Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

Improvement the quality of life of patients with trophic ulcers of venous etiology in the application of photodynamic therapy

Purpose. To analyze quality of life dynamics of patients with trophic venous ulcers of the lower limbs after the treatment with the use of photodynamic therapy. Materials and methods. Quality of life research was conducted in 57 patients with trophic ulcers of venous etiology. The first group included 30 patients who received standard treatment, the second group — 27 patients, in which standard treatment was combined with a course of photodynamic therapy. To assess the quality of life of the patients in both groups, a questionnaire was conducted using the EuroQol-5D-5L survey system and the visual analogue scale EQ-VAS. The quality of life assessment was carried out at the beginning of treatment, 10 days and 6 weeks after starting treatment. Results. The results indicate a significant improvement in the quality of life in both groups, but the degree of improvement in this indicator in group 2 was 20.7 % higher.An analysis of the dynamics of improvement in quality of life showed an increase in the mean of the indicator 10 days after the beginning of treatment in patients in the first group of 26.7 %, the second group by 43 %, and in 6 weeks, its increase was achieved in patients in the first group by 32.7 %, in the second group — by 53.4 %. Conclusions. The use of photodynamic therapy in the treatment of venous trophic ulcers significantly affects the quality of life, which is manifested in the anti-inflammatory effect and reduction of pain syndrome in the shorter term (by 76.2 %), compared with patients in the first group.

Cellular and tissue mechanisms for the action of low-intensity optical radiation on patients with diabetic foot syndrome

Introduction. The low-intensity visible and infrared radiation of lasers and LEDs is widely used in medicine for the treatment of a number of diseases, including in patients with diabetic foot syndrome. However, there is no consistency and certainty in the characteristics of radiation and the duration of exposure to achieve the best effect in a particular patient. The aim of the work is a systematic analysis of the literature on the influence of low-intensity electromagnetic radiation of the optical spectrum range on the healing of foot ulcers and the normalization of the condition of patients with diabetes, as well as the mechanisms of therapeutic action. Materials and methods. An analysis of medical publications based on the MedLine database for the period from 1995 to 2019 was carried out on this topic. Results. Based on the analysis of published works, the parameters of low intensity optical radiation are established that stimulate the healing of ulcers, the normalization of blood supply and innervation in patients with diabetic foot syndrome. The most probable mechanisms of the therapeutic effect of low intensity optical radiation with diabetic foot syndrome have been identified. Findings. A systematic analysis of the literature shows that low-intensity optical radiation from both lasers and LEDs causes a reaction at the cellular and tissue levels, which results in pronounced therapeutic effects, including the healing of ulcers in both experimental animals and patients with diabetic syndrome feet. The mechanisms of therapeutic action of low-intensity electromagnetic radiation of the optical spectrum range are biochemical rather than thermal. As a result of photochemical stimulation, the proliferation of cells, in particular fibroblasts, is accelerated, cellular respiration, production of collagen and growth factors are enhanced, macrophage activity and angiogenesis are activated, which leads to the cleansing of wounds and ulcers, the removal of inflammation, the normalization of microcirculation and the development of a new blood vessel system. period from 1995 to 2019 was carried out on this topic.

Psychosomatic pain correction in patients with discogenic dorsopathies

The article discusses the psychosomatic approach to the treatment of pain syndromes in patients with discogenic dorsopathy, based on the combined use of kinesitherapy and psychological correction of anxious depression using transcranial exposure using neuroacoustic stimulation on individually rhythms and meso-encephalic modulation using magnetically and photostimulation. It was established that the treatment of pain syndromes in patients with discogenic dorsopathy based on the proposed method reduces the subjective assessment of pain on the VAS scale by almost 30 % and the level of depression by 20 % in the A. Beck psychometric table compared to the control group.

Spectral analysis of sphygmogram

Actuality. The heart system executes the important role in the organism. It is important task of medicine to diagnose of the state of this system. Electrocardiogram is the one of methods of control its state. Cardiointervalgram is another way of study of the state of the heart system. I studies the change of rhythm of heart as reaction of organism on external influences. Sphygmografia is the method of graphic registration of pulses vibrations of vessels, allowing to judge about their resiliently-viscid properties. The method of registration is used by a pair light-emitting diode and photo-diode. A signal, which is forming is due to the change of volume of blood in the place of indication. The most comfortable place for the location of sensor is the finger of Purpose of work. The spectral analysis of the sphygmogram impulses gives the information about heart system. The spectrum of sphygmogram of healthy man is wider. Numeral coefficients, which are characterizing correlation high and low frequencies, are offered. This was offered to analysis the spectrum of signal from the optical sensor, which is containing information by the of impulses and cardiountervals. These signals contain more information, than cardiointervalgram and single impulse of sfigmogram only. Methods. The spectrums of signals from the optics-electronic sensor was analyzed by computer methods. Results. The spectrum of cardiointervalgram contains information about the slow waves of heart work. The spectrum of sphygmogram contains information about frequency of heart work and about higher frequencies also. Conclusion. The analysis of heart work was made by the spectrum of cardiointervalgram and on the spectrum of sphygmogram. The second method allows to obtain more information about health of man.

Artificial sources of light used in photomedicine: history of discovery

Introduction. The history of the development of photomedicine over the past one and a half years is directly related to the history of the development of artificial light sources. And the medical direction of using these sources, as befits the light, has always been extremely bright. The purpose of this study was to familiarize doctors, scientists, engineers working in the field of photomedicine, with the creators of artificial sources of the light that is used for the rehabilitation, diagnosis, treatment and prevention of the most common human diseases. Materials and methods. Sources of information were archival documents of scientific libraries, scientific journals, and conference proceedings. The search depth was almost 160 years. Results. As a result of this work, the names of three outstanding inventors of the first incandescent lamps born in the same 1847 and giving people artificial sun were mentioned again (Russian engineer Alexander Nikolaevich Lodygin, Russian military engineer Pavel Nikolaevich Yablochkov and American electrical engineer Thomas Alva Edison) . The work of the first arc lamps was based on research by the Russian inventor V.V. Petrov and the English naturalist G.Devi. As a result of complex experiments, the Russian physicist S.I. Vavilov discovered in 1924 that the efficiency of luminescent substances is much higher than the efficiency of incandescent lamps. The Nobel laureates of 1964 for fundamental work in the field of quantum electronics, which led to the creation of generators and amplifiers of a new type - masers and lasers, became the American physicist C. Townes and Soviet physicists N.G. Basov and A.M. Prokhorov. In 1960, the laser era began with the light arm of Theodor Harold Meiman, who created the first ruby-crystal laser operating at a wavelength of 694.3 nm. Then A. Javan, W. Bennet and D. Herriot created a gas (helium-neon) laser. In 1962, a semiconductor laser was created by a group of American (B.Lex, U. Dumke, M.Naten) and independently Soviet scientists (B.M. Vul and others). A carbon dioxide laser (molecular) was created in 1964 by K. Patel. A dye laser was created in 1966 by P. Sorokin and J. Lancard. The “father” of LEDs is considered by the whole world to Nick Holonyak, who in 1962 created the world’s first GaAsP luminescent diode emitting in the red spectrum. Findings. In the process of evolution of artificial light sources (from incandescent lamps, fluorescent lamps to lasers and LEDs), phototherapy methods were also improved.

Anti-inflammatory and antimicrobial effect of “Barva-Flex/BIR” device radiation in its application for prosthetic stomatitis treatment

The anti-inflammatory and antimicrobial effects of LED radiation on the oral mucosa when used in the combined treatment of prosthetic stomatitis were investigated. The test evidenced that the light radiation of Barva-Flex/BIR device (λ = 470 nm and λ = 940 nm) contributes to the reduction of inflammatory changes in oral mucosa and has a significant antimicrobial effect. LED radiation holds promise for use in the combined stomatitis treatment.

Estimation of the influence of photobiomodulation on the endothelial function in patients with arterial hypertension under the conditions of hyperuricemia

Introduction. In 2015, the global prevalence of hypertension in the world was estimated at 1.13 billion. The European Association for the Treatment of Hypertension (ESH) updated its recommendations in 2018 and officially added to the already existing risk factors of hypertension hyperuricemia. In patients with comorbidity of hyperuricemia and hypertension, endothelial dysfunction is observed. The aim of the study is to establish correlation between uric acid level and pulse wave velocity, Tei index, endothelium-dependent vasodilation of the brachial artery and evaluate the effect of photobiomodulation on endothelial dysfunction in patients with hypertension. Materials and methods. The study included 102 patients with hypertension: 48 without hyperuricemia (group 1) and 54 with comorbidity of hypertension and hyperuricemia (group 2). Groups 1A and 2A received antihypertensive therapy. Groups 1B and 2B — antihypertensive therapy with a course of intravenous laser therapy with a wavelength of 635 nm, course 10 procedures. Endothelium-dependent vasodilation of the brachial artery was determined by a breakdown with reactive hyperemia. Tei index was calculated during echocardiography. The pulse wave velocity was measured with a SonoScape S6 Pro. Results. Antihypertensive therapy in group 1A reduced the rate of the pulse wave by 7.8 %. Antihypertensive therapy and intravenous laser therapy in Group 1 reduced uric acid by 5.7 %, pulse rate by 12.2 %, Tei index by 9.5 %, increased endothelium dependent vasodilation of the brachial artery by 19.1 % (p < 0,05). Antihypertensive therapy in Group 2A reduced uric acid by 4.7 %, pulse rate by 8.5 % and increased endothelium-dependent brachial artery vasodilation by 31.7 %. Combined use of antihypertensive therapy and intravenous laser therapy in group 2B reduced uric acid by 19.2 %, pulse wave speed by 21.9 %, Tei index by 29.0 %, increased endothelium- dependent vasodilation of the brachial artery by 97.7 % < 0.05). A correlation was established between uric acid level and endothelium dependent vasodilation of the brachial artery r = - 0.62 (p < 0.001) and between uric acid level and pulse wave velocity r = + 0.68, uric acid level and systolic blood pressure (day ) r = + 0.48 (p < 0.001), uric acid level and Tei index r = + 0.47 (p < 0.05). Conclusion. Given the established negative correlation between the mean strength between uric acid level and endothelium-dependent vasodilation of the brachial artery, it is appropriate to use in clinical practice a combination of antihypertensive therapy with intravenous laser therapy, which significantly reduces the level of uterine fibrillation hypertension and in patients with comorbidity of hypertension and hyperuricemia.

Photodynamic therapy of gunshot wounds soft tissue

Introduction. An important component of the treatment of gunshot wounds is antibiotic therapy. Unfortunately, due to the antibiotic resistance of many strains of microorganisms, there remains a risk of purulent- infectious complications even with prolonged antibiotic therapy. In recent years, methods of physical action, in particular, photodynamic therapy (PDT), have been used to accelerate bacterial decontamination of wounds. Gunshot wounds have their own characteristics that create certain difficulties for the application of the method of photodynamic therapy. Purpose. Аnalyzes the results of the application of the developed PDT method in the complex treatment of gunshot wounds of soft tissues. Materials and methods. A comparison was made of the main indicators of the wound healing process between the wounded of the main group who used PDT (n = 52) and the comparison group (n = 32) who used treatment with complex water-soluble ointments. To increase the effectiveness of the method, the «Photolon» photosensitizer was administered in two ways: by injection infiltration of tissues around the wound and by application directly to the wound surface. The wavelength of laser radiation is 660 nm. The dose of laser energy was 20 J/cm2. Results. The results of the study showed an improvement in the course of the wound process in all respects when using PDT: the period of regression of local edema in the main group on (3.7 ± 0.4) days in the comparison group (6.2 ± 0.5), the period of wound cleansing (4.7 ± 0.6) days (7.3 ± 0.8) days, respectively; the timing of the start of granulation (4.6 ± 0.5) days and (7.8 ± 0.6). At the beginning of treatment, 45 pathogenic strains were isolated in 38 (73.1 %) wounded main groups and 26 strains in 22 (68.7 %) wounded comparison groups. A day after the use of PDT, pathogenic wound microflora was isolated in 5 (9.6 %) wounded main groups — 5 strains and 23 strains in 19 (59.4 %) wounded comparison groups. Conclusions. The effects of PDT were observed: rapid inactivation of pathogenic wound microflora, reduction of edema, pain syndrome and stimulation of granulation growth, which contributes to early closure of wounds.

Influence of led radiation on the staphylococcus aureus sensitivity to antibiotics

We studied the influence of LED radiation of red + infrared (MEDOLIGHT Red device) and blue + infrared (MEDOLIGHT BluDoc device) ranges on clinical isolates Staphylococcus aureus and collection test strain Staphylococcus aureus ATCC 25923 sensitivity to antibiotics. The dependence of radiation on the studied objects depending on exposure, wavelength and frequency were defined. The result of photo modification on the state of microorganisms was increase of their sensitivity to some of the tested antibiotics. Based on the data obtained, we developed an algorithm and clinical recommendations for the use of LED radiation in the complex therapy of purulent-inflammatory diseases.