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Author(s):  
V. M. Bensman ◽  
A. G. Baryshev ◽  
S. N. Pyatakov ◽  
K. G. Triandafilov ◽  
V. N. Ponomarev ◽  
...  

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.


2021 ◽  
Vol 100 (4) ◽  
pp. 133-140
Author(s):  
I.I. Babich ◽  
◽  
A.A. Pshenichniy ◽  
M.S. Avanesov ◽  
Yu.N. Melnikov ◽  
...  

Objective of the study: to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant trauma by developing a new technique of depressed fracture treatment. Materials and methods of research: from 2015 to 2020 at the Regional Children's Clinical Hospital, Rostov-on-Don, 80 children have undergone reconstructive surgical interventions for damage to the skull bones. Thirty patients with a depressed skull fracture, who underwent a one-stage reconstructive operation according to the method developed by the authors (patent № 2017143056 dated 08/12/17), and concomitant trauma made up the main group. Fifty patients, who underwent reconstructive correction of skull bone defects using the standard technique (cranioplasty with an allograft – titanium plate), made up a comparison group to analyze the effectiveness of the author's method of treating a depressed fracture. All children with concomitant injury underwent X-ray computed tomography (CT) of the brain, cervical spine, chest organs, abdominal cavity, pelvic bones, which made it possible to quickly diagnose and begin the required treatment. Results: no inflammatory changes were observed in the early/late postoperative period among 30 children in the main group. Patients in satisfactory condition were discharged 10–12 days after surgery. Conclusion: the presented author's method of one-stage reconstructive surgery allows to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant injury and their quality of life in general. This method of correcting a depressed fracture of bones of the cranial vault in children has a significant economic effect due to reduction of the length of hospital stay of the inpatients and saves budgetary resources on alloplastic materials used for bone defect hiding. In the presence of a concomitant injury and the severity of the patient’s condition, it is necessary to perform an X-ray examination of the damaged organs and systems in order to quickly establish a diagnosis and prescribe appropriate treatment. In case of damage to several organs and systems requiring surgical treatment, at the first stage, surgical intervention for brain damage is recommended, in the second stage, in the absence of a life-threatening condition, on the same day or at delay, depending on the patient's condition, further surgical correction of other damaged organs and systems should be carried out.


Author(s):  
A. A. Uksumenko ◽  
M. V. Аntonyuk ◽  
E. E. Мineeva ◽  
A. V. Yurenko ◽  
K. K. Khodosova

Introduction. An important part in the rehabilitation treatment of patients with asthma associated with obesity is the ambulatory-polyclinic stage of rehabilitation that includes drug and physiotherapeutic treatment. Recently, dry carbon dioxide baths (DCDB) are increasingly used.Aim. is to assess the clinical and immunological efficiency of DCDB in the complex rehabilitation treatment of patients with asthma and obesity at the ambulatory-polyclinic stage of rehabilitation.Materials and methods. The study included 60 patients with asthma and obesity admitted to the departments of medical rehabilitation and clinical examination of scientists of the Medical Association of FEB RAS. Patients of the main group (30 subjects) received DCDB and drug therapy. Patients of the comparison group (30 subjects) received only drug therapy. The DCDB procedures were carried out using the “Reabox” device at CO2 concentration of 15-20%, a temperature of 28-30ºC, 10 procedures. The changes in symptoms, ACQ-5 test, and respiratory function were assessed. The parameters of cellular immunity CD3+, CD4+, CD8+, CD16+, CD19+ and the levels of tumor necrosis factor (TNFα), interleukins (IL) IL-2, IL-4, IL-6, IL-10, IL-17A in the blood were analyzed.Results. The achievement of asthma control took less time in patients of the main group. The improvement of bronchial patency was evidenced by the positive dynamics of spirometric indices. After DCDB therapy, an increase in suppressive activity of the cellular immunity, a decrease in the levels of pro-inflammatory cytokine IL-4, IL-17A were revealed. The TNF-α/IL-10 ratio statistically significantly changed due to the increase in the level of anti-inflammatory cytokine IL-10. In the comparison group, the positive dynamics was less pronounced.Conclusion. The use of DCDB increases the clinical and immunological efficiency of the rehabilitation of patients with asthma and obesity at the ambulatory-polyclinic stage. The clinical effect is associated with immunocorrective action, which allows achieving control of the disease in a shorter period of time. 


Author(s):  
G.V. Sorokoletov ◽  
◽  
E.R. Tumanyan ◽  
A.N. Bessarabov ◽  
M.A. Soboleva ◽  
...  

The formation of secondary cataracts in patients with high-grade myopia remains the main cause of vision loss in the long-term postoperative period. Taking this into account, a soft model of posterior chamber «reverse» IOL was developed in the Fyodorov Eye Microsurgery Federal State Institution, Moscow, which allows reducing the development of secondary cataracts. Purpose. Comparative analysis the clinical and functional results of implantation of «reverse M and M1» IOL in patients with high myopia in the long-term follow-up. Materials and methods. Clinical studies were conducted on 140 eyes of 97 patients with high-grade myopia aged from 42 to 83 years (on average, 64.24±0.79 years) after phacoemulsification cataract (FEC) with IOL implantation in high-grade myopia. The main group consisted of 57 eyes of 40 patients who were implanted with «reverse-M1» IOL, the control group-83 eyes of 57 patients who were implanted with «reverse-M» IOL. Visual acuity before surgery without correction in any patient did not exceed 0.01, and with the maximum correction was no more than 0.2 (80%). The follow-up period was up to 5 years. Results. Visual functions in the majority of patients increased and remained stable throughout the postoperative period, amounting to 0.55+0.04 in the main group, and 0.54+0.03 in the control group. In the late postoperative period, dissection of the posterior lens capsule with «reverse-M» IOL was performed in 11 eyes of 13 patients (13.2%), in the main group, YAG laser dissection of the posterior capsule was required in 2 patients with 3 eyes (5.3%). Conclusions. Implantation of a «reverse-M1» IOL is safe, predictable and allows you getting less PCO formation compare with «reverse-M» IOL in the long-term follow-up in patients with high myopia. Keywords: phacoemulsification cataract, implantation of «reverse» IOL, high myopia.


2021 ◽  
Vol 2 (3) ◽  
pp. 4188-4202
Author(s):  
Solange Karina Quijije Segovia

RESUMEN La investigación tuvo como objetivo analizar la realidad de la educación familiar y el embarazo a temprana edad en el país, el cual se considera como problema social y de salud pública siendo el grupo de mayor vulnerabilidad las adolescentes con deficiencia de conocimientos en educación sexual, el diagnóstico demostró que la mayoría de los casos  tienen afectaciones en la salud de la madre y del hijo por nacer, ocasionando alteraciones en la calidad de vida de ellas, familia y sociedad,  los padres a su vez no brindan la suficiente confianza para dialogar sobre estos temas transcendentes, buscando en personas ajenas al hogar información que puede ser errada. Se utilizó los siguientes métodos teóricos: inductivo-deductivo y descriptivo, y como métodos empíricos encuestas a padres, adolescentes y entrevistas a especialistas en la temática de investigación. La investigación se realizó en el centro de salud Jipijapa, con las adolescentes embarazadas controladas, edades que oscila entre  17 a 19 años representando el grupo de mayor frecuencia de atención y con 3 embarazadas entre 10 a 13 años de edad. Un dato importante de destacar es un elevado porcentaje de padres de familia que no mantienen un dialogo fluido con sus hijos. El aporte teórico del trabajo lo constituyó la fundamentación de un club de madres adolescentes y una escuela para padres surgiendo participación activa de ambos grupos como alternativa para dar solución al problema planteado.   ABSTRACT The research had as objective analize the reality of the familiar education and pregnancy to early age in the country, which consider as social problem and public health being the vulnerability main group the teenagers with deficiency of knowledges in sexual education, the diagnostic showed that mayority of the cases have affections in the health of the mother and son to born, causing changes in the quality of life of their family and society, the parents not give the sufficient confidence to dialogue about these trascendents topics, searching in people to home information that can wrong. Used the following theorical methods descriptive inductive deductive and as empirical method as surveys to parents and teenagers and interviews with specialists in the topic of researchs field. The research was conducted at health center Jipijapa, with pregnants teenagers controled, ages that ranging from 17 and 19 representing the mayor group of more frequent attention and 3 pregnants from 10 to 13 years old. An important point to note is a high percent of parents of famiy that not care a dialogue fluid with their sons. The theorical contribution from job constituted the foundametation of a club of pregnants mothers and a parents schcool  emerging active participation of both groups as an alternative to give solution to established  problem.


2021 ◽  
Vol 1038 ◽  
pp. 393-400
Author(s):  
Volodimir Kotukh ◽  
Yevhenii Varlamov ◽  
Kateryna Palieieva ◽  
Oleksii Ilinskyi

Ensuring technogenic and environmental safety of transport pipeline systems is a complex state task. The main group of reasons leading to failures, accidents and other incidents in these systems is associated with the quality of manufacture (repair) of equipment, as well as the level of operation of transport pipeline systems. At the present stage of transport pipeline systems development, the design-technological approach, including the maintenance and repair of valves, is significantly changing. Particular attention is paid to the abrasive finishing and lapping treatment, which allows, in one operation, carrying out first the roughing (allowance removal), and then the final finishing with achievement of the shape and dimensional accuracy of the workpiece. The proposed calculated dependences allow predicting the operation reliability and durability of high-precision products of transport pipeline systems valves and, thus, increase the level of environmental safety of transport pipeline systems.


2021 ◽  
Vol 18 (3) ◽  
pp. 53-57
Author(s):  
S. V. Sokolov ◽  
V. А. Gluschenko

The preoperative anemia in patients increases the risk of perioperative blood transfusion, myocardial infarction, ischemic stroke, acute kidney injury, and higher nosocomial and 30-day mortality, lengthens the duration of treatment, and increases the risk of re-hospitalization.The objective: to improve treatment results of patients after revision shoulder replacement through management of preoperative anemia.Subjects and methods. 170 medical files of patients who underwent revision shoulder replacement from 2014 to 2021 were retrospectively analyzed. On the day when they were examined by the physician, all patients had blood hemoglobin level below 130 g/l. The patients were divided into two groups that were comparable in their characteristics. Patients of the Main Group (n = 90) received preoperative preparation with iron carboxymaltate in combination with recombinant human erythropoietin 4 weeks before the expected date of surgery. Patients of the Control Group (n = 80) did not have any specific preparation.Results. The data obtained showed that the volume of intraoperative and postoperative drainage blood loss did not differ statistically between the groups; hemoglobin blood level in patients from the Main Group was statistically significantly higher both before the surgery and on the first day after it, and no hemotransfusion was indicated. In the Control Group, a statistically significantly greater decrease in hemoglobin level was observed in the postoperative period; 3 (3.8%) patients in the Control Group required RBC-transfusion. Complications in the early postoperative period (myocardial infarction, pulmonary embolism, and cardiac arrhythmia) were significantly less frequent in the Main Group versus the Control one (4.5% of cases vs. 8.8%; p < 0.05).Conclusion. The use of iron carboxymaltate at the dose of 1,000 mg once and, if necessary, repeatedly in 14 days in combination with recombinant human erythropoietin at the dose of 150 IU/kg allows preparing patients for revision shoulder replacement within the period from two weeks to one month. Preoperative management of anemia until the hemoglobin concentration reaches 130 g/l using the proposed regimen can significantly reduce the need for blood transfusion and frequency of somatic complications in the early postoperative period.


2021 ◽  
Vol 18 (3) ◽  
pp. 46-52
Author(s):  
А. А. Ponomarev ◽  
V. V. Kazennov ◽  
А. N. Kudryavtsev ◽  
А. V. Korneev ◽  
А. А. Аlekseev

Some patients with severe burn injury have a high risk of developing acute respiratory failure, the cause of which may be interstitial pulmonary edema caused by inadequate infusion therapy.The objective: to evaluate the effectiveness of high-flow oxygen therapy (HFOT) in acute parenchymatous respiratory failure in burn patients.Subjects and methods. The prospective analysis included 74 patients with ARF in the stage of burn toxemia, without inhalation trauma, with PaO2/FiO2 below 300. In Main Group (37 patients), HFOT was used, while in Control Group patients received oxygenation through nasal cannula with the rate up to 15 l/min. Parameters of respiratory rate, PaO2/FiO2, PaCO2, MAP, heart rate, the number of intubations, respiratory comfort were recorded within 48 hours.Results. Main Group had higher values of oxygenation index in 48 hours of the trial (342 vs. 305.5, p = 0.02), faster normalization of blood gas composition compared to Control Group. HFOT was associated with greater respiratory comfort (8.4 vs. 5.3 VAS scores, p = 0.03), lower need in mechanical ventilation (4 vs. 11, p = 0.04).Conclusion: HFOT is an effective method for the treatment of respiratory failure in inpatients with burns. The need for intubation decreases, it is more comfortable to be tolerated than standard methods of oxygen therapy.


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