INTENSIFICATION OF COMBINED THERAPY IN PATIENTS WITH FOOT PHLEGMON

2019 ◽  
pp. 28-33 ◽  
Author(s):  
A.V. Edilov ◽  
V.K. Tat'yanchenko ◽  
V.L. Bogdanov ◽  
Yu.V. Sukhaya
Keyword(s):  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Clinical Laboratory ◽  
Combined Therapy ◽  
Diagnostic Algorithm ◽  
High Strength ◽  
Diagnosis And Treatment ◽  
Efficacy Evaluation ◽  
Tissue Pressure ◽  
Group I

The purpose of the work is to improve surgical treatment of foot phlegmon by developing a method for diagnosis and treatment of compartment syndrome (CS). Materials and Methods. The study involved 64 patients with foot phlegmon of non-diabetic etiology. The patients were divided into two groups. Group I (control, n=31) suggested traditional treatment techniques. Group II (main, n=33) provided a new algorithm for the diagnosis and treatment of compartment syndrome (patent No. 2683855), along with ultrasonic cavitation and ozone therapy. To assess the severity of the purulent-inflammatory process in the foot, the authors suggested to include a tissue pressure measurement technique in the diagnostic algorithm. The obtained indicators contributed to the diagnosis of the compartment syndrome and, thus, administration of decompressive fasciotomy in fascial foot structures with a high strength level and elastic modulus. The authors also evaluated the degree of reparative processes in the postoperative wound and the level of its microbial contamination (CFU calculation). Results. It was estimated that the increase in tissue pressure by more than 25 mm Hg in 87.9 % of patients is an indication for a know-how decompressive fasciotomy. The obtained results of clinical, laboratory and instrumental research allowed the authors to develop an algorithm for treatment efficacy evaluation. Conclusion. The positive treatment results observed in 90.9 % of patients make it possible to recommend the developed algorithm for implementation in clinical practice. Keywords: phlegmon, tissue pressure, surgical treatment, fasciotomy. Цель работы – улучшение результатов хирургического лечения флегмоны стопы путем разработки способа диагностики и лечения компартмент-синдрома (КС). Материалы и методы. В исследовании участвовали 64 пациента с флегмоной стопы недиабетической этиологии, разделенных на две группы. В I группе (контрольной, n=31) использовалась традиционная методика лечения, во II группе (основной, n=33) – разработанный алгоритм диагностики и лечения компартмент-синдрома (патент на изобретение № 2683855), а также методы ультразвуковой кавитации и озонотерапии. Для оценки тяжести течения гнойно-воспалительного процесса в области стопы было предложено включить в диагностический алгоритм методику измерения тканевого давления. Полученные показатели послужили основанием для диагностики компартмент-синдрома и выполнения по показаниям декомпрессивной фасциотомии в области фасциальных структур стопы, обладающих высокими уровнем прочности и модулем упругости. Также оценивались степень репаративных процессов в послеоперационной ране и уровень ее микробной обсемененности по значению КОЕ. Результаты. Установлено, что увеличение тканевого давления более чем на 25 мм рт. ст. у 87,9 % пациентов является показанием для выполнения декомпрессивной фасциотомии по оригинальной методике. Полученные результаты клинических, лабораторных и инструментальных методов исследования позволили выработать алгоритм оценки эффективности лечения. Выводы. Отмеченные у 90,9 % пациентов хорошие результаты лечения дают возможность рекомендовать разработанный алгоритм для внедрения в клиническую практику. Ключевые слова: флегмона, тканевое давление, хирургическое лечение, фасциотомия.

scholarly journals Study on the Usefulness of APR Scores from the Viewpoint of Proinflammatory Cytokines

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
T. Nakamura ◽  
D. Hatanaka ◽  
T. Yoshioka ◽  
S. Yamada ◽  
H. Goto
Keyword(s):  
Inflammatory Response ◽  
Proinflammatory Cytokines ◽  
Proinflammatory Cytokine ◽  
Clinical Laboratory ◽  
Diagnosis And Treatment ◽  
Antibiotic Administration ◽  
Acute Phase Reactants ◽  
Group I ◽  
Cytokine Levels ◽  
Fetal Inflammatory Response

Background. Delayed diagnosis and treatment of newborn infection adversely impact outcomes. Clinical laboratory parameters have aimed to obtain the most correct and prompt diagnosis and treatment of this disease. This study simultaneously observed changes over time in APR as well as proinflammatory cytokines and anti-proinflammatory cytokines and aims to clarify usefulness of APR scores.Methods. We evaluated the usefulness of acute phase reactants (APR) in 46 newborns whose serum up to age 7 days had been stored, with comparison of three types (Group I: infection 15, Group F: fetal inflammatory response syndrome 17, and Group C: control 14) of APR-based scores, those of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), and haptoglobin (Hp), with proinflammatory cytokine levels. APR scores for CRP, AGP, and Hp and the levels of the proinflammatory cytokines IL-1β, IL-6, IL-8, IL-10, and TNFαwere determined.Results. The cytokine levels started to increase from age 0 days and then decreased rapidly. The three APR scores, CRP, AG, and Hp, were elevated at age 0 days and then gradually decreased in infection (Group I) and fetal inflammatory response syndrome (Group F). The duration of antibiotic administration according to APR scores was significantly shorter in Group F than in Group I.Conclusion. This study demonstrated APR scores to be more useful for deciding whether antibiotics should be discontinued than proinflammatory cytokine levels.

scholarly journals EXPERIMENTAL STUDY OF CLINICAL INDICATORS OF INTRATISSUE PRESSURE IN DEEP CIRCULAR BURNS AND ITS DYNAMICS DEPENDING ON THE NATURE AND VOLUME OF SURGERY

2021 ◽  
pp. 22-26
Author(s):  
O. V. Kravtsov ◽  
T. A. Kurbanov ◽  
Yu. I. Kozin
Keyword(s):  
Experimental Study ◽  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Surgical Intervention ◽  
Radical Excision ◽  
Tissue Pressure ◽  
Clinical Indicators ◽  
Experimental Animals ◽  
Rapid Decompression ◽  
Surgical Tactics

The purpose of research. To improve in the experiment the optimal variants of surgical tactics to eliminate the phenomena of compartment syndrome in circular deep burns on the basis of studying the dynamics of intratissue pressure. Materials and methods. An experiment to study the effectiveness of treatment of deep circular burns of III degree, accompanied by compartment-syndrome with objectification of intra-tissue pressure was performed on 18 male WAG rats weighing 190.0-200.0 g, which were divided into three groups depending from the nature and scope of surgery. Research results and their discussion. Based on the assessment of the dependence of the level of intratissue pressure in the tissues on the timing of modeling of deep circular burns in the experiment and tactics and volume of surgical treatment, a clear dependence of indicators in all groups of experimental animals. The primary necrectomy performed in the III main group due to the radical surgical intervention allowed to completely normalize the intratissue pressure within 24 hours. Conclusions. 1. Clinical indicators of intratissue pressure at deep circular burns depending on time of modeling of a thermal trauma and character and volume of surgical intervention are defined in experiment. 2. It is established that primary necrectomy due to radical excision of necrotized tissues and rapid decompression contributes to the nor malization of intratissue pressure.

Modern aspects of pathogenetic endometriosis therapy

2017 ◽  
pp. 101-108
Author(s):  
O.V. Grishchenko ◽  
◽  
V.V. Bobrytska ◽  
O.L. Chernyak ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Rating Scale ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Abnormal Uterine Bleeding ◽  
Pain Scale ◽  
Uterine Bleeding ◽  
Emotional Status ◽  
Group I ◽  
Group Ii

The objective: to optimize treatment of endometriosis using a combined hormonal Luvyna medicine. Materials and methods. The study included 50 patients 22-36 years old with a diagnosis of endometriosis. In line with the patient’s therapy are divided into groups: I group (n = 25) received the Luvyna on a continuous 63/7 scheme, then 3 months in scheme 21/7; group II (n = 25) after surgical treatment of endometriosis (gistero-, laparoscopy) also received the medicine in a similar way. The mode of menstrual function disorders, pain on a visual rating scale of pain, psycho-emotional status, concomitant dysfunction of adjacent organs were evaluated. Results. According to the results of therapy established algodismenorei reduction in symptoms I group – 80%, II – 83%, abnormal uterine bleeding I – 96%, II – 100%; the disappearance of heavy uterine bleeding, improving the function of adjacent organs, psycho-emotional status in both groups. Reduced pain on a pain scale from 8±2.0 to 2±0.5 in the group I and from 7±2.5 to 1±1.0 in the group II. Conclusion. Luvina is a highly effective medicine for the treatment of endometriosis, comparable to the combined treatment - surgery, followed by the appointment of combined oral contraceptives. Recommended mode 63/7, followed by a reception 21/7, including after surgical treatment. Key words: endometriosis, Luvyna, conservative therapy, combined therapy.

scholarly journals THE PECULIARITIES OF PERIOPERATIVE CLINICAL CHARACTERISTICS OF PATIENTS WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH HYPOTHYROSIS

2020 ◽  
Vol 1 (1) ◽  
pp. 40-50
Author(s):  
T. Struk ◽  
O. Gordeichuk ◽  
O. Nikitinа ◽  
O. Lytvak
Keyword(s):  
Surgical Treatment ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Reproductive Function ◽  
Surgical Approaches ◽  
Complete Relief ◽  
Surgical Interventions ◽  
Female Patients ◽  
Group I

Purpose: to elucidate the peculiarities of perioperative clinical characteristics of female patients with genital endometriosis associated with hypothyrosis. To attain our object, the following tasks had to be accomplished: to determine the localization of endometrioid heterotopia and severity of endometriosis in patients with hypothyrosis; to study the types of surgical interventions in patients with endometriosis associated with hypothyrosis; to assess the frequency of endometriosis recurrence after surgical treatment in patients with endometriosis associated with hypothyrosis. Material and methods. We examined 100 female patients: 40 patients – with endometriosis associated with hypothyrosis (main group – group I); 60 patients – with endometriosis and without thyroid pathology (group of comparison – group II). We analyzed the results of clinical, laboratory and instrumental examination, including radiological methods (CT-scan, X-ray). The diagnosis in all the patients was based on pathohistological verification. All surgical interventions were performed by the use of endovideosurgical technology.                 Results and discussion. According to the results of patients` examination, we identified the following localization of endometrioid heterotopia and severity of endometriosis:                 Stage I – 38,0 % of patients with ovarian endometrial cysts and adenomiosis;                 Stage II – 27,0 % of patients with peritoneal endometriosis and adenomiosis;                 Stage III – 23,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and urinary tract endometriosis;                 Stage IV – 12,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and retrocervical endometriosis. The 80,0 % of patients underwent organ-preserving procedures, and radical surgery was performed in 20,0 % of cases. We used the following surgical approaches to the endometrial lesions: 56,0 % − combined laparoscopy and hysteroscopy; 42,0 % − transvaginal laparoscopy; and only in 2,0 % of cases – conversion to laparotomy. The frequency of endometriosis recurrence after surgical treatment in patients with hypothyrosis was established: 4,0 % − at 6-month follow-up; 6,0 % − at 9-month follow-up; and 10,0% − at 12-month follow-up. We observed complete relief from the endometriosis symptoms in 80,0 % of patients after the surgical procedure. Additionally, the reproductive function was recovered in 24,0 % of females. Conclusions. The surgical treatment of patients with endometriosis associated with hypothyrosis should be based on the principle of radical removal of endometriotic lesions, particularly through the combined simultaneous procedures in case of advanced extragenital endometriosis. Additionally, several aspects should be taken into account, namely: localization of endometrioid heterotopia and severity of endometriosis; the age of patients and their interest in the preservation of reproductive function; the presence of the highly qualified surgeons (gynecologists, general surgeons, urologists), as well the high level of anesthetic support with thorough postoperative monitoring.

Síndrome da Anca de Ressalto

2018 ◽  
Vol 9 (1) ◽  
pp. 8
Author(s):  
Bernardo Almeida
Keyword(s):  
Surgical Treatment ◽  
Hip Joint ◽  
Scientific Literature ◽  
Therapeutic Targets ◽  
Clinical History ◽  
Disease Diagnosis ◽  
Diagnosis And Treatment ◽  
Snapping Hip ◽  
Predominant Symptom ◽  
Snapping Hip Syndrome

Snapping hip syndrome is a condition in which the predominant symptom is the snapping feelingaround the hip joint caused by a dynamic impingement between muscles or tendons and boneprominences. The etiology of the snapping hip types and consequently the therapeutic targets havebeen subjects of discussion and controversy along the years. A careful clinical history and physicalexamination is frequently enough for this disease diagnosis. Treatment is typically conservative,however when it is not successful surgical treatment is indicated, consisting on the snapping muscleor tendons lengthening. The authors review in this paper the current scientific literature about functionalanatomy, physiopathology, symptoms, diagnosis and treatment of snapping hip.

MORPHOLOGICAL EVALUATION OF EFFECTIVENESS OF NECROFASCIOTOMY AND INFILTRATION WITH OZONATED SALINE AREA OF DEEP CIRCULAR BURN OF SKIN WITH UNDERLYING TISSUES COMPLICATED BY COMPARTMENT SYNDROME

2020 ◽  
pp. 28-33
Author(s):  
Teimur Ahaliievich Kurbanov ◽  
O. V. Kravtsov ◽  
M. S. Myroshnychenko ◽  
Yu. I. Isaev
Keyword(s):  
Compartment Syndrome ◽  
Physiological Solution ◽  
Burn Wound ◽  
Local Pressure ◽  
Tissue Pressure ◽  
Surgical Interventions ◽  
Morphological Evaluation ◽  
General Pathology ◽  
Saline Area ◽  
The One

Compartment syndrome is one of the complications of tissue damage of various origins, the basis of which is the compression of blood vessels and disruption of blood supply to tissues due to an increased local pressure in the closed space of the fascial sheath. The consequences of compartment syndrome can be local and general. An effective treatment of compartment syndrome in burns is to perform a necrotomy, which due to decompression helps to reduce intra−tissue pressure and diminish the scale of necrotic changes in tissues. In order to morphologically evaluate the effectiveness of necrofasciotomy, as well as the one in combination with infiltration of ozonated saline area of deep circular skin burns with underlying tissues, complicated by compartment syndrome, an experimental study was conducted. Circular deep burns, complicated by the formation of compartment syndrome, were simulated in 18 WAG rats. To reduce the pressure in the burned and surrounding tissues, surgical interventions such as necrofasciotomy were performed, which provided a notable reduction in pressure. In parallel, infiltration of damaged tissues with ozonated saline was performed, which was bubbled for 15 minutes at a dissolved ozone concentration of 4.0±0.2 mg / l, which improved microcirculation and reduced tissue hypoxia. The findings indicate that the compartment syndrome is characterized by a significant severity of general pathology. Performance of necrofasciotomy of a burn wound with its infiltration by ozonated physiological solution in comparison with just necrofasciotomy has more positive medical effect, and efficiency of these medical measures increases when they are performed at early terms (day 1) of formation of a burn wound in comparison with late terms (day 3). Key words: burns, surgical treatment, compartment syndrome, histological examinations.

On the diagnosis and treatment of orbital complications of sinusitis

1995 ◽  
Vol 76 (1) ◽  
pp. 31-33
Author(s):  
P. D. Firsov ◽  
A. Y. Dogalyuk ◽  
A. I. Sabirov
Keyword(s):  
Surgical Treatment ◽  
Computer Tomography ◽  
Diagnosis And Treatment ◽  
Orbital Complications ◽  
Endoscopic Methods

It is necessary to use the current possibilities of the diagnosis, namely, the computer tomography and endoscopic methods of the surgical treatment in providing service to patients with orbital complications of sinusitis.

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