Ulcerative Defects Research Articles

Effectiveness of an innovative oral hygiene product in patients with obesity and type 2 diabetes mellitus in regulating appetite and food preferences

Background. Diabetes mellitus (DM) and obesity are diseases that lead to systemic complications that shorten life expectancy and reduce quality of life. Treatment and control of these diseases can reduce the risk of complications. However, existing lifestyle change programs and drug therapy have limited effectiveness, and therefore, the search for new methods of treating diabetes and obesity is still relevant. Aim. To determine the effectiveness of an oral care product (OCP) containing curcumin, thyme, and catechins in patients with obesity and type 2 DM (T2DM) in reducing appetite, changing taste preferences, and improving oral hygiene. Materials and methods. The study patients were divided into three groups: those with obesity and T2DM, those with obesity without T2DM, and a control group of persons without obesity and carbohydrate metabolism disorders. All participants were recommended to irrigate the oral cavity 3 times a day for 20–30 with an OCP containing 0.25% curcumin, 0.05% thyme, and 0.05% catechins 30 minutes before meals for 30 days. Initially and after a month of daily use of the OCP, food preferences were assessed based on the NHANES Food Questioner and the oral cavity condition. Results. The study included 67 patients. According to the questionnaire, the consumption of the following products decreased in all three groups of subjects: red meat, sausages, fast food, cookies, tomato juice, beer, red wine, and butter. Hyperemia, edema, ulcerative defects, and oral dryness decreased in obese patients with and without T2DM. Conclusion. OCP use decreased appetite and changed taste preferences and also significantly improved the condition of the oral mucosa and gums in obese patients with and without T2DM. Further studies are needed to assess the therapeutic potential of OCP with curcumin, thyme, and catechins in treating obesity and carbohydrate metabolism disorders.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ МЕСТНОГО ЛУЧЕВОГО ПОРАЖЕНИЯ ТЯЖЕЛОЙ И КРАЙНЕ ТЯЖЕЛОЙ СТЕПЕНИ БОЛЬШОЙ ПЛОЩАДИ С НЕБЛАГОПРИЯТНЫМ ТЕЧЕНИЕМ РАНЕВОГО ПРОЦЕССА

Purpose: to familiarize medical workers with the unfavorable course of local radiation injury (LRI) due to its depth and area, damage to underlying bone structures and internal organs, the presence of concomitant severe somatic disease, drug addiction and the impossibility of radical surgical intervention due to a lack of own tissues to hide the ulcerative defect. Material and methods: The article presents a clinical observation of a 46–year-old man who had accidental household contact with a radiation source of electric current RIT-90 with an activity of 30 kCu – a powerful source of bremsstrahlung. Results: The patient suffered severe acute radiation syndrome from extremely uneven beta-gamma irradiation (moderate bone marrow syndrome, acute posterior thoracic LRI of extremely severe degree (IV) – 5%, severe and moderate degree – 10% and both hands of mild degree (I) – 2%). He was admitted to the clinic for treatment 3 months after irradiation. On admission, against the background of pronounced hyperpigmentation and atrophy of the skin of the left and partly right half of the back, there were ulcerative defects in the form of a figure eight (diameter – 10 and 3 cm). The ulcers are covered with a thick layer of fibrin with scanty discharge. Within 3 months after admission to the clinic, pulmonary tuberculosis was treated with good clinical effect. 6 months after the irradiation, a phased surgical treatment was initiated. However, necrotization of transplanted autografts and infection of the ulcerative surface were almost constantly noted. Despite the ongoing supportive, detoxification and antibacterial therapy, multiple organ failure developed, which led to the death of the patient. Conclusions: With extensive and deep radiation lesions accompanied by severe damage to underlying bone structures and vital internal organs localized in anatomical areas that are not subject to amputation, in the presence of severe concomitant somatic pathology in the patient, surgical closure of the skin defect with a full-layer flap with axial blood supply capable of restoring trophicity of the affected tissues becomes an almost unsolvable problem. Covering with patient’s tissues is impossible, first of all, due to the complexity of the necessary size flap extraction. The remaining open skin defect is the gateway to infection with its further generalization and death of the patient. It is possible that the solution in this case may be the use of various collagen films or artificial skin, which will mechanically close the defect, however, the inability to restore trophicity in the area of affected tissues still makes the prognosis extremely unfavorable.

A case report of gastrointestinal bleeding during dual antiplatelet therapy in a patient with coronary heart disease

Cardiovascular disease continues to be the leading cause of death in both developed and developing countries. Low-dose acetylsalicylic acid is used worldwide for primary and secondary prevention of cardiovascular events on a long-term basis to reduce mortality and lethality. At the same time, the incidence of gastrointestinal bleeding associated with acetylsalicylic acid intake is steadily increasing. The presented case report illustrates the development of gastrointestinal bleeding against the background of dual antiplatelet therapy in a patient with coronary heart disease with a history of ulcers. A 65-year-old patient with an aggravated coronary history was routinely hospitalized in the cardiology department. On admission to the hospital, taking into account the increasing complaints of crushing pain behind the sternum, acute coronary syndrome was excluded in the patient, esophagogastroduodenoscopy was performed, which revealed a subcardia callous ulcer. On the same day, there was a negative trend in clinical manifestations in the form of syncope, hypotension up to 70/50 mmHg, vomiting «coffee grounds». According to the data of repeated emergency esophagogastroduodenoscopy a superficial ulcerous defect in the subcardia area with bleeding vessel in the bottom was revealed and combined endoscopic hemostasis was performed. Further examination of the patient revealed Helicobacter pylori infection, which in combination with other risk factors influenced the occurrence of this complication. First-line anti-ulcer eradication therapy was prescribed. The patient subjectively evaluated his condition as satisfactory and was discharged with recommendations for outpatient treatment. The purpose of this case report is to emphasize the importance of timely detection and treatment of gastrointestinal diseases in high-risk patients. This may allow for timely prevention of bleeding in patients with high-risk coronary heart disease in the future, taking into account a personalized approach.

Perforated gastroduodenal ulcers: perioperative prognosis and prevention of complications

Objective. To improve the effectiveness of treatment for patients with perforated gastroduodenal ulcers (PGDU) by developing criteria for predicting postoperative complications and mortality. Materials and methods. The treatment outcomes of 127 patients with PGDU were analyzed. Prognostic scales ASA, SOFA, Peptic Ulcer Perforation Score (PULP), and the Mannheim Peritonitis Index (MPI) were used for the assessment in all the patients. Specialized classifications (DEP and ulcer defect classes) developed at Sklifosovsky Research Institute For Emergency Medicine were employed to determine the surgical approach and the extent of surgical intervention. Results. Duodenal ulcers were observed in 97(76.4 %) patients, gastric ulcers in 28(22.0 %), and combined ulcers in 2(1.6 %). According to the clinical form, chronic ulcers were identified in 81 (63.8 %) patients, while acute ones were detected in 46(36.2 %) patients. Helicobacter pylori infection was revealed in all patients with chronic ulcers. The majority of patients sought medical care within the first 6 hours after perforation (53 patients, 41.7 %); from 6 to 12 hours – 24 patients (18.9 %), 12–24 hours – 17 patients (13.4 %), and in more than 24 hours – 33 patients (26.0 %). Fatal outcome occurred in 45 (35.4 %) patients, while 82 (64.4 %) patients were discharged after the recovery had been observed. The mortality rate was significantly higher in patients with MPI grades 2 and 3, in those with an initially high risk according to the PULP scale, and those who were hospitalized more than 24 hours after perforation. Indications for laparoscopic ulcer suturing were proposed based on the scales used. Conclusions. The risk factors for adverse outcomes in PGDU include the following criteria: surgery performed more than 24 hours after perforation, MPI 2-3 grades, and a PULP scale score more than 8. In patients with PGDU who are at high surgical-anesthetic risk and have a complicated comorbid background, the risk of sepsis development is more than 30 %. Laparoscopic techniques for suturing PGDU are preferable when performed within 6 hours of perforation, with a PULP score not more than 7, MPI grade 1, and DEP classification scores less than 9, specifically in IIC, IIIC, IVA, IVB, and IVC ulcer defect classes.

Features of the endoscopic picture of the upper gastrointestinal tract in Helicobacter pylori-infected patients of different ages

The aim. To evaluate the features of the endoscopic picture of the upper gastrointestinal tract (GI tract) in Helicobacter pylori-infected patients of different ages.Materials and methods. The study involved 126 adult patients aged 18 to 76 years (mean age 44.75±15.05 years) and 19 children aged 9 to 17 years (mean age 14.26±2.68 years) infected with H. pylori. All subjects underwent gastroscopy with an assessment of inflammatory and atrophic changes in the mucous membrane of the upper gastrointestinal tract, cardia insufficiency, sliding hernia of the esophageal orifice of the diaphragm (HE), duodenogastric reflux (DGR), as well as the presence of H. pylori (rapid urease test). Statistical data processing was carried out using the SPSS Statistics 27.0.1 program. Results. According to the endocropic data, in adult patients, signs of catarrhal esophagitis were detected in the esophagus: in 32.7% of cases, esophageal erosion was detected in 4.8% of the examined patients, HE occurred in 15.6%, and cardia insufficiency – in 23.3% of patients. When visualizing the gastric mucosa, its atrophy and hyperemia were observed in 8.8% and 77.9% of cases, respectively, erosive changes were detected in 2.8% of patients. Endoscopic signs of atrophy of the mucous membrane of the antrum of the stomach occurred in 34.0%, hyperemia – in 85.5%, and erosive changes – in 10.95% of the examined, DGR was observed in 8% of cases, pyloric deformity was detected in 13.5% of patients. Pathology of the mucous membrane of the duodenal bulb (duodenum) was noted in 89.9% of cases: signs of mucosal atrophy were detected in 2%, hyperemia in 79%, erosion in 21% of the examined, ulcerative defects of the mucosa were detected in 44% of patients: ulcer on the anterior wall – 47.8%, on the posterior wall – 25.4%, along the upper wall – 16.4%, ulcer of unspecified localization – 10.5%, two or more ulcers were detected in 9% of cases. According to the endoscopic data, the following changes in the esophagus were detected in children: 31.5% of patients showed signs of HE, cardia insufficiency and catarrhal esophagitis – in 57.9% and 15.8% of patients, respectively. When visualizing the mucous membrane of the stomach body, it was revealed: in 10.5% of cases – atrophic changes, in 63.2% of cases – signs of hyperemia. Hyperemia of the mucous membrane of the antrum of the stomach occurred in 100% of children. The frequency of detection of DGR was 42.1% of cases. Hyperemia of the mucous membrane of the BPC bulb was present in 84.2% of cases. No other changes were observed. A comparative analysis of the frequency of detection of gastrointestinal pathology in adults and children found that patients infected with H. pylori in childhood and adolescence are more likely to have cardia insufficiency (p<0.0001) and DHR (p<0.001). At the same time, the detection of erosions and ulcers of the mucous membrane of the BPC bulb was higher in patients over 18 years of age (p=0.023 and p<0.001, respectively).Conclusion. The age-related features of the endoscopic picture in patients infected with H. pylori are characterized by a predisposition of children and adolescents to impaired motility of the digestive tube, and adults to erosive and ulcerative changes, which may be a consequence of higher acid production. The fairly frequent detection of endoscopic signs of atrophy of the gastric mucosa dictates the need for histological examination in this category of patients using the OLGA system to establish the degree and stage of pathological changes, determine management tactics and follow-up of patients.

Comprehensive treatment of the patient with venous trophic ulcer

Improving the results of treatment for patients with varicose veins in the lower extremities, complicated by trophic ulcers, is an urgent task for modern medicine. A long-term, recurrent course of the disease leads to a reduction in working capacity and deterioration in quality of life, as well as permanent disability for patients, whose treatment causes special economic problems. At present, there are virtually no effective methods for conservative therapy, leading to prolonged unsuccessful treatment of such patients. This article presents the clinical case of a 63-year-old patient undergoing complex treatment for chronic lower limb venous insufficiency of class C6 according to the CEAP classification. Conclusion. An effective complex method for treating trophic ulcers in patients with chronic venous disease involves the correction of venous hemodynamic disorders (in this case, through radiofrequency ablation), as well as primary surgical treatment for the ulcerative defect, and simultaneous autodermaplasty with a perforated skin flap.

Application of biomedical cell products in the treatment of congenital epidermolysis bullosa

Congenital epidermolysis bullosa is a phenotypically and genetically heterogeneous group of genodermatoses, which which is clinically manifested by the development of blisters on the skin and mucous membranes after mechanical injury. The presence of long-term erosive and ulcerative defects in patients with congenital epidermolysis bullosa reduces the quality of patients` life and also leads to malignancy of the lesions, as a result of constant stimulation of regenerative processes.Currently, there are a lot of publications describing the use of skin substitutes, three-dimensional tissue-engineered structures based on auto- and allogeneic cells that promote rapid epithelization of wounds in patients with congenital epidermolysis bullosa. The most prospective and at the same time the least studied direction of congenital epidermolysis bullosa treatment is the use of a combined skin equivalent created on the basis of keratinocytes and fibroblasts, which mixes the advantages of epidermal and dermal grafts.

Immunological indicators of the risk of the transition from chronic gastritis to gastric ulcer in adolescents

As is known, gastric ulcer (GCC) and duodenal ulcer (duodenal ulcer) are chronic, complex-etiology diseases, the mechanism of which is based on complex transformations of nervous, hypothalamic-pituitary, hypothalamic-pituitary-adrenal and local gastroduodenal processes that lead to a change in trophism in the mucous membrane of the stomach and duodenum. In turn, the incipient ulcerative defect is a source of irritation of the enteric receptors, supporting disorders of neurohormonal regulation. Thus, the resulting “vicious circle” causes the chronic course of peptic ulcer disease. During the study of chronic diseases of gastroduodenal localization, including peptic ulcer disease, many doctrines of its occurrence have been proposed. However, the issue of the origin of peptic ulcer disease still remains insufficiently studied; approaches and tactics for managing patients with erosive and ulcerative lesions of the upper gastrointestinal tract are being developed. The aim of the study was to evaluate immunological indicators that determine the risk of chronic gastritis turning into gastric ulcer. The study included 120 children aged 14-17 years, permanently residing in the Bukhara region of the Republic of Uzbekistan. Taking into account the importance of H. Pylori in the development of HCG, patients were distributed depending on the association of HCG with H. Pylori. To study cytokines, blood tests of patients were performed to determine the titer of antibodies (IgG and IdM) to H. Pylori, immunoglobulins A, M, G in blood serum, secretory IgA in oral fluid, IL-1β, IL-10, TNFα, VEGF in the serum of patients. At the same time, blood sampling was carried out in the periods before and 3 weeks (21 days) after treatment. Thus, the study of the value of immunological blood parameters in the progression of HCG to gastric ulcer disease dictates the need to develop immunological indicators for predicting the progression of HCG to gastric ulcer in adolescents. An increase in TNFα levels indicates a high risk of developing gastric ulcer as a result of vascular damage and impaired local circulation. In the study, an established increase in the level of IL-1β indicates activation of the synthesis of proinflammatory cytokines in HCG, especially in HCG associated with H. Pylori. The use of these recommendations contributes to the monitoring of HCG, improving the effectiveness of diagnosis and the correct choice of treatment for patients with HCG, reducing mortality and disability at the same time.

POSSIBILITIES OF NON-STANDARD METHODS FOR TREATING INFECTED WOUNDS

Summary. Introduction. Some representatives of the microcosm can secrete a variety of biologically active substances that have a detrimental effect on other groups of microorganisms. The geniuses of humanity noticed this, and today medicine has about 1600 antibacterial drugs. However, the struggle for survival at all levels continues. Many bacteria have become resistant to existing antibiotics. Taking this into account, the treatment of purulent-inflammatory diseases faces insurmountable difficulties. Contaminated ulcerative processes and various wounds of the legs are accompanied by suppuration, the treatment of which is extended by weeks and months. The above justifies the relevance of the problem. Aim: to study the possibilities of using non-standard methods for treating purulent and infected wounds and ulcers. Materials and methods. In experimental conditions (patent), we studied and tested the treatment of purulent ulcers (S=2.0–42.0 cm2) and wounds (S=22.0–48.0 cm2) in 21 patients without the use of antibiotics. Apatite polymer drainage bandages (APDB) were applied under compression conditions. Results and discussion. The dressing was changed after 12–24–48 hours, depending on the exudation level. The clinical effect was observed from the 4th day. Epithelization of wound surfaces was observed on days 14–21, of ulcerative defects – on days 18–32. Conclusions. APDB based on zinc oxide may be an alternative to existing standard treatment methods for purulent diseases. Funding. This study was carried out with grant support from the National Research Foundation of Ukraine (project No. 2023.04/0109).

Retrospective multicenter analysis of the results of treatment for chronic duodenal ulcers complicated by bleeding

Introduction. Today, despite the therapeutic and diagnostic algorithms in the treatment of patients with ulcerative bleeding and the development of medical technologies, high postoperative and overall mortality remains amid a decrease in operational activity, which indicates the urgency of the problem and requires optimization of existing therapeutic and diagnostic algorithms.The objective was to analyze the results of treatment of patients with chronic duodenal ulcers complicated by bleeding.Methods and materials. A multicenter retrospective analysis of medical records of patients diagnosed with gastrointestinal bleeding was conducted in 4 hospitals in St. Petersburg for the period from 2018 to 2023. The sample included 379 patients with chronic duodenal ulcers complicated by bleeding. Such indicators as the size and localization of the ulcerative defect, J.A. J.A. Forrest type of bleeding, type of primary hemostasis, relapse rate, age, bed-day, mortality, presence of comorbid pathology, use of oral anticoagulants and antiplatelet agents were assessed.Conclusions. A high mortality rate in patients with duodenal ulcers is associated with a high frequency of recurrent bleeding. The cause of relapse in some cases is inadequately performed endoscopic hemostasis. For chronic duodenal ulcers complicated by bleeding, combined endoscopic hemostasis with clipping of the bleeding vessel and subsequent drug therapy is indicated. The existing tactics in the treatment of ulcer bleeding are universal for ulcers of various diameters, however, as a retrospective analysis showed, a high percentage of recurrent bleeding and mortality is associated with bleeding from ulcers with a diameter of more than 2 cm, which determines the need to optimize treatment tactics specifically for ulcers of this ulcer diameter.

A clinical case report of aberrant pancreas in the practice of a general practitioner

An aberrant pancreas is a fairly rare developmental anomaly, which, de spite its congenital genesis, is most often found in people of the middle age group. The article presents a clinical case of an aberrant pancreas with localization in the antrum of the stomach in a 52-year-old patient. Congenital pathology has an asymptomatic course for a long time, which is subsequently associated with late diagnosis and the need for a comprehensive examination of the patient. Despite the long-term symptomless course of the pathology, the secretory activity of the ab errant pancreas contributes to persistent inflammation of the gastric and duodenal mucosa, potentiates irreversible pathological changes, and increases the risk of complications, including gastric intestinal metaplasia. The patient under consider ation was diagnosed with a multimorbid chronic pathology of the gastrointestinal tract, which, despite ongoing therapy, was characterized by frequent exacerbations. Due to the established diagnosis, it was possible to prescribe successful conser vative treatment and avoid surgical intervention in this patient. According to the literature, differential diagnosis with malignant neoplasms is necessary. The choice of surgical treatment tactics is determined by the development of complications, among which both obstructive complications (dysphagia, pyloric stenosis, intus susception, intestinal obstruction, obstructive jaundice) and complications specific only to pancreatic tissue, such as pancreatitis, cysts and pseudocysts, ulcerative defects with perforation of the hollow organ, benign and malignant neoplasms, are described. The question of the expediency of surgical treatment of patients in the absence of complications remains debatable to the present day, which causes diffi culties in the management of these patients.

Original Empirical Research Protective Effects of Succinic Acid upon Exposure to the Low-Frequency Alternating Magnetic Field Determined in the Experiment

Introduction. The need to simulate the oxidative stress by an experiment of exposure to the low-frequency alternating magnetic field is induced by the persistent increase of the electromagnetic load on the endothermic organisms caused by the annual deterioration of the electromagnetic state of the environment. The low-frequency alternating magnetic field starts a chain of biochemical reactions in the laboratory animals, which alter the homeostasis against the increased intensity of free-radical oxidation (peroxidation) of biomembrane lipids. The preparations containing succinic acid have the antioxidant, antihypoxant, actoprotective and stress-protective effects, tested through various kind of modelling, however, the absence of data on the efficacy of succinic acid under the exposure to the alternating magnetic field has become the reason for the present experiment. The aim of the research is to determine the protective effects of succinic acid upon exposure of the laboratory rats to the low-frequency alternating magnetic field.Materials and Methods. The objects of the research were 90 white outbred male rats weighing 200–250 g, divided into three groups: group 1 — intact, the animals were in standard vivarium conditions and were not exposed to any effect; group 2 — control, the rats were exposed to the low frequency alternating magnetic field (LF-AMF) for 21 days daily per 3 hours, preceded by daily intraperitoneal administration to animals of the 0.9% sodium chloride solution at a dose of 1 ml / kg straight before them being exposed to LF-AMF; group 3 — experimental, the rats were daily intraperitoneally administered the succinic acid at a dose of 100 mg / kg (1 ml / kg) for 21 days prior to being exposed to LF-AMF. The exposure to the low-frequency alternating magnetic field was created by the Helmholtz coils (of diameter 1 m) powered by the alternating current source with a frequency of 50 Hz, with a magnetic field induction of 0.4 mT, whereas the cages with animals were placed in the centre of the device. The actoprotective effect of succinic acid was checked on the 7th, 14th and 21st days from the beginning of the experiment by duration of swimming of rats in water. The antioxidant effect — by concentration of diene conjugates, lipid hydroperoxides, malondialdehyde, ceruloplasmin, vitamin E in the blood plasma of rats measured according to the commonly accepted methods. The stress-protective effect was determined by the masses of the adrenal glands, thymus gland, spleen and the number of erosive defects on the suRussian Federationace of the gastric mucosa.Results. The experimental data has confirmed the actoprotective effect of succinic acid — the duration of swimming of the rats in the experimental group increased by 25–37% compared to the control one. The antioxidant effect of succinic acid under magnetic induction has been manifested in a decreased concentration of lipid peroxidation products against increased level of ceruloplasmin in the blood of rats in the experimental group compared to the animals in the control group. Administration of the succinic acid into the peritoneum of rats in the experimental group under exposure to the low frequency alternating magnetic field has prevented involution of the thymus gland by 45% (7th day), 56% (14th day), 71% (21th day) and the spleen by 52%, 58% and 66% respectively, alongside, the number of erosive and ulcerative defects on the suRussian Federationace of the gastric mucosa has decreased by 2.5–4 times compared to the animals in the control group.Discussion and Conclusion. The protective effects of succinic acid upon exposure to the low-frequency alternating magnetic field have been confirmed that include the stress-protective, actoprotective and antioxidant effects of the exogenous succinate. The ability of succinic acid to prevent the negative changes in the internal organs caused by the magnetic loads is proved by the statistically significant excess of the mass coefficients of the thymus gland and spleen in the experimental group, compared to the control one, along with the fewer erosive defects on the suRussian Federationace of the gastric mucosa. Succinic acid reduces the intensity of lipid peroxidation processes upon the magnetic exposure due to reducing the concentration of lipid peroxidation products and increasing the level of ceruloplasmin in the blood of animals.

Valproic acid induced Stevens–Johnson syndrome

A 27-year-old transgender female at the stage of gender transition with bipolar disorder for which she received valproic acid developed multiple petechial rashes on the chest, upper and lower extremities, local erythematous lesions with forming blisters, large-platelet peeling on the face, neck, chest and inguinal area, erosion on the oral mucosa. She was diagnosed with drug eruption, Stevens–Johnson syndrome. The diagnosis was verified on the basis of complaints, medical history, clinical picture, laboratory findings. Treatment included valproic acid withdrawal, dexamethasone, infusion therapy, vancomycin, cyclosporine A. Against the background of the therapy, skin condition was improved: there was the epithelization of ulcerative defects and the absence of new elements.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ ГАНГРЕНОЗНОЙ ПИОДЕРМИИ У ДЕВУШКИ-ПОДРОСТКА

Pyoderma gangrenosum (PG) is the most severe type of pyoderma and is extremely rare among children and adolescents. Authors represent a clinical case of PG in a 14 years old female adolescent characterized by multiple sharply painful ulcerative defects with a pronounced tendency to peripheral growth. PG had arisen and proceeded further during the postoperative period against the background of iron deficiency anemia, chronic nonspecific nonulcerative colitis and a dysfunctional state of humoral immunity. Making a diagnosis, conducting differential diagnostics, identifying provoking factors, searching for concomitant somatic pathology, using a set of therapeutic measures made possible eliminating the PG clinical manifestations completely though development of the preventive measures and determination of the prognosis of the disease are difficult clinical tasks for pediatric practitioners nowadays.

Problems of late radiation injuries of the skin and possibilities of their treatment

Currently there is a problem of insufficient effectiveness of treatment of late radiation skin lesions. Possibilities of application of combined schemes of treatment of malignant neoplasms, including radiation therapy, show both good immediate and distant results, life expectancy of patients has increased. However, the issue of such remote local radiation lesions as radiation ulcers also remains relevant. Such lesions in the practice of clinical oncologists usually occur from 1-1,5 months and more after the end of the course of close-focus X-ray therapy for skin cancer. The peculiarity of radiation ulcers is that they heal extremely poorly even by secondary tension. In the pathogenesis of late radiation ulcers, along with disruption of microcirculation, the main role is played by the direct damaging effect of radiation on stem cells and, consequently, suppression of reparative processes. For this reason, such ulcerous defects are characterized by torpidity to drug and surgical treatment. The analysis of modern scientific and practical literature does not fully reveal the peculiarities of the pathogenesis of post-radiation skin lesions leading to the development of radiation ulcers. Researchers have set a goal to search for new modern methods of effective treatment of this pathology. The main purpose of the literature review was to theoretically substantiate the possibilities of including enzyme antioxidants and epidermal growth factor preparations into the complex of pathogenetic treatment of radiation skin ulcers. Superoxide dismutase (SOD) is an active enzyme-antioxidant, it neutralizes excessive free oxygen radicals, and also has a pronounced anti-inflammatory effect by means of oxidative post-radiation stress of skin tissues. Epidermal growth factor promotes cell growth and differentiation of stem cells (SC) involved in ulcer defect regeneration. Pathogenetically justified stepwise application of these drugs will improve the effectiveness of treatment of post-radiation skin ulcers. This paper presents the current information about the pathogenesis of late radiation skin ulcers, the mechanism of action of SOD, epidermal growth factor preparations, as well as the importance of the microenvironment and the homing effect in controlling the links of the pathogenesis of radiation ulcers and the possibility of their reparative regeneration.

Endoscopic picture of pseudopolyposis in inflammatory bowel diseases

Aim. To evaluate the frequency of pseudopolypes (PP), as well as their histological structure in patients with inflammatory bowel diseases (IBD). Materials and methods. 165 patients with IBD were examined (113 with ulcerative colitis (UC), 52 with Crohn’s disease (CD)). All patients underwent ileocolonoscopy with taking the material for histological examination in case pseudopolypes were detected. Results. It was revealed that pseudopolypes were found in 27% of patients with IBD (in UC - in 29%, CD - 23%). In different phases of the inflammatory process in UC, the number of PP was comparable to each other. In CD, PP was statistically significantly more often detected at the stage of scars and outside of exacerbation than in the phases of infiltration and ulcers. During histological examination of biopsy material from PP tissue hyperplasia, inflammatory polyp and granulation tissue were verified. Adenoma was detected in one case in each of the IBD. Crypt abscesses and crypt discomplexation were found only with exacerbation of UC. Conclusion. Based on the results of our study, pseudopolypes occur in both UC and CD in different phases of the inflammatory process, which indicates the absence of specificity of these tumors for any of the IBD. The identification of a large number of PP at a pronounced stage of UC, in our opinion, indicates the connection of PP with an aggressive attack, which can serve as one of the criteria for predicting the course of UC. The cellular composition of PP in most cases reflected inflammation or healing of erosive and ulcerative defects, as well as in a small number of cases, the presence of adenoma. Thus, PP requires careful examination during endoscopic examination, if there is a suspicion of neoplasia or dysplasia in the PP tissue, biopsies must be taken for histological examination.

DIABETIC POLYNEUROPATHY AND COMORBIDITY ARE DIABETIC FOOT SYNDROME FORMATION FACTORS

Background. Data from the literature indicate about the development of diabetic polyneuropathy in 5 years after the onset of type 1 diabetes and in 10-15% of patients with newly diagnosed type 2 diabetes. The purpose of the study was to find out the clinical course of diabetic polyneuropathy and to determine the frequency of the occurrence of diabetic foot syndrome in conditions of the comorbidity. Methods. We examined 121 patients, aged from 19 to 69 years, diagnosed with diabetic polyneuropathy due to type 1 and type 2 diabetes. The examined patients were divided into three groups: with diabetic polyneuropathy and cardiovascular comorbidity (group A, n=52), multimorbidity (more than 3 nosologies) (group B, n=30), without comorbidity (group C, n=39). Conclusions. Clinical manifestations of the diabetic polyneuropathy were more significant in the individuals with the cardiovascular comorbidity. The presence of stenoses and occlusions in the arterial channel in groups A and B served as a basis for the formation of ulcerative defects of the limbs in the future.

Orbital apex syndrome secondary to Noma Destruction: A Case Report

Purpose To present a case report of orbital apex syndrome secondary to Noma destructive processes. Method A case of 7-year-old child who presented with an ulcerative defect on the left cheek region and left orbital pain with reduced vision in the left eye has been presented. There was a history of cheek swelling, fever and, loss of appetite with a recent history of malaria treatment. Clinical examination revealed a cone shaped buccal ulcerative defect involving both the left outer and inner cheek walls with extension to the dentoalveolar segment, the maxilla and, the posterior palatal region with an observable sequestrum. Ophthalmological examination revealed loss of vision, complete ptosis and, ophthalmoplegia. There was loss of sensation in the frontal and preorbital region and, absolute pupillary defect in the same eye. A clinical diagnosis of orbital apex syndrome secondary to noma destruction was made. Result Management was instituted by a team of maxillofacial surgeons, ophthalmologists and, nutritionists. Antibiotics, serial debridement, and sequestrectomy were the predominant treatments given and there was resolution of the symptoms except persistent ptosis, loss of vision and, ophthalmoplegia. Conclusion Noma is a rapidly progressive disease that is capable of destroying oral and surrounding soft and, hard tissues with serious functional and cosmetic complications. Orbital apex syndrome was seen as a complication in this case report. This reinstates the need for early detection and treatment of noma.

A Case of Corneal Melt and Perforation Associated with Rheumatoid Arthritis Managed by Corneal Patch Graft

Corneal melt is a rare yet severe complication of Peripheral Ulcerative Keratitis (PUK), observed in patients with Rheumatoid Arthritis (RA). The mortality rate associated with corneal melt is high, warranting aggressive treatment. A 50-year-old female, a known case of RA for 20 years, presented with complaints of blurred vision, watering, irritation, and photophobia in both eyes for the last year, with worsening symptoms in the Right Eye (RE) for the past 15 days. She was diagnosed elsewhere in a private hospital with RE corneal melt and perforation and inferior corneal thinning in the Left Eye (LE), with an ulcer defect. She underwent corneal perforation suturing in the RE before reaching the present facility. On examination, a sutured corneal perforation was present in the RE, and corneal thinning and melt were seen para-centrally and inferiorly in the LE. Surgical treatment with RE corneal patch graft repair was performed. The patient was given oral methotrexate and prednisolone for aggressive systemic control of RA and to ensure the survival of the patch graft. The vision in the RE improved following the procedure, maintaining the tectonic integrity of the cornea. On follow-up, aleucomatous opacity was noted in the RE patch graft tissue. Corneal thinning in the LE was treated topically with artificial tears and antibiotic eyedrops, which eventually healed, forming macular corneal opacity. Overall, corneal patch graft repair enabled the maintenance of tectonic support and corneal integrity, as well as vision improvement in the patient with RA presenting with the complication of corneal melt and perforation.

Gastric resection in emergency surgery

The success of the therapeutic treatment of gastric and duodenal ulcers has also changed the attitude of surgeons to the complications of peptic ulcer. Currently, the main aim of the surgeon is to eliminate the life-threatening consequences of perforation or bleeding. In addition, methods of intraluminal endoscopy continue to develop vigorously, in some cases competing with both open and laparoscopic surgeries for perforated ulcers, and endoscopic and endovascular hemostasis is increasingly used for ulcer bleeding.Purpose. To analyze the immediate and long-term results of surgical treatment of complicated gastric and duodenal ulcers and to evaluate the place of gastric resection in emergency surgery.Results. The paper analyzes the results of resection and organ-preserving gastric surgeries in perforated and bleeding ulcers using modern instruments that improve the results of the operation. As a reserve for improving the results of this intervention, one should consider performing optimal mobilization and a full revision of the ulcer defect zone, and, of course, involving a more experienced surgeon.