[Efficacy of compression knee-high socks ULCER X in treatment of venous-genesis trophic ulcers].

UNLABELLED: The study was aimed at comparatively assessing the efficacy of treatment for venous trophic ulcers at stages II-III of the wound process using special compression knee-length socks of the ULCER X kit (Sigvaris AG, St. Gallen, Switzerland) and long-stretch bandages Lauma. Compression therapy was included into the programme of outpatient treatment of forty 31-to-74-year-old patients presenting with trophic ulcers (stage II-III of the wound process) with an average area of 5,36±1,1 cm2. The Study Group consisting of 20 patients used compression knitted fabrics in the form of knee-length socks ULCER X and the comparison group (n=20) used long-stretch bandages Lauma. RESULTS: The obtained findings (6 months) demonstrated that using compression therapy exerted a positive effect on the process of healing of venous trophic ulcers, also proving advantages of compression therapy with the knee-length socks ULCER X that create an adequate level of pressure on the crus and maintain it in long-term daily use, reliably accelerating the healing of venous trophic ulcers as compared with elastic long-stretch bandages. The use of long-stretch elastic bandages in treatment of venous trophic ulcers turned out to be not only ineffective but fraught with a possibility of the development of various complications. During 6 months of follow up the patients using the special knee-length socks ULCER X were found to have 80 % of ulcers healed (16 patients), mainly within the first 2 months, whereas using elastic bandages resulted in only 30 % of healing (6 patients) by the end of the study. Along with it, we documented a considerable decrease in the malleolar circumference in the study group patients (from 30,05±0,78 to 28,35±0,86 cm) and in the control group from 31,2±30,35 to 30,25±0,75 cm), accompanied and followed by more than a two-fold increase in quality of life of the patients along all the parameters in the study group and a 1.4-fold increase in the control group patients.

[Peculiarities of peripheral haemodynamics in patients with varicose disease of lower-limb veins complicated by trophic ulcers].

The work was dedicated to studying local, regional and systemic circulatory disorders in patients suffering from varicose disease of the lower extremities veins with accompanying trophic ulcers. The possibility of performing this work was determined by a diagnostic complex possessing high informative value (especially it concerns studying microcirculation). Based on the obtained findings we managed not only to evaluate severity of microcirculatory disorders but also to characterize them qualitatively, in particular to reveal the so-called blood microshunting phenomenon. Pathophysiologically important is the development of inflammatory hyperaemia in the area of trophic ulcers, which is prognostically favourable for their healing. Proceeding from the above-mentioned, utterly true turned out the conclusion concerning the necessity to include microcirculation-improving pharmaceutical substances into the program of treatment of patients suffering from varicose disease of the lower-limb veins, especially those presenting with concomitant trophic ulcers, along with surgical intervention.

Trophic venous ulcers and their relationship with the immune status.

This paper describes the results of an original study into the systemic and local immunity in 25 patients with trophic venous ulcers. The authors discovered a number of significant parameters demonstrating the influence of the immune status on the formation of venous ulcers and tempo of their healing. They revealed previously unknown relationships between the immune status, clinical manifestations arid natural history of venous ulcers. Presented herein are the first results of the local use of the immunomodulator gepon and evidence for its efficacy in the treatment of chronic trophic venous ulcers.

[Acerbin for treatment of indurative cellulite in patients with venous trophic ulcers].

Acute indurative cellulite can impair regeneration processes in patients with venous trophic ulcers. Wide range of antimicrobial agents is used for its management, while their role and place remain disputable. The choice of adequate local therapy plays a key role in total success. Conventional topical drugs and anticeptics in most cases appear to be ineffective or, besides antimicrobial action, can inhibit reparative processes. Combined formulation Acerbin exhibits not only antimicrobial properties, but stimulates granulation and epithelization, as well, and resolves inflammation in adjacent to ulcer tissues. That is why it can serve a beneficial alternative to conventional topical drugs.

Micronized diosmin (Detralex) for vein-related trophic ulcers: European experience.

The paper presents a meta-analysis of 5 large European studies (N - 723) on the micronized diosmin administration to patients with venous trophic ulcers (CEAP class VI). With the use of evidence-based approach, it was shown that micronized diosmin has a statistically significant clinical effect on middle-sized trophic ulcers (5 - 10 cm(2)) that persisted for 6 - 12 months. The study concludes that polyvalent venotonics are an appropriate and valuable addition to complex therapy of complicated chronic venous insufficiency.

[Drug therapy of chronic venous insufficiency with Venza].

An open prospective study on the use of the drug Venza for complex variceal disease treatment was conducted. The study included 125 patients aged from 21 to 75. The outcome measures were: patient complaints and medical history, as well as Doppler ultrasound of lower limb veins, arteriovenous index (AVI) and leg circumference at the ankle level for the objective assessment of therapeutic effectiveness. Malleolar circumference decreased by average 0.8+/-0.3 cm. The drug therapy resulted in the regression of clinical signs (leg fatigue heaviness and edema, night palsies). Venza had a positive effect on all evaluated parameters of patient's quality of life. Its clinical effectiveness was estimated as "very good" and "good" in 27.5% and 57.5%, respectively. The study proved the Venza's effectiveness in treatment of patients with lower limb chronic venous insufficiency.

Shave therapy for non-healing venous trophic ulcers.

Venous trophic ulcers comprise an important social and medical problem. Conventional therapy includes initial healing of ulceration with consequent surgical intervention. Persistent or recurrent venous ulcers elicit irreversible changes in skin, subcutaneous fat and fasciae making impossible complete success of standard autodermoplasty. We present our experience in shave therapy with autodermoplasty and simultaneous correction of hemodynamic disturbances for this cohort of patients. Study results have demonstrated that in patients with chronic venous trophic ulcers and manifested lipodermatofasciosclerosis shave therapy suggests an optimal volume of intervention.

[Treatment of trophic ulcers of the lower extremities with Trental-400]. / Lechenie troficheskik iazv nizhnikh konechnostei "Trentalom-400".

Thirty-two patients with arterial and venous trophic ulcers were treated by Trental-400 in a dose of 1200 mg a day within 6 months. The full success has been achieved in 65.6% of all cases. Significant progress was in 9.4% of all patients. There were several reasons for no success in other cases. The mains of them are: aterial insufficiency in a complex with an old age, other severe problems, unadequate local therapy.

[Peripheral hemodynamics and the orthostatic phenomenon in patients chronic arterial obliterative diseases of the lower extremities with severe ischemia]. / Perifericheskaia gemodinamika i ortostaticheskii fenomen u bol'nykh khronicheskimi obliteriruiushchimi zabolevaniiami arterii nizhnikh konechnostei s tiazheloi ishemiei ikh.

The authors offer a new approach to dividing patients with pain at rest into groups with stage IIIa and IIIb as they think it inappropriate to base on the values of regional arterial pressure. The above differentiation is needed because there exist qualitative differences between these stages, for instance, in stage IIIb a new factor appears --ischemic edema. The results obtained can be used for more adequate definition of the notion "critical ischemia" of the legs.

[The efficacy of the combined conservative therapy of patients with chronic obliterating arterial diseases of the extremities in outpatient practice]. / Ob éffektivnosti kompleksnoi konservativnoi terapii bol'nykh s khronicheskimi obliteriruiushchimi zabolevaniiami arterii konechnostei v ambulatornoi praktike.

The paper provides the results of multimodality conservative therapy in 527 patients with chronic obliterating diseases of extremity arteries, which was performed in the outpatient setting. Factors influencing its efficiency were analyzed. The paper emphasizes the value of this direction of treatment whose underestimation sharply aggravates the prognosis of these diseases, including the results of their surgical management. Having obtained positive results in 84.5% of patients, the authors note the efficiency of treatment to be decreased with severe arterial insufficiency of lower extremities (5% of negative results in Stage IIa, 23% in Stage IIb, and 40% in Stage III), in patients with prior surgical interventions, and in elderly patients with atherosclerosis obliterans and younger patients with non-specific aortoarteritis.

[A method for evaluating skin mechanical parameters for examination of patients with varicose veins of the legs]. / Ispol'zovanie metoda otsenki mekhanicheskikh parametrov kozhi dlia obsledovaniia bol'nykh varikoznoi bolezn'iu nizhnikh konechnostei.

Possibility of application of the new method, based on detection of surface acoustic wave spreading velocity, for diagnostics of various disease extent. It has been determined that there is some correlation between the skin mechanical parameters at the more affected sites of it and the disease extent. Correlation between acute thrombophlebitis and skin state in affected zone has been shown.

[An outpatient contingent of patients with chronic arterial obliterating diseases of the extremities]. / Ob ambulatornom kontingente bol'nykh khronicheskimi obliteriruriushchimi zabolevaniiami arterii konechnostei.

Case records of 2135 outpatients referred to a specialized department with a provisional diagnosis of limb arterial affection have been analyzed. It appeared that in 35% of the cases the diagnosis was erroneous, the complaints being due to neurological and locomotor disturbances. Nosological entities of confirmed vascular diseases were the following: obliterating atherosclerosis (81.8%), obliterating peripheral aortic arteritis (9%), obliterating atherosclerosis associated with diabetic angiopathy (6%), obliterating thromboangiitis (1.6%), Raynaud's disease (1.6%). The disease-specific age pattern showed that obliterating atherosclerosis and age-specific cholesterol levels have the same trends, that there may be transformation of obliterating thromboangiitis into nonspecific aortic arteritis which eventuates in advanced age into obliterating atherosclerosis.

[Short-term preservation of venous transplants and evaluation of their viability]. / Nedlitel'naia konservatsia venoznykh transplantov i otsenka ikh zhiznesposobnosti.

A method for short-term (7 days) storage of venous grafts was developed. The grafts were stored in 2% solution of neutral formaldehyde and isotonic buffer solution (Henks' solution). The viability and tissue metabolism were studied in grafts taken from 54 patients who underwent operation for primary varicosity of the lower limb veins without trophic disorders. Light and electron microscopy as well as biochemical tests showed that grafts stored in Henks' solution maintain viability for up to 7 days, while those stored in a 2% neutral formaldehyde solution for 2 days cannot be used as allografts in reconstructive operations on the lower limbs.

[The use of venous allografts in vascular surgery]. / K voprosu o primenenii venoznykh allotransplantatov v sosudistoi khirurgii.

Biochemical, morphological and biomechanic study of various veins which were taken from 54 patients without trophic disorders during phlebectomy and kept for 7 days was made. 2% solution of neutral formalin and isotonic buffer solution (Henx solution) was used; results of the study show, that conserved veins can be used for grafting in arterial reconstructive surgery in cases of absence of autogenous vein material. Optimal period of conservation is 1 day.