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The study of the results of endolumbal insufflation of ozone and pyracetam in the treatment of posttraumatic epilepsy
In the case of patients operated laparoscopically increase of IAP, fixed with manometer of endoscopic equipment, was equal to 11,8 ± 0,16 mm Hg. The latter is interpreted as II Grade of IAP. The duration of the acute increase IAP due to pneumoperitoneum, was 52 ± 7 min. Changes in hemodynamic parameters associated with the rise of IAP during laparoscopic cholecystectomy, are presented in Table 1. Filling the abdomen with gas and, as a consequence, increase of IAP led to a decrease in cardiac index, left ventricular filling pressure and stroke index in the background of increase of total peripheral vascular resistance. Changing parameters in blood pressure are also characterized by a tendency to increase. The measurement results in patients operated laparoscopically were significantly different from the control parameters and from baseline (P <0.05).
After removing the pneumoperitoneum, as shown from Table 1, the hemodynamic profile was similar to the pre-operative. In the group of patients operated laparoscopically, remained significantly higher total peripheral vascular resistance. The other parameters of
blood circulation in patients after abdominal decompression were not significantly different from either preoperative values, or values from those in the comparison group. Changes in hemodynamic profile in a group of patients operated with laparotomic method, were less pronounced. Besides IAP the differences between the groups of patients who underwent cholecystectomy, concerned at the degree of traumatization forward abdominal wall. Laparotomy in this regard seems to be more traumatic than to puncture of the abdominal wall by trocar. However significant (for t-test) hemodynamic responses, as shown, is paired with acute IAP (pneumoperitoneum) and a rapid decline of IAP at the end of operation (elimination of pneumoperitoneum).
Conclusion. Thus, the imposition of pneumoperitoneum, or caused by this sharp increase in IAP, leading to the hypodynamic response of circulatory (decrease in SI and MI), with increased systemic vascular resistance, blood pressure, heart rate, decrease in left ventricular filling pressure. Removing of pneumoperitoneum led to the reversible changes.
References:
1. Aashish P, Chaudane G. L., Gugory S. Abdominal Compartment Syndrome//Am. J. Roentgenol. - 2007. - Vol.189. - P. 1037-1043.
2. Acta Clinica Belgica: proceedings of the Third World Congress of the Abdominal Compartment Syndrome. - Antwerp, Belgium, 2007. - 21-24 March. - P. 113-118.
3. Akopyan R.V., Shahinyan A., Panoyan A. Prognostic Profile of Intra-Abdominal Pressure in SICU Patients//Anesthesiology. - 2013. -Р 2013. A1250.
4. Alsous F., Khamiees M., DeGirolamo A. Negative fluid balance predicts survival in patients with septic shock//Chest - 2000. - Vol. 117. - P. 1749-1754.
5. Baiter, D. E. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients/D. E. Baiter, HJ. Kaufman, Smith L.A., Ciraulo D. L., Richart C. L., Bums R. P.//J Trauma. 2000. - № 48. - P. 201-206.
6. Balogh Z., Jones F., D'Amours S., Parr M., Sugrue M. Continuous intra-abdominal pressure measurement technique//Am J Surg. -2014. - Vol. 188. - P. 679-684.
7. Balogh Z., McKinley B. A., Cocanour C. S. Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation//Am J Surg. - 2002. - Vol.184. - P. 538-543.
Aliev Mansur Abdukholikovich, Samarkand State Medical Institute, Senior researcher, Department of Neurosurgery, E-mail: dr.mansoor1982@mail.ru Mamadaliev Abdurakhmon Mamatkulovich, Samarkand State Medical Institute, Doctor of Medical Sciences, Professor, Department of Neurosurgery,
E-mail: mam412000@mail.ru Mamadalieva Saodat Abdurakhmonovna, Samarkand State Medical Institute, Neurosurgeon, Clinic of Neurosurgery, E-mail: saodat973@gmail.com
The study of the results of endolumbal insufflation of ozone and pyracetam in the treatment of posttraumatic epilepsy
Abstract: The article about use and the results of endolumbally insufflation of ozone and pyracetam in the treatment of posttraumatic epilepsy. Received the positive results — improved clinical and neurological status, reduced epileptic seizures. Keywords: endolumbally, ozone, pyracetam, posttraumatic, epilepsy.
Year after year due to the modernization of industry and transportation, increase of urbanization the level of traumatism, especially neuro-traumatism has become significantly high. As the result of craniocerebral traumas (CCT) in 45-60% of patients it has been
developed different types of invalid groups, partial and full limitations of working activities [1; 8; 9; 10; 13; 15]. CCT is the actual problem of Public Health and Health Policy and it is presented by the following conditions: 1). CCT mostly occurs in physically active
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Section 6. Medical science
youths and in children; 2). It causes high level of mortality, partial and full limitations of patients' working activities; 3). It is negatively influenced to the demographic process; 4). In order to treat this condition it is required a big public means and permanent public policy provided by government and patients' relatives [8; 9; 10; 13].
Acute duration of CCT is characterized by the development of severe outcomes, but the basic complications and outcomes are mostly developed in the intermediate and late periods of cerebral traumatic disease. Among outcomes of CCT, posttraumatic epilepsy (PE) is mostly occurred [2; 3; 4; 5; 6; 9; 10; 11; 16].
The aim of the study: Clinical manifestation, diagnostic and treatment methods of PE in the most cases are going to be a main
aspect of discussions among neurosurgeons, nevrologists and psychiatrics. For the present time with the use of the achievments of modern medicine and technics we have the opportunity to improve diagnostic and treatment methods of PE. In this article we have studied the effectiveness of treatment of PE by the endolumbal insufflation of ozone and pyracetam.
Materials and methods: In this scientific investigation we have analysed clinical-neurological, diagnostic and treatment results of 54 patients with the diagnoses of PE admitted to the Neurosurgical Department of the Clinic of Samarkand State Medical Institute during the period of2008-2014. Among patients 40 (74,1%) were men and 14 (25,9%) were women, at the age from 4 to 55 years old (Table 1).
Table 1. - Distribution of the patients treated regarding posttraumatic epilepsy due to the indexes of age and sex
№ Age groups Patients In general
Men Women
abs. % abs. % abs. %
1 4-15 5 9,3 4 7,4 9 16,7
2 16-19 6 11,1 1 1,9 7 13,0
3 20-29 13 24,1 3 5,5 16 29,6
4 30-39 10 18,5 2 3,7 12 22,2
5 40-49 4 7,4 2 3,7 6 11,1
6 50-55 2 3,7 2 3,7 4 7,4
7 In general 40 74,1 14 25,9 54 100
It has been determined that the beginning period of the clinical manifestation of PE as a result of CCT was from 1 to 3 years. In order to confirm the diagnoses in 44 patients (81,5%) it has been performed computer tomography (CT) and in 10 patients (18,5%) it has been performed magnet-resonance imaging (MRI), electroencephalography (EEG) have been periodically performed to all patients.
All patients have been received the complex treatment course consisting of the neuroprotective medications, nootropics, medications which improve microcirculation, diuretics, desensititive drugs, vitamins of B-group, anticonvulsants (convulex, benzonal, carbam-azepine, lamitor). In order to have positive results and to increase the effectiveness of treatment in patients with PE we have been carried out the elaborated in the clinic endolumbal ozone [5; 7; 12] and insufflation of pyracetam [1, 14].
Therefore in the aseptic conditions and in ordinary manner it has been carried out lumbar puncture with measure oflumbar pressure and according to the indexes of lumbar pressure we carried out evacuation portion of liquor in definite volume (individually 20-50 ml). After it with the use of syringe ozone was taken from medical
ozonator (Ozonator 1M) and in the volume of 10-40 sm3 it is en-dolumbally injected. Then we dissolve 20% solution of pyracetam in 0,9% solution of sodium chloride in order to get 3-5% solution and in the concentration from 200 mg to 1,0 g (due to the patient's age) it is injected to the lumbar canal. This manipulation has been performed after getting consent of patients' relatives and clinical discussions. In general ozone and insufflation of pyracetam have been carried out 202 times for 109 patients. During the 10 days of the treatment course insufflation of ozone and pyracetam was performed once in 16 patients (14,7%) and twice in 93 patients (85,3%). The repeated course of ozone and pyracetam insufflation has been carried out after 3-4 months.
Results and discussion:
On the basis of CT and MRI investigations in 37,1% of patients it has been determined posttraumatic CT - changes of the mild degree, in 48,1% of patients it has been determined posttraumatic CT - changes of the moderate degree and in 14,8% of patients it has been determined posttraumatic CT - changes of the severe degree [9, 17, 18] (Figure 1).
В Changes of the mild degree И Changes of the moderate degree 1 Changes of the severe degree
Fig. 1. Distribution according to the degree of CT and MRI changes in posttraumatic epilepsy
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The study of the results of endolumbal insufflation of ozone and pyracetam in the treatment of posttraumatic epilepsy
There have been determined the presence of different developed degrees of the general and local cerebral symptoms, and the presence of epileptic spasms on the basis of clinical-neurological investigation and anamnestic data.
In 54 patients it has been observed epileptic seizures (ES) and due to its character the distribution was in the following manner: in 8 patients (14,8%) it has been observed focal ES (without loss of consciousness), in 13 patients (24,1%) it has been observed complex partial ES, in 26 patients (48,1%) it has been observed secondary generalized partial ES and in 7 patients (13%) it has been observed secondary generalized tonic-clonic ES (Table 2).
Table 2. - Distribution of posttraumatic epilepsy due
Due to the observed ES patients were divided into the following groups: in 5 patients (9,3%) ES have been observed 1-2 times and more per day; in 23 patients (42,6%) ES have been observed 4-12 times per month and in 26 patients (48,1%) recurrent ES have been observed 1-3 times per month.
Due to the duration of the observed ES patients were divided into the following groups: in 5 patients (9,3%) ES have been continued 1-10 seconds, in 42 patients (77,7%) ES have been continued 10-60 seconds and in 7 patients (13%) ES have been continued more than 1 minute.
to the character of the observed epileptic seizures
№ Character of the epileptic seizures Distribution
Abs. %
1 Focal epileptic seizures (without loss of consciousness) 8 14,8%
2 Complex partial epileptic seizures 13 24,1%
3 Secondary generalized partial epileptic seizures 26 48,1%
4 Secondary generalized tonic-clonic epileptic seizures 7 13%
5 In general 54 100%
In the investigated patients there have been studied the catam-nesis after the performed treatment course lasted from 3 to 6 months. During the assessment of the presence of epileptic spasms after 3 months of treatment in 24 patients (44,4%) it has been observed ES, due to the character of the spasms in 14 patients (25,9%) there have been observed focal ES without loss of consciousness, in 4 patients (7,4%) there have been observed complex partial ES and in 6 patients (11,1%) there have been observed secondary generalized ES.
On the basis of the data presented after 6 months of treatment we could say that 10 patients (18,5%) it has been observed ES, among them in 6 patients (11,1%) spasms were in the focal character, in 1 patient (1,8%) ES were in the complex partial character and in 3 patients (5,6%) spasms were in the secondary generalized partial type. ES in tonic-clonic character after 3 and 6 months of treatment were not observed (Figure 2.).
48,1%
13%
I
Before treatment
25,9%
After 3 month of treatment After 6 month of treat ment
E Focal ep ileptic seizures (without loss of consciousness)
□ Complex partial epilepticseizures
□ Secondary generalized partial epileptic seizures
■ Secondary generalized tonic-clonic epilepticseizures
Fig. 2. Differential manifestation of epileptic seizures in posttraumatic epilepsy due to its character before and after treatment
According to the presence of ES after 3 months of treatment we have had the following dynamic of changes: the presence 1-2 and more recurrent spasms per day have not been observed; the presence of 4-12 spasms per month have been observed in 11 patient (20,4%) and the presence of 1-3 recurrent spasms per month have been observed in 23 patients (42,6%).
After 6 months of treatment the presence of 1-2 spasms per day and 4-12 recurrent spasms per month have not been observed, the presence of 1-3 recurrent spasms per month have been observed in 3 patients (5,6%) and the presence of 1 spasm per 6 months have been observed in 8 (14,8%) patients (Figure 3.).
Due to the duration of ES the evaluation results were positive and after 3 months of treatment we have had the following duration of the presented spasms: in 15 patients (27,8%) duration of spasms was 1-10 seconds, in 9 patients (16,7%) duration of spasms was 10-60 seconds, after 6 months of treatment the duration of spasms has become short, so that in 6 patients (11,1%) duration of spasms was 1-10 seconds and in 4 patients (7,4%) duration of spasms was 10-60 seconds. After 3 and 6 months of treatment we have not determined duration of spasms more than 1 minute (Figure 4.).
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Section 6. Medical science
Fig. 3. Differential manifestation of the amount of epileptic seizures in patients with posttraumatic epilepsy before and after treatment
Fig. 4. Differential manifestation of epileptic seizures in posttraumatic epilepsy due to duration of spasms before and after treatment
Conclusions. During the assessment of the results of scientific investigation we have come to the following conclusions.
After performing of endolumbal insufflation of ozone with pyracetam the number ofpatients with epileptic seizures have been decreased on average in 5 times:
- Due to the character of epileptic seizures we have examined mostly mild types of spasms, tonic-clonic generalized spasms have not been observed at all;
- The presence of epileptic seizures 1-2 times per day and the presence of 4-12 recurrent spasms per month were not examined, the presence of the recurrent epileptic spasms 1-3 times per month was examined in 2,8% of patients and the presence of
epileptic seizures 1 time per 6 months was examined in 7,3% of patients;
- Duration of epileptic seizures was short, in 5,5% of patients the duration of spasms was 1-10 seconds, in 3,7% of patients the duration of spasms was 10-60 seconds and the duration of spasms more than 1 minute was not completely examined.
So, in the complex treatment of patients with posttraumatic epilepsy the use of endolumbal insufflation of ozone with pyracetam could cause rapid regression of neurological deficit, epileptic seizures were stopped and decreased, and it could cause the restoration of physical activities and could increase the effectiveness of performed treatment.
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Immunity state on the background of osteotropic therapy with medicine calcium D3 in endoprosthesis of the knee joint
References:
1. Agzamov М. К. Comprehensive assessment of the efficacy of nootropic-ozone therapy in severe traumatic brain injury (The dissertation of candidate of medical sciences), Samarkand State Medical Institute, 1994, Uzbekistan, in Russian.
2. Aliev M. A., Mamadaliev M. A. Age-clinical features of patients with posttraumatic cerebral arachnoiditis. Materials of 8th Asian Congress of Neurological Surgeons, 2010, Kuala Lumpur, Malaysia, - P.267.
3. Aliev M. A., Mamadaliev M. A. The diagnostic importance of the computer and magnet-resonance tomography in posttraumatic cerebral arachnoiditis. Materials of 8th Asian Congress of Neurological Surgeons, 2010, Kuala Lumpur, Malaysia, - P.194.
4. Aliev M. A. The importance endolumbal ozone and nootropic insufflation during the postoperative period after evacuation of posttraumatic arachnoidal cysts. Abstract book of European Association of Neurosurgical Societies' Young Neurosurgeons Meeting, Innsbruck, Austria, 2011., - P.40.
5. Bolg'ayev A. B., Madiyarov S. D. (1977). Treatment of chronic arachnoiditis via introduction of ozone in the subarachnoid space. Journal of Neurology and Psychiatry, Moscow, № 2. - 227-231, in Russian.
6. Gaevaya M. A. (2000). Features vegetovascular paroxysms of posttraumatic cerebral arachnoiditis different localization. - (The dissertation of candidate of medical sciences)./Kharkiv Medical Academy of Postgraduate Education. - Kharkiv, Ukraine, in Russian.
7. Dubrovina Y. A. (2007). Endolyumbal introduction of ozone-oxygen mixture in the treatment of traumatic brain injury and its complications: Clinical and neurophysiological evaluation (The dissertation of candidate of medical sciences), Kazan, Russian Federation, in Russian.
8. Konovalov A. N., Likhterman L. B., Potapov A. A. (1998, 2002). Clinical guidelines for traumatic brain injury. Volume № I and III. Moscow, “Antidor", in Russian.
9. Konovalov A. N., Potapov A. A., Likhterman L. B., Kornienko V. N., Kravchuk A. D., Okhlopkov V. A., Zakharova N. Y., & Yakovlev S. B. (2012). Reconstructive and minimally invasive surgery of outcomes of craniocerebral injury. Moscow, In Russian.
10. Konovalov A. N., Likhterman L. B., Potapov A. A. Neurotraumatology: directory. - M.: Medicine, 1994. - 415 p, in Russian.
11. Madyarov S. D. (1988). Pathogenesis, diagnosis and surgical treatment of cerebral arachnoiditis. (The dissertation of doctor of medical sciences). - Kiev, Ukraine, in Russian.
12. Madyarov S. D., Bolgaev A. B. Modification method of introducing ozone into the subarachnoid space/Rat. Offer № 127 of04/19/78, issued by the summit in Russian.
13. Mamadaliev A. M. (1988). Predicting outcomes of traumatic brain injury in the acute period (The dissertation of doctor of medical sciences), Burdenko Neurosurgery Institute, Russian Federation, in Russian.
14. Mamadaliev A. M., Agzamov M. K. (1993). A method for treating severe traumatic brain injury in the acute period (The patent for the invention of the Russian Federation № 5042297/14/023170 on 07/21/93)., in Russian.
15. Mamadaliev A. M., Aliev M. A. (2009). The Importance of the Duration Disorders of Consciousness to Prognosis of the Outcome of Cranio-Cerebral Trauma. In Black P. (Eds)., Proceedings of XIV WFNS Congress, Boston, USA.
16. Macheret E. L., Samosyuk I. Z., Garkusha L. G. Cerebral arachnoiditis. - K.: Health Protection, 1985.- 168 p., in Russian.
17. Firsching R. Early magnetic resonance imaging and CT ofbrain-stem lesions after severe injury//J. Neurosurg. - 1998/ - V. 89 (5). - P. 707-712.
18. Zlader J., Boguslawaka-Staniaszezyk R. Comparadility of CT-tomography and EEG in the evaluation of posttraumatic sequelae (pol-ish)//Neurologia I neurochirurgia polska. - 1993. - Mar. - Apr. - 27 (2). - P. 175-180.
Alimov Aziz Pulatovich, Scientific Research Institute of Traumatology and Orthopedics, Ministry of Health of the Republic of Uzbekistan Kamalov Zaynitdin Sayfutdinovich Iinstitute of Immunology Academy of Sciences of the Republic of Uzbekistan
Azizov Mirhakim Javharovich, Scientific Research Institute of Traumatology and Orthopedics, Ministry of Health of the Republic of Uzbekistan Aripova Tamara Uktamovna Iinstitute of Immunology Academy of Sciences of the Republic of Uzbekistan E-mail: zay_kamal@rambler.ru
Immunity state on the background of osteotropic therapy with medicine calcium D3 in endoprosthesis of the knee joint
Abstract: The clinical-immunologic examinations were performed in 44 patients with degenerative-dystrophic changes of knee joint (DDCKJ), of them 21 patients — before treatment (group 1), 23 patients — received preparation Calcium D3, and 20 were healthy volonteers of comparable age. There were studied features of changes of the cellular and humoral immu-
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