SURGICAL REHABILITATION OF NERVUS FACIALIS LESION / Шинэ санаа Шинэ нээлт

There are a lot of influencing factors of facial nerve palsy; experts believe that is most likely caused by a Virus (54%) and Bacterial infections. Noninfectious causes of facial nerve palsy induce tumors (28%) and less commonly influences head trauma (18%). The retrospective analysis of WHO, in 2012. There are some cases of postoperative complication in middle ear surgery is facial nerve palsy and the total recovery outcome of function was not good. From 2013 to 2016 in EMJJ hospital, Mongolia, we enrolled 16 cases with facial nerve damaged in intratympanic canal but we could not recruit some patients with facial palsy over 6 months. Each subject was tested with pure tone test, ABR, Tympanometry. These were performed for the detection of hearing loss after Temporal bone injury. Then we also investigated location of facial nerve damages of patients by MRI and CT before reconstructive surgery. After that surgery, all patients were given corticosteroid treatment (20mg/day) and physical therapy performed such as acupuncture for a week. Study results revealed that 6 cases after 18 days, 2 cases after 30 days, 1 patient after 45 days of reconstructive surgery regained good symmetry. Therefore, we considered that, postoperative treatments like physical therapy with B12, steroid had good benefits for operation result and to shorten the recovery time. There was a patient who had damaged facial nerve in the tympanic segment during Mastoidectomy. In that case, we performed cable nerve grafting using the r.auricularismagnium but we could not recover facial nerve function. Traumatic facial nerve paralysis is the second most common type. We discussed that performing reconstruction surgery within first 3 months after intratemporal facial nerve injury is extremely desirable and more effective. In our opinion, nerve recovery might be not successfully cause of injured myelin sheet of facial nerve during middle ear surgery.

The comparative study of thyroid isotope scanning and FNA cytology in the nodular lesion of thyroid gland / Шинэ санаа Шинэ нээлт

Thyroid nodular lesions are the common clinical problem in the world. A variety of tests have been employed to separate benign from malignant thyroid nodules. These tests include isotope scanning and fine needle aspiration cytology (FNAC). Our research was based on the fact that the comparison of FNAC and thyroid isotope scan in thyroid nodule was not researched in Mongolia. Therefore, we want to evaluate the specimen adequacy of FNAC, and compare its result to thyroid isotope scanning in patients with thyroid nodule. The research was conducted on archive materials of FNAC and thyroid isotope scanning of patients with thyroid nodule who were treated in surgical department of The First Central Hospital from 2012 to 2015, and the statistic analyze was done by using SPSS 20 under the auspices of School of Pharmacy and Bio-Medicine,Department of pathology, Mongolian National University of Medical Sciences. We have collected the FNAC of 807 patients, including 34 patients (4.2%) were males and 773 patients (95.8%) were females. FNA cytology results were interpreted as benign in 495 cases (61.3%), follicular lesion of undetermined significance in 31 cases (3.8%), follicular neoplasm in 9 cases (1.1%) suspicious in 17 cases (2.1%), malignant in 3 cases (0.4%), and unsatisfactory in 252 cases (31%). We have got the result of thyroid isotope scanning of 43 (5.32%) patients out of 807 cases. On thyroid scan, 18 patients (41.9%) having cold nodule were labeled as suspicious for malignancy, 25 patients (58.1%) had hot nodule. The FNA diagnosis of 25 patients with a hot nodule following: 1 patient (4%) with neoplasm, 17 patients (68%) with benign results, 6 patients (24%) had non-diagnostic. The FNA diagnosis of 18 patients (41.9%) with cold nodule following: 1 patient (5.5%) with follicular lesion of undetermined significance, 10 patient (55.5%) with benign, 5 patient (27.7%) with non-diagnostic, 2 patient (11.1%) had malignant. The FNAC results were interpreted as benign in 495 cases (61.3%), malignant in 3 cases (0.4%), and unsatisfactory in 252 cases (31%). Two patients out of 18 patients with cold nodule diagnosed as malignancy by FNAC. The sensitivity and specificity of thyroid isotope scanning was 96% and 16.6%, respectively.

The laboratory inventory handling with poliovirus and potential infectious materials in Mongolia / Монголын Анагаах Ухаан

BackgroundIn 1988, the Forty-first World Health Assembly adopted a resolution for the Global Polio Eradication.Since the initiative was launched, number of polio cases has fallen by over 99%. Today, only threecountries in the world, Afghanistan, Pakistan and Nigeria - remain polio-endemic. The Polio Eradicationand Endgame Strategic Plan of 2013-2018 calls for the gradual eradication of wild virus strain and thevaccine virus strain at the same time. In order to prevent the border transmission of wild type poliovirus,virus leakage from laboratories, it is required to conduct inventory of laboratories handling poliovirus andpotential infectious materials every 2 year.GoalTo identify laboratories handling poliovirus and potential infectious materialsMethodsSurvey of laboratories handling poliovirus and potential infectious materials was conducted amongstate, private, clinical, biomedical and environmental testing in total of 127 laboratories operating in21 provinces and 9 districts of Ulaanbaatar city by questionnaire. Survey questionnaire consists of 6sections (general, sample storage, laboratory biosafety, staff knowledge, information source, trainingand etc.). Study results were processed using SPSS-19 statistical programme.Results34.7% of 96 biomedical laboratories were analyzed stool samples. These laboratories were analyzedrotavirus (17.0%), intestinal bacteria (67.0%), Helicobacter (14.3%), parasite and other indicators (1.7%)in stool samples. 43.8% of laboratories were stored stool samples for one day and 3.1% up to oneyear. From 31 environmental testing laboratories 73.3% were bacterialdetection test on environmentalsamples. 60% of wastewater samples were collected from rivers, 16% on entrance to wastewatertreatment plant and after biological treatment combined, and 24% from other sources. Soil sampleswere collected near waste disposal and other sources (46.4%), and from unknown sources (53.6%).24.1% of all laboratories were stored environmental samples for 3 days, 3.4% for 45 days. Accordingto results, surveyed laboratories did not store samples for more than 1 year. Also, none of surveyedlaboratories (100%) were not stored poliovirus and potential infectious materials.Conclusion· The investigated laboratories were not stored poliovirus and potential infectious materials.· The biosafety and biosecurity status of laboratories should be improved in near future throughenhancing knowledge of laboratory workers and organizing training related to biosafetyandbiosecurity.

Some implications on tympanoplastic III types surgery / Шинэ санаа Шинэ нээлт

Among world population, 23.4% have different kinds of hearing disorders and 56% are middle ear disorders, 30% are inner ear disorder, 10% are congenital deaf and 4% are congenital mixed outer and middle ear disorder (WHO info, 2006).In 1995, by the German research, 2% of newborn babies were deaf therefore, among children from 1-18, 16% had middle ear disorder and 0.8% had inner ear disorder. In most cases (54%) cause of hear loss and deaf as sound transmitting apparatus. Later in 2010, sound transmitting apparatus related disorder was decreased by 22.4% J.Helms1995 , K.Schwager 2010 . Doctors proved that 62% of sound transmitting apparatus related disorders are middle ear diseases, 16,2% out of the diseases have the defect of malleus, 44,1 % have the defect of incus and discontinuity of incus and stapedius, and 39,7% is totally absent of ossicular chain 120 tympanoplasty III type surgeries were operated in 2011-2013 in Mongolia. Clinical and operative features of the tympanoplasty III type surgeries were prospectively recorded. Aim: To recover sound transmitting related hear loss with titan prosthesis implant. 120 tympanoplasty III type surgeries were operated in 2011-2013 in Mongolia. Clinical and operative features of the tympanoplasty III type surgeries were prospectively recorded. Out of the surgeries, 51 cases (42.5%) were cholesteatoma, 53 cases (44.2%) were granuloma middle ear and 16 cases (13.3%) were adhesive otitis media. The air and bone gap of all patients were above 15-35 dB. HEINZKURZ firm’s TTP-Variac system’s titan prosthesis was used. Titan prosthesis PORP was carried out in 86 cases (71.6%). For 40 (45.5%) out of the 86 cases, size of titan prosthesis PORP 2.25 mm was chosen. Hearing level increased for 72% out of patients by 10-25 dB after the operation. However, for 46 (54.5%) out of the 86 cases, size of titan prosthesis PORP 2.5 mm was chosen. Hearing level increased for 82% out of patients by 10-30 dB after the operation. Titan prosthesis TORP size 4-4.25 mm waschosen for 34 (28.4%) out of 120 cases. Hearing level increased by 10-30 dB for 80% out of patients involved after the operation Out of the surgeries, 51 cases (42.5%) were cholesteatoma, 53 cases (44.2%) were granuloma middleear and 16 cases (13.3%) were adhesive otitis media.Titan prosthesis PORP was carried out in 86 cases (71.6%). For 40 (45.5%) out of the 86 cases, size oftitan prosthesis PORP 2.25 mm was chosen. Hearing level increased for 72% out of patients by 10-25 dB after the operation. However, for 46 (54.5%) out of the 86 cases, size of titan prosthesis PORP 2.5 mm was chosen. Hearing level increased for 82% out of patients by 10-30 dB after the operation. Titan prosthesis TORP size 4-4.25 mm was chosen for 34 (28.4%) out of 120 cases. Hearing level increased by 10-30 dB for 80% out of patients involved after the operation. Implantation of Titanium prosthesis increased hearing capability by 80% dB. We drum cover the cartilage and cartilage film is used to by Canal wall down, Canal wall updone. Hearing level decrease d by patients involved after the operation. Implantation of Titanium prosthesis increased hearing capability by 80% dB. The air transfer of more than35 dB air-bonegapofmorethan15dB we observed defect of hearing bone

Some normal Results of Brainstem Evoked Response / Шинэ санаа Шинэ нээлт

Brainstem Evoked Response Audiometry test is a method to diagnose and differentiate the type, degree and the location of cochlear and retroocochlear hearing loss for infants early. Test methods to determine cochlear and retroocochlear hearing loss was introduced relatively late in the clinical practice of our country. Even though, we started to conduct BERA tests since 2007, there hasn’t beenany research conducted for determining the normal results for children aged 0-5. Aim: The study aims to determine some average Results of BERA tests for Mongolian children aged 0-5 with normal hearing by age groups using Octavus-BERA apparatus.The research has been conducted using cross sectional method of analytic research from 2009-2013.For the study, 110 children from children aged 0-5 who were diagnosed to have normal hearing from audiological department of Otorhinolaryngological hospital and 16 children with sensorineural (cochlear) hearing loss have been selected randomly. When the latency of waves for children aged 0-5 with normal hearing were measured and the average results for 70 dB were obtained in the BERA test: wave I was identified to be 1.64±0.15 – 2.08±0.5msec. Wave III was 3.68±0.18 - 4.47±0.73 msec, Wave V was 5.37±0.23 - 6.76±0.65 sec. When the latency between waves were measured and the average results were obtained in the BERA test: Between waves I-III, it was 2.05±0.20 – 2.39±0.53 msec. Between waves III-V was 1.69±0.10 -2.34±0.70 msec and between waves I-V was 3.70±0.29 - 4.65±0.56 msec. The latency of wave I for children with sensorineural hearing loss was 2.32±0.76 msec, 4.62±0.59msec for wave III and 6.55±0.65 msec for wave V, which was elongated with a statistical probability (p=0.00-0.05). Latency between waves was 2.39±0.45 msec between wave I-III, 1.83±0.16 msec between waves III-V and 3.97±0.88 msec between waves I-V, which doesn’t have statistically significant difference from the normal results.As the children’s age increases, the latency of the waves will shorten and becomes relatively stable from 25-30 months which is similar to adults. While the latency between waves I-III had no difference with statistical probability for children with all ages, latencies for waves III-V and I-V shortens as children’s age increases.Latency for children with sensorineural hearing loss was elongated with statistical probability (p0.05). This Result has critical importance in diagnosing cochlear deafness.

Results of the otosclerosis surgery treatment / Шинэ санаа Шинэ нээлт

Otosclerosis is a disease that involves the cochlea and it is developed when the structure ofconnecting tissue in the area of stapedius and the oval window has changed and become unmovable.Consequently, conductive hearing loss and therefore severe sensorineural hearing loss are caused.The causes of otosclerosis have not been discovered yet but many factors impact on this disease. Anyresearch works has not been done on otosclerosis in Mongolia until now and we have conducted theresearch in 2008-2013. Therefore, we aimed to identify the hearing condition after surgery treatmentof otosclerosis.41 patients /47 ears/ who were diagnosed of having otosclerosis with conductive hearing loss, nomiddle ear infection through the comprehensive ear and hearing examinations were selected in thisstudy which was done at EMJJ Clinics between 2007 and 2013. The hearing improvement after thesurgery has been tested under bone and air conduction frequency 500, 1000, 2000, 4000, 8000 Hzand the results before and after the surgery were statistically processed on Excel 2010 and SPSS 17.0software programs. Stapedotomia and Stapedoectomia surgery approaches were applied and afteropening of attics, the hearing bones are palpated and the diagnosis of stapes otosclerosis is confirmedby the surgeon, who removes the stapes. Then a titanium K-piston (prosthese or implant) is thenplaced into this opening and connected to the malleus, or the incus.Out of 41 patients (85.4% female) involved in the study and 36 people had one ear side otosclerosisand 5 people had both ear otosclerosis. After the surgery 25 patients did not have dizziness andvomiting symptoms and 14 patients did not have dizziness with movement after 12 hours, andfor 4 patients all symptoms were disappeared after 24 hours. As for the result from the hearingexamination after 21, 60 days of the surgery, bone conduction was normal, air conduction, andhearing for 32 patients improved completely, and after 120 days of the surgery, the hearing of 33patients improved completely, bone conduction became 2000 Hz at 4000 Hz frequency 12-15 dB,average of air conduction 15,4±10,1 dB, bone-air gap 10,4±3,1 dB for 5 people, and bone conduction2000 Hz-4000 Hz, at 8000 Hz frequency 20-40dB, air conduction became 25-45dB 10,4±5,1db for 9patients and all patients had no hearing loss except for 4 people who still had tinnitus.After surgery stapedotomia and stapedoectomia for the otosclerosis, the hearing improvement was95.2% and it has been concluded that there is full possibility to perform surgeries of stapedotomia andstapedoectomia for the otosclerosis in Mongolian situation.

THE SITUATION OF PRODUCTION AND USE OF BLOOD AND BLOOD PRODUCTS IN KIIOYD AIMAG / Шинэ санаа Шинэ нээлт

Morbidity of cancer and injury or surgical treatment has been increasing due to socio-economic and environment changes, rapid urbanization from rural to urban and technological development. Our main purpose is to provide necessary blood and blood products for surgical treatment and urgent neede The aim of this study was to assess the current situation of production and use of blood and blood products at the Regional diagnostic treatment center (RDTC) in Khovd aimag. Amounts of production of blood and blood products at the blood bank increased during the years of 2008-2011. But it decreased a little in 2012. Our main products were red blood cell concentration, packed red blood cell and fresh frozen plasma in these years. The appropriate use of blood and blood products has been improving at our blood bank.

The characteristic noisy sound of the mongolian word used by hearing field / Монголын Анагаах Ухаан

Introduction:According to studies range by the World Health Organization in 2010, 278 million people are deaf or hearing impairment, out of which 24% use an hearing aid and one out of every 10 people has been treated with surgical method and 9 people’s hearing loss has been restored using acoustic treatment method.Purpose:Our purpose is to define noisy vowels of Mongolian word, which will be used for configuration of hearing aid, thereby improve hearing ability.The objectives1. Analyze spectrogram for noisy sound of Mongolian word and define frequency and level of noisy words.2. Define average difference of listening level of the noisy sounds of Mongolian language using “Listening field of Mongolian word”Materials and method:We did the spectrogram for noisy sounds of the Mongolian word using voices of 62 people including male and female children as well as adults. Also, we analyzed frequency energy of all vowels noted in the 60-65 dB computer, via the “PRAAT” software, which defines analysis of speech in phonetics and studied listening level of the strong vowels using listening sphere of word.Result:During our studies, we selected the vowels [a], [e], [u], [o] [a], [ʊ], [ɔ], [i] and defined spectrogram and energy concentration (formant) of each vowel to define the vowels with the highest energy, and further found out that distance difference of the spectrogram of each vowel and frequency between vowels as 300-780 Hz. On the other hand, difference between spectrogram of each strong sound such as [sh], [s], [v], [z], [dj], [kh] has been defines as 340-2800 dB.When we observed the words with strong sound in the listening field of Mongolian words, which were 3- 5 dB lower than the clearer words.Conclusion:1. According to spectrogram, noisy sound [sh], [s], [z], [dj] has frequency of 3300Hz-3500Hz, which is noisier and resulted in poor acoustic listening ability. Further, we found out that Distant difference of vowels of Mongolian language [a], [e], [o] and consonants [m], [n] is far, accordingly, acoustic listening ability has been good, on the other hand, distant difference of vowels of Mongolian word [ʊ], [ɔ], [u] is near or close, accordingly, acoustic listening ability has been not well.2. Level of distinquishment of the noisy sounds of Mongolian word has been lower by 3.6+ 0.8Db to 5.2+1.2Db at levels of clear sound to feedback.