Tdy lai chu y l u Id VTTDT ben trai.
Ve phuang phap phau thudt' phuang phdp phdu thudt d tdng benh nhdn phu thudc vdo benh nhan dd dd cd b i l n chdng hay chua va dd ndnq cua b i l n chdng. Trong nghign cdu nay chung tdi thay chu yeu d c bgnh nhdn dugc tien hdnh d t bo tiii thda, khdu vui hoac cat doan njgt, ndi rugt (76%), chi cd 9BN (24%) dugc t i l n hdnh p h l u thuat Hartmann do nhilm trung ndng trong d byng, cdc con sd ndy trong nghign cdu cua Belmonte theo thd t y Id 88% vd 12%.
Ddnh gid k i t qua sdm sau md
Trong sd 38 BN md 31 BN (77.5%) dat k i t qua sau md tdt, I B N (2,5%) d k i t qua xau. Trong khi dd, theo nghign cdu ciia Belmonte cd 52 BN (chiem 23%) t d vong. Sy khdc bigt tren cd t h i Id do mau chiing tdi nghign cdu nhd, chua cd ^ nghTa thdng ke.
Thdi gian trung binh n i m vign sau md Id 8,7 ± 0,8 ngdy, trong thdi gian nam vien phu thudc vao BN dd d b i l n chdng hay chya: chya d bien chdng nam vien ngan (7,46 ± 0,49 ngdy), dd cd b i l n chdng nam vign kdo ddi han (10,4 ± 2,42 ngdy).
KfiT LUAN
1. Dac d i i m ldm sang, can lam sdng - VTTDT thydng gap d Ida tudi dudi 40 (chiem 55%), trong dd chii y l u Id nam gidi (chiem 72,7% Ida tudi). Vi tri thydng gap cua VTTDT la d d?i trang phai (chilm.75%)
- Trong s6 cdc trieu chdng lam sdng, dau bung Id trieu chdng hay gdp nhlt (95%)
- Da so benh nhan (75% trydng hgp) khdng dugc c h i n dodn la VTTDT trydc md do cdc_trigu chdng dau hd chau phdi, sdt, bach eau cao d l c h i n dodn
nham vdi vidm njdt thda.
- Chup khung dai trdng bam thudc d n quang, chyp d t Idp d bung vd soi dai trdng Id cdc phuong tien hdu Ich giiip chan dodn VTTDT tm-dc md.
2. K i t qua s d m d i l u trj b l n g p h y a n g phdp phdu thuat
- Da sd d c BN d k i t qua hdu phdu sdm tdt. C^c b i l n chdng hgu phdu cd t h i gdp nhy nhilm trOng, chdy mau v l t md,...
- Thdi gian n i m vien trung binh Id 8,7 ± 0,8 ngdy, phu thudc n h i l u vdo da cd bien chdng hay chua.
T A I U E U THAM KHAO
1. Painter NS, Burkitt DP vd d n g sy (1975) Diverticular disease of the colon, a 20th century problem, trang web Clin Gastroenterol; 4: 3-22.
2. Hildebrand P, Birth M, Bruch HP, SchwandnerO (2005), Surgical therapy in right-sided diverticulitis, trang web The diverticulitis file.
3. Chapman J vd cdng sy (2005) ComplicatSi diverticulitis: is it time to rethink the rules? trang web The diverticulitis file; 242(4):576-81; discussion 581-3.
4. Minh Chau T Nguyen, MD va cdng sy (2008).
Diverticulitis, trang web eMedicine.
5. Tursi A, Brandimarte G va cgng sy (2007) Balsalazide and/or high-potency probiotic mixture (ySUtZ) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon, trang web The diverticulitis file.
6 Cho KC, Morehouse HT vd epng stf (1990) Sigmoid diverticulitis: diagnostic role of CT- comparison with barium enema studies trang web Radiology:176(1):111-5
TAG DONG CUA CHAT DOC DA CAM - DIOXIN DOI VOI TRE EM TAI LANG HUTU NGHI VIET NAM
DANG DLTC NHU, PHAM V A N DEM, Khoa Y Dwac - Dai hgc Quoc gia Hd Ngi BUI TH! THU IHA, Ldng HQ-u Nghi Viet Nam TOM T A T
Muc tidu: Binh gii tic dong cua chat ddc da cam/dioxin lin si/ phit trien tmh than va the chit cua tri em tai Ling HOu Nghi Viit Nam. PhuKyng phdp nghidn cOu: Nghidn cCru md ta cdt ngang. Kit qua nghien CLFU: Nghiin cifu 180 tre tie nam 01/01/2010 din 30/12/2013 cho tbay 85.55% tri bi lun, 60% tre cin ning thip. 91,67% tre gap kho khan vi hoc.
Ngoai ra, nhirng tr^ em niy cdn mang nhiiu khuyet tat vi van dgng, cam diec, bam sinh. Kit ludn: Chit ddc da cam/dioxin vin flip tuc anh hwang nang ni vi k6o dai Idn sue khde con ngwdi.
TCP khda: Chat ddc da cam, dioxin, phit trien tinh than vd the chat, tre em
SUMMARY
Objective: Assess the impact of Agent Orange/dioxin on mental and physical development of children at the Vietnam Friendship Village. Methods:
Cross-sectional descriptive study Results: 85.55%
dwarf children, 60% children with low weight. 91.67%
children with learning difficulties. 15.56% children have normal IQ (intelligence quotien). In addition, these children have motor disabilities, deaf and dumb, congenital. Conclusions: The results suggest that dioxin exposure influent continuously on human health of Vietnamese population.
Keywords: Agent Orange, dioxin, mental and physical development, child.
DAT V A N Dt
Trong sudt thdi gian chiln tranh t d 1961 din 1971, qudn ddi My da rai xudng m i l n Nam Vidt Nam kho§ng 76,9 trieu lit chat diet d . Trong dd, 49,3 tngu lit Id "ChS da cam - Agent Orange" (ehiem 64%), logi thudc digt ci chya ham |yang_dioxin cao vd doc tinh manh nhlt [1].
Tai d c vCing nhiem dioxin, do dioxin d trong d c hgt bui bdm vao d y d i , hoa mdu vd trong d l t ndn cdc ddng vdt dn rau d d chda dioxin sg tich ty trong ca t h i , ddc biet trong md m d Do dd, khi con ngydi tigu ttW
Y HOC THirC HANH (924) - s6 7/2W4
thjt. mfr, sda vd cdc s i n p h i m t d thjt sda dgng vdt se bj rt^kn tfioxin. Nhy v$y, dioxin tCr trong mdi trydng cd t i l l di vdo ca t h i ngydi qua dudng tigu h d , hd h i p vd qua da ^ . Khodng 4.8 trigu ngydi bj phai nhilm vdi dioxin, trong dd d 3 trigu ngydi bj I n h hydng ndng n l , d n khodng 200 nghin qudn nhdn dang bj dnh hudng ndng n l cua dioxin. Trdn thyc nghigm. cdc nhd khoa hgc dd cN>ng minh r i n g , dioxin cd tdc hai gdy ra qudi thai, gdy dgt b i l n gen, gdy ddc hai vdi cdc t l bdo, ddc bigt Id d c t l bdo ndo. thgn, gan, tim, gdy ngg dge F^di. ung thy. gdy rdi loan nhilu qud trinh trao ddi c h i t khdc niiau trong t l bdo vd tdc dgng tryc t i l p bdn bd mdy di tiuyln t l bdo. Cdc nhd Idioa hgc Vigt Nam dd nghidn cdu vd phdt hign nhdng b i l n ddi sinh hgc d nhting ngydi phoi nhilm d l t dioxin. Nhilu nghidn d u dd kbing (^nh r i n g dioxin cd t h i gdy nen dj d^ng b I m sinh vd d c b i t thudng thai s i n , gdy ung thy, I n h thudng d i n hocmon vd nhilu bgnh khdc [2},[3],[41,[5].
Hdng van gia dinh Vigt Nam dang phdi gdnh d j u hdu qud d a chit dge da cam, nhlt Id gia dinh cdc qudn nhdn tdng chiln dau tai chiln tm-dng m i l n Nam, nai khdng qudn Hoa Ky rdi c h i t dge da cam. Hon 40 muai ndm qua, nhdng trigu chdng Ndn quan d i n dioxin van xult hign thydng xuydn d Vigt Nam. Trd em sinh ra t d d c gia dinh d ngydi bj nhilm ddc (thugc t h i hg thd 3) van bj d c dj tdt d U i l k i t lugn Id do tdc dgng d a chit dge dioxin. D l Hm h i l u thdm v l tdc hgi d a dioxin ldn sdc khde con ngydi. Nghidn cdu ndy vdi myc tigu
"Ddnh gid tdc dgng d a d d t dge da cam/dioxin Idn s y phdt tnen tinh t h i n vd t h i c h i t cua t r i em tai L^ng HOu Nghj Vigt Nam".
D d i TUVNG VA PHU'ONG P H A P NGHIEN CCfU 1. o i l twqmg vd dja d l l m nghidn c d u : 180 tre em t d 175 gia dinh Id con, chdu cDa d c cyu chiln binh bj nhilm c h i t dge da cam/dioxin dang dugc nudi dydng vd d i l u tri tai Ldng Hdu Nghj Vigt Nam.
2. T h d i gian nghign cu'u: T d 01/01/2010 d i n 30/12/2013
3. T h i l t k l nghidn c d u : Nghidn cdu md t l d t ngang
4. Phuwng phdp t i l n hdnh:
Do chilu cao: bgnh nhdn ddng thing, m l t nhin thing, cd bdn d l l m cham (chim. lyng. mdng vd gdt chdn phdi cCing cham vdo tydng). L l y mgt thudc gd hinh chd nhgt ddt mgt canh dp vdo tydng, mgt canh cham vdo d l u bgnh nhdn, ddnh mdc vd do chilu cao b l n g thudc. K i t qud d y g c so sdnh vdi gid trj sinh hgc cOa ngydi binh thydng ciJng dg tudi. N l u giam trgn 2SD (SD: Standard Deviation: dd l$ch d u i n ) Id ICin. tdng g i l m trong khodng t d -2SD d i n +2SD Id binh thudng, chilu cao tdng t r i n 2SD Id cao.
Do d n ngng: DCing cdn bdn. d n ICic ddi. khi b i t d l u d i n Ldng vd cQng dygc so sdnh vdi gid trj sinh hgc d a ngyd^ binh thydng cUng tudi. N l u d n ngng t h l p han chuIn trdn 2SD Id t h l p d n , t d -2SD d i n +2SD Id binh thudng, tdng trdn 2SD Id thda cdn [6].
Do d T sd Vndng minh IQ: (intelligence quotien) dygc tinh theo d n g thdc t u l i tri tug chia cho tudi thyc nhdn 100 vd d y g c phdn loai nhy sau [7]:
Binh thydng: d IQ t d 70 d i n 130.
Kdm phdt trien til tug dang nh^: d IQ h> 55 den 70.
Kdm phdt tiiin til tue dang tiung binh: d IQ ti> 35 d i n 55
Kdm phdt t r i l n til tijg dang ndng: cd IQ t d 25 d i n 35.
Kdm phdt tiiin til tue dang r l t n$ng: d IQ dudi 25.
Phdn loai tdn tdt: phdn loai 7 nhdm tdn tgt theo td chdc y t l t h i gidi VWO (Worid Health Organization)
5. X d ly so ligu: Sd lieu dygc x d ly bang phifang phdp thdng kg y hgc tiidng thydng ti-gn p h l n m i m SPSS 16.0.
K £ T Q U A NGHIEN CI>U
Tudi: T d 6 den 18 tudi, trung binh 14,2 ± 3 tudi.
Gidi: Nam 100. n d 80. ty Ig nam/nd = 1/1.
Y l u td phai nhilm: 100% trd d bd m? hodc dng bd Id cyu chiln binh bj phai nhilm c ^ l t dge da cam/dioxin.
Bdng 1. Phdt triln chilu cao d a tre em tai Ldng Hdu Nghj Vigt Nam
Phat tnen chieu cao Giam > 2SD TCP -2SD aan +2SD
TSnq >2SD T6ng
n 154
26 0 180
T«le%
85,55 14,45 0.0 100 Nhdn xdt: nghidn cdu chilu cao cua trd em tai Ldng Hdu Nghj Vigt Nam cho thly. cd 154 t r i bj lUn d i i m 85.55% (gidm chilu cao > 2SD).
Bang 2. Cdn ndng ciia t r i em tai l ^ n g Hdu Nghj Vigt Nam
CSn nsng Giam > 2SD TO -2SD 6in +2SD
Tflng > 2SD Tong
n 108 67 15 180
T}ie%
60,00 31,67 8,33 100 Nhgn xdt: d 108 tre cdn ndng t h l p chilm 60%
(gidm > 2 SD).
Bang 3. Phdn loai tdn tdt cua trd em taj Ldng Hdu Nghj Vigt Nam.
Nh6m tan tSt Kh6 l(han v l hoc Kho Ithdn ve v^n d$nq
Khd khan nghe ndi Kho khan ve nhin
Hanh vi xa la Oonq kinh Mat cam gidc
n 165 85 45 15 12 12 0
Tv I W 91,67 47,22 25,00 8,33 6,67 6,67 0,0 Nhdn xdt: tre cd khd khdn v l hgc chilm t} Ig r l t cao 91,67%, khd khdn v l vgn d$ng chilm 47.22%.
Bdng 4. Chi sd IQ cua trd em tai Ldng Hdu Nghj Vigt Nam
Chi so IQ DmS>i25 n 25 dSn 35 liy 55 den 70 70 den 130
T6ng
n 16 62 76 28 180
T} l#%
8,33 34,44 41,67 15,56 10O Nh^n x « : CW c6 15,56% tri cU chl s6 IQ trSn 70 (mCrc binh thtjding). Tr£ k6m phdt triSn tri tu$ d^ng
Y HQC THVC HANH (924) - SO 7/2014
nhg chiem cao nhlt Id 41,67% cd chi sd IQ t u 55 d i n 70.
B A N LUAN
Qua nghien cdu 180 tre em Id eon, chdu c y u chiln binh bi phai nhilm c h i t ddc da cam/dioxin tai Ldng Hdu Nghj Viet Nam chung tdi nhdn t h l y , v l s y phat trien chilu cao, can nang cho t h l y h l u h i t thap han chuan. Nhieu nghien edu dd khang dinh r i n g Dioxin cd t h i gdy ndn dl dang bam sinh vd cdc bat thydng thai san, gdy ung thy vd nhilu bgnh khdc.
Vign Hdn lam Khoa hgc My da d n g nhdn mdt sd bdnh cd Hdn quan vdi Dioxin, trong do cd 4 bgnh dd d y g c xac djnh Id ed bang chdng lign quan chac chan vdt Dioxin (Ung thu p h l n m i m - Sarcoma, Non- Hodgkin Lymphoma, Hodgkin Lymphoma vd Benh trdng ea do cior - cloracne) vd 7 benh d y g c coi la cd b l n g chdng lidn quan vdi Dioxin (Ung thy dydng hd h i p gdm ung thy thanh quan, ung thy phdi, ung thy khi p h i quan; Ung thy t i i n het tuyen, tjenh da u tuy dc tinh - Multiple Myeloma; Bgnh gai sdng che ddi - Spina Bifida; bgnh Porphyria Cutanea Tarda; benh rdi loan than kinh ngoai bien va benh ddi dydng) [2],[81.
Ngodi ra, nhdng nghien cdu gan ddy eho t h l y chat doe da cam/Dioxin cdn ed lien quan_dln mdt so benh cOa hg thdng hd hap, he thdng mien dich, bgnh da lilu, benh di truyin, Tai My cQng nhy d Vidt Nam d l u cdng nhan d\Dioxin cd the gay ra cdc di tat sinh san hudng d i n t h i he thd 3, trong nghien cdu nay chung tdi t h l y cd 19 tre (10,55%) Id chdu cua cdc cyu chiln binh (thudc t h i hd thd 3) Do dioxin tham vdo cdc md md, khdng dygc chuyin hda ndn rat khd thai trd_nen cd the tdn tai vd tich luy g i n nhy sudt ddi cua mdi cd t h i gdy anh hydng den he gen, qua trinh ehuyen hda euaeatheI3],[4].
Trong nghign edu cua chung tdi eho thly, tat ea cdc tre em deu trong dd tudi di hoc, tuy nhien cd den 91,67% so tre cd khd khdn v l hgc. dieu ndy cOng phCi hap khi cd 34,44% tre cd chi sd IQ kem phdt trien tri tug dang nang Dac biet, 8,33% tre cd mdc kdm phdt then rat ndng phai phyc vy hodn todn Ddy Id mdt thdeh thdc rat Idn trong cdng tdc gido due vd day n g h l cho tre Sy phat triln t h i chat cua nhdng tre em ndy eung bi anh hudng nghigm trong.
K^T LUAN
Cd 154 tre bj ICin cbiem 85,55% (giam chilu cao >
2SD). 108 tre edn ndng thap chilm 60% (giam>2 SD) Tre cd khd khdn v l hgc c h i l m i)f Id rlt cao 91,67%, khd khdn v l vdn dgng c h i l m 47,22%.
Chi cd 15,56% tre ed chl sd IQ tren 70 (mdc binh thydng). Tre kdm phdt trien tri tug dang nhg chilm cao nhat Id 41,67% ed chi sd IQ t d 55 den 70.
C h i t CQC da cam/Dioxin gay anh r l t nghidm trgng ldn tre em Id con, chdu cua nhung c y u chiln binh Viet Nam cd tiln s d phai n h i l m . S y anh hydng ndy Id cd iSnh, kdo ddi r l t khd k h l c phuc.
T A I L I E U THAM K H A O
1. Stellman J.M., Stellman S.D., Christian R., et al (2003). The extent and pattems of usage of Agent Orange and other herbicides in Vietnam. Nature. 422, 681-687.
2. Hoang Dinh Cau va cs (2000). A Lydi - Thira Thign - H u l , mot vung nghien cdu va giai quyet h^u qua chat diet d , phat quang sd dung trong chien tranh 06ng Dyang l l n thd II. Ky yeu cdng trinh nghien cdu, Oy ban 10-80, Bg Tdi nguyen va Mdi trydng. Ha Ngi: 235 - 345.
3. Nguyen Van Nguyen, Le Bdch Quang va cs (1998). Nghien cdu tac dpng hgu qua lau dai cua chat ddc da cam doi vdi con ngydi d khu vyc san bay Bien Hod va hien phap khlc phuc, Nghien cdu y sinh thu^c dy an Z1 - Bd Quoc Phdng, Hgc vign Quan y Ha Npi: 1- 25.
4. Le Bach Quang, Dodn Huy Hau, Hoang Van Lyang va cs (2005). Nghign cdu cdc bgnh lien quan den chat dOc hoa hgc da cam/Dioxin d cyu chien binh Vi^t Nam, Hpi thao qudc t l lan thy hai: 188-205.
5. Nhu D.D., Kido T , Naganuma R., et al (2010).
Salivary Cortisol and cortisone levels, and breast milit dioxin concentrations in Vietnamese primiparas Toxicol Environ Chemistry. 92, 1939-1952
6. Bd Y te (2004). Cac gia tq sinh hpc ngudi Vi§t Nam binh thydng thap ky 90 the ky XX, Nhd xult ban Y hpc. Ha Npi: 14-20.
7. Shaw P, Greenstein D et al (2006). Intellectual ability and cortical development in children and adolescents. Nature 440: 676-679.
8. lOM (Institute of Medicine), 2002. Veterans and Agent Orange—health effects of herbicides used in Vietnam. National Academy Press, Washington, DC.
TO! im HOA KY THUAT \M TAI CHO HUYNH QUANG TRONG CHAN DOAN TRUfrC SINH MOT SO BAT THUfifNG NHIEM SAC THE
TOM T A T
€$t vin de: K^ thuSt tai tai chd tiujfnti quang (FISH) ti Iff thuit di truyin ti bio - phin tir, vii viec si> dung AON dd cho NST 13, 21, 18, X, Y phit hiin dur;fc nhanh lich boi nhiim s^c thi. Muc tieu: (1) CU tiin mit s6 buryc trong chuin bi tiiu bin tnrifc vi sau khi lai ADN dO: (2) (Tng dung ky thuit FISH trong
DINH THIJY LINH, Benh vi^n Phu sin Hi W HOANG THU LAN, N G U Y I N THU HA Bg mdn Di truyen - Trwdng Dai hgc YHi N^i chin doin tm^ sinh mdt s6 bit thuang NST. Dii tiscmg vi phucmg phip nghiin c&u: Trong nghiin cCni niy, chung tdi tiin hinh xirly 12 miu dich 6i sau dd Cmg dung bi ADN dd cho cic NST 13, 18, 21, X, y di phit hiin mit sS bit thuirng NST. Kit qui: 1 tnf&ng hop thai Hii chung Down thsomy 21 thuin; 1 tnfdng hop khim (65% ddng ti bio binh thuimg;
y HOC TH0C HANH (924) - s 6 7/2014