Современные особенности комплексного лечения гнойно-воспалительных заболеваний челюстно-лицевой области

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Икрамов G., Икрамов S., Сапарбаев M., & Рузибаев D. (2022). Современные особенности комплексного лечения гнойно-воспалительных заболеваний челюстно-лицевой области. in Library, 22(3), 273–279. извлечено от https://inlibrary.uz/index.php/archive/article/view/14873
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Аннотация

Актуальность  проблемы  диагностики  и  лечения  гнойно-воспалительных заболеваний ЧЛО определяется необходимостью дальнейшего изучения  и  разработки  принципиально  новых  способов  прогнозирования характера течения и повышения эффективности лечения. Существующие  методы  диагностики,  включая  клинические,  не  всегда позволяют  адекватно  отслеживать  патологический  процесс,  что  не  дает  врачу своевременную, эффективную коррекцию лечения больного. В обзоре описаны современные  основы  комплексного  лечения  гнойно-воспалительных заболеваний челюстно-лицевой области. Поднимается вопрос о необходимости разработки о новых лечебных  мероприятий по борьбе с этим заболеванием.

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MODERN PECULIARITIES OF COMPLEX TREATMENT OF PURULENT-

INFLAMMATORY DISEASES OF THE MAXILLOFACIAL REGION

Ikramov G.A.

Ikramov Sh.Sh

Saparbaev M.K

Ruzibaev D.R

(Tashkent State Dental Institute)

Purulent infection occupies one of the leading places in the structure of morbidity

among the surgical pathology of the maxillofacial region. Many aspects of
pyoinflammatory diseases are currently being revised due to the constantly changing
relationship between different types and strains of microbial pathogens and the
human div. The very likelihood of developing an infectious process, the features of
the clinical course and the prognosis largely depend on the factors that determine
these relationships. The effectiveness of the treatment of patients with purulent-
inflammatory diseases is largely determined by early diagnosis, which presents
significant difficulties, as evidenced by a high percentage of diagnostic errors (30-
50%). The situation is aggravated both by the lack of information about the state of the
acute odontogenic focus of inflammation, perimaxillary soft tissues, and the lack of
available informative diagnostic and prognostic tests.

At present, to predict the complications of purulent-inflammatory processes, a

method has been developed based on the study of the ability of pathogens to inactivate
a number of factors of natural anti-infective resistance. A known method for predicting
the course of purulent-inflammatory diseases caused by cultures of Staphylococcus
aureus or Escherichia colli, including the determination of anti-complementary activity
in the pathogen. For diagnostic purposes, the parameters of the blood coagulation
system were studied. Examining the coagulogram revealed an increase in
homeostasis during the first three days of the development of phlegmon of
odontogenic etiology. The general background of coagulation (plasma recalcification
time and its tolerance to heparin) was slightly increased.

When studying the individual components of the homeostasis system - fibrinase,

fibrinogen and fibrinolytic activity, a significant increase was noted. The authors
believe that this fact indicates the development of a compensatory-adaptive reaction of
the div and can be used to assess the severity of the pathological process. An increase
in all indicators of the homeostasis system indicates the possibility of developing
thrombosis. A well-known forecasting technique based on the severity of the general
reaction of the div (div temperature, heart rate), these blood parameters (ESR,
white blood cell count), as well as the localization of the pathological focus. Currently,
a search is underway for non-invasive methods for diagnosing and predicting the
disease.


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Thus, the antioxidant coefficient ceruloplasmin-transferrin of the oral fluid

reflects the severity of the course of acute odontogenic purulent-inflammatory
diseases of the maxillary fossa and the degree of damage to the bone and soft tissue
structures of the focus of acute odontogenic inflammation, allows for differential
diagnosis of acute purulent periostitis and acute odontogenic osteomyelitis [1,12,15,].

According to N.V. Malychenko (2005), evaluation of the effectiveness of treatment

by various methods by identification CD-markers using the immunohistochemical
method made it possible to determine the numerous proliferation of vessels, the
appearance of collagens and factors contributing to early tissue regeneration when
using phonophoresis with Coltex.

An increasing number of cases are described, associated with an increase in the

number of patients with a complicated course of pyoinflammatory processes in the
maxillofacial area. Secondary complications of odontogenic phlegmon, such as sepsis,
mediastinitis, thrombophlebitis of the facial veins, intracranial inflammatory processes
are often characterized by a pronounced increasing intoxication, rapid onset and rapid
spread to adjacent anatomical areas [2,5].

In recent decades, an increasing number of researchers of the pathogenesis of the

development of acute purulent-inflammatory diseases of the maxillofacial area have
been assigned to the syndrome of endogenous intoxication. Endogenous intoxication is
a multicomponent process characterized by a toxic effect on the div of end and
intermediate metabolic products. The starting factor in the development of
endogenous intoxication is bacterial exo- and endotoxins.

Characteristic features of the syndrome of endogenous intoxication in purulent-

inflammatory diseases of the maxillofacial area are: staging, abundant intake of toxic
substances into the circulatory, lymphatic system, as well as into the interstitial fluid.
Consequently, cellular metabolism and metabolism are disturbed, the balance of
biological systems of the div is shifted, protective functions fade, which ultimately
leads to the development of multiple organ failure [1,2,5].

So, S.S. Ksembaev (2006) proposes to assess the effect of endogenous intoxication

syndrome on the blood-brain barrier using neuropsychological and neurolinguistic
methods to identify speech disorders (aphasia), writing (agraphia), reading (alexia),
counting purposeful movements (apraxia) and recognition (agnosia).

There are also well-known methods for clinically determining the quality of the

treatment performed by the area of collateral edema, the timing of suppuration, the
nature of purulent exudate, the severity of the pain syndrome, the degree of microbial
contamination of the wound, the timing of the appearance of granulations and the
degree of epithelialization. But clinical tests alone do not give a complete picture of
recovery. To confirm clinical indicators, laboratory methods are required, which
include the determination of a complete blood count, microbiological, immunological
research methods, and the mandatory determination of an antibiogram [4].


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A significant proportion of patients with purulent-inflammatory process have a

humoral, cellular or combined immunodeficiency state, and in this case a hyperergic
type of inflammation develops [6,7,9].

The development of a protracted and chronic course of purulent-inflammatory

diseases mainly depends on such factors of the immune system as the phenomenon of
delayed-type hypersensitivity and autoimmune reactions. A low phagocytic number is
combined with a reduced total percentage of the final stages of phagocytosis, which
indicates the depletion of the reserve oxygen-dependent mechanisms of bactericidal
neutrophilic granulocytes at the beginning of the odontogenic purulent-inflammatory
process, insufficient killing and splitting of the antigen. Inflammation acquires a long,
sluggish chronic course if the antigen is not completely removed or the immune
system does not recognize its own proteins, as well as if the secretion of anti-
inflammatory cytokines is impaired. In this case, inflammation tends to spread and
massive tissue damage, which aggravates the severity of clinical manifestations and
contributes to the development of more severe complications [11,13].

General immunological reactivity is reduced against the background of chronic

diseases and due to acute infectious diseases (influenza, acute respiratory viral
infections, tonsillitis) E.A. Durnovo (2003) indicates that the most important indicators
characterizing the state of general immunity during the development of phlegmon of
the maxillofacial region are: indicators of oxygen-dependent metabolism of blood
neutrophils and activity of the total fraction of protein cations, antioxidant activity of
blood serum [16].

With age, according to the results of many studies, the effectiveness of antigen

recognition and further transmission of the pathogen necessary for its elimination
decreases. In addition, with age, the ability to proliferate T-cells is reduced and this
defect is associated with premature depletion of clone power. The next change
concerns the reduced sensitivity of T cells to cytokines (interleukin2, interferon). This
is due to a decrease in the binding of interleukin-2 to its receptor and a violation of the
transmission of surface tension. As a result, the proliferative activity of T cells is
enhanced to a lesser extent by interleukin-2 [17].

An imbalance of immunoglobulins leads to a decrease in the effectiveness of

antimicrobial protection, as a result of which susceptibility to infections increases with
age. The course of any inflammatory process, in addition to immune mechanisms,
determines the state of hematopoiesis, the expression of molecules, their adhesion, the
synthesis of chemokines, the ability of cells to pass through the vascular wall and
accumulate in the focus of acute inflammation. The starting point for the chain of
events in the focus of acute inflammation is an increase in the level of pro-
inflammatory cytokines, which is determined by the functional activity of cells -
effectors of inflammation (granulocytes, monocytes, lymphocytes) [4,14].

If earlier the assessment of the severity and prediction of the clinical course of

purulent-inflammatory diseases was based on changes in blood and urine tests, now


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the indicators of its cellular and humoral reactions are an objective criterion for the
functioning of the immune system. At the same time, a certain pattern has been
established between the severity of the inflammatory process and changes in the
cellular and humoral immunity.

The most informative indicators are recognized: phagocytosis, the content of

immunoglobulins, indicators of cellular immunity: the number of T-cells and their
ratio. A number of researchers note an increase in immunodeficiency states associated
with the widespread use of antibiotics, their depressive effect on immunity and
nonspecific protective factors.

Also, for the detection of immune deficiency, an immunogram plays a primary

role, which includes a set of indicators of immunocompetent cells and characterizes
the functional state of the immune system. Of the analyzed parameters of the immune
system in patients with acute odontogenic abscesses and phlegmons of the
maxillofacial area, the most manifest indication is the expression of membrane
receptors of neutrophilic granulocytes and the relationship of subpopulations of T-
lymphocytes, which characterizes them as the most significant diagnostic markers of
the severity of the disease and evaluation of the effectiveness of both traditional
therapy and therapy using immunocorrection [7].

A comprehensive approach to the treatment of odontogenic phlegmon is

generally accepted, including the mandatory opening of a purulent focus followed by
antibiotic therapy, local daily dressings and antiseptic treatment of the wound. Wound
healing is an adaptive process requiring the integration of multiple processes such as
cell migration and proliferation, angiogenesis, connective tissue degradation and
synthesis. Specialized cells - platelets, leukocytes, macrophages, epithelial cells,
histiocytes, fibroblasts, interacting with each other with the participation of cytokines
and growth factors, ensure wound healing [10].

Under conditions of inflammation, microcirculation disturbance inhibits redox

processes due to a drop in oxygen tension, which also reduces tissue resistance to
infection. One of the reasons for the development of microcirculatory disorders is the
direct damage to the capillary endothelium by antigen-antidiv complexes.

Correction of hemorheological disorders becomes essential in the complex

therapy of purulent-inflammatory diseases in those areas that have a rich network of
blood vessels. This is especially noticeable in iron deficiency anemia. So with this
disease, hemorheological characteristics, such as erythrocyte aggregation, change. This
leads to a decrease in the transport potential of the blood and a decrease in the
delivery of oxygen to tissue microregions. Therefore, to improve microcirculation,
rheopolyglucin, polyglucin (dextran derivatives) are prescribed.

Their effectiveness is associated with an increase in the movement of fluid from

the tissue into the bloodstream [16].

In the treatment of acute purulent diseases of the maxillofacial area, the positive

effect of chitosan is noted. One of its effects is the correction of the rheological


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properties of blood. No less effective is Traumeel-S, and the parenteral form is used as
an immunomodulating agent.

So, Inoyatov A.Sh. (2006) determined the clinical and microbiological rationale

for the use of Bakstims in the treatment of children with abscesses and phlegmon of
the maxillary tract. He proved that Bakstims optimally restored the parameters of local
and general immunity by suppressing streptococci and staphylococci. Moreover, due
to the drug Bakstims, the wound process proceeded without complications in children,
the number of bed-days decreased due to the faster recovery of children, which also
had an economic benefit.

Nicotinamide, which is part of the feramide, takes part in the biochemical

processes of the neoplasm of protein molecules. The trivalent iron contained in the
feramide is less toxic and has a higher level of bioavailability due to the slow release of
the drug, so the iron-containing bacterium, which was mentioned earlier in the
dissertation of the genus Thiobacillus, is able to convert ferrous iron to ferric, which
makes heme iron easy to digest.

Since feramide has iron compounds in the form of protein and hydroxide

polymaltose complexes, which with great difficulty penetrate from the intestine into
the blood, and then only due to active transport, which explains the impossibility of an
overdose of the drug, and differs from salt iron compounds that are absorbed along a

concentration gradient. Obviously, with this, first of all, the insufficient “efficiency” of

inflammation is associated with many atypically current and chronic purulent-
inflammatory diseases.

Thus, the analysis carried out indicates that new and unusual manifestations have

appeared in the clinical picture of purulent-inflammatory diseases, which significantly
complicate their diagnosis. Patients with an atypical course of purulent-inflammatory
diseases of the maxillofacial region or with signs of its chronicity belong to the group
with an unfavorable clinical prognosis, which requires the creation of new evidence-
based approaches to their treatment.

CONCLUSIONS:

1. The cause of the development of odontogenic abscesses and phlegmon in

childhood are staphylococci and streptococci. In the mechanism of occurrence of acute
odontogenic abscesses and phlegmon, modified macrophages, T-, B-cells of the
immune system are isolated.

2. Modern methods for diagnosing acute odontogenic abscesses and phlegmon in

childhood are clinical, radiological, immunological and microbiological research
methods. The principles of therapy are surgical and therapeutic. Among the surgical
ones, it is worth noting the wide excision of the wound, drainage, the imposition of a
draining bandage. Therapeutic support should be considered the use of anti-
inflammatory, analgesic and antibacterial drugs, as well as immunomodulators.


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BIBLIOGRAPHY:

1.

Aleksandrov S.S. Dynamics of changes in indicators of nonspecific reactivity in

patients in the treatment of odontogenic inflammatory processes / S.S. Aleksandrov //
Dentistry.- 2019.- No. 3.- P. 38 41.

2.

Bazhanov H.H. Ways to improve the methods of treatment of patients with

phlegmon of the maxillofacial area / H.H. Bazhanov // Vestn. RAMN.- 2015.- No. 10.- S.
32 37.

3.

Begiev M. Complex treatment of patients with phlegmon of the maxillofacial

area / M. Begiev: Abstract of the thesis. dis. . PhD med. Sciences. - M., 2019

4.

Viberman Ya.M. Changes in the composition and properties of microflora in

abscesses and phlegmons of the maxillofacial area / Ya.M. Wieberman, B.C.
Starodubtsev, T.M. Litovkina // Dentistry.- 2016.- No. 1.1. C. 34 35.

5.

Gevorkyan O.V. The value of opsono-phagocytic reactions of the div in the

choice of tactics for the treatment of odontogenic osteomyelitis complicated by
phlegmon / O.V. Gevorkyan: Dis. . cand. honey. Sciences.-Kazan, 2018.

6.

Glinnik A.B. Microbiological characteristics of odontogenic purulent foci of the

maxillofacial region / A.V. Glinnik // Actual problems of dentistry.- Minsk, 2015.- P. 50
51.

7.

Dynamics of the microflora of purulent wounds during enzyme therapy / V.K.

Gostishchev, I. Tolstykh, JI.A. Gamaleya and others // Sov. the medicine. -2015.-No.9.-S.
52-56.

8.

Zhdanova L.P. Clinical and bacteriological characteristics of phlegmon of the

maxillofacial area / L.P. Zhdanova, I.I. Oleinik, T.G. Robustova // Dentistry.- 2017.- No.
5.- P. 39 42.

9.

Zakharov Yu.S. Clinic and surgical tactics for bacteroid infections of the

maxillofacial region / Yu.S. Zakharov // Dentistry.- 2017.- No. 3.- P. 43 45.

10.

Ivashchenko N.I. Anaerobic infection of the face and neck / N.I. Ivashchenko

// Dentistry.- 2015.- No. 3.- P. 45 46.

11.

Ivchenko V.I. Anaerobic non-spore-forming infection in surgery: (Literature

review) / V.I. Ivchenko // Vestn. surgery them. Grekova.- 2012.- No. 7.- S. 131 137.

12.

Izrailov V.A. Features of the diagnosis of inflammatory processes of the

maxillary soft tissues / V.A. Izrailov // Dentistry.- 2018.- No. 3.- P. 34 36.

13.

Kovaleva Z.I. Microflora in odontogenic phlegmon and its sensitivity to

antibiotics / Z.I. Kovaleva // Dentistry.-2019.- No. 6.- P. 78 79.

14.

Kolodkin A.B. Microflora in perimaxillary phlegmon and its sensitivity to

antibiotics / A.V. Kolodkin // Dentistry.- 2017- No. 2.- P.86 87.

15.

Complex treatment of patients with odontogenic phlegmon of the

maxillofacial region / A.A. Levenets, S.M. Shuvalov, A.D. Karger, T.L. Maruchina //
Rehabilitation of patients with major dental diseases. - Irkutsk, 2015. - P. 76 78.


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16.

Aderhold I. The bacteriology of dentkgenous pyogenic infection / I.

Aderhold, H. Khnate, G. Frencel // Oral. Surg.- 2019,- Vol. 5,- P. 103 -109.

17.

Galbraith M.N. Insect Moulting hormones: crustecdysone (20

hydroxyecdusone) from Podocarpus elatus / M.N. Galbraith, D.N.S. Horn // Australian
J. Chem.- 2019.-

№ 5.

- P. 1045 1057.

18.

Sanders B. Current concepts in the management of osteomyelitis of the

mandible / B. Sanders // J. Oral. Med.- 2018.-

Vol. 33, № 2.

- P. 40 42.

19.

Annotation

:

The urgency of the problem of diagnostics and treatment of purulent-

inflammatory diseases of the PMO is determined by the need for further study and
development of fundamentally new methods for predicting the nature of the course and
increasing the effectiveness of treatment.

Existing diagnostic methods, including clinical

ones, do not always allow adequate monitoring of the pathological process, which does
not give the doctor a timely, effective correction of the patient's treatment. The review
describes the modern foundations of the complex treatment of inflammatory diseases
of the maxillofacial region. The question is raised about the need to develop new
therapeutic measures to combat this disease.

Key words:

Treatment, purulent-inflammatory disease, maxillofacial area.

Аннотация:

Актуальность проблемы диагностики и лечения гнойно

-

воспалительных заболеваний ЧЛО определяется необходимостью дальнейшего
изучения и разработки принципиально новых способов прогнозирования
характера течения и повышения эффективности лечения.

Существующие методы диагностики, включая клинические, не всегда

позволяют адекватно отслеживать патологический процесс, что не дает врачу
своевременную, эффективную коррекцию лечения больного. В обзоре описаны
современные

основы

комплексного

лечения

гнойно

-

воспалительных

заболеваний челюстно

-

лицевой области. Поднимается вопрос о необходимости

разработки о новых лечебных мероприятий по борьбе с этим заболеванием.

Ключевые

слова.

Лечение,

гнойно

-

воспалительные

заболевание,

челюстно

-

лицевая область.

Библиографические ссылки

Aleksandrov S.S. Dynamics of changes in indicators of nonspecific reactivity in patients in the treatment of odontogenic inflammatory processes / S.S. Aleksandrov // Dentistry.- 2019,- No. 3.- P. 38 41.

Bazhanov H.H. Ways to improve the methods of treatment of patients with phlegmon of the maxillofacial area / H.H. Bazhanov // Vestn. RAMN.- 2015.- No. 10.- S. 32 37.

Begiev M. Complex treatment of patients with phlegmon of the maxillofacial area / M. Begiev: Abstract of the thesis, dis.. PhD med. Sciences. - M., 2019

Viberman Ya.M. Changes in the composition and properties of microflora in abscesses and phlegmons of the maxillofacial area / Ya.M. Wieberman, B.C. Starodubtsev, T.M. Litovkina // Dentistry.- 2016.- No. 1.1. C. 34 35.

Gevorkyan O.V. The value of opsono-phagocytic reactions of the body in the choice of tactics for the treatment of odontogenic osteomyelitis complicated by phlegmon / O.V. Gevorkyan: Dis.. cand. honey. Sciences.-Kazan, 2018.

Glinnik A.B. Microbiological characteristics of odontogenic purulent foci of the maxillofacial region I A.V. Glinnik // Actual problems of dentistry.- Minsk, 2015,- P. 50 51.

Dynamics of the microflora of purulent wounds during enzyme therapy / V.K. Gostishchev, I. Tolstykh, Jl.A. Gamaleya and others // Sov. the medicine. -2015.-No.9.-S. 52-56.

Zhdanova L.P. Clinical and bacteriological characteristics of phlegmon of the maxillofacial area / L.P. Zhdanova, 1.1. Oleinik, T.G. Robustova // Dentistry.- 2017.- No. 5.- P. 39 42.

Zakharov Yu.S. Clinic and surgical tactics for bacteroid infections of the maxillofacial region I Yu.S. Zakharov // Dentistry.- 2017.- No. 3.- P. 43 45.

Ivashchenko N.I. Anaerobic infection of the face and neck / N.I. Ivashchenko // Dentistry.- 2015,- No. 3,- P. 45 46.

Ivchenko V.l. Anaerobic non-spore-forming infection in surgery: (Literature review) / V.l. Ivchenko // Vestn. surgery them. Grekova.- 2012.- No. 7.- S. 131 137.

Izrailov V.A. Features of the diagnosis of inflammatory processes of the maxillary soft tissues / V.A. Izrailov // Dentistry.- 2018.- No. 3,- P. 34 36.

Kovaleva Z.l. Microflora in odontogenic phlegmon and its sensitivity to antibiotics / Z.l. Kovaleva // Dentistry.-2019.- No. 6,- P. 78 79.

Kolodkin A.B. Microflora in perimaxillary phlegmon and its sensitivity to antibiotics / A.V. Kolodkin // Dentistry.- 2017- No. 2.- P.86 87.

Complex treatment of patients with odontogenic phlegmon of the maxillofacial region I A.A. Levenets, S.M. Shuvalov, A.D. Karger, T.L. Maruchina // Rehabilitation of patients with major dental diseases. - Irkutsk, 2015. - P. 76 78.

Aderhold I. The bacteriology of dentkgenous pyogenic infection / I. Aderhold, H. Khnate, G. Frencel // Oral. Surg.- 2019,- Vol. 5,- P. 103 -109.

Galbraith M.N. Insect Moulting hormones: crustecdysone (20 hydroxyecdusone) from Podocarpus elatus / M.N. Galbraith, D.N.S. Horn // Australian J. Chem.- 2019.- № 5.- P. 1045 1057.

Sanders B. Current concepts in the management of osteomyelitis of the mandible / B. Sanders // J. Oral. Med.- 2018,- Vol. 33, № 2,- P. 40 42.

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