Treatment of patients with progressing primary glalcama with normalized intern al eye pressure

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Мирбабаева F., Янгиева N., Семенов L., Рахимова A., & Клоп B. (2020). Treatment of patients with progressing primary glalcama with normalized intern al eye pressure. in Library, 20(1), 44–45. извлечено от https://inlibrary.uz/index.php/archive/article/view/14715
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Аннотация

Despite  significant  advances  in  microsurgical  treatment  of  glaucoma, glaucomatous optic neuropathy (GON) continues to progress in more than half of patients. Lt is proved that the main pathogenetic factors of its development after normalization of LOP are hemomicrocirculation disorders and the associated violation of transcapillary exchange in the optic nerve. This causes damage to the axons of the ganglion cells, leading to their apoptosis and death. According to leading glaucomatologists, the pathogenetically targeted treatment is the use of medications with neuroprotective and antioxidant effects. In clinical medicine, in particular, in the treatment of ischemic brain conditions, the drug of complex action, Gliatilin, is widely used. Gliatilin - choline alfoscerate is a central cholinomimetic with a primary effect on the central nervous system.

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44

Material and metho

ds:

From August 2018 to August 2019, in

our

medical center

52

infant patients

underwented

tubuless mini-PCNL

with

antegrade

stent

tether.

All

procedures

performed by Storz

M1P

system 12F nephroscope, using

16F

metallic

sheath. Stone

fragmentation was

performed

holmium laser

and

pneumatic lithitriptor.

All

cases was

finished

with

antegrade stent placement w ith proximal tether

via

percutaneous tract, which

protected by a clear occlusive bandage. The prolen thread was sutured through

the

proximal

lumen of

stent and from inside

to

outside which contributed to

the

easy removal while

minimizing damage

to

surrounding tissue with

the

tip of

the

stent.

Results:

A total of

52

children

-

(42 male,

10

female),

with a

mean age 54,5 (17-75)

months

w

ere included

in

this

study.

The mean size

of

the stones

w

as

19.0

(15-24) mm.

Renal

stones were located

in renal

pelvis (n=34), lower pole (n=l

1

),

middle

pole/upper pole {n=7).

All

intrarenal

access was performed in

the prone

position under ultrasound and fluoroscopic

guidance. Stone

free rate was 98%.

Mean

operative

time

w

r

as 68.5 (45-92)

min.

Hospital stay

time was 2-3 days in

all

cases.

In

all

cases ureteral stent removed

by

tether via

flank

without

anesthesia,

in

40

(76%)

cases

in

third

day

and

in

12

(24%) cases

in

fifth day after surgery

7

.

There was no incidence

of

bleeding and

pain

during stent removal.

Conclusions:

Tubeless

mini

PCNL

with

stent tether is

safe

and effective technique for

preschool

children wich

avoids possibility of postoperative cystoscopy, anaestesia, hospital

stay and allows easy access to calyceal system for second look nephroscopy w

r

hen it needs.

TREATMENT

OF

PATIENTS

WITH

PROGRESSING

PRIMARY

GLALCAMA WITH NORMALIZED INTERN AL EYE PRESSURE

Mirbabaeva F.A., Yangieva N.R_, Semenov L, Клоп V., Rakhimova A.

Tashkent state dental institute

Relevance.

Despite

significant advances

in microsurgical treatment

of glaucoma,

glaucomatous optic neuropathy (GON) continues

to

progress

in

more

than

half of patients. Lt

is proved

that the

main pathogenetic factors of its development after normalization of LOP are

hemomicrocirculation disorders and

the

associated violation of transcapillary

exchange

in

the

optic nerve. This causes damage

to the axons

of the ganglion cells,

leading to

their apoptosis

and death. According

to leading

glaucomatologists,

the

pathogenetically targeted treatment is

the use

of

medications with neuroprotective and

antioxidant

effects. In clinical

medicine, in

particular, in the treatment of ischemic brain conditions,

the drug

of complex action,

Gliatilin,

is widely used. Gliatilin

-

choline

alfoscerate is

a

central

cholinomimetic

with a

primary

effect

on the

central

nervous

system.

The composition

of

the

drug

includes 40.5% of

choline

released from

the compound in

the

brain;

choline

is involved in the biosynthesis of acetylcholine (one of the

main

mediators

of nervous

excitation).

Alfoscerate is biotransformed to glycerophosphate, which is

a

precursor

of

phospholipids. Acetylcholine

has a

positive effect on

the

transmission of петле impulses,

and

glycerophosphate is involved

in the

synthesis

of

phosphatidylcholine (membrane

phospholipid),

resulting

in

improved membrane elasticity and receptor function.

Gliatilin increases cerebral blood flow, enhances metabolic processes and activates

the


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45

structure

of

the

reticular formation

of

the

brain, and also restores consciousness

in

traumatic

brain damage.

It

has a preventive and corrective effect on factors of involutional psycho- organic

syndrome,

such

as

a

change

in the

phospholipid composition of the membranes of neurons

and

a

decrease

in

cholinergic activity.

The aim of

the

work was to study the feasibility and clinical effectiveness of

the

use

of

gliatilin

in

patients with unstable glaucoma with persistently normalized I OP.

Materials

and

methods.

Under observation were

45

patients

(81

eyes) with

an

unstable

course

of

POAG with persistently normalized I OP. Among them were 49 eyes

with

developed

and 32

with

advanced stages of glaucoma The age of patients ranged from 51 to 73 years, and

the

level

of

1OP

-

from 18 to 23 mm Hg. Patients were divided into two

groups,

comparable

in

age, sex, stages

of

glaucoma,

the

level of

I OP.

The

first

group included 17 patients (34 eyes). These patients underwent traditional

treatment, including parabulbar injections of 0.5 ml of

1%

solution

of em

oxipin, intravenous

drip infusions

of 50-100 mg

of

pentoxifylline, 250 mg

of

ascorbic acid

and

oral administration

of

lipoic acid 25 mg 3 times

a

day.

The second group consisted of 28 people (45 eyes), Patients

of

this group,

instead

of

intravenous infusion of pentoxifylline and ascorbic acid, received intramuscular injections of
1000

1

4.0 Gliatilin

per

day

and

intravenous infusions of 200 mg of Actovegin. The duration of

treatment

in

both

groups was

10

days.

All patients underwent visometry and perimetry with

the

determination

of

the

total

boundaries of

the field

of view (CPS). We also studied the indicators of regional hemodynamics

-

the linear velocity of blood

flow in

the suprablock artery (LSC NBA);

studied

the level of

microcirculation of

the

bulbar conjunctiva; ocular perfusion pressure

(P

perf.)

was

determined

using

the Lobstein formula.

The results of

the

study.

The

effectiveness

of

treatment was evaluated immediately

after its completion. In

both

groups,

at

the

end

of treatment,

there

was a vary ing degree of

positive dynamics in

visual

functions.

Thus,

the increase

in

GPA in

patients

of

the

1st (control)

group was

on

average 1.9%, and

in the

2nd (main) group

-

by

1

9.7%.

In addition, in this group

of

patients, a decrease

in

the size

and

number of relative paracentral

cattle

was revealed. In

45.6%

of

the eyes of patients

of

the 1

st and 53.3% of

the

eyes of

the 2nd

group,

an

increase

in

visual acuity was revealed above

the

initial level by 5.2% and 22%, respectively (p

0.05).

An increase

in

regional hemodynamics and microcirculation

in

patients of both groups

was also detected, but

their

degree also turned

out to

be different. So, the NSC BFV increased

by 7.1% (p <0.05)

in the

control group and by 36.2% (p <0.02) in patients receiving gliatilin:

Ocular Rperf.

-

increased by 6.1% and by 38.8%, respectively

(p

<0.02). Biomicroscopy

showed a significant increase

in

DA by 1.9% and 13.1%, respectively; PFC

in 1 mm2

field of

view at 13.6%

and

50%, respectively (p <0.03).

INDEXES OF TRACE HEMOPOIETIC

ELEMENTS

IN

ADOLESCENTS

HEALTHY AND WITH

HYPOMICROELEMENTHOSES

RESIDING IN AN

INDUSTRIAL

CITY CONDITIONS

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