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Sectiom 6. Medical science
Sectiom 6. Medical science
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-48-49
Abdurahimov Shavkatbek Abdumuminovich Senior scientific researcher of Andizhan State Medical Institute of Andizhan city, Uzbekistan E-mail: [email protected]
Surgical treatment approach spondylitis complicated by epidural spinal abscess
Abstract: The problem of treatment of complicated forms of spondylitis of the spine up to the present time is still current and delayed treatment of patients will lead to permanent disability. In the article the authors propose surgical treatment approach in complicated forms spondylitis, decompression of the spinal cord, followed by drainage of the affected segment. Active drainage of spinal cord inflammation prevents possible complications and provides favorable conditions for the activation of the patients in the early postoperative period, significantly improving their adaptive capacity and quality of life.
Keywords: spondylitis, inflammation, spinal cord, spinal column, disability.
4 patients (27%) in the thoracolumbar section 3 patients (20%) in the lumbar 7 patients (46%). Microscopy of sputum for acid-fast bacilli detected environment of tuberculosis in 12 patients (64%)
Actuality: inflammatory diseases of the spine currently remains one of the most severe crippling orthopedic diseases with a high percentage of disability (85%) [9; 1; 3]. In the practice ofver-tebral problem of treatment of complicated forms of inflammatory diseases of the spine to date it remains valid. This is evidenced by the increase in the number of patients and an increase in the number of publications on the diagnosis and treatment of inflammatory diseases of the spine [12; 6; 1; 7]. Tuberculous lesions ofbones and joints make up about 50% and more of the total number of extrapulmonary manifestations of tuberculosis and tuberculous spondylitis is 40 to 65% of all cases [13; 3; 8; 10]. Nonspecific osteomyelitis of the spine is 1.5-2% of all cases of osteomyelitis, and it is the most difficult to diagnose and difficult flowing localization of the purulent process [2; 4; 5]. In the past decade have greatly improved diagnostic possibilities for early detection of inflammatory diseases of the spine (CT, MRI, scintigraphy of the skeleton).
However, diagnostic errors make up 70-80% and the average time patients entering the clinic is 3-4 months [11]. In this regard a timely diagnosis and verification process in the spinal column is an urgent problem in the Spine and significantly affects the effectiveness of therapy.
Objective: To improve the results of treatment of inflammatory diseases of the spine.
Materials and methods: under our supervision there were 34 patients with tuberculous and nonspecific spondylitis who were treated at the Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology in the bone department. Of these 18 patients male (52%) and 16 females (48%) age ranged from 20 to 60 years. Patients on the basis of clinical, radiological and microscopic examinations were divided into two groups: one group of 19 patients (51%) with tuberculous spondylitis, including 11 men (58%) and 8 women (42%), second group of 15 patients (46%) with nonspecific spondylitis including 6 men (40%), 9 women (60%). Localization process: in the first group in the cervical region, two patients (10%), thoracic 8 patients (42%) in the thoracolumbar section 6 patients (20%) in the lumbar 3 patients (16%). In tuberculous lesions most often affected thorax. In the second group, in the cervical region 1 patient (7%), thoracic
from the first group. All patients underwent computed tomography study. Needle biopsy performed 7 (22%) patients. From the observed 31 (91%) patients after conservative treatment (an average of 25-30 days) are routinely performed surgery (resection of the defeat of the vertebral bodies, sequestrectomy and fusion with bone autograft and drainage of the spinal cord). The final diagnosis is made after histological verification of the material. All patients received antibiotics spondylitis of the spine, antibacterial, restorative therapy before and postoperative period.
Results and discussion: the epidural space (ES) has a minimum content of the vessels in the cervical and thoracic spine, the maximum — in the lumbar spine, epidural veins which have a maximum diameter. Anterior-posterior size ES progressively narrows with lumbar level (5-6 mm) to breastfeeding (3-5 mm) and becomes the minimum at the level of C 3-6, and under normal conditions of ES pressure has a negative value. The lowest it is in the cervical and thoracic spine. On this basis it can be assumed that the inflammatory process extends to the ES usually at the transition where the ES size is more and more often formed epidural infiltration. Because of the smaller sagittal cut cervical-thoracic complications of the spinal cord was observed in almost 66% of patients with lumbar localization abscess complications were observed in 25% of patients. Pelvic disorders was observed in 14%, movement disorders in 30%, sensory disturbances 21% and 35% of cases of radicular pain. All the patients produced anterolateral access reconstructive surgery using autobone, decompression of the spinal cord at the level of injury, followed by leaving mikroirrigation tube on the epidural area with drainage tube. After surgery, an average of 8-10 days through mikroirrigation tube washing their epidural area with isotonic solution then administered broad-spectrum antibiotics. After 10 days after spinal surgery complications in 26 patients underwent, at the 1-st patient remained stable paraplegia, in 2 patients did not reinstated pelvic disorders, radicular pain in 5 patients. One month after surgery for an MRI study in 28 patients the patency of cerebrospinal fluid spaces completely
Phenotypic and genotypic resistance to antimicrobial performance in stains of Salmonella Typhimurium
restored, and in 4 patients infiltration preserved in 2 patients were followed epidural sequesters and 2 months 31 patients activated with hard corset.
Conclusion:
Complex treatment of patients with inflammatory diseases of the spine complicated with epidural abscess through the use mik-
roirrigation tube on the site of the lesion prevents possible inflammatory complications in the postoperative period, allow recovery and active rehabilitation of patients and provides favorable conditions for seam and autograft reconstruction without resorption in the early postoperative period and significantly increasing their adaptation opportunities and quality of life.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-49-51
Abdukhalilova Gulnara, Research Institute of Epidemiology, Microbiology and Infectious Diseases, kandidat of medical sciences Tuhtamurodov Hojiakbar, Tashkent Medical Academy, magistr Ibragimov Adil,
Research Institute of Epidemiology, Microbiology and Infectious Diseases, kandidat of medical sciences
Ahmedov Ildar,
Research Institute of Epidemiology, Microbiology and Infectious Diseases, kandidat of medical sciences Gulyamov Nariman Gylamovich, Research Institute of Epidemiology, Microbiology and Infectious Diseases, doctor of medical sciences professor
E-mail: [email protected]
Phenotypic and genotypic resistance to antimicrobial performance in stains of Salmonella Typhimurium
Abstract: We studied 39 strains of Salmonella Typhimurium, which were allocated from patients in 2012-2013 by bacteriological and molecular genetic methods, strains sensitivity to antimicrobial agents. It revealed an extremely high proportion of strains resistant to the antibiotic medicines, including — ^-lactams (84.6%) and fluoroquinolones (92.3%). Strains of S. Typhimurium characterized by multiple resistances to different classes of the antibiotics. About half of the isolates (43.6%) have the same resistance phenotype A-AC-T-C-CO-CTX-CA-NA-CPM, which may indicate the clonal propagation of the pathogen. Resistant strains of S. Typhimurium to ^-lactams (including cephalosporins of 3-4 generations) is due to produce ^-lactamase
