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Division of the patients depending on the use of SO showed, in both groups, significantly big visual function in the eyes, which LC was preliminarily used on (p<0,01, for the group SO- and p<0,001 for the group SO+), which is apparently related to the initially high visual function before operation and better structural-functional pre-operation state of the eyes.
The removal of silicon oil contributed to the reduction of IOP level (in the group PLC- p<0,001, in the group PLC+--insignificant) and increase of the sharpness of vision (in the group
PLC- p<0,01, in the group PLC+--insignificant) compared to
the results fixed at the level of maximal IOP.
Thus, the present research demonstrated that in the group PLC- after vitreo-retinal surgery, there was a big frequency and expressiveness of ocular hypertension, which was coupled with the reduction of visual function. This phenomenon is not completely explained by tamponade of vitreous body, because, even after randomization of groups depending on the use of SO, the differences in IOP level were preserved. The use of silicon oil was significantly associated with diabetic nephropathy, decompensation of carbohydrate metabolism and complicated course of operation and post-operation period.
References:
1. Shen Y.D., Yang C.M. Extended silicone oil tamponade in primary vitrectomy for complex retinal detachment in proliferative diabetic retinopathy: a long-term follow-up study.//Eur J Ophthalmol. 2007 Nov-Dec; 17 (6): 954-60.
2. Honavar S. G., Goyal M., Majji A. B., Sen P. K., Naduvilath T., Dandona L. Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments.//Ophthalmology. 1999 Jan;106 (1):169-76; discussion 177.
3. Henderer J. D., Budenz D. L., Flynn H. W. Jr, Schiffman J. C., Feuer W. J., Murray T. G. Elevated intraocular pressure and hypotony following silicone oil retinal tamponade for complex retinal detachment: incidence and risk factors.//Arch Ophthalmol. 1999 Feb; 117 (2): 189-95.
Lipartia Mary Givievna, The doctor of the Tashkent City Oncology Center, Republic of Uzbekistan E-mail: evovision@bk.ru
Morbidity of children with non-hodgkin lymphoma from them in Uzbekistan
Abstract: Knowledge of basic epidemiological factors and the prevalence of reasons in will allow general practitioners, pediatricians, pediatric surgeons, otolaryngologists and other professionals ofvarious parts of the pediatric network to regularly-purposeful work of the Management Board to increase the level of timely diagnosis and oncologic alertness, especially childhood. Keywords: Children, non-Hodgkin's lymphoma, the incidence.
nal and internal factors (physical, chemical and biological, and others.) [1; 2; 3].
The internal factors, first of all, should include genetic factors.
Additional malignancies worldwide in children with non-Hodgkin's lymphomas up 5-7% in adolescents over 15 years — 10%. The prevalence of NHL in children and adolescents up to 18 years in Europe and North America is 0.6-1.5 cases per 100,000, in Uzbekistan this figure, according to current statistics, locat-ditsya in the same range. The peak incidence between the ages of 5-10 years, children under 3 years old rarely get sick.
Despite the fact that pediatric oncology is one of their young directions in oncology, to date, it has been substantial progress. Known co-temporal methods of treatment allow to cure more than 50% of children suffering from malignant tumors, and in non-Hodgkin lymphoma in the presence of timely diagnosis and conducting the specialized help cure occurs in 80% of patients.
Improving methods of prevention, early detection of non-Hodgkin lymphomas promotes adequate treatment, thereby leading to the achievement of satisfactory results and lower mortality rates in children. For a full understanding the current situation it is necessary to have reliable data statistics NHL, as well as their changes over time, which can be carried out epidemiological analysis and monitoring of all disease entities encountered in the pediatric population.
Over the past 30-40 years in the dynamics of the incidence of non-Hodgkin's lymphomas in children on the rise of a number of diseases. This may be due to the improvement of the diagnosis and the influence on the developing child's body to various exter-
To date, there is no clearly defined endogenous and exogenous risk factors that affect the mother and child, who were studied depending on the location, in this connection, this research is relevant and necessary [2; 3; 4].
The study ofthe prevalence of social aspects, possible causes and factors in the development of childhood diseases, including cancer is quite important-nym in planning work onkopediatricheskoy service.
Objective: analysis of key statistical indicators Non-Hodgkin Lymphoma in the dynamics of the child population in the Republic of Uzbekistan.
Uzbekistan — a country with great human potential. At the end of 2015 was more than the population of Uzbekistan — 30 million people, of which 63.1% — in rural areas, 36.9% — urban population. The age structure of the population belongs to a progressive type: the number of children — 28.8%; adolescents up to 15 years — 6.7%, significantly higher than the number of persons over 65 years old.
Against the background of high fertility and population growth, the imbalance in the age structure of the complex social and environmental situation in particular, Aral-ray of the crisis in the country in the mid 80-ies of the last century began to unfold "demographic crisis".
Morbidity of children with non-hodgkin lymphoma from them in Uzbekistan
It is characterized by:
— Increasing levels of child and maternal mortality;
— Deterioration of the health of the population, especially women and children;
— Child-bearing age;
— A reduction in life expectancy.
Consequences boomers are considered with a 2-position:
Medical — high fertility; deterioration in maternal and child health;
Socio-economic — the increase in population density in the oasis areas; reducing the amount of arable land per capita; decline in GDP per capita on-villages; the main part of the population — children and young people 48-50%; increase the burden on the working population.
Thanks to the Republic of Uzbekistan the government's policy in the health system takes a number of measures to improve and enhance the quality of the copper-care services to the population, including children, that started especially active in connection with the commemoration in 2014 on the initiative of President of the Republic — the "Year of a healthy child" 2016 — "The Year of healthy mother — healthy child".
In reviewing Uzbekistan in terms of the territorial unit it includes 12 regions, the Autonomous Republic of Karakalpakstan and Tashkent city. Each region in turn is composed of several parts, so the total number of districts — 162; 118 cities and towns.
Materials and methods:
A retrospective analysis of the dynamics and structure of non-Hodgkin's lymphoma in children in the Republic of Uzbekistan on the basis of statistical reports the National Cancer Research Center (RCRC) Ministry of Health of Uzbekistan in the form 7-SSV for the period from 2005 to 2015., With the calculation and analysis of the main statistical indicators (incidence, morbidity) by region of the country.
Results: According to reports in the Republic of 10,485,000 of the child population in the dispensary with non-Hodgkin lymphomas comprise 1186 (. 2015), this suggests that Uzbekistan is gradually approaching the countries with high incidence of cancer in children.
Also, the dynamics of different size in the analyzed period were indicators of morbidity in children. We tended to increase, so in Navoi (10.5 times), Syrdarya region (5 times), Samarkand (3.6 times) areas. The relatively stable indicators of morbidity remained in Andijan and Jizzakh regions.
Analysis of published data [1; 4; 5] show that the frequency and incidence of non-Hodgkin lymphomas structure can vary and have territorial variability, which is associated with the presence of the socio-economic, geographical, genetic, natural, household and other factors, which currently require study.
In our country, as in all other countries, there are some problems in the study of the epidemiology of origin non-Hodgkin lymphomas in children. Through analysis of the assessment of the main statistical indicators of non-Hodgkin's lymphomas in children can not only be based on official statistics. It is therefore necessary to carry out epidemiological studies in each individual region, the identification of risk factors, the study of their specificity, followed by the possibility of preventing their occurrence.
The incidence rate of non-Hodgkin's lymphoma in children in our country is an average of 3.9 per 100 000 population. According to the literature, this show-Tel in other countries is 13-18 per 100,000 population. According to global statistics, one hundred in the world there is a slow but steady increase in the incidence of lymphomas.
The incidence of non-Hodgkin's lymphoma in childhood in Uzbekistan this figure respectively averages 2.0-2.5. On account of the proportion of children 2 to 8% of all cancer [2; 3; 4; 5; 6]. It should be noted that there has recently been an increase in sick children lim-foproliferativ diseases and central nervous system, which is likely due to the presence ofimmuno-genetic mechanisms ofregulation, as well as man-made factors causing the activation process of carcinogenesis.
Indeed, the average annual rate of morbidity in children with non-Hodgkin lymphoma is different depending on the region of the Republic of Uzbekistan. The most frequent MN in children identified in regions with ecologically unfavorable situation, as well as the presence of a large number of industrial facilities, in particular the chemical, oil, gold, metals and mining and uranium mining. This can be seen in terms of morbidity: Tashkent (453.1), Namangan (396.2), Khorezm region — (341.2), Tashkent (319.0), Samarkand (264.1), Jizzakh (219.5), the Republic of Karakalpakstan (111.3), Navoi — (201.6). In this country's index amounted to 376.2 per 100 000 population (Table).
Existing territorial differences in morbidity related, most likely, with possible underestimation of patients in some regions of the country, also plays an important role such factors as — environmental conditions are unstable for large centers and cities with developed industrial infrastructure.
Table 1. — The incidence of non-Hodgkin's lymphoma by year from 2005 to 2015 in the Republic of Uzbekistan
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Andijan 15 17 10 17 11 8 8 8 7 9 7
Bukhara 9 14 13 10 16 10 15 18 4 1 9
Jizzakh 5 6 3 9 5 11 4 3 4 12 2
Kashkadarya 11 12 13 20 22 5 0 6 17 4 8
Navoi 4 2 1 3 1 5 0 3 4 1 5
Namangan 15 11 15 8 13 9 1 3 12 5 4
Samarkand 17 17 16 11 9 8 6 2 5 6 9
Surkhandarya 12 7 14 16 13 13 8 12 5 10 11
Syr 3 3 4 2 5 1 2 2 0 1 1
Tashkent 8 3 12 7 6 7 4 5 6 2 0
Tash.obl 12 9 6 16 15 8 0 13 5 10 7
Fergana 22 24 12 13 27 16 3 8 7 12 9
Khorezm 17 18 15 18 24 12 2 5 5 5 8
KKR 6 1 1 11 5 2 0 1 4 0 2
Res. Uzb. 72 144 135 161 172 115 53 89 85 78 82
Conclusion. On this basis, we can conclude that the change in statistics is-exponent in the dynamics and epidemiological analysis requires more study in depth-of. The necessary is primarily a study of the dynamics of disease, its structure, factors that contribute to their development, as well as the impact of immunogenetic, immu-
nomorphological features of the child's body. The important values-is the establishment of continuity in the work of primary health care (general practitioners and pediatricians) and oncology service in order to provide more accurate data to original sources and to improve diagnostic results and treatment of children with cancer.
References:
1. Злокачественные новообразования в России в 2013 г. (заболеваемость и смертность)/Под ред. В. И. Чиссова, В. В. Старинского. -М., 2013. - 180 с.
2. Злокачественные новообразования на радиационном следе в Алтайском крае./Под ред. Лазарев А. Ф., Петрова В. Д.//Материалы 5 съезда онкологов и радиологов СНГ. - Ташкент, 2008. - С. 23.
3. Киреев Г. В., Баленков О. Ю. Изучение канцерогенной загрязненности атмосферного воздуха жилых микрорайонов г. Ташкента.//Материалы 5 съезда онкологов и радиологов СНГ. Ташкент. - 2008. - С. 30.
4. Аксель Е. М., Горбачева И. А. Заболеваемость детей злокачественными новообразованиями и смертность от них в России и странах СНГ//Вестник РОНЦ им. Н. Н. Блохина РАМН. - 2012, - т. 19, - № 2 (прил. 1), - С. 135-152.
5. Трапезников Н. Н., Аксель Е. М. Заболеваемость злокачественными новообразованиями и смертность от них населения стран СНГ в 1996 г. - М., 1997. - 189 с.
6. Рыспекова Ч. Д., Жумабаев А. Р., Макимбетов Э. К. Заболеваемость злокачественными новообразованиями у детей в Ошской области//Вестник Кыргызско-Российского Славянского университета. - Бишкек, - 2007, - Т. 7.- № 2. - С. 159-161.
Matlubov Mansur Muratovich, Samarkand State Medical Institute Head of the Department of Anesthesiology and Rehanimatology Associate professor E-mail: mansur.matlubov@mail.ru Semenihin Arseniy Arsenevic, Republican Scientific-Practical Center of Obstetrics and Gynecology of the Ministry of Health of the Republic of Uzbekistan Professor of the Department of Anesthesiology and Rehanimatology.
E-mail: prof_saa@list.ru
Assessment of the effectiveness and safety of epidural-sacral anesthesia during cesarean section
Abstract: Investigation was carried out with the aim to determine reasonability of using epidural-sacral anesthesia during cesarean section and also to assess the effectiveness of such method. 19 women with supposed difficulties of traditional methods of anesthesia have been included in the investigation. The implementation method of epidural-sacral anesthesia and also subsequent monitoring of patients' health status have been described in detail. The results of investigation allow us to consider that this type of regional blockade on the assumption of its correct technical realization provides reliable antinociteptive defense and hemodynamic stability, limits neuro-endocrine reaction for the surgical aggression.
Keywords: epidural-sacral anesthesia, cesarean section, regional anesthesia.
Introduction. Continually growing temps of distribution of obesity in the world wide, and also connecting with obesity the increased morbidity and mortality have been made it one of the most actual problems of the modern health care, while the obesity of pregnant women has been attracted the most attention. In spite of the constant improvement of the system of antenatal observation and delivery system the amount ofpregnant women with obesity in economically developed countries has been reached 15,5-26,9% and continually increased, in connection with it the actuality of this problem takes the particular importance [1].
According to the data of the world health care statistics the frequency cesarean sections in the USA increased from 20,7% in 1996 to 31,1% in 2006 and for the present time it is the most distributed surgical operation in women [2; 3; 4]. The generally accepted "gold standard" during anesthetic supplying of cesarean section considers central neuroaxial blockades (CNB).
Spinal and epidural anesthesia are generally accepted as the most rational methods of regional anesthesia during cesarean section [5; 6]. However in the certain contingent ofpatients (obesity, congenital and acquired deformations of spinal column, edema) their technical implementation is accompanied by considerable difficulties [7; 8; 9]. At the same time type of regional blockade called epidural-sacral anesthesia (ESA) technical implementation ofwhich is not presented difficulties has already existed for a long time [10; 11]. For the present time this method is rather widely used in proctology, traumatology [12], and urology [10]. However in the operative obstetrics it has not found due acknowledgement probably because of the cesarean section requires highly extensive sensor-motor blockade on the level of lumbar and low thoracic segments of spinal cord.
ESA considers as a variant of epidural blockade since local anesthetics injected through sacral foramen is extended to the cranial direction and in the enough injected amount could reach low
