated. Achieved significant improvement in visual function (visual acuity, expanding the field of view, improving the electrical performance, rheographic factor). In our opinion, this is due to the pharmacological action of the drug, as well as the manner of its introduction. With the introduction of the drug through a burr hole in the sclera it becomes possible to enhance the degree of penetration in the internal stuk-tura eyeball and to maximize the Retinalamin.
Literature
1. Use Retinalamin drug leads to significant improvement in visual function in 86% of patients with advanced stage central chorioretinal dystrophy.
2.65% of the patients received a significant improvement in visual acuity by an average of 0.1 to 0.3.
3. Improving rheographic factor in the majority of patients (34 patients) objective evidence of the degree of improvement of hemodynamics and microcirculation in the posterior eye structures.
Literature
1. Maksimov I.B., Moshetova L.K. Retinalamin in treatment of involutional central chorioretinal dystrophy // St. Petersburg. 2008. P. 95.
2. Basinskii S.N. Lasertherapy in thepractice // Vladivostok. 1994. P. 250.
3. Basinskii S.N., Krasnogorskaya V.N. New method of treatment of atherosclerotic macular degeneration // Vestnik ofthalmologii. 1997. № 6. P.17-18.
4. Selitskaya A.V. Central atherosclerotic maculardegeneration // Tomskuniv. 1985. P. 109.
5.. Berenov S.N Laser stimulation in the treatment of central retinal dystrophy // J.Ophthalmological. 1982. №4. P. 214-216.
6. Davidova I.G., Bunin A.J. Reaction vessels of the conjunctiva and the defeat of the fundus // Vestnik ofthalmologii. 1985. № 8. P. 38-40.
7. Miroshnikova L.M. The pathogenesis of sclerotic macular degeneration // Ophthalmological Journal. 1979. №3. P.167-169.
8. Morgolis M.G. Spasmolyticvasodilator and antihypertensiveagentsin ophthalmology // Vestnik ofthalmologii. 1980. №5. P. 62-65.
9. Garther S., Henkind P.Againg and degeration of the human macula. I. Quter nuclear layer and photore-ceptops // Brit.J.Ophthalm. 1981. №.1. P.23-28.
10. Marsch R.J Treatment of senile macular disease // Trans.ophtalmol.soc. UK. 1975. Vol.95. P. 62.
DOI: 10.22448/AMJ.2016.15-16.54-56
UDС 617.5.
VARIANTS OF CLINICAL COURSE AND DIFFERENTIATED TACTICS OF MANAGEMENT OF PATIENTS WITH INTRACRANIAL HEMATOMAS
Karnaukh A.I.
Amur State Medical Academy, Blagoveshchensk, Russia
Abstracts. The research was based on a comprehensive clinical and neurological examination of patients with traumatic intracranial hemorrhages and hematomas. The peculiarities of clinical manifestations depending on the compression rate and the factors affecting the unfavorable outcome of postoperative period were analyzed. The concept that witnessed the including of some hematomas, as a secondary brain damage, to
54
Амурский медицинский журнал №3 - 4 (15 - 16) 2016
