scholarly journals Biological necrectomy and vacuum-therapy in complex treatment of decompensated chronic venous insufficiency of the lower extremities

2019 ◽  
Vol 86 (7) ◽  
pp. 32-35
Author(s):  
V. I. Rusyn ◽  
V. V. Korsak ◽  
O. A. Nosenko ◽  
V. V. Rusyn ◽  
S. S. Kalinich
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Combined Treatment ◽  
Lower Extremities ◽  
Vacuum Therapy ◽  
Working Capacity ◽  
Group I ◽  
Varicose Disease ◽  
Group Ii ◽  
The Impact

Objective. To improve the results of treatment in patients, suffering decompensated forms of chronic venous insufficiency (CHVI) of the lower extremities, using introduction of biological necrectomy and vacuum-therapy in combination with complex of optimal surgical interventions, depending on state of venous hemodynamics of the lower extremities. Materials and methods. In 2015-2018 yrs in Surgical Clinic of the Zakarpattya Regional Clinical Hospital named after Andriy Novak 147 patients, ageing 40 yrs old and older, suffering CHVI Category C6 in accordance to the CEAP Classification, were treated. All the patients were divided into two groups: the Group I consisted of 76 patients, suffering CHVI in decompensated stage on background of varicose disease, and the Group II - 71 patients, suffering trophic ulcers (TU) on background of postthrombophlebitic syndrome (PTHPHS). Results. There was established, that the TU clearance under the action of maggot-therapy in patients, suffering decompensated course of CHVI, is significantly more effective, than under the impact of vacuum-therapy. Autodermoplasty must be performed in all the patients, having TU with 4 cm in diameter, Good and satisfactory results were observed in 75 (98.7%) patients of Group I and in 63 (88.7%) patients of Group II, while poor results - in 8 (11.3%) patients of Group II. The working capacity of patients, suffering CHVI in decompensated stage of varicose genesis, have enhanced in 16.5 times, while in the patients, suffering TU on background of PTHPHS – in 1.25 times. Conclusion. Combined treatment of CHVI in decompensated stage, occurring on background of varicose disease includes the TU clearance, using vacuum-therapy or biological necrectomy with subsequent elimination of vertical reflux. In the patients, suffering TU on the PTHPHS background the biologic necrectomy with elimination of horizontal reflux is advantageous. The working capacity in patients with CHVI in decompensated stage of varicose genesis have enhanced in 16.5 times, while in the patients with TU on the PTHPHS background - in 1.25 times.

scholarly journals Characteristic of the hemostasis indices in chronic venous insufficiency in stage of decompensation

2018 ◽  
Vol 85 (7) ◽  
pp. 47-50
Author(s):  
V. І. Rusyn ◽  
V. V. Коrsak ◽  
О. М. Коchmar ◽  
S. S. Каlynych ◽  
О. Т. Devinyak
Keyword(s):  
Blood Flow ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Regional Blood Flow ◽  
Local Character ◽  
Group I ◽  
Thrombotic Complications ◽  
Group Ii

Objective. To compare the hemostasis indices in patients, suffering chronic venous insufficiency (CHVI) in decompensation stage, owing or not the thrombotic complications. Маterials and methods. The indices of hemostasis were studied up in 47 patients, suffering CHVI in decompensation stage, in whom the blood was obtained from central and regional blood flow. To Group I 27 patients were included, suffering CHVI in decompensation stage and complicated by an acute varicothrombophlebitis. To Group II (control) were included 20 patients, suffering CHVI in a decompensation stage without thrombotic complications. Results. The indices of hemostasis of the regional blood flow of Group I and Group II differ significantly more, than the hemostasis indices of the central blood flow. Conclusion. The changes in hemostasis in patients, suffering an acute varicothrombophlebitis, are predominantly of a local character.

scholarly journals Peculiarities of treatment and healing of trophic ulcers of the lower extremities of the mixed genesis

2019 ◽  
Vol 86 (7) ◽  
pp. 36-41
Author(s):  
V. I. Liakhovskyi ◽  
O. M. Bezkorovaynyy ◽  
A. V. Sydorenko
Keyword(s):  
Blood Supply ◽  
Comparison Group ◽  
Healing Process ◽  
Local Treatment ◽  
Lower Extremities ◽  
Main Group ◽  
Local Temperature ◽  
Group I ◽  
Group Ii ◽  
The Impact

Objective. To study the impact of sulodexide on the healing process of trophic ulcers of the mixed genesis in the lower extremities. Materials and methods. Analysis of the medical cards data was done for 105 patients, who in 2015 - 2019 yrs have had treated the trophic ulcers of the mixed genesis of the ankles in Department of Vascular Surgery of the Poltava Regional Clinical Hospital. The causes of development of trophic ulcers were confirmed by data of ultrasonographic color angioscanning of the lower extremities and pelvis with measurement of the ankle-brachial pressure index and arteriography. All the patients did not accepted the proposal for performing of correcting and restoration surgical treatment on the lower extremities vessels. Depending on the treatment prescribed the patients were divided into two groups. Into the Group I (comparative) 53 (50.5%) patients were included, who obtained a casual conservative treatment, directed to improvement of the lower extremities blood supply, as well as the blood rheological properties, which included venotonic, analgesic, antibacterial preparations and local treatment, depending on the wound process stage. Into the Group II (the main) 52 (49.5%) patients were included, who on the background of typical treatment have obtained sulodexide in a dose 600 LU (lipoproteidlipase units) on 200 ml of physiological solution of sodium chloride up to 15 days long with subsequent therapy in the dose of 1 capsule twice a day (500 LU) during up to 60 days. In the Group I there were 32 (60.4%) men and 21 (39.6%) women, and in the Group II – 30 (57.7%) men and 22 (42.3%) women. Average age of patients in the Group I have constituted (65.8 ± 4.38), and in the Group II – (66.2 ± 5.04) yrs old. The pain intensity in accordance to the ten-point numerical rating scale was checked before the treatment beginning, in 7 and 14 - 15 days, the trophic ulcers square was measured, local temperature of the patient’s body, pН-metry and cytological investigations of the wounds exudate were done in all the patients before the treatment. Besides this, 38 (71.7%) patients of the comparison group and 40 (76.9%) patients of the main group were followed during 90 - 120 days after leaving a stationary. Results. In the patients, who have obtained sulodexide additionally, reparative processes in the trophic ulcers regions of the lower extremities have become accelerated, the pain syndrome have been lowered rapidly, the water index normalized, the blood supply improved, the ankle-brachial index enhanced, a local temperature raised, cytological picture of the wound exudate improved, what promoted more rapid healing of ulcers and reduction of the stationary stay duration. During the planned visits of the patients in 90 - 120 days a complete healing of trophic ulcers of the lower extremities in 31 (77.5%) patients of the main group and in 24 (63.2%) patients of the comparison group was proved. Conclusion. Application of sulodexide in the treatment dosage is expedient to include into complex of treatment for trophic ulcers of the mixed origin in the lower extremities.

scholarly journals Relapse of varicose veins of lower extremities

2018 ◽  
Vol 11 (3) ◽  
pp. 183-185
Author(s):  
Galina Viktorovna Yarovenko ◽  
Alexey Vitalievich Fesun
Keyword(s):  
Varicose Veins ◽  
Statistical Significance ◽  
Young Patients ◽  
Lower Extremities ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Group I ◽  
Venous Diseases ◽  
Varicose Disease ◽  
Group Ii

According to modern data, there are no signs of chronic venous disease in only 15.9% of people. Observing the clinical data of recent years, there is a tendency to increase the number of people with venous diseases and, unfortunately, the number of young patients is increasing (there are data that schoolchildren of the senior classes have signs of varicose transformation in 10-15%). Polymorphism of matrix metalloproteinase-12 is a key link in the pathogenesis of varicose veins.We conducted surveys of 50 patients. The average age is 43.7 ± 15.9 years, of them women 32, men 18 people. All patients with the class C2-C6 varicose veins (CEAP-classifier) ​​were divided into two groups by the method of serial sampling: group I (n = 20) - with relapse of varicose veins; Group II (n = 30) - patients treated with varicose disease for the first time. The only exception was patients with deferred vein thrombosis. Ultrasound diagnosis of the main veins of the lower extremities and genomic analysis of blood samples of patients was used.The obtained results confirm that in patients of the I group the MMP-12 gene occurs in 80% of cases (homo- and heterozygous variation), whereas in group II only in 33.3% of cases. The Pearson consensus criterion is 10.4 (the critical value of the criterion is 6.63). The significance level of this relationship corresponds to p <0.01. The statistical significance of the frequency of recurrence of varicose disease and the MMP-12 gene was established using the Spearman rank correlation coefficient, which is equal to 1,000 (criterion value is 0.398). Dependence of signs is statistically significant, with p <0.05

scholarly journals Choice of the method of surgical treatment for ectasias of saphenofemoral and saphenopopliteal junctions

2019 ◽  
Vol 86 (10) ◽  
pp. 33-37
Author(s):  
O. V. Sokolov
Keyword(s):  
Surgical Treatment ◽  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Lower Extremities ◽  
Recurrence Rates ◽  
Endovenous Laser Ablation ◽  
The Third ◽  
Varicose Disease

Objective. Analysis of results of radiofrequency laser ablation and crossectomy with stripping in patients, suffering varicose disease of the lower extremities veins in ectasias, sizing more than 14 mm in saphenofemoral and saphenopopliteal junctions. Materials and methods. Analysis of the treatment results was conducted for 66 patients, among whom there were 46 women. Average age of the patients have constituted 54.7 yrs. The patients were divided into three groups: the first - 22 patients, in whom crossectomy with stripping was accomplished, the second - 21 patients, in whom endovenous laser ablation was done, and the third - 23 patients, in whom radiofrequency ablation was performed. Level of the pain intensity was estimated during 7 days, dynamics of severity of chronic venous insufficiency, presence of complications and recurrences half a year postoperatively. Results. Severity of chronic venous insufficiency have reduced in 6 mo in all the groups under the influence of treatment: in the first group - by 63.8%, in second - by 50.1%, in the third - by 65.3%. The most reduction of the pain level (by 50%) on the second day postoperatively were registered in patients of the third group. Half a year before a recurrence in the first group have occurred in 4 (18.2%) patients, in the second - in 3 (14.3%), and in the third - in 1 (4.3%) patients. Conclusion. The selected methods of surgical treatment for varicose disease of the lower extremities are effective. In presence of ectasias of saphenofemoral and saphenopopliteal junctions the morbidity and recurrence rates were lowered, the pain indices reduced after the radiofrequency ablation application, comparing with endovenous laser ablation and crossectomy with stripping.

scholarly journals Impact of hemodialysis on the wellbeing of chronic kidney diseases patients: a pre-post analysis

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Um-e-Kalsoom ◽  
Sabiha Khan ◽  
Israr Ahmad
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Perceived Social Support ◽  
Kidney Diseases ◽  
Chronic Kidney Diseases ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
The Impact

Abstract Background Hemodialysis may have serious psychological impact upon patients suffering from chronic kidney diseases. The aim of the present study is to investigate the impact of hemodialysis on the wellbeing of individuals with chronic kidney diseases (CKD). Result A sample consists of (N = 100) CKD patients referred from neurology ward of Leady Reading Hospital Peshawar. Data was collected from both male (50%) and female (50%) in 2017. Participants were divided into two groups on the basis of pre-set criteria. In group I, individuals with 4–5 stage of CKD referred first time for dialysis treatment were recruited. Group II comprised of CKD patients with 1–3 stage. Demographic data sheet, Pakistan Anxiety and Depression, WHO Quality of Life scale, and Perceived Social support scale (PSS) were used to test the hypotheses. Paired sample t test was use to see the difference between pre- and post-analysis of depression, anxiety, QOL, and PSS in group I (experimental group). Results suggests significant difference on depression (p > .001), anxiety (p > .001), and QOL (p > .001), while no significant difference was reported on perceived social support (p <.673). Findings also indicate no significant difference between group I and group II on QOL depression, anxiety, and PSS. Conclusion The findings concluded that patients under hemodialysis treatment suffered from depression, anxiety, and poor quality of life.

scholarly journals The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding

2018 ◽  
Vol 90 (1) ◽  
pp. 15
Author(s):  
Ercan Ogreden ◽  
Ural Oguz ◽  
Erhan Demirelli ◽  
Erdal Benli ◽  
Özkan Özen
Keyword(s):  
Ureteral Stone ◽  
Ureteral Stones ◽  
Stent Insertion ◽  
Female Ratio ◽  
Group I ◽  
Dj Stent ◽  
Group Ii ◽  
Fat Stranding ◽  
The Impact ◽  
Perirenal Fat

Objective: To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS) in patients with perirenal fat stranding (PFS) due to ureteral stones. Material and methods: Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ) stent insertion following semirigid URS were classified as Group I (n: 52), while those who underwent stent insertion were classified as Group II (n: 20). Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs) and urosepsis rates were compared in the two groups. Results: The average age of the patients was 44.4 (20-71) years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05). Fever occurred in 23 cases (44.2%) in Group I and in 15 cases (75%) in Group II (p = 0.038). UTIs occurred in 15 cases (28.9%) in Group I and in 12 cases (60%) in Group II (p = 0.03). Urosepsis presented in 3 (5.8%) and 5 (25%) of the patients in Group I and II, respectively (p = 0.033). Conclusions: According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications.

Psychosocial profile of encopretic children and their caregivers in relation to parenting style

2016 ◽  
Vol 33 (S1) ◽  
pp. S362-S362 ◽  
Author(s):  
E. Zaky ◽  
M. Rashad ◽  
H. Elsafoury ◽  
E. Ismail
Keyword(s):  
Parenting Style ◽  
Parenting Styles ◽  
Healthy Controls ◽  
Psychosocial Profile ◽  
Group I ◽  
Egyptian Children ◽  
Paternal Anxiety ◽  
Group Ii ◽  
Anxiety Depression ◽  
The Impact

BackgroundThe role of psychological factors in the development and maintenance of encopresis is controversial.ObjectivesAssessment of the psychosocial profile of encopretic children and their caregivers in relation to parenting style compared to controls.MethodologyThe current cross sectional study comprised 90 Egyptian children classified into three groups: group I (encopresis without constipation and overflow incontinence), group II (encopresis with constipation and overflow incontinence), and group III (clinically healthy controls); each group included 30 children. Thorough clinical evaluation and psychometric assessment were carried out for all enrolled children while caregivers were evaluated for their parenting styles, anxiety, depression, and introversion scores.ResultsHardness, undue blaming, and indecisive parenting styles were significantly more prevalent among caregivers of group I. Encopretic children of group I & II had poorer self-esteem and higher prevalence of clinically manifest depression compared to healthy controls. Furthermore, there was a higher prevalence of clinically manifest paternal anxiety, depression, and introversion and maternal depression among caregivers of group II and higher prevalence of clinically manifest paternal anxiety and depression among fathers of group I.ConclusionThe approach of toilet training, not the time of its initiation, seems to be the factor that really matters in predisposing to and perpetuating encopresis. Further exploration is needed to determine if the documented association of psychological disorders of enrolled encopretic children and their caregivers was causal or being just the impact of the child's encopresis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Estimation of quality of life after operative treatment for venous trophic ulcers of the lower extremities

2020 ◽  
Vol 87 (7-8) ◽  
pp. 33-37
Author(s):  
V. І. Liakhovskyi ◽  
R. М. Riabushko ◽  
А. V. Sydorenko
Keyword(s):  
Quality Of Life ◽  
Lower Extremities ◽  
Well Being ◽  
Operative Intervention ◽  
Group I ◽  
Subjective Estimation ◽  
Standard Set ◽  
Group Ii ◽  
Arteries And Veins

Objective. To study the patients’ quality of life after operative interventions, performed for venous trophic ulcers of the lower extremities. Маterials and methods. Analysis of data from 82 hospital cards of stationary patients was conducted. The patients were treated during 2010 - 2017 yrs in the Department of Vascular Surgery of Poltava Regional Clinical Hospital named after М. V. Sklifosovskyi for venous trophic ulcers of the lower extremities (Class С5 in accordance to Clinical-Etiological-Anatomical-Pathophysiological classification - СЕАР). The cause of trophic ulcers occurrence in all the patients was confirmed, using ultrasound duplex scanning of pelvic and the lower extremities arteries and veins. After conduction of certain conservative therapy the operative intervention, directed on elimination of the occurrence cause of trophic ulcers, was done. In all the patients the conduction of endovenous thermal ablations was not indicated, taking into account the anatomic peculiarities presented. Depending on the methods of operative interventions performed, the patients were distributed into two groups: Group I - 48 (58.5%) patients, surgical treatment of whom consisted of typical conventional open operative interventions, using a standard set of instruments, while Group II - 34 (41.5%) patients, to whom operative interventions were done, using elaborated own gadgets for the wounds edges opening, dissection and ligation of perforant and large subcutaneous veins, nontraumatic suturing of postoperative wounds. All operative interventions in the Group II patients were performed, using ultrasonographic support. In patients of both Groups a subjective estimation of quality of life was conducted, using questionnaire CIVIQ (Chronic Insufficiency Venous International Questions) for interviewing preoperatively and in 1, 3 and 6 mo postoperatively. Results. In accordance to data obtained, in patients of Group II the score in points of quality of life was higher, because in them the ulcers have healed faster, the pain sensation reduced, resulting in the psycho-emotional state improvement. Besides this, 29 (85.3%) patients of Group II have noted, that even while some symptoms persisted, their subjective signs reduced, leading to the well-being improvement. The conduction of treatment in accordance to own procedures proposed have promoted the raising of the quality of life score in patients, suffering trophic ulcers of the lower extremities. Conclusion. Application of gadgets of own elaboration during operative intervention on venous system of the lower extremities accelerates its performance and reduces traumaticity. This leads to reduction of the pain sensitivity intensity, raising of subjective estimation of quality of life in remote postoperative period.

scholarly journals Diagnostic possibilities of thermal vision study of trophic ulcers

2020 ◽  
Vol 19 (2) ◽  
pp. 38-42
Author(s):  
G. V. Yarovenko
Keyword(s):  
Conservative Treatment ◽  
Chronic Venous Insufficiency ◽  
Infrared Radiation ◽  
Venous Insufficiency ◽  
Soft Tissues ◽  
Scattered Light ◽  
Life Quality ◽  
Lower Extremities ◽  
Imaging Method ◽  
Thermal Imager

Chronic venous insufficiency is often accompanied by trophic changes in soft tissues. The treatment of such patients is long and often, ineffective. Relapse of a trophic ulcer is about 30% and leads to deterioration of life quality and dissatisfaction with conservative and even surgical treatment. Goal. Objectification of changes in the microvasculature and compensatory the possibilities of collateral circulation in the lower extremities with complicated forms of chronic venous insufficiency. Materials and methods. The studies were carried out on the Linsor installation characterizing the biological tissue by the change of scattered light intensity and on the thermal imager making possible to determine the temperature of a point with an accuracy of 0,001 degrees, followed by software image processing. The examination was performed 3-4 times in the dynamics of the treatment process and before the patient discharge, from a standard distance of 1,5 meters. The soft tissues in 23 patients with chronic venous insufficiency of the lower extremities and the presence of open trophic ulcers was studied. There were 21 women, 2 men, the average age was 45,2±3,6 years. The area of the ulcer defect varied from 5,7 cm² to 15,3 cm². Patients with extensive trophic ulcers (circular) were excluded from the examination, because of absence of ulcer defect epithelization during the period of hospitalization and its visualization by the thermographic method. Results. As a result of the study, we obtained a reduced intensity of infrared radiation of the ulcer surface in all patients. To clearly isolate ulcerative defect from the surrounding tissues, we set the temperature range 35,0–37,5 °C and recalculated the resulting area in cm² (conversion factor 22,73). We studied the microcirculatory changes occurring in the trophic ulcer and surrounding tissues, confirming the need to continue conservative treatment after complete ulcer defect epithelization for at least 7 days, and only after that period the normalized level of infrared radiation was detected and subsequently relapsed trophic ulcers did not occur for a long time. Conclusion. Based on the obtained data, we confirmed the thermal imaging method sensitivity is suitable for assess of microcirculation in the trophic ulcer area; the method provides the possibility to apply it for the dynamics of conservative treatment in patients with complicated forms of chronic venous insufficiency.

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