Trophic Disorders Research Articles

Results of Controlled tissue regeneration in surgery for diabetic foot syndrome

Relevance. The problem of tissue regeneration in diabetic foot syndrome has currently become particularly relevant due to the multipolarity of the mechanisms of trophic disorders, their tendency to recur, the expansion of the affected areas when using traditional treatment methods, resistance to drug treatment methods, deterioration of patients' quality of life, as well as due to the significant expenditure of time and effort required for treatment. All these factors lead to significant economic costs in the management of patients in this cohort.The aim of the study: to develop new combined methods of surgical treatment of tissue defects in patients with complicated forms of diabetic foot syndrome.Materials and methods. The paper presents an original approach to solving one of the urgent problems of modern surgery of complications of diabetes mellitus, to the treatment of pathological processes of soft tissues of the lower extremities.Conclusions. At the stages of the entire study period, rapid wound healing was registered regardless of the initial clinical data and patient's medical history. There was also a decrease in the inflammatory response and active restoration of damaged tissues.

Investigation of the Relationship Between Prostate-Specific Antigen Levels and Prostate Cancer in Patients Attending a Urology Clinic from 2014 to 2023

Background: Prostate cancer is the second most common neoplasm and the fifth most aggressive cancer among men worldwide, with approximately 1.4 million new cases diagnosed annually. The incidence and mortality of prostate cancer increase with age, with a mean age at diagnosis of 66 years. Prostate cancer may be asymptomatic in its early stages and often has a latent period. The use of the Prostate-Specific Antigen (PSA) Index in the definitive diagnosis of prostate cancer remains a challenge for many urologists, and further research in this area can help to better understand the precise relationship between PSA levels and prostate cancer. Objectives: The present study aimed to investigate the relationship between PSA levels and prostate cancer in patients attending a urology clinic from 2014 to 2023, with the goal of improving diagnosis, developing effective treatments, and enhancing clinical outcomes. Methods: In this cross-sectional study, 242 patients with prostate cancer who attended a urology surgical clinic over a nine-year period from 2014 to 2023 were included. The patients were divided into two groups—youngest and oldest—based on the duration of their disease diagnosis. Demographic and clinical laboratory data were collected and entered into a checklist. Subsequently, the patients underwent a biopsy, and the results were recorded. Upon completion of the study, the collected data were entered into SPSS software for statistical analysis. Multiple regression analysis was used for correlation tests, while nonparametric tests, such as the Kruskal-Wallis test and the Mann-Whitney U test, were applied for nonparametric data analysis. Results: This study included 242 out of 276 samples for analysis. The ages of the participants ranged from 41 to 90 years, with a mean age of 67 ± 9.42 years. The data indicated that at PSA concentrations of 4 - 10 ng/mL, 5% of the samples were healthy, 15.2% had cancer, 46% had benign prostatic hyperplasia (BPH), and 33% had prostate intraepithelial neoplasia (PIN). At PSA concentrations of 10 - 50 ng/mL, 6% of the samples were healthy, 37% had cancer, 26% had BPH, and 29% had PIN. At PSA concentrations greater than 50 ng/mL, 3% of the samples were healthy, 76% had cancer, 14% had BPH, and 7% had PIN. A chi-square test revealed a significant association between PSA levels and pathological response (P < 0.001). Additionally, an analysis of variance (ANOVA) test showed a significant difference between different age and severity groups (P < 0.001). The free PSA-to-total PSA ratio in this study was 0.18, and the PSA-to-prostate volume ratio was 0.15, both of which were significantly associated with biopsy results (P < 0.01). Conclusions: Overall, the data obtained from this study indicated that plasma PSA levels were directly associated with the likelihood of prostate cancer. Additionally, the results showed that plasma PSA levels were not only directly associated with age but also correlated with the severity of trophic disorders, such as cancer, as indicated by biopsy results.

Parameters of physical development of term newborns with Intrauterine Growth Retardation, born in a 3B Level Perinatal Centre of St. Petersburg State Pediatric Medical University in 2022

BACKGROUND: Intrauterine growth retardation of a newborn child is an current problem in neonatology, obstetrics and pediatrics. Due to intrauterine development disorders, these newborns have increased morbidity and mortality rates. In the presence of Intrauterine growth retardation, the likelihood of developing complications in the early neonatal period increases (birth asphyxia, meconium aspiration, hypoglycemia, polycythemia, etc.), and the risk of developing infections and neurological disorders) is increased. AIM: The aim of this study is to study the parameters of physical development of term newborns born in the Perinatal Centre 3B level of the St. Petersburg State Pediatric Medical University in 2022 year, to determine the frequency and structure of disorders associated with Intrauterine growth retardation and malnutrition depending on the gestational age of term newborns for a differential approach in the management of children with Intrauterine growth retardation by neonatologists and paediatricians. MATERIALS AND METHODS: There were analyzed 1000 hospital neonatal records of newborns children born at the Perinatal Centre of Level 3B of St. Petersburg State Pediatric Medical University in 2022 year. Of these, 55 term babies were born with Intrauterine growth retardation. The study examined the physical development of term newborns, determined the frequency and structure of disorders associated with intrauterine growth retardation and malnutrition, depending on the gestational age of term newborns. RESULTS: Retardation of intrauterine growth and development in newborn children born in level 3B centres are represented by low body weight in relation to gestational age in 63.6% of cases, trophic disorders with normal body weight and reduced weight/length ratio in 34.6% of cases, and low height index with normal body weight in 1.8% of cases. Severe physical developmental disorders were found only in children with low body weight: in 13% of cases of low birth weight for gestational age, and in 55% of cases of small fetal size for gestational age. CONCLUSIONS: the distribution of physical development disorders (ICD code P05.2) in term infants, depending on the degree of maturity has a linear trend and occurs with maximum frequency (50%) in late term newborns, which is associated with the onset of aging of the placenta and the intensification of existing, even compensated, placental insufficiency.

Surgical treatment of a teenager with an extensive wound defect of soft tissues against the background of severe combined injury

Extensive posttraumatic wounds, affecting functionally active areas and complicated by a purulent–necrotic process, are a serious problem in the acute period of injury due to a critical condition and in reconstructive surgical treatment. This study presents the case of a 16-year-old victim of a transport accident on a ferry who underwent a surgical treatment. Due to a truck collision, the girl was crushed against the metal structure of the ship and received a severe combined injury: closed craniocerebral injury, moderate brain contusion, linear fracture of the occipital bone on the right, closed chest injury, fracture of 9–11 ribs on the right, closed abdominal injury, rupture of the right kidney, damage to the bladder, retroperitoneal hematoma on the right, closed spinal injury, fracture of the spinous processes of the L4–L5 vertebrae, open fractures of the pelvic bones, and extensive posttraumatic wounds of the right half of the pelvic girdle and hip joints. During the initial hospitalization, the following were performed within 2 days: laparotomy, nephrectomy of a crushed kidney on the right, suturing of the bladder, primary surgical treatment of the wound in the sacrogluteofemoral region on the right and the wound of the left thigh with their primary suturing, and external osteosynthesis of the pelvic bones with a rod-based external fixation device. The early postoperative period was complicated by necrosis of injured soft tissues and a new surgical infection (polyantibiotic-resistant strains of microorganisms), which led to an increase in the size of the wound defect and loss of soft tissues due to their purulent melting. Complex surgical treatment aimed at eliminating surgical infection and transferring the wound process to the regeneration phase included repeated surgical treatments and the use of modern dressings and negative pressure therapy. An extensive wound defect of soft tissues caused by and injury or surgical treatment for purulent–necrotic complication was found in the functionally active zone of the hip joint and in the sacral region, which required the restoration of the skin of these areas. A strategy for surgical repair of a soft tissue wound defect is presented. Nonfree (rotated) blood-supply flaps were used: fasciocutaneous muscle flap based on the musculus tensor fascia lata from the right thigh and gluteal fasciocutaneous flap from the left gluteal region. After multistage surgical treatment, it was possible to replace an extensive wound defect of soft tissues and restore full skin in the hip joint and sacrogluteal region, which enabled avoiding trophic disorders and joint contractures and ensured a satisfactory cosmetic and functional result during 5-year followup.

Possibilities of surgical correction of complicated forms of chronic venous insufficiency in patients after coronavirus infection

Introduction. COVID-19 causes generalized endothelitis and impaired arthriolo-venular circulation leading to a slowdown in blood flow and venous hypervolemia. This leads to decompensation of the drainage function of perforated veins and the occurrence of horizontal venous reflux. Aim. To determine the possibilities of surgical correction of decompensated forms of chronic venous insufficiency (CVI) in patients after COVID-19, when determining the localization of pathological venous reflux by ultrasound duplex scanning of the lower extremity veins. To determine the character of microcirculatorydisorders in the examined patients. Material and methods. Ultrasound duplex scanning with a 7.5-10 MHz linear sensor was performed in 59 patients aged 40-78 years, 34 women and 25 men who had suffered from COVID-19 in a moderate form that did not require hospitalization. Patients had not previously noted manifestations of CVI and did not use diosmin drugs. The reason for treatment was the manifestation of complicated forms of CVI, which first appeared after COVID-19. 39 patients of group I underwent surgical correction of horizontal venous reflux, 20 patients of group II received conservative treatment. The microcirculatory bed was examined using a high-frequency ultrasound Dopplerograph on the nail bed of the 1st finger of the upper limb with a 25 MHz sensor. Results. The revealed microcirculatory disorders were characterized by a depletion of the Doppler spectrum, which corresponds to parietal stasis. Isolated horizontal venous reflux was recorded in the area of trophic disorders: pigmentation, induration and trophic ulcers (TU) of the shin. In group I patients, as compared to group II, pain syndrome, edema, induration and inflammation significantly decreased after treatment when assessed by the VCSS scale. More rapid and complete healing of TU was observed. Conclusions. COVID-19 provokes accelerated progression of isolated horizontal venous reflux, due to generalized microcirculatory disorders reported in patients in the post-COVID period. The surgical intervention for its elimination in the nearest future after applying undoubtedly surpasses conservative methods of treatment and allows achieving a good cosmetic and clinical result.

The effectiveness of minimally invasive surgical techniques for treating patients with chronic venous insufficiency in the stage of trophic disorders: comparative study

Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux. Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.

Open-label observational study of effectiveness and tolerability of ipidacrine in treatment of patients with diabetic polyneuropathy (DIAMANT study)

Diabetic polyneuropathy (DPN) is one of the most common complications of diabetes mellitus, leading to the development of flaccid paresis, neuropathic pain syndrome, sensitive ataxia, as well as trophic disorders in the distal parts of the lower extremities.The purpose of the randomized, open-label, comparative, prospective study was to evaluate the effectiveness and tolerability of ipidacrine in the complex treatment of patients with DPN.Materials and methods. Patients with DPN (n = 60) were randomized into 2 groups. Both groups received basic therapy (alpha-lipoic acid, B vitamins, gabapentin); in the treatment of patients of the main group (n = 30), in addition, ipidacrine was used (Ipidacrine-SZ, North Star Co., Russia). We have analyzed the intensity of pain syndrome (VAS-P), the average daily dosage of gabapentin, and the results of the neuropathic dysfunctional scale (modified version, NDSm), Pittsburgh Sleep Quality Index, PSQI), Global Rating of Change Scale (GROC), the results of electroneuromyography (ENMG). The total duration of the observation and treatment period was 2 months.Results. After 2 months of therapy in the main group of patients, compared with the control group, there was significantly more complete pain control (VAS-P: 3.0 ± 0.9 vs 3.6 ± 0.8), a decrease in the average daily dosage of gabapentin (390 vs 500 mg/day), reduction in the severity of clinical manifestations of polyneuropathic syndrome (NDSm: 4.4 ± 1.0 vs 4.9 ± 1.0 points) and improvement in sleep quality (PSQI: 6.8 ± 1.3 vs 7.9 ± 1.7). According to ENMG data, patients in the main group showed a significant improvement in the neurophysiological parameters of both motor and sensory fibers, which was significantly more pronounced compared to the control group. A significantly larger proportion of patients in the main group assessed the improvement from the therapy as ‘pronounced’ (GROC: 10/33.3 % vs 6/20.0 %).Conclusions. The use of ipidacrine in complex therapy of patients with DPN can significantly reduce the clinical manifestations of disease and improve the neurophysiological parameters of the peripheral nerves of the lower extremities. Ipidacrine can be considered as a basic drug for the treatment of patients with neurological complications of diabetes mellitus.

DIFFERENTIAL APPROACH IN THE COMBINED SURGICAL TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES ACCORDING TO THE RESULTS OF ULTRASOUND DOPPLER ULTRASOUND

The most common pathology of the lower extremity veins is varicose veins, which is an urgent medical and social problem. The number of patients with trophic disorders is not decreasing, despite the improvement of treatment methods, which leads to a deterioration in the quality of life. Therefore, the topic of introducing new and improving existing minimally invasive treatment methods is relevant and requires further research. According to international studies, the combined laser method of treatment is superior in terms of therapeutic and cosmetic results to all known methods of surgical treatment of varicose veins and can be used in most cases.Aim. To demonstrate the eff ectiveness of individual diff erentiated combined surgical techniques for the treatment of varicose veins of the lower extremities, taking into account the data of ultrasound preoperative and intraoperative navigation.Material and methods. The study included 246 patients with varicose veins of the lower extremities of class C2-C5, who had various variants of varicose veins of the lower extremities – saphenous varicose veins in the system of small and/or large saphenous veins, which in some patients was combined with varicose veins in the basin of non-saphenous veins and reticular varicose veins. Patients were divided into clinical groups due to the diff erence in surgical and tactical treatment approach. All patients underwent preoperative ultrasound Doppler ultrasonography (USG) of the lower extremity veins in horizontal and vertical positions. The patency of deep and saphenous veins, the presence of unable varicose dilated saphenous venous tributaries with an assessment of the aff ected basin (saphenous, non-saphenous varicose veins and combined forms) were assessed. Horizontal and vertical pathological venous refl uxes were detected. All patients underwent combined surgical intervention – EVLC and miniphlebectomy under ultrasound Doppler monitoring, and sclerotherapy as indicated. The observation period lasted 1.5 years for each patient.Research results and discussion. The assessment of the treatment results was based on the presence of patient complaints, analysis of the clinical picture, the presence or absence of complications during the observation period, recurrence of the disease during the observation period, and analysis of the ultrasound assessment of the veins by an ultrasound diagnostician during a dynamic examination. USG was mandatorily performed in patients of all groups before surgical treatment, during surgical correction and as a control within 1-3 days after surgery. Dynamic follow-up was performed in all patients at 1, 3, 6 and 12-18 months after surgical treatment.Conclusions. Most patients have a complete recovery after surgical treatment. Careful history taking in patients of this group and performance of ultrasound Doppler ultrasonography of the veins of the lower extremities allowed to choose an eff ective individual surgical treatment. Specialists’ understanding of the capabilities of ultrasound Doppler ultrasound of the veins of the lower extremities, as well as compliance with the full examination protocol for ultrasound Doppler veins, allows us to provide detailed information to determine the most eff ective treatment tactics and prevent complications of the disease.

Prevention and treatment of severe complications after radical surgery for portal cholangiocarcinoma

Aim. To develop the concept of prevention and treatment of severe complications after radical surgery for portal cholangiocarcinoma based on a comparative analysis of two periods of the surgical treatment program. Materials and methods. The study involved an analysis of multidisciplinary treatment of patients with portal cholangiocarcinoma for 8 years (2013–2020). The study consisted of two stages: program formation in 2013–2018 and evaluation of results in 2019–2020. Results. 140 patients with portal cholangiocarcinoma underwent radical or relatively radical surgery: 94 patients in the first period and 46 patients in the second period. 35 pairs of observations were formed by means of propensity score matching. In the second period, the incidence of Clavien-Dindo grade IV and V complications, CCI>40 index, duration of stay in the intensive care unit, and 90-day mortality significantly decreased. Proven reasons for the improvements included more thorough preparation of patients for the resection stage of treatment, elimination of clinical and laboratory manifestations of biliary drainage complications, careful invasive monitoring of fluid accumulations, and prevention of cholangitis. Conclusion. Maximum compensation of inflammatory and trophic disorders, elimination of jaundice, prevention and early elimination of complications as a result of their prognosis and monitoring at all stages of treatment reliably improve the immediate results of radical surgery for portal cholangiocarcinoma.

Is it possible to anticipate complications after reconstructive surgery in patients with trophic disorders on the background of peripheral atherosclerosis in combination with diabetes mellitus?

Background. Complications after revascularization in individuals with peripheral atherosclerosis and diabetes mellitus can lead to negative results of surgical interventions against the background of critical ischemia. Objective. The aim of the study was to identify predisposing circumstances for the development of certain complications after reconstruction in patients with critical ischemia and diabetes mellitus. Materials and methods. A prospective study of the results of reconstructive interventions was carried out in 78 patients with trophic disorders on the background of peripheral atherosclerosis and diabetes mellitus. Complications were detected in 25 cases (the main group), 53 patients had uncomplicated course of the postoperative period. The influence of concomitant diseases, peculiarities of surgical treatment on the occurrence of adverse outcomes was analyzed. Results. Manifestations of heart failure increase the likelihood of arterial thrombosis (p < 0.05). Signs of hepatic dysfunction increase the frequency of PE in the perioperative period (p < 0.05). Adequate correction of hypergly-cemia reduces the risk of stroke. Conclusion. The data on the circumstances predisposing for the development of complications make it possible to prepare more carefully for reconstruction against the background of critical ischemia in people with peripheral atherosclerosis and diabetes mellitus and minimize the number of adverse outcomes of intervention.

Differential diagnosis of chronic acquired demyelinating polyneuropathies

Introduction. The rarity of chronic acquired polyneuropathies (PNP) with the demyelinating nature of peripheral nerve damage causes the difficulties of their differential diagnosis that persist in our country and abroad. Objective: to identify significant clinical, neurophysiological and sonographic differential diagnostic markers in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and non-IgM paraproteinemic demyelinating polyneuropathies (PDP).Material and methods: 80 patients were included in the study: 30 with CIDP, 30 with non-IgM-PDP associated with monoclonal gammapathy of unclear significance (PDP-MGUS), and 20 with non-IgM-PDP associated with lymphoproliferative disease (PDP-LPD). The patients included in the study underwent clinical evaluation of neurological disorders according to the MRC, NIS, VAS, INCAT, IRODS, SARA scales; ENMG and ultrasound studies of peripheral nerves.Results. The predominance of men in all groups was noted (p > 0.05). Compared with patients with CIDP, patients with PDP were significantly older, they were more likely to have neuropathic pain syndrome and trophic disorders (p < 0.05). In patients with PDP-LPD, in contrast to CIDP and PDP-MGUS, there was a predominance of the distal pattern of muscle weakness distribution and a greater severity of sensitive ataxia (p < 0.05). During NCV studies in patients with CIDP, compared with patients with PDP, blocks of conduction and dispersion of M-waves were signifi -cantly more often recorded in the study of motor fibers of the nerves of the hands (p < 0.05); and in the study of motor nerves of the legs, non-excitability of motor fibers was significantly less often noted (p < 0.05). Ultrasound examination of peripheral nerves showed no significant differences between patients (p > 0.05).Conclusion. Clinical phenotype, neurophysiological and sonographic changes in patients with CIDP and PDP do not have highly specific differences. Electrophoresis of serum proteins with immunofixation makes it possible to differentiate CIDP and PDP, and further examination by an oncohematologist with paraproteinemia makes it possible to distinguish MGUS from LPD.

Adjuvant pulse-dose-rate brachytherapy for oral cavity and oropharynx carcinoma: Outcome and toxicity assessment of 66 patients.

Brachytherapy (BT) is a validated radiation technique for treatment of early stage tumors of oral cavity and oropharynx. This study aimed to analyze the results of our institute's patients after replacing low-dose-rate (LDR) with pulse-dose-rate (PDR) brachytherapy. We retrospectively collected data from all patients treated between 2009 and 2020 for squamous cell carcinoma (floor of the mouth, tongue, and oropharynx) using adjuvant interstitial BT with or without external RT. Primary outcome was local control. Secondary outcomes were regional control rate and toxicity. Statistical analysis of local and regional recurrences were described using Kaplan-Meier method. Prognostic value of each factor for recurrence or toxicity was evaluated with bivariate Fine-Gray model. Data from 66 patients were analyzed. Local and regional recurrences were reported in 11% and 20% of the patients, respectively. No significant factors were identified in the present study. Grade 2 and 3 acute mucositis were reported in 21% of patients, and were more frequent in the BT only group. Almost half (47%) of the patients described acute pain following BT, and 26% required stage 2 or 3 analgesics. Trophic disorders were observed in 16 patients. Five patients presented with soft tissue necrosis (STN) and required medical treatment, of whom one subsequently required hyperbaric oxygen therapy. No predictive factors were identified for STN risk. Two patients developed osteoradionecrosis. Oral and oropharyngeal PDR-BT as adjuvant treatment is safe and effective for well-defined indications.

ИСПОЛЬЗОВАНИЕ ПРЕПАРАТОВ ГИАЛУРОНОВОЙ КИСЛОТЫ ДЛЯ СТИМУЛЯЦИИ РЕГЕНЕРАЦИИ ПРИ РАЗВИТИИ ТРОФИЧЕСКИХ НАРУШЕНИЙ У ПАЦИЕНТОВ С ХРОНИЧЕСКИМИ ОБЛИТЕРИРУЮЩИМИ ЗАБОЛЕВАНИЯМИ АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ

Trophic ulcers as a result of chronic vascular diseases of the lower extremities are an urgent and complex task of surgical treatment. Local treatment of the ulcer is an important role after revascularization. Hyaluronic acid (HA) preparations are among the most promising in this regard. HA provides increased tissue resistance to ischemia, suppression of the inflammatory response, stimulation and acceleration of tissue regeneration. HA ensures the formation of a temporary matrix in a fresh wound, facilitates the diffusion of nutrients and cleans the wound from products of cellular metabolism. Secondly, it takes an active part in the proliferation and migration of keratinocytes, which make up the bulk of the epidermis. Due to the insignificant use of HA in local therapy of trophic disorders of chronic vascular diseases of the lower extremities, it is interesting to further study the effect as part of complex and pathogenetically oriented treatment in patients of this group.

Профилактика поздних неврологических и хирургических осложнений сахарного диабета в условиях дневного стационара городской поликлиники: восьмилетнее ретроспективное когортное исследование

Diabetes mellitus is one of the most common diseases in the outpatient unit, leading to many lesions of various organs and systems. One of the most threatening late complications is diabetic foot syndrome, which can lead to a lower limb amputation. The purpose — to evaluate the effect of combined therapy of diabetic polyneuropathy on the prevention of late trophic complications of diabetes mellitus in the long term. Material and methods. Statistical data on the overall incidence of diabetes mellitus, data on the number of patients treated in the daycare center for diabetic polyneuropathy and the number of patients with trophic disorders of the lower extremities observed by surgeons in 2015–2022, and the number of amputations performed. Results. We studied the effectiveness of combined therapy with thioctic acid and B vitamins, used for the treatment of diabetic polyneuropathy, for the long-term prevention of trophic complications in patients observed in City Polyclinic No. 3 for diabetes mellitus for 2015–2022. Conclusions. Regular therapy for diabetic polyneuropathy in a daycare hospital statically significantly (p < 0.001) decreases the risk of trophic disorders of the lower extremities, reduces the need for surgical treatment, and also decreases the risk of amputations.

Possibilities of Surgical Interventions in Severe Lower Limb Ischemia in the Stage of Trophic Disorders

Occlusive pathology in the branches of aortic bifurcation or linear remains an urgent task of endovascular surgery in all highly developed countries throughout the world due to atherosclerotic narrowing of the vessels especially in the lower extremities. We have described the possibilities of surgical elimination of critical limb ischemia (CLI) in the stage of trophic disorders through the cohort study, which was conducted in the Grodno university clinic. The hospital and university committee approved the study. Within the last two years 2020-2022 in the hospital a total number of 68 patients were surgically treated for the CLI with trophic disorders. All of them were staged III-IV according to R.Fontine - A.V. Pokrovsky staging and ankle-brachial index (ABI). Aorto-femoral, Infrainguinally femoro-popliteal-tibial revascularization and transplantation of autologous venous allograft for the reconstruction of the lower extremities in the above mentioned patients were carried out. We obtained a very positive results, in 97.1% the patients had a limb with positive dynamics and its functional state was preserved. Only in 2 patients out of 66 which is 2.9%, the limb was amputated due to complications developed and inadequate revascularization. Based on our clinical observation we have proposed that, the use of autogenous venous material, modern original deobliterating reconstructions of arterial vasculature and transplantable allograft structures may be promising in the amelioration of occlusive pathology in severe life threatening lower limb ischemia in the stage of trophic disorders

Simulation of a Trophic Purulent Wound: an Experimental Study

Background. Long-term non-healing wounds are one of the common complications of multiple diseases, injuries and surgical interventions. In order to optimize their treatment options, experimental simulation of the wound process are created and improved.The aim of study was to develop an experimentally simulated trophic purulent wound, and to evaluate the potential of its use to study the impact of various factors on the wound process.Materials and methods. The trophic purulent wound simulation was performed on 80 nonlinear albino rats. Experimental wounds were formed using a silicone disk, the inner edges of which were sutured to a round wound formed in the interscapular region of the animal. Next, the silicone disc was sutured to the skin along the outer edge and additional sutures were placed around the disc to enhance tissue ischemia. The fascia at the bottom of the wound was incised, the bottom of the wound was crushed with a clamp, and a bacterial culture was injected into the wound defect. The developed model was evaluated visually, using thermometry, luminescent analysis, planimetry, microbiological, cytological and morphological tests.Results. The features of the simulated wound allowed achieving the size and protection similar to experimental wounds, and forming trophic disorders in the tissues, In 48 hours, a picture of a complicated purulent process was observed in most animals. The data obtained during the analysis of the proposed experimental model confirmed its quality, simplicity and reproducibility.Conclusion. The proposed approach can be recommended to study protracted wound processes and various factors affecting them.

Autologous platelet-rich plasma for the treatment of interstitial cystitis/bladder pain syndrome in women: evaluation of clinical efficacy

Introduction. The pathogenetic theory of interstitial cystitis/bladder pain syndrome (IC / BPS) development declares that due to vascular changes and trophic disorders in the bladder wall, a complex of dystrophic, necrobiotic and sclerotic processes develops, involving all layers of the bladder wall with the subsequent development of fibrosis. Therapy of moderate-to-severe symptoms of IC/BPS that recommended in EAU guidelines is not so effective.Objective. To evaluate the results of intradetrusor autologous platelet-rich plasma (PRP) injections in female IC / BPS-patients.Matherials & methods. A single-centre controlled randomized prospective trial that includes 85 women from 20 to 79 years old and with average disease duration of 4.8 ± 2.1 years. They were divided into two groups: group 1 — 35 patients were treated with total of five cystoscopies and hydrodistension, each once in two weeks for 10 weeks; group 2 — 50 patients were treated with total of 5 intradetrusor PRP-injection (mean platelet concentration was 982 х 103/l) into 20 – 22 points, each once in two weeks. We assessed pain (VAS-scale), urgency and frequency (PUF-scale, IUS-scale), bladder urinary, Global Response Assessment (GRA), bladder diary and bladder capacity before treatment, after one and 12 months.Results. Conventional IC/BPS therapy leads to a significant reduction in symptoms one month after its completion, and a similar pattern of symptoms and signs is observed in the PRP-treatment group. However, in group 1, negative dynamics is further determined up to 12 months, but the indicators do not reach the initial values. In contrast, in group 2, we found stabilisation of pain severity and improvement of all other symptoms and signs by 12 months compared to baseline and one month after the completion of PRP-therapy.Conclusion. The developed method of PRP-therapy of IC/BPS has high efficacy not only at the treatment completion, but also at monitoring of patients for 24 months. PRP-therapy combined with classical treatment will probably have a higher level of efficacy both in terms of symptoms and signs of the disease over a long-term monitoring.

Experience in the lower extremities trophic ulcers treatment in patient with combined pathologies: varicose veins and rheumatoid arthritis

Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body. Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations. Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.

The role of heavy metal exposure on the microbiome in the etiology of gastrointestinal disorders: a scoping review

In recent years, epidemiological studies have increasingly recognized the significance of heavy metals as an important pathogenetic factor in many gastrointestinal diseases, particularly those associated with in gut microbiota functions. The toxicity of heavy metals towards essential intestinal microflora goes beyond causing dysbiotic disorders; it can also exacerbate intestinal infections, alter metabolic processes, and influence the development of antibiotic resistance. Since the negative effects of heavy metals are environmental in nature, there is a need to systematize the etiological role between the effects of heavy metals on the microbiome and possible nosological conditions for a more accurate approach to treatment and further research. Given the environmental origins of the abovementioned effects, there is a need to systematize the impact of heavy metals on the microbiome and their role in disease development to improve approaches to treatment and further research. We aimed to analyze the latest scientific evidence on the associations between heavy metals exposure and the intestinal microbiome and its role in the development of gastrointestinal disorders. For this scoping review we used PubMed and eLIBRARY.ru databases. We searched for keywords: «gut microbiota», «intestinal infections» (disorders), «antibiotic resistance» «heavy metals» in both Russian and English. Based on the research reviewed in this study, we can infer that heavy metals act as exogenous toxicants contributing to the development of dysbiotic, metabolic and trophic disorders of the gastrointestinal tract. They also influence the progression of infections and the development of antibiotic resistance in bacteria. Further studies should focus on exploring the toxicity of heavy metals in relation to specific populations of intestinal flora and associations with metal and antibiotic resistance. It is important to consider the therapeutic potential of microbiome modulation in the management of gastrointestinal diseases.

МИНИФЛЕБЭКТОМИИ У БОЛЬНЫХ С ХРОНИЧЕСКОЙ ЛИМФОВЕНОЗНОЙ НЕДОСТАТОЧНОСТЬЮ НИЖНИХ КОНЕЧНОСТЕЙ

In most patients, lymphovenous insufficiency (LVI) of the lower extremities develops as a complication of chronic deep vein disease of the lower extremities. As a rule, people of working age make up up to 90% of patients. With delayed diagnosis and late start of treatment, patients have complications: edema of the lower extremities with trophic disorders and lymphorrhea, which lead to a significant reduction in the quality of life of the patient and disability. Changes in the lymphatic system develop secondarily. Lymphovenous insufficiency of the lower extremities or phlebolymphedema is one of the most frequent forms of combined lymphedema, in which against the background of chronic venous insufficiency, lymphatic edema develops or venous insufficiency can complicate the course of classical lymphedema. Lymphovenous insufficiency of the lower extremities is characterized by a progressive course and requires lifelong treatment. The article discusses the possibilities of miniflebectomy surgery in patients with chronic lymphovenous insufficiency of the lower extremities. Surgical treatment was performed for patients with post-thrombophlebitis. The correction of the perverted venous blood flow was performed with little trauma. In terms of three to ten years, the majority of patients showed positive results. The need for an integrated approach and the right choice of treatment tactics can facilitate and improve the patient's life for many years, as well as avoid possible relapses of the disease.