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Section 7. Medical science
The patient in dynamics for estimation of the development the veins of lower extremities.
of thrombotic process there was performed dopplerography of
References:
1. Aseeva I. A. Ultrasound diagnosis and prognosis of the thrombosis of the veins of the lower extremities in the traumatological patients: Synopsis of thesis ... cand.med.sci. - Moscow, - 2003: 17 p.
2. Boriskin A. A. Prevention and treatment of the thrombosis of the deep vein in the patients with fractures of long tube bones of the lower extremities: Synopsis of the thesis ... cand. med. sci., - Moscow, - 2010, 26 p.
3. Vlasov S. V. Mechanisms of the development, prognosis and prevention of the thrombus formation in traumas and orthopedic operations with high risk of thrombembolic complications: Synopsis of the thesis ... d.med.sci. - Kemerovo, - 2014, 46 p.
4. Epanchintsev P. M. Early diagnosis and prevention of the acute thrombosis of the deep vein of the ankle in the suffered with closed comminuted fractures of the tibial bones: Synopsis of the thesis.. cand.med.sci. - Omsk, - 2007, 20 p.
5. Kopenkin S. S. Prevention of the venous thrombosis and pulmonary embolism in the orthopedics. Klinicheskaya farmakologia I terapia, - Moscow, - 2006, - N2: - P.38-42.
6. Raptanova L. O. Ultrasound diagnosis of the venous thrombosis under the ambulatory conditions. Midicinskiy jurnal "SonoAce-Ultrasound" - Moscow, - N 17..
Yugay Igor Aleksandrovich, Republican Scientific Centre of Neurosurgery.
Tashkent, Uzbekistan. E-mail: [email protected] Mamadjanova Risolat Abduvahabovna, Republican Scientific Centre of Neurosurgery.
Tashkent, Uzbekistan. E-mail: [email protected] Akhmediev Makhmud Mansurovich, Republican Scientific Centre of Neurosurgery.
Tashkent, Uzbekistan. E-mail: [email protected]
The method of determination of intracranial pressure in patients with crania bifida associated with hydrocephalus
Abstract: here have been analyzed 35 children in Republican Scientific Center of Neurosurgery with encephalocele associated hydrocephalus. Patients were divided into 2 groups: Basic and control group. For the first group to choose correct parameters used program — "Ликвородинамический тест" (so called "CSF dynamics test"). This method enhanced to choose parameters accurately there by helping deal with postoperative shunting procedures complications. Keywords: encephalocele, hydrocephalus, intracranial pressure.
Introduction. Cranio-cerebral herniations (cranium bifi-dum) — congenital malformation occurs from 1: 4000-6000 to 1: 35,000 newborns and often has a poor prognosis for recovery [3, 22-25; 7, 39-42], especially at the location of craniocervical junction. Meningocele has better forecasts. Encephalocele can results in serious complications such as hydrocephalus. Encephalocele — frontal or occipital is the worst case of brain-skull herniation [9, 224]. The combination of encephalocele with hydrocephalus can be up to 30% of cases. This group of patients requires a landmark of surgical procedures [2, 40].
In modern literature research in hydrocephalus and other problems of intracranial pressure are used the concept of elasticity ofthe cranial system and its capacity [6, 25]. Carrying intracranial pressure correction from this position will also be considered to be justified also in cranial hernias. In addition, delayed primary operation — removing encephalocele in some cases may also be dictated by the somatic burdened child, poor physical development, early age [1, 40].
Surgical treatment of hydrocephalic syndrome carries out shunting operations using valve systems that are configured on dif-
ferent pressure [4, 29-32; 5, 153; 8, 15-26].
In our clinic, hydrocephalus shunt surgery demonstrations are held as the first stage ofthe treatment ofthese patients. Postoperatively, in some cases, there may be signs of inadequate correction of hydrocephalic syndrome that can be judged by the covers of encephalocele: maintaining its voltage and increase until its rupture, worsening of the neurological deficit, no increase of the surface epithelium in the hernial sac, as well as the progressive growth of the skull circumference.
With this in mind, we have begun a study on the selection of adequate parameters of the shunt systems for patients with encephalocele, combined with hydrocephalus.
Stress tests which are used to determine the production of liquor rate in hydrocephalus patients are unacceptable in encephalocele since there is an increased risk of the hernia sac rupture [6, 25].
Additionally, elastic and capacitive characteristics of the ventricular system in these patients are radically different compared to patients with isolated hydrocephalus because of the presence of an additional capacitance — encephalocele sac, the dimensions of which may vary within wide limits and elasticity of an encephalocele
The method of determination of intracranial pressure in patients with crania bifida associated with hydrocephalus
walls, which depends on its walls — thickness, elongation, etc.
So we had to develop a method for determining the parameters of the shunt system for adequate correction of hydrocephalus combined with encephalocele and explore the results of the treatment.
Material and Methods. It were analyzed 35 children treated at the RNSC with encephalocele, combined with hydrocephalus at the primary (n = 18) and control groups (n = 17). From the total number of children in 22 observed had a thread of a cranio-cere-bral hernia sac rupture due to the tension and thinning of its walls. This includes children with "weeping" of the surface of cranio-cere-bral herniations, as manifestations of the extreme threat of rupture. 17 patients of the control group were operated according to standard procedures in our clinic until 2008.
We used the technique of fractional excretion of CSF from the ventricular system with constant pressure monitoring. On this basis is developed the liquor dynamic test with the definition of the "critical point of deformation of the ventricular system" as a sign of decompensation craniospinal compliance — the level of the ultimate strain of the cranial system.
With a view to the objective finding the critical level of the liquor system, we used the computer program named" liquor dynamic test " DGU 20100102. The program works on the basis of the algorithm exceeded the arithmetic mean between the indicators change liquor pressure during the fractional excretion of CSF. The " liquor dynamic test" has a comfortable interface and the ability to conduct the archive and save the database. (Figure 1).
Fig.1. The active window of the program named " liquor dynamic test"
The result of the " liquor dynamic test" program was to define the parameters of the setting shunt systems.
The positive effect of shunting operations assessed on the estimated regression of the clinical manifestations of hypertension — hydrocephalic syndrome, decrease of a cranio — cerebral sac tension, rise of the surface epithelium, improving the neurological status.
Results and discussion. Conducted surgeries were successful in these patients as far as the right was picked up the parameters of a shunt system. This led not only to the regression of hydrocephalic symptoms, but also created conditions for the improvement of the walls of the cranial hernia sac — build-up of a skin, prevented growth and rupture of a sac. Later it created favorable conditions for the second stage of the operation — the removal of encephalocele with plastics of the hernial gates.
The methodology was used in the study group of 18 patients with encephalocele, combining with hydrocephalus. In 10 of them there was a threat of rupture.
The use of this technique significantly improved the results of treatment when compared to the control group — 17 patients with similar pathology. In addition to this, the main group had the regress of hydrocephalic syndrome and elimination of the encephalocele sac rupture threat, also reduced the size of the hernia and this state remains stable until the 2 — nd stage of surgery — hernia repair. An indicator of the positive dynamics also showed
the epithelial growth in a thin wall of cranio-cerebral hernias that facilitates the subsequent surgery of the hernia sac plastics.
In 8 (47%) patients from the 17 patients in the control group the decrease in size and voltage of the hernia sac and its softening effects were temporary, despite the regression of hypertension — hydrocephalic syndrome. In 3 (17,6%) patients after shunt surgeries, in spite of the expected effect, there was a rupture of the hernia sac for the period of 3 to 30 days.
Patients of the main group, in accordance with the proportion of test of liquor dynamic implantable shunt systems at low pressure was 6 patients, which accounted for — 33,3% of the number of the main group, and set the system to a high pressure in 3 patients. The use of these systems has been dictated by our method of determining craniospinal compliance (Table 1).
Table 1. - Distribution of patients by the level of pressure correction
Groups
Pressure Main; n=18 Control; n=17 In all n=35
High 3 (16,6%) 1 3 (8,6%)
Middle 9 (50%) 14 (82,3%) 23 (65,7%)
Low 6 (33,3%) 3 (17,6%) 9 (25,7%)
Section l. Medical science
From this table it is also seen that a control group shunt system extreme pressure parameters have been set in all 4 patients, which was 23,5%.
We analyzed complications observed in the two groups of patients. The results are shown in table 2.
Table 2. - Complications after shunt surgeries compared in 2 groups of patients
Complications 1 -group; n=18 2 - group; n=17
Infection - 5 (29,4%)
Epileptic seizures 2 (11,1%) 4 (23,5%)
Dysfunction in a year 3 (8,6%) 5 (29,4%)
Hypo drainage 2 (11,1%) 4 (23,5%)
Hyper drainage - 17,6 (8%)
The data in table 2 allows to judge the reduction of the number of complications after shunt surgeries in patients of the main group as evidenced by the decrease in the number of dysfunctions in the study group (8.6%) compared with the control group — 29,4% and the number ofhypo drainage states 11,1% and 23,5% respectively. Statistical significance was confirmed by Spearman rank correlation (r=0,82).
It should be noted that initially poorly chosen option implantable shunt system creates unfavorable conditions for wound healing, and to a violation of its functionality.
Conclusions.
1) Established a direct link between the outcomes of operational activities and the accuracy of the determination craniospinal pressure in patients with encephalocele combines with hydrocephalus.
2) Application of methods for determining craniospinal pressure using " liquor dynamic test" program has reduced the violations of a shunt systems drainage dysfunctions in more than 2 times.
References:
1. Асадов Р. Н., Бельченко В. А., Притыко А. Г. Опыт хирургического лечения гигантских энцефалоцеле.//Сборник статей 3-й всероссийской конференции по детской нейрохирургии. - Казань, 8-10 июня 2011.
2. Асадов Р. Н. Одноэтапное комплексное лечение детей с врождёнными передними черепно-мозговыми грыжами//Сборник статей 3 -й всероссийской конференции по детской нейрохирургии. - Казань, 8-10 июня 2011.
3. Асадов Р. Н., Бельченко В. А., Притыко А. Г., Петров Ю. А. Хирургическое лечение передних черепно-мозговых грыж. Вопросы нейрохирургии. 2007.
4. Арутюнов Н. В., Петряйкин А. В., Корниенко В. Н. Изучение ликворотока на основе магнитно-резонансной томографии//Вопр. нейрохир. - 2000. - № 3.
5. Доманский Д. С., Белкин А. А. Влияние ликвородинамических нарушений на реализацию системы церебральной защиты//Мат-лы II Всероссийской конф. «Детская нейрохирургия». Екатеринбург. 27-29 июня 2007 г. - М., 2007.
6. Коммунаров В. В. Выбор параметров имплантируемой дренажной системы в лечении гидроцефалии: Автореф. дис.. канд. мед. наук. -СПб., 2003. -25 с.
7. Субботина М. В., Ларионов С. Н., Антошкина Е. П. Диагностика назоэтмоидальной мозговой грыжи у ребенка//Российская ринология. 2015;23 (2): 39-42.
8. Pudenz R. H. The surgical treatment of hydrocephalus//Surg. Neurol. - 1981.
9. Villarejo F. J. Atlas of pediatric Neurosurgical techniques//Basel; - New York: Karger. - 1985.
Yuldashev Nabijon Primovich, Prof. Kurbanov Ravshanbek Davletovich, «Republican specialized center of cardiology» JSC, Uzbekistan E-mail: [email protected]
Immediate and medium-long-term clinical and angiographic results of the use of bioresorbable vascular scaffold ABSORB
Abstract: To study the safety and efficacy of the use of the second generation everolimus-releasing bioresorbable vascular scaffold Absorb in our real practice and the average long-term clinical results. The study involved 53 patients with various forms of ischemic heart disease who was undergone percutaneous coronary intervention with implantation of bioresorbable vascular sacaffold Absorb. The use of the Absorb BVS in clinical practice is associated with good immediate clinical and angiographic success rate and acceptable midterm clinical outcomes.
Keywords: bioresorbable vascular scaffold, ischemic heart disease.
Since the discovery of coronary balloon angioplasty in 1977, despite the large number of achievements in the field of interventional cardiology biggest challenge remains the development of neo-intimal hyperplasia inside the stent, in-stent thrombosis and neoath-erosclerosis with the subsequent development of late and very late thrombosis [1; 2]. The constant presence of a metal prosthesis in the vessel wall causes a continual overlapping of lateral branches at the level of branching vessels, prevents promising surgical re-
vascularization, worsens vasomotor function and vascular imaging stented segment during computed tomography [3]. In this connection, established bioresorbable vascular scaffold (BVS) Absorb (Abbott Vascular, Santa Clara, CA, USA) which is fully absorbable device for the temporary maintenance of the vascular wall and delivery of antiproliferative drugs Everolimus, which allows the vessel wall to recover without permanent presence of a metal stent [4]. In this study was to evaluate the success of the procedure, angiographic
