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mode, which, according to Cross et al., VH can be attributed to the aggressive group [6, 143-153].
In professional literature there are reports about the use of unilateral transpedicular access when carrying out the puncture vertebro-plasty [1, 287-296]. Thus, Kim et al. recommend the use ofunilateral pedicle access needle in a vertebroplasty. The number of complications and recurrences in a series of Kim et al. higher than that of other authors. In our work, unilateral transpedicular access when symptomatic VH contributes to a higher degree of filling of posterior VH affected vertebra and avoids the use of additional therapies, as well as to prevent invasion of a tumor inside the spinal canal. Our view is consistent with data from professional literature [9, 311-320].After the cement in the epidural space we associate with a high degree of aggressiveness VH and having her epidural component.
The results of treatment by the method of puncture vertebroplasty in the analyzed group is comparable to the results of a series Galibert et al. and a number of other authors [7, 341-348]. Over a two-year observation period in all patients in this series was filled with cement to stabilize the vertebrae, there was no secondary deformities and pathological fractures of vertebral bodies.
In the postoperative period one patient was asymptomatic after the revealed cement in the epidural space without compressing the spinal cord. This complication did not require additional treatment and increased length of stay in the hospital. In this case, also obtained a positive effect from the puncture vertebroplasty with regression of pain syndrome and improvement of quality of life. Even one patient for four days after surgery, remained pain at the puncture site not requiring the use of analgesics. Infectious, hemorrhagic and embolic complications in the analyzed series of patients are not marked. Low rate of complications when using puncture vertebroplasty noted by many researchers [10, 13-19].
Conclusion
1. Percutaneous vertebroplasty is a safe and effective minimally invasive treatment symptomatic and aggressive VH, which allows to eliminate pain.
2. Percutaneous vertebroplasty to restore lost strength and stability of the affected vertebra and prevent compression of the nervous structures in the future.
3. The use of a C-arm in the puncture vertebroplasty increases the safety of this method.
References:
1. Acosta F. L., Dowd C. F., Chin C., et al. Current treatment strategies and outcomes in the management of symptomatic vertebral hem-angiomas//Neurosurgery. 2006. Vol. 58. P. 287-296.
2. Bas T., Aparisi F., Bas J. L. Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years//Spine. 2001. Vol. 26. P. 1577-1582.
3. Belkoff S. M., Maroney M., Fenton D. C., et al. An in vitro biomechanical evaluation of bone cements used in percutaneous vertebro-plasty//Bone. 1999. Vol. 25. P. 23S-26 s.
4. Carlier R., Engerand S., Lamer S., et al. Foraminal epidural extra osseous cavernous hemangioma of the cervical spine: a case report/Spine. 2000. Vol. 25. P. 629-631.
5. Cross J. J., Antoun N. M., Laing J. C., et al. Imaging of compressive vertebral haemangiomas//Eur. Radiol. 2000. Vol. 10. P. 997-1102.
6. Deramond H., Darrasson R., Galibert P. [Percutaneous vertebroplasty with acrylic cement in the treatment of aggressive spinal angio-mas]//Rachis. 1989. Vol. 1. P. 143-153.
7. Doppman J. L., Oldfield E. H., Heiss J. D. Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol//Radiology. 2000. Vol. 214. P. 341-348.
8. Galibert P., Deramond H., Rosat P., et al. [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebro-plasty]//Neurochirurgie. 1987. Vol. 33. P. 166-168. French.
9. Gangi A., Kastler B. A., Dietemann J. L. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy//AJNR. Am. J. Neuroradiol. 1994. Vol. 15. P. 83-86.
10. Pedachenko E. G.,. Kudaev S. V. the Possibility of puncture vertebroplasty in compression fractures of the vertebral bodies in osteopo-rosis//Neurosurgery. 2006. No. 4. P. 13-19.
Saidkhodjayeva Saida Nabiyevna, Neurology, children neurology, and medical genetics department, Tashkent Pediatric Medical Institute
E-mail: mbshakur@mail.ru
Headaches in children with attention deficit hyperactivity disorder: clinical manifestations and specific progressing
Abstract: The article presents the issues of comorbidity of attention deficit hyperactivity disorder and primary headaches in children: tension headaches (TTH) and migraine. Considering the fact that all children with ADHD have the predisposing factors to the development of tension-type headache (schooling difficulties, family problems, the impact of stress, anxiety and depressive disorders), there is a need to study the clinical manifestations, mechanisms of pathogenesis and characteristics. Keywords: attention deficit hyperactivity disorder, tension headache, migraine, children.
Attention deficit hyperactivity disorder (ADHD) syndrome in mechanisms, and as a result, high efficiency of the available thera-childhood is one of the most topical problems of the modern med- peutic agents. According to the research data, the values of ADHD icine due to its high prevalence, insufficient study of pathogenic prevalence in children varies in a quite wide range from 1% to 30%
Headaches in children with attention deficit hyperactivity disorder: clinical manifestations and specific progressing
of population [1-7]. According to comorbidity concept, ADHD in childhood often is accompanied by headaches, which are met in 25% of children with ADHD according to some authors [2]. The most widely spread forms of headaches met in children with ADHD are tension headaches (TH) and migraine [8; 9].
Among the predictors ofheadaches in childhood there are disorders of attention concentration, slow speed of cognitive activity, emotional instability, hyperactivity, and tense relationships in school [3]. According to population research of T. W. Strine et al., among 4-12 years old children, suffering often headaches, attention disorder and hyperactivity was met 2.6 folds more often [11].
Besides that, the results of the study of ADHD and primary headaches comorbidity are fragment and discrepant. According to the data of special epidemiological study, where the possible association between ADHD and primary headaches was assessed, migraine and TH are comorbide not with just ADHD, but hyperactivity impulse behavior [4].
From the other side, the studies of some authors demonstrate the association between attention disorders in children and both basic types of primary headaches (migraine and TH). There is a hypothesis that migraine and TH form a continuum, which can have some common pathologic physiological mechanisms, while complexes of brain structures provide mechanisms of attention, characteristic personal profile, and mechanisms of headache can overlap [6]. It is possible that, difficulties of schooling and problems of behavior linked with ADHD, which are accompanied with long-term and multiple stresses in family, school, relationships with children of the same age and other people promote formation of TH via the impact of repeated stresses [8, 10].
Thus, both ADHD and primary headaches (migraine and TH) widely spread among children and teenagers are accompanied with the disorders of social-psychological functioning and difficulties of schooling.
The objective: was to study the structure and peculiarities of basic clinical characteristics of primary headaches in children with attention deficit hyperactivity disorder.
Materials and methods of the research: We followed 102 children (84 boys and 18 girls) from 5 to 12 years old suffering ADHD. Diagnostics of attention deficit hyperactivity disorder and associate tic hyper kinesis was performed on the basis of DSM-V criteria [5]. Assessment of the disease severity was performed with the help of Vanderbilt scale, which is a questionnaire for parents consisting of 50 questions for the evaluation of the degree of lack of attention, hyperactivity and impetuosity, and associate opposition-anxiety states [2].
Diagnostics of cephalgia was performed in compliance with the classification of international society of headache study (IHS — 1988) [11]. Assessment of cephalgia severity was performed with the help of Visual Analogue Scale (VAS). Neurological checking was performed according to the common scheme.
Criteria of inclusion to the study were the following: age of children from 5 to 12; correspondence of clinical manifestations of the pathology to diagnostic criteria of IDC-10, DSM-IV; absence of mental retardation; informed consent of parents to participate in the research. Criteria of exclusion were the age of patients under 5 and above 12 years old, severe focal neurological symptoms, presence of severe somatic pathology, significant decrease ofvision and hearing ability, epileptic seizures, and mental retardation.
Results of the research. Complaints ofheadaches were stated by 56.2% of the children with ADHD. There was prevalence of TH among all primary headaches in children; it was diagnosed in 76.2%.
The part of migraine was equal to 19.4% cases, combination of TH and migraine 2.3%, rare forms ofheadaches 2.1%.
Character of TH in our group was often described as suppressing (41.2%), rare pulsating (14.5%). Though 10.9% of the children characterized TH as suppressing\pulsating (changing its character in each attack), 14.5% as obtuse, 3.6% stinging, 1.8% bursting, and 13.3% various combinations of pain. Bilateral location was determined in 73.3% of the children with ADHD. 38.2% of the children with TH had intensification of pain from usual physical activity, but intensity of TH was weak or moderate in 89.7% of the cases. In 42.4% of school children TH was accompanied by photo\pho-nophobia. Only 4 children with TH (2.4%) had nausea as associate symptom. In 18.8% of the children TH was accompanied with just anorectic reactions, in 4.2% anorexia and photo\phonophobia. Thus, in the performed study the most specific characteristics of TH in children were intensity and location of pain.
In our study in 6.7% of the children duration of TH was less than 30 minutes (these children were diagnosed possible TH due to incomplete correspondence to TH criteria).
Assessment of attack intensity in headache (H) in childhood did not get sufficient attention in literature until now. In international headache classification the criteria of H expression are not specific for children. We revealed that, the assessment of pain expression according to verbal scale in 100% cases the children with migraine characterized headache as moderate or intensive, and 91.3% characterized it as moderate or intensive according to VAS. 89.7% of school children suffering TH according to verbal scale characterized headaches as weak or moderate, and according to VAS the same assessment was given by 85.8% of the children. According to VAS children, suffering migraine, assessed headache equal to 6.76±0.42 points, and children with TH to 4.98±0.15 points (p<0.001).
Intensity of headaches in children with TH increased in transformation of episodic variants from rare to often ones from 4.41 to 5.09 points (p>0.05), and episofic forms to chronic ones from 5.09 to 5.61 points (p>0.05). In comparison the values of headache assessment in children with often episodes of TH and chronic TH statistically did not differ (p=0.145), though there were reliably statistically significant differences in children with rare episodes of TH (p=0.034).
Assessment of pain expression in migraine without aura was higher, than in children suffering migraine with aura: 8.75 and 5.36 points, respectively (p=0.003). In children with chronic migraine the intensity of headache was a little bit stronger, though statistically insignificant (7.5 points), than in children suffering migraine (6.92 points; p>0.05). Pain assessment according to VAS in CTH and chronic migraine was 5.61 and 7.50 points, respectively (p=0.015). Pain intensity in case of other kinds of headache was between average values of intensity in TH and migraine and was equal to 6.07 points.
Almost in all types of headaches intensity of pain according to VAS was higher in girls, than in boys. According to verbal scale these differences were absent due to less sensitivity of that scale. Though in comparison of the groups of boys and girls with migraine without aura the difference reached the values of statistical reliability (p<0.05).
Conclusion: Thus, the performed study showed that attention deficit hyperactivity disorder syndrome (ADHD) can be met in combination with primary headaches, more often tension headache and migraine. Headaches associate with ADHD were considered as unfavorable prognostic factors for long-term progress ofADHD, up to chronic one.
References:
1. Budchanova N. U., Delyagin V. M., Khondkaryan G. S. Prevalence and peculiarities of clinical manifestations of primary headaches in school children. Rasprostranyonnost I osobennosti klinicheskikh proyavleniy pervichnikh golovnikh boley u shkolnikov. [Pediatrics]. 2008. № 87 (5). P. 138-140. (in Russian).
2. Zavadenko N. N. Hyperactivity and attention deficit in childhood. - M., 2005. P. 256 (in Russian).
3. Barkley R. A. Attention-deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 3rd ed. N. Y., 2005. 770 p.
4. Behavioral and Temperamental Characteristics of Children and Adolescents Suffering from Primary Headache/L. Mazzone, B. Vitiello,
G. Incorpora, D. Mazzone//Cephalalgia. 2006. - № 26 (2). P. 194-201.
5. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. (DSM-V). Washington, 2013. 947 p.
6. Kröner-Herwig B., Heinrich M., Morris L. Headache in German Children and Adolescents: a Population-based Epidemiological Study//Cephalalgia. 2007. - № 27 (6). P. 519-527.
7. Pennington B. F. Diagnosing Learning Disorders: A Neuropsychological Framework. N. Y.; L., 2009. 355 p.
8. Prevalence and Clinical Characteristics of Primary Headaches among School Children in South Korea: a Nationwide Survey/Y. I. Rho,
H. J. Chung, K. H. Lee et al.//Headache. 2012. - № 52 (4). P. 592-599.
9. Prevalence of Headache and Migraine in Children and Adolescents: a Systematic Review of Population-based Studies/I. Abu-Arafeh, S. Razak, B. Sivaraman, C. Graham//Dev. Med. Child Neurol. 2010. - № 52 (12). P. 1088-1097.
10. Primary Headaches, Attention Deficit Disorder and Learning Disabilities in Children and Adolescents/J. Genizi, S. Gordon, N. C. Kerem et al.//The J. of Headache and Pain. 2013. - № 14. P. 54.
11. The Associations among Childhood Headaches, Emotional and Behavioral Difficulties, and Health Care Use/T. W. Strine, C. A. Okoro, L. C. McGuire, L. S. Balluz//Pediatrics. 2006. - № 117 (5). P. 1728-1735.
Salakhiddinov Kamoliddin, Andijan State Medical Institute, assistant professor, of faculty and hospital surgery, Uzbekistan E-mail: kamaliddin@mail.ru
Modern view in treatment of burn wounds
Abstract: The authors studied 65 patients with burn wounds upper and lower extremities with the use of chelating agent in the treatment of regional lymph and antibiotic biosynthetic wound Parapran coatings. Showed a positive result of the application of lymphatic therapy can reduce wound complications.
Keywords: burns, lymphatic therapy, wound dressings, wound complications.
Introduction
It is important to notice that any combustions, especially extensive, irrespective of their localization, are followed by inflammatory process and the expressed external lymphorrhea (plasmorrhea) with which, the organism is left by the vital elements, proteins, electrolytes and etc.
Do not forget about the often accompanying the process of burn wound infections [1].
Plasma loss at deep combustions it is shown not only wound loss, but also formation of an edema in surrounding a burn wound of a tissue.
At the disorders of microcirculation resulting in massive stagnation of a blood in vessels the local compensatory augmentation of a limfoproduktion takes place. During this period the lymphatic bed can be one of the main drainage links of an interstitial [2; 3].
Lymphatic system is not only a derivative ofvenous system, but also highly provides communication of an interstition with other departments of the blood course [3; 4].
Important circumstance of lymphatic system, the factor of accumulating of the damaged cages, microorganisms and toxins with the subsequent neutralization and removal is in their natural way.
Washing away or so-called capture, happens lymphatic capillaries, but not blood microvessels since the wall of the first, without possessing on the histologically structure a basal membrane, is capable to pass through itself the microbial bodies and other corpuscular particles having big molecular weight [2; 3; 4].
Research purpose: to estimate clinical efficiency of application of regional lymphatic therapy in treatment ofburn wounds, various localization.
Materials and methods.
We studied 65 patients with combustions of III And the Art., various localization. From them 30 it is groups sick with a basis by which the complex of medical actions included a regional lymphatic antibi-oticotherapia (RLAT) and a wound covering «Parapran». 35 patients made control group which received traditional treatment. All studied patients were mainly with combustions of the top or lower extremities.
The clinical assessment of results of treatment was carried out on the basis of a current of a wound process, terms of depression of an edema, cuticularization terms from an initiation of treatment, bacteriological and cytologic researches, by wound pyeses. At patients in dynamics studied changes of the main clinical laboratory indicators.
Results of researches:
Comparing clinical and datas of laboratory of the compared groups we received the following: against complex treatment of RLAT at 16 (53.3%) patients already by the beginning of 2 days it was noted appreciable and places and full depression of an edema and refocal inflammation, in control group these indicators were shown in later terms for 3-4 days.
From burn wounds prior to treatment of control and main groups strains of P.aeruginosa of 20% of S.aureus, in other cases of S.epideridis were sowed in
