Treating diabetic foot syndrome at the General Surgery Clinic of the S.M. Kirov Military Medical Academy

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

Practical use of parenteral calcimimetics for severe secondary hyperparathyroidism. A case report

Secondary hyperparathyroidism (SHPT) leads to bone disorders and cardiovascular complications in long-term dialysis patients. SHPT is caused by hyperphosphatemia. Abnormalities of calcium-sensing receptor (CaSR) are associated with the pathogenesis of SHPT. Clinical trials have shown that calcimimetics significantly reduce the risks of parathyroidectomy, bone fracture and cardiovascular hospitalization among long-term dialysis patients with SHPT. Etelcalcetide, a novel calcimimetic compound, acts as a direct CaSR agonist, restores the sensitivity of the CaSR in parathyroid cells, and decreases serum parathyroid hormone without inducing hypercalcemia or hyperphosphatemia. Etelcalcetide's properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session improving medication adherence.

Potential predictors of the immunotherapy effectiveness

The development of novel predictors of immunotherapy efficacy is a clinically important and rapidly developing area. The currently existing predictors (PD-L1, MSI tumor status) do not always guarantee a positive treatment result. In addition, performing these analyses is characterized by the complexity, high cost, and long execution period. Thus, identifying potential new biomarkers in peripheral blood, which would be more accurate and accessible from a technical and economic point of view, is of great interest and is the object of active research. The article is a literature review of the currently available studies written worldwide on the topic of potential markers of the immunotherapy effectiveness. The most interesting and promising studies with intermediate conclusions are presented. We highlighted a number of clinical studies on the use of various assays and platforms for monitoring peripheral immune status. These studies point to the usefulness of these biomarkers as potential prognostic indicators.

The Moscow hospital in the first half of the XVIII century: the beginning of the glorious path

The article highlights the formation of the Moscow Hospital, founded by the Decree of Peter I in 1706 in Lefortovo, and its activities in the first half of the XVIII century as a clinical institution, where from the first days the treatment of patients took place together with the training of the first Russian doctors – students of the Moscow Medical and Surgical School. The article tells about the first chief doctor and director of the Hospital School — Nikolai Bidloo — the author of the national “Instructio de chirurgia in theatro anatomico”, and his followers who devoted their lives to preserving the health of the Russian army.

Early diagnosis of melanoma: current challenge for a modern clinician

Authors assessed the incidence of skin melanoma during outpatient consultations at the Consultation and Diagnostic Center of the Main Military Clinical Hospital named after academician N.N. Burdenko. During the period from 2019 to 2020, the authors diagnosed 68 patients with skin melanoma with stages ranging as follows: in situ ― 3 (4.4%) cases, stage IA ― 11 (16.2%) cases, IB ― 13 (19.1%) cases, IIA ― 11 (16.2%) cases, IIB ― 6 (8.8%) cases, IIC ― 9 (13.2%) cases, IIIA ― 3 (4.4%) cases, IIIB ― 4 (5.9%) cases, IIIC ― 3 (4.4%) cases, IV ― 5 (7.4%) cases. The necessity to apply the knowledge about the clinical and dermoscopic features of this malignant disease to diagnose skin melanoma, as well as exceptional prognostic significance of early detection of skin melanoma, were demonstrated.

Evaluation of the effectiveness of using biodegradable implants based on magnesium oxide compared to titanium alternatives. Experimental study

The issues of improving surgical implants used in treating patients with traumatological and orthopedic profiles continue to remain relevant. The development of a material not inferior in its elastic-strength properties to metal and that does not require further removal remains a reason for studying new samples that are inert during resorption. The purpose of this study was to experimentally explore and compare the bone tissue reaction to the introduction of titanium and magnesium oxide implants, as well as to study the state of magnesium oxide structures at different times after implantation. The material for the study was an implant based on magnesium oxide manufactured by the «MAGNEZIX» company. We operated on 30 rabbits based on the experimental laboratory of the Main Military Clinical Hospital named after academician N.N. Burdenko Russian Defense Ministry. The main group consisted of 10 rabbits, which were injected with a biodegradable screw made of a material based on magnesium oxide. The control group included 10 rabbits, which were injected with a titanium screw. In addition, another group of rabbits was studied. It included 10 young subjects who were injected with an implant based on magnesium oxide into the growth zone. Subjects were removed from the experiment one at a time at various stages. Then X-ray and histological assessment of the paraimplant zone were performed. As a result, the experiment showed that biomaterials based on magnesium oxide are bioinert, do not cause an inflammation reaction or osteolysis of the surrounding tissue, do not lead to the release of gas and the formation of a pathological cavity. During the introduction of magnesium-containing implants to young subjects, no pathological changes in bone tissue, deformities or stunting in the growth of the studied individuals were detected. Based on the obtained experimental data gathered for 6 months, it should be concluded that the material based on magnesium oxide is very promising and suitable for use in traumatology and orthopedics.

Monocytosis in rational empirical antibacterial therapy in moderate forms of COVID-19

Microbiologically confirmed bacterial co-infection occurs in 1.2%–7% of hospitalized patients with COVID-19. The study of rational approaches to empirical antibacterial therapy (ABT) of SARS-CoV-2 virus-induced pneumonia continues. Glucocorticoid (GCS) therapy, the main method for pathogenetic treatment of moderate forms of CОVID-19, can lead to the development of neutrophilic leukocytosis. The criterion for the differential diagnosis of leukocytosis could be determining the quantity of peripheral blood monocytes. Assessing the significance of identifying the monocyte quantity can serve as an additional criterion for assigning empirical ABT in the treatment of pneumonia caused by the new coronavirus infection. The aim of the study was to identify the characteristics of glucocorticoid-induced leukocytosis in patients with moderate COVID-19. The study included 86 patients with a confirmed diagnosis of COVID-19 (ICD codes: U07.1, U07.2) of moderate severity. The patients were divided into 2 groups. The comparison group consisted of 40 patients who were prescribed ABT after the manifestation of leukocytosis on the background of glucocorticoid therapy. The control group included 46 people who were not prescribed ABT after the manifestation of leukocytosis on the background of glucocorticoid therapy and until the end of their stay in the hospital. We compared the parameters of the clinical blood tests (the absolute number of white blood cells, neutrophils and monocytes (×109/L)) on days 3, 6 and 9 from the start of GCS therapy. As a result, on the 3rd day, both groups had neutrophilic leukocytosis (>9.0×109/L) and absolute monocytosis (>0.8×109/L). There was a statistically signif icant decrease in the absolute number of white blood cells, neutrophils and monocytes by days 6 and 9, compared with day 3 from the start of glucocorticoid therapy. When comparing blood parameters between the groups, there was no statistically significant difference in the number of cells on the 3rd, 6th and 9th day of GCS therapy (p>0.05). Glucocorticoid-induced leukocytosis is associated with absolute monocytosis. The administration of ABT in response to the occurrence of leukocytosis in this study did not affect the change in the level of white blood cells. At the same time, a likely factor in reducing these indicators was a decrease in the daily dosage of corticosteroids.

Tricuspid regurgitation prevalence in general hospital patients

Tricuspid regurgitation (TR) is a widespread valvular heart disease. Most times life expectancy doesn’t depend on trace to mild degrees of TR. Tricuspid valve surgery is probably recommended for patients with moderate to severe TR because of their poor long-term outcomes. It is necessary to study TR in different patients. The aim of this work was to study the incidence of TR in general hospital and to investigate moderate to severe TR incidence rate. We analyzed 50.647 transthoracic echocardiograms (TTE) done in Federal State Governmental Establishment «Burdenko Main Military Clinical Hospital» of Russian Federation Defense Ministry in 2004–2019. The median age of patients was 56 years (age 54.23±17.95 years). We discovered 44.854 cases of TR. Moderate to severe TR was detected in 5.735 (11.3%) patients (age 68.11±14.42 years, M=71 years). In general hospitals TR can be found in 88% of patients. Patients with moderate to severe TR are older patients with progressive TR. Male patient with severe TR is often older than a female patient.

Severe reactive hyperthrombocytosis secondary to coronavirus infection. Сlinical cases

The article presents two cases of the new coronavirus infection COVID-19 with pronounced hyperthrombocytosis, which resolved independently.

Selecting the surgical treatment for patients with diaphragmatic hernia

Hernias of the diaphragm (HAP) are a common pathology that negatively affects the patients’ quality of life and in some cases requires high-quality surgical correction. This pathology has a progressive course, which leads to an increase in the severity of clinical manifestations with the age of the patient. At present, behavioral and conservative therapy is the first line of treatment for HAP, while surgical correction is performed only if they are ineffective. This tactic helps to reduce the likelihood of discrediting surgical treatment and increase its effectiveness. The article presents the experience of surgical treatment of HAP on the basis of general surgery clinics of the N.N. Burdenko MMCH of the Ministry of Defense of the Russian Federation.