Reducing the number of complications after dental implantation remains an urgent problem in dentistry. All risk factors can be divided into general (comorbidities, bad habits, systemic pathology, condition after radiation therapy, etc.,) and local (unsatisfactory dentures, poor oral hygiene, periodontal disease, iatrogenic conditions, defects in the transgingival part of the implant and etc). Understanding the course of inflammatory and destructive processes around a dental implant after its installation directs scientists and implant manufacturers to improve the already used conservative and surgical methods of treating these diseases, as well as to pay more attention to the prevention of this pathology, and, accordingly, risk factors for its development. The development of new methods of surgical interventions and prosthetics, the creation of new implant systems will help to increase the service life of dental prostheses on implants, improve the quality of life of patients
The results of examination of 107 patients with glandular hyperplasia of the endometrium are presented. The age of women ranged from 43 to 67 years, on average it was 41.2 + 2.6 years, of which 76 patients were of reproductive age and 49 during the perimenopause. The diagnosis of glandular hyperplasia was established on the basis of morphological scraping of the uterine mucosa. The morphological forms of glandular hyperplasia of the endometrium were analyzed and a comparative analysis of the frequency of all this pathology in the Bukhara region was carried out. The results of the study showed a high growth of this pathology, the cause of which is uterine bleeding, which was confirmed by morphological examination.
Preserving the life and health of premature newborns continues to be one of the priorities of peri- and neonatology. The proportion of premature newborns is 5.8-6% of all births (G.M. Dementieva et al., 2004). They, to a large extent, determine early neonatal mortality, perinatal diseases and cerebral pathology in newborns (Yu.I. Barashnev, 2000). In recent decades, due to significant advances in neonatology and the improvement of perinatal care, the number of surviving newborns with a short gestational age has increased. However, the severity of neurological consequences in these children decreased insignificantly, and it is premature babies who have a serious neurological pathology to a large extent (O.N. Malinovskaya et al. 2005). Therefore, at present, the criteria for success should be considered not only the survival of the child, but also the possibility of his subsequent normal development (A.A. Baranov, 2001).
Currently, despite significant achievements in the field of surgery, anesthesiology and resuscitation, the results of treatment of patients with advanced purulent peritonitis remain one of the most intractable problems, almost every sixth patient with acute surgical diseases and injuries of the abdominal cavity is admitted to medical institutions with peritonitis [1,3] Common peritonitis in 17-29% complicates the course of most acute surgical diseases and is the main cause of deaths in surgical hospitals [3,7]. Lethality in advanced peritonitis remains extremely high and reaches 20-39% [1,2,4,5]. In recent decades, great importance has been attached to recording intra-abdominal pressure in purulent pathology of the abdominal cavity. It was found that intra-abdominal hypertension occurs in every third patient with acute surgical pathology and negatively affects the functioning of all organs and systems of the body [1,6,8]. Pathological changes that occur with acute and excessive increase in intra-abdominal pressure (IAP) are manifestations of abdominal compartment syndrome (ACS) with disorders of the cardiovascular system; urinary disorders, disorders of perfusion of internal organs and the development of intestinal ischemia, which contributes to bacterial translocation and endogenous infection [2,7,8]. Ischemic blood flow disorders of the splanchnic zone are fraught with the development of bacterial translocation and the development of systemic inflammatory response syndrome and multiple organ failure (PON). Unsatisfactoriness with such results gave rise to a fundamentally different approach to the surgical treatment of common forms of peritonitis-the introduction of an open abdominal management method based on the ideas of I. Mikulich (1881), Jean-Louis Faure (1928), N. S. Makoch (1984) and D. Steinberg (1979).
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.
The history of the study of hyperhomocysteinemia goes back half a century. It is interesting that the increased level of homocysteine as a factor of vascular damage was first noticed in pediatric practice. In 1969, Kilmer S. MeCully, a professor in the Department of Pathology at Harvard University, studying a rare genetic disorder manifested by homocysteinuria (increased levels of homocysteine in the urine), suggested a link between elevated serum homocysteine levels and arterial disease. Without treatment, these children usually die at an early age from myocardial infarction or cerebral strokes. During autopsy, it was found that their vessels were the same damaged and thickened as in elderly patients with cardiovascular diseases. Clinically, this disease is characterized by a marfan-like phenotype, connective tissue lesions (high growth, arachnodactyly, lens subluxation, chest deformities, heart defects), neuropsychiatric disorders, arterial thrombosis. The pathology is based on a defect in one of the metabolic enzymes of sulfur-containing methionine, mainly in the amino acid cystothionine-E-synthetase (classical tomocysteinuria). Subsequently, it was shown that moderate and mild homocysteinemia affects the vessels of various localization, leading to pathological changes in them.
Until recently, the study of socially dangerous actions of the mentally ill and persons with mental abnormalities, in domestic studies, was the prerogative of forensic psychiatry. The common interest of lawyers and forensic psychiatrists arose mainly on the basis of the appointment and conduct of forensic psychiatric examination, establishing a kind of border between the spheres of competence. Now, interest in this problem is observed in several branches of science (in criminal law, criminology, forensic psychiatry, psychology, etc.), and at the same time, the point of view of each of them has an independent meaning for determining the normative parameters of limited sanity. At the same time, given the growing prevalence of mental pathology among criminals, there remains an urgent need to create a general theoretical concept of the influence of mental pathology on crime in general and certain types of criminal behavior. This is especially true of many important issues related to the prevention and investigation of serious crimes, mechanisms and motivation of criminal behavior, etc.
This study aimed to evaluate the diagnostic utility of Fine Needle Aspiration Cytology (FNAC) in the evaluation of neoplastic cutaneous nodular skin lesions and to provide insights from a tertiary care institute. A total of 150 patients with cutaneous nodular skin lesions were included in the study, and FNAC was performed using a 23-gauge needle attached to a 10-ml syringe. The study found that FNAC is a valuable diagnostic tool for the evaluation of neoplastic cutaneous nodular skin lesions. It had a sensitivity of 88% and a specificity of 100% for diagnosing malignant lesions. The high sensitivity and specificity of FNAC for diagnosing malignant lesions indicate its usefulness as a diagnostic tool, and it can also help to guide appropriate management and treatment decisions. Therefore, FNAC should be considered as an initial diagnostic tool for evaluating cutaneous nodular skin lesions.
Annotation. Despite the fact that bronchial asthma has been studied, there is currently a trend towards an increase in the incidence in the children's population, therefore, in our work, aspects of this pathology are reflected on the basis of the literary analysis.