Currently, the Republic of Uzbekistan deservedly pays attention to the introduction of inhibitors to protect equipment from corrosion and scaling in production. The use of inhibitors allows several times to increase the service life of expensive equipment. In this regard, the most effective inhibitors of neutral and slightly alkaline media are nitrogen, amine and oxygen-containing organic compounds [1-3] as well as zinc organophosphonic acids, which effectively prevent corrosion and deposits of mineral salts on the surface of equipment.
21 patients with a severe course of COVID-19 were under observation. The study was carried out in a specialized hospital for the treatment of patients with coronavirus infection. A more detailed analysis of the ECG was carried out: the duration of the corrected QT interval, the variance of the QT interval, the Tp-Te interval and the Tp-Te/QT ratio were determined. Prolonged repolarization rates are a poor predictor of a dangerous COVID-19 outcome.
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.
Subject of the inquiry: 148 patients with degenerative dystrophic diseases of the hip joint, of them 103 with osteoarthritis and 45 with avascular necrosis of the femoral head.
Aim of the inquiry: improvement of the diagnosis of degenerative-dystrophic diseases of the hip using possibilities of ultrasonography and magnetic resonance imaging.
Methods of research: X-ray, ultrasonography and magnetic resonance imaging.
The results achieved and their novelty: For the first time, the role of ultrasonog-aphy and magnetic resonance imaging in osteoarthritis and avascular necrosis of the hip was established in comparison with conventional X-ray. The result have shown that sensitivity of ultrasonography in osteoarthritis was low (57.7%) in the detection of femoral head deformation. In avascular necrosis of the hip detection of femoral head deformation was revealed better - 89.7%, which can be explained by differences in the mechanism and localization of deformation in these diseases. Ultrasonography was quite sensitive to changes of the joint capsule both in osteoarthritis and avascular necrosis, the sensitivity 86.0% and 84.6% respectively. MRI was superior to X-ray in the assessment of space orientation of the joint surfaces, necrosis zone, synovitis, subchondral cysts, structural changes and joint effusion. X-ray was more preferable for the detection of ostephytosis, subchondral sclerosis and changes of the joint space in osteoarthritis.
Practical value: of the work consisted in the concretization of sonographic and MRI signs of degenerative dystrophic diseases of the hip joint and in the suggested algorithm of using radiological methods for establishing the nature of hip joint pathology.
Degree of inculcate: the results of research were introduced in the Radiology Department of First Tashkent Medical Institute and the Department of Large Joint Pathology Department of the Traumatology and Orthopedy Research Institute.
Sphere of usage: radiology, traumatology and orthopedy, rheumatology.
Purpose of reseach: to optimize outcomes of therapy of the patients SD, purulent - septic complicated of lower extremities (PSCLE), by monitoring, duly revealing of character disturbans of function of the liver and purposeful correction them in complex therapy of the specified pathological condition.
Methods of research: clinical-biochemical researches, ECG, ultrasonic research of the liver, ultrasonic dopplerography, percutaneus definition a pressure (voltage) of oxygen, angiography, radionuclide researches, psichometric tests.
The results achieved and their novelty: the carried researches have shown, that the liver is not one of the basic organs - targets at SD (at the expense of features it blood circulation), at decompenciation SD, complicated PSCLE, there is an essential infringement liver blood circulation in system lever artery, to the subsequent disturbance of its numerous functions. The inclusion in complex therapy hepatoprotectory, antioxygents and preparations blocking ALT activity is pathogenic proved and promotes optimization of outcomes such of complication SD, as PSCLE.
Practical significance: the elaborated and offered complex therapy of the patients provides of optimization of outcomes, is an effective method of treatment and preventive maintenance of complications.
Degree of introduction and economic efficiency: the results of research have been introduced into practice of branches intensive therapy and reanimation 2-clinic TMA and Republican Centre of Purulent Surgery and Surgical Complication of Sugar Diabetes
Area of application: reanimation and intensive therapy, surgery.
Кейинги йилларда мамлакатимизда халқаро стандартлар талабларига мос келадиган олий таълим тизимини яратиш бўйича кенг кўламли ишлар амалга оширилмоқда. Ҳудудларда янги олий таълим муассасаларининг ташкил этилиши, янгидан бунёд этилаётган замонавий ўқув бинолари ёшларимизга берилаётган юксак эьтиборлардан бири сифатида кўрсатишимиз мумкин. Ўқув хоналари янги замонавий конструкцияларга мувофиқ қайтадан таьмирланиб, ўқув жиҳозлари, ўқув лабораториялари, замонавий АКТ билан таъминланмоқда.
Many people know that the special science of organology deals with the issues of the origin, functioning and interaction of musical instruments. Among its well-established rules, it is believed that the instrument is the most important support of the musician. In a sense, it is a partner and companion of the performer in his creative aspirations, a reliable basis for improvisation, a source of inspiration and fantasy.
Especially great is the importance of musical instruments in the context of the unwritten tradition. Here, in addition to everything, musical instruments act as a kind of fixators for the established norms of oral traditions.
It is no accident that the notation system in the classical music of the East was formed as a tablature for the instrument dominating in its era, for example, the tablature for oud of the 13th-15th centuries, the Khorezm tanbur tablature of the 19th century. The instrument was used to explain the modal and rhythmic systems, the principles of the structure of vocal and instrumental melodies. It is not for nothing that they say that the Bukhara tanbur is the key to the maqomat system, the tar is the personification of the Azerbaijani-Iranian mugams and dastgahs, the Kashgar tanbur (a different scale and principles of execution than the Bukharian one) is the leading instrument of the Uyghur muqams.
The forms and designs of the instruments are the result of the age-old searches of musicians to perfect their timbre-acoustic capabilities, the adaptation of the instruments of their profession to themselves. And the scales established on them are also the result of natural selection of more than one generation of musicians-performers and listeners, in a word, the material embodiment of stages in the history of musical culture.
Мазкур тадқиқот ишида Ўзбекистон ЯИМ таркибида кичик бизнес ва хусусий тадбиркорликнинг улуши, мазкур корхоналарда таҳлилий ишларнинг амалга ошириш масалалари ёритилган. Маҳсулот ишлаб чиқариш ҳажми орқали эришиладиган кўрсаткичларнинг назарий ва амалий жиҳатлари очиб берилган.