scholarly journals Effectiveness of Perioperative Local Use of Anesthetics and Antiseptics in Patients with Purulent-necrotic Lesions of Lower Extremities in Diabetes Mellitus

2021 ◽  
pp. 356-364
Author(s):  
Yuliana Babina ◽  
Dmytro Dmyrtriiev ◽  
Oleksandr Nazarchuk ◽  
Pavlo Hormash ◽  
Serhii Vernyhorodskyi
Keyword(s):  
Diabetes Mellitus ◽  
Comparison Group ◽  
Local Treatment ◽  
Lower Extremities ◽  
Perioperative Period ◽  
Histological Structure ◽  
Morphological Examination ◽  
Healing Of Wounds ◽  
Local Use ◽  
Infiltration Anesthesia

Background: Every second patient with the diabetes mellitus (DM) needs surgery due to purulent-necrotic changes in the feet. The aim of the study was comparative morphological examination of the course of the wound process in purulent-necrotic lesions of the lower extremities of patients with DM with different approaches to local treatment in the perioperative period. Materials and Methods: We investigated changes in the histological structure and the nature of the reactions of skin tissues, muscles and fascia during the healing of an ulcer in patients with the diabetes mellitus after various types of local treatment. Then the specimens were photographed and analyzed using the OLIMPUS BX 41 light microscope. Results: In the first comparison group, which used standard anesthesia techniques and locally antiseptic povidon-iodine - granulation tissue was characterized by the complete absence of fibrous structures and the presence of a small number of small-sized neoplastic vessels with swollen endothelium. And in patients of the II observation group who received locally decamethoxin and infiltration anesthesia with a 2% solution of lidocaine after surgery during the study of histological preparations of the affected tissues, a significant decrease in signs of pathological vascular reaction was established compared with the comparison group. Conclusions: In group 1 (control) healing of wounds on the third-seventh day is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic decamethoxin.

scholarly journals Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

2021 ◽  
Vol 27 (3) ◽  
pp. 22-28
Author(s):  
Yu.M. Babina ◽  
D.V. Dmyrtriiev ◽  
O.A. Nazarchuk ◽  
P.P. Hormash
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Povidone Iodine ◽  
Local Treatment ◽  
Lower Extremities ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

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 Clinical-functional and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome using programmable sanitation technologies

2021 ◽  
Vol 5 (3) ◽  
pp. 260-275
Author(s):  
Vladimir A. Sergeev ◽  
Alexander A. Glukhov ◽  
Alexander S. Sorokin ◽  
Sergey A. Zhuchkov ◽  
Alexander V. Gorokhov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Diabetic Foot ◽  
Comparison Group ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Morphological Parameters ◽  
Supporting Function ◽  
Fold Reduction

Diabetes mellitus is currently characterised by a high progressive prevalence of patients. The purpose of this study is to evaluate the clinical, functional, and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome (DFS) using programmable sanitation technologies. The patients were randomised into two groups. In the comparison group (n=51), patients received conventional local treatment after surgery. In the main group (n=55), after surgical treatment, the wound was sutured, and in the postsurgical period, programmable sanitation was conducted using the AMP-01 device. The cytological smears of the main group identified a higher rate of cellular reactions in the wound. There was a 1.3-fold reduction in the duration of hospitalisation, the number of purulent complications was significantly less (p=0.014). It was possible to preserve the supporting function of the foot in patients of the main group in a larger percentage of cases (p=0.023). There was a statistically significant increase in the frequency of high amputations in the comparison group (p=0.026). As a result, the effectiveness of the use of programmable sanitation technologies for purulent lesions of the diabetic foot has been proven.

scholarly journals Phototherapy in complex treatment of wounds in patients with ischemic and neuroischemic form of diabetic syndrome

2018 ◽  
Keyword(s):  
Wound Healing ◽  
Growth Factor ◽  
Diabetic Foot ◽  
Comparison Group ◽  
Local Treatment ◽  
Lower Extremities ◽  
Bone Defects ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Algorithm Analysis

The aim of the study was to improve results of wound healing in patients with ischemic and neuroischemic forms of diabetic foot syndrome by using a combination of phototherapy, platelet-derived growth factor and modern cover materials The results of surgical treatment of 48 patients with ischemic and neuroischemic diabetic foot syndrome, which were divided into main group (24 patients) and comparison group (24 patients). All these patients who underwent treatment in the Department of acute vascular diseases in the Clinic of the SI “Institute of General and Urgent Surgery named after V.T. Zaitsev of the National Academy of Sciences of Ukraine” suffered from diabetes mellitus type II and had IV degree of foot ischemia according to Fontaine. The diagnostic was performed for all patients according to a standard algorithm. Analysis of the results of clinical, laboratory, non-invasive and invasive methods of examination in the preoperative period enabled to determine the degree of disorder in blood flow, the nature of collateral circulation and microcirculation. Patients of both groups underwent femoro-tibial and femoro-popliteal bypass, as well as hybrid reconstructions. The parameters of regional hemodynamics in patients of main group and the comparison group before and after revascularization were comparable. The patients of main group used the treatment technology developed by us. In cases of development of phlegmons of the foot after the opening of the abscess, vacuum therapy was performed for 7–14 days until the wound was completely cleaned. In the preoperative preparation complex, phototherapy was performed, according to local situation, wounds were irradiated with different wavelengths (405, 470 or 525 nm). After the wounds were cleaned, the wound defect was covered with PCL coating (Nanopharma, Czech Republic) with the application of a fibrin clot and platelet-rich plasma without fibrin, after which further local treatment was accompanied by irradiation of wounds with A. Korobov-V. Korobov photon matrices “Barva-Flex” (the wavelength of the maximum of the emission band of 660 nm). In two cases, the closure of bone defects with ILAYAOSTEOGEN® “A.A. PARTNERS” L.L.C. bone implants of medical company “ilaya” was used. Using these tactics, allow to achieve complete wound healing in 91.7% of patients and partial healing (more than 50%) in 8.3% of patients in main group. The terms of treatment of these patients did not exceed 2 months, high amputations were not required. In patients of comparison group against the background of traditional local treatment, the wounds healed within 2–4 months; in eight cases, repeated hospitalization was required to perform a plastic closure; in two cases amputation was performed below the knee. Thus, phototherapy and plastic closure of wounds of the lower extremities after revascularization in isch- emic diabetic foot syndrome is indicated in cases where the wounds have no tendency to spontaneous healing; introduction of the developed tactics of treatment of “problem” wounds of the lower extremities allowed to achieve complete healing in 91.7% of patients, partial (more than 50%) healing in 8.3% of patients and avoid high amputations; the use of a complex of treatment including phototherapy, wound closure with a synthetic coating with platelet growth factor, and the closure of bone defects with implants is an extremely effective stim- ulator of development in the wound of granulation tissue suitable for further autodermoplasty

The experience of using a diode laser in the herpes labial treatment

2020 ◽  
Vol 25 (1) ◽  
pp. 43-46
Author(s):  
S. L. Blashkova ◽  
E. V. Krikun ◽  
Yu. V. Fazylova ◽  
Yu. V. Blashkova
Keyword(s):  
Oral Cavity ◽  
Diode Laser ◽  
Comparison Group ◽  
Treatment Time ◽  
Local Treatment ◽  
Allergic Reactions ◽  
High Prevalence ◽  
Dental Diseases ◽  
Simplex Virus

Relevance. The relevance of the problem is in the high prevalence of the herpes simplex virus. According to WHO, nearly 90% of the population are carriers. Relapses can occur several times a year, which leads to disability and impairs the quality of life. Currently, there are a large number of drugs for general and local treatment. However, they are toxic and can cause allergic reactions. In recent years, a large number of studies have been devoted to the use of lasers in the treatment of dental diseases. Therefore, the question of the use of a laser in the treatment of herpetic lesions of the oral cavity remains relevant.Purpose. The research purpose was to determine the effectiveness of the use of a diode laser in the treatment of herpetic lesions of the lips.Materials and methods. We conducted a comparative assessment of the effectiveness of the use of a diode laser in monotherapy of herpetic lip lesions in 18 patients. The comparison group consisted of 18 patients, in the local treatment of which antiviral ointments were used.Results. The results of the study showed that the use of a diode laser can reduce treatment time, accelerate the epithelization of foci.Conclusion. The results of our study allow us to recommend the use of a diode laser in the complex treatment of herpetic lesions of the oral cavity.

Experience of using atraumatic ointment bandages based on peruvian balsam in the complex treatment of patients with chronic wound defects of the lower limbs

2020 ◽  
pp. 43-57
Author(s):  
Anna Tabuika
Keyword(s):  
Diabetes Mellitus ◽  
Staphylococcus Aureus ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Local Treatment ◽  
Lower Limbs ◽  
Complex Treatment ◽  
Average Area ◽  
Arterial Insufficiency ◽  
Significant Activation

The article reflects the results of a retrospective non-comparative study, the objects of which were 34 outpatient comorbid patients (15 of which are over 60 years old) with chronic wounds of the lower limbs developed against the background of varicosity, post-thrombotic disease, chronic arterial insufficiency of the lower limbs, diabetes mellitus or their combination. Their local treatment was carried out using atraumatic ointment dressing «Branolind N» containing Peruvian balsam. There were 23 women (67.6 %) and 11 men (32.4 %). In microbiological study prior to the beginning of treatment in 31 patients the growth of a pathogen of wound infection was revealed; in 19 patients — Staphylococcus aureus in monoculture and in various associations, in 6 patients — Pseudomonas aeruginosa in monoculture, in other cases — other pathogens. In 3 patients the pathogen was not detected. The average wound size was 34 cm2 . The phase of the wound process was additionally confirmed by cytological studies. After treatment the average area of the wound defect decreased by 10 cm2 and made 24 cm2 on average. Full healing of the wound defect occurred in 11 patients, the others had granulation and active marginal epithelization. There was also a decrease in bacterial semination of wounds, a change in composition of infection agents to less aggressive monoflora, and cytologically — a decrease in signs of inflammation against the background of significant activation of reparative processes.

STUDY ON THE CHARACTERISTICS OF DOPPLER ULTRASOUND OF LOWER EXTREMITY ARTERIES IN PATIENTS WITH DIABETES MELLITUS TYPE 2

2011 ◽  
pp. 25-30
Author(s):  
Keyword(s):  
Diabetes Mellitus ◽  
Doppler Ultrasound ◽  
Lower Extremities ◽  
Arterial Stenosis ◽  
Invasive Technique ◽  
Atherosclerotic Plaques ◽  
Type 2 Dm ◽  
Arterial Lesions ◽  
Patients With Diabetes

Objectives: Vascular Doppler ultrasound is a non-invasive technique to rapidly detect lesions of the vessels in the lower extremities with high accuracy. The use of this technique for detecting early vascular damages in patients with diabetes mellitus (DM) type 2 could help preventing major vascular complications caused by this disease. Materials and Method: This descriptive, cross-sectional study included 31 patients with type 2 DM who were treated in Endocrinology - Neurology - Respiratory Department, Hue Central Hospital between March and August 2011. All patients were undergone clinical and biochemical examinations, and Doppler ultrasound for detection of arterial lesions in their lower extremities. Results: Most patients had high intima media thickness (IMT) (77.42%), and all of them suffered from hypertension concomitant, with the rate of atherosclerotic plaque accounted for 35.48%. No one experienced arterial stenosis >50% and arterial occlusions, but the peak systolic velocities were significantly higher in patients with atherosclerotic plaques than those without atherosclerotic plaques. Conclusion: Vascular Doppler ultrasound should be used as routine test for early detection of arterial lesions in patients with type 2 DM.

The Diabetic Surgical Patient

2020 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

scholarly journals Features of the histological structure of the placenta in women with recurrent miscarriage depending on polymorphic variants of the metalloproteinase and hemostasis systems

2020 ◽  
Vol 17 (2) ◽  
pp. 158-169
Author(s):  
T. N. Grinevich ◽  
S. A. Lyalikov ◽  
V. A. Basinsky ◽  
T. T. Shtabinskaya ◽  
C. M. Butolina ◽  
...  
Keyword(s):  
Comparison Group ◽  
Recurrent Miscarriage ◽  
Morphological Characteristics ◽  
Reproductive Function ◽  
Placental Tissue ◽  
Histological Structure ◽  
Chorionic Villi ◽  
Intervillous Space ◽  
Reproductive Losses ◽  
Polymorphic Variants

The article is devoted to the analysis of the morphological characteristics of placental tissue in women with early reproductive losses with recurrent miscarriage, depending on the presence of polymorphic variants of metalloproteinases and hemostasis. It was established that in women with recurrent miscarriage, the area of the trophoblast of the placenta is significantly larger (р < 0.003), the area of the chorionic villi is smaller (р < 0.04) than in the group of women with implemented reproductive function. Thrombosis of the chorionic vessels, necrosis and calcinates in the placenta with PNF were detected in 80.0 % (р = 0.001), 93.3 % (р = 0.001), and 30.0 % (р = 0.049) of cases, respectively, which is significantly higher than in the comparison group. In patients with PNP with the T/T genotype of the 735 C/T polymorphism of the MMP-2 gene, the trophoblast area is significant (р < 0.05) more than with the C/C genotype, acute full-back (р = 0.02) and intervillous hemorrhage (р = 0.02). In women with the C/T genotype of the polymorphism 735 C/T of the MMP-2 gene, edema and dystrophic changes in the chorionic villi, placental necrosis are determined more often (р = 0.02) than with the C/C genotype. In carriers of the T allele of the polymorphism 735 C/T of the MMP-2 gene in the placenta, necrosis is significantly more common than in the CC genotype; the carriage of the T allele is also associated with large values of the relative area of the trophoblast and the stromal-intervillous relation, as well as with a smaller value of the ratio of the intervillous space area to the total area of the photograph.

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