[Efficacy of prostaglandin E1 and systemic antibacterial therapy application in patients with diabetes mellitus and purulent-necrotic lesions of the foot].

The results of prostaglandin E1 et systemic antibacterial therapy use in 1836 patients, suffering purulent-necrotic affection of foot, were summarized. There was established, that cefuroxym constitutes the first line preparation for the ostheoarthropathy focus elimination, when the affection is limited and the patient state is stable, and meronem--for extended affection and unstable patient's state. In the pronounced ischemia of the foot the initial administration of cefepim is the most effective. For purulent-necrotic affection as a consequence of the foot wounding, erysipelas or operative intervention it is expedient to use carbapenem or meropenem. The systemic antibacterial therapy administration had promoted significant reduction of the treatment duration and improvement of its result.

[Experimental substantiation of the new method of hemostasis].

The article provides the results of experimental welding occlusion of arterial and venous vessels 2-12 mm in diameter, including 998 bench tests of resected animal vessels, 256 bench tests of resected human vessels, and also experiments involving 42 live animals (pigs). During the above-mentioned tests 748 vessel obturations were performed. Manual regimen of welding enables the leakproof obturation of the vessel in 66.4% of animals, the result was instable in 22% of cases, no obturation was achieved in 11.6%. Selecting the optimal automatic regimen, we obtained the best results during whelming with the use of the program N.6. The mean strength of the suture obtained in 98.2% of cases was 91,066.7 +/- 215.20 mm Hg. The instable outcome of welding in 1.8% of cases of the use of program N 6 was the result of the use of different welding instruments. The best results (1324 +/- 258) mm Hg were obtained when the electrodes of the welding clamp were compressed at one peg and the force of compression was 91.9 +/- 0.2) MPa. We have established that the short-term impact of increased temperature (from (56 +/- 1.9) to (81 +/- 2.7) degrees C enables denaturation and coagulation of protein molecules, which results in welding connection without coagulation necrosis.

[Application of preperitoneal access for surgical treatment of inguinal hernia].

The results of treatment of 51 patients suffering uncomplicated inguinal hernia were analyzed. There was established that application of preperitoneal access permits to estimate the inguinal channel height and to determine the indications for application of alloplasty. In 29.4% of observations the internal inguinal space height have had exceeded 3.1 cm, predisposing to hernia recurrence in postoperative period. While the internal inguinal space height have constituted 4.1 cm and more it is mandatory to use the net for its secure fixation in the early postoperative period and for prophylaxis of the abdominal wall deformity, setting the net no less than 5 cm behind the muscles edges. In two years after the operation there were examined 24 patients, recurrence was absent.

[Optimization of modern tactics of operative treatment for hemorrhoids of stages III-IV].

The literature review and results of observations of their own, concerning treatment of patients with hemorrhoids, are adduced. Separation of circular and segmental forms of coexistent prolapsus recti permits to choose pathogenetically substantiated method of operative intervention for the hemorrhoidal nodes enlargement. Performance of the sun-like circular anorectal vasomucosectomy in the treatment of circular prolapsus recti, coexistent with enlargement of hemorrhoidal nodes, secures the pathological blood flow disconnection, the pain intensity and sphincteric spasm reduction, permits to escape postoperative inflammation, which is characteristic for procedure of the apparatus circular anorectal vasomucosectomy.

[Variants of surgical treatment of cholecystitis]. / Varianty khirurhichnoho likuvannia kholetsystytu.

Basing on analysis of the treatment results of 375 patients with cholecystitis the indications for application of broad laparotomy, variable laparotomy, mini access, endotracheal narcosis and epidural anesthesia are substantiation.

[Efficacy of vascular therapy in complex of treatment of purulent necrotic foot ulcers in patients with diabetes mellitus]. / Efektyvnist' sudynnoï terapiï v kompleksi likuvannia hniino-nekrotychnoho urazhennia stopy u khvorykh na tsukrovyi diabet.

The result of treatment of purulent-necrotic affection of foot (PNAF) in 151 patients with diabetes mellitus (DM) was estimated. The conduction of preoperative medicinal therapy is mandatory for the general status of patient stabilization only. After prescribing of heparin, no-spa, papaverin, rheopolyglucinum, solcoseryl, aspirin the foot tissues blood supply is changing nonvitally, the foot tissues blood supply while the alprostan intravenous infusion improves significantly. The alprostan prescription during performance of operative intervention on foot in patients with PNAF, caused by DM, and in the collateral blood flow decompensation of the leg and foot arteries is mandatory.

[Peculiarities of the occurrence of soft tissue disorders and prospects of their closure in patients with diabetes mellitus]. / Osoblyvosti vynyknennia defektu m'iakykh tkanyn stopy ta perspektyvy ioho zakryttia u khvorykh na tsukrovyi diabet.

Cause and mechanisms of the foot soft tissues defect (FSTD) and efficacy of its closure were analyzed in 62 patients with diabetes mellitus. FSTD presented as chronic infected (in 7 observations) or uninfected (in 4) ulcer of foot or it occurred acutely immediately after excision of necrotized tissues (in 32) and after the operation due to disordered healing of wound or to necrosis of her edge (in 12). In presence of osteoarthropathy, purulent inflammation as a consequence of trauma or isolated affection of toes II or III the conduction of intensive antibacterial therapy permits to eliminate purulent inflammation during 4-7 days and than to close FSTD using existing methods. Occurrence of FSTD on background of disordered blood supply of foot forces to conduct not only systemic, but intensive local antibacterial therapy as well, yet it is not possible to achieve clearing of all the wound. In such a case it is expedient to perform staged closure of little-infected places of wound and sawn surfaces of the bones, what reduces the wound cachexia of patient and promotes the foot stump preservation. Closure of chronic ulcer of the foot by the cutaneous flap transposition must be done on background of alprostan injections.

[Clinico-radiological estimation of the foot changes in patients with diabetes mellitus]. / Kliniko-renthenolohichna otsinka zmin stopy u khvorykh na tsukrovyi tiabet.

Results of roentgenography, performed in 92 patients with diabetes mellitus, complicated by purulent-necrotic affection of foot, and data of nuclear-magnetoresonance tomography (NMRT), conducted in 17 patients, were analyzed. In 70% patients tactics of their further treatment was influenced by presence of deformity and destruction of the foot bones and joints, revealed by roentgenography. Data of the foot roentgenography permitted to differentiate diabetic osteoarthropathy vs the foot bones osteomyelitis in 81% of observations. It is impossible to determine the bone integrity according to NMRT results, but inflammatory foci in bone may be revealed. In presence of obscure data of roentgenography and NMRT it is necessary to make diagnosis of osteomyelitis and to perform proper treatment during 3-6 weeks.

[Indexes of activity of specialized department for the treatment of foot lesions in patients with diabetes mellitus]. / Polaznyky diial'nosti spetsializovanoho viddilennia z likuvannia urazhennia stopy u khvorykh na tsukrovyi diabet.

Experience of treatment of 2524 patients with diabetes mellitus (DM) for the 1990-2001 yrs period was summarized. Of all the patients 48-52% are presenting the citizens of Darnitskiy and Kharkivskiy regions of city of Kyiv. For the 1990-1994 yrs period general lethality had constituted 7.5-9.1%, postoperative mortality--9.2-13.5%, while after 1996--4.3-1.9 and 5.4-1.1% accordingly. Improvement of results of treatment was promoted by conversion in 1996 to conduction of operative interventions using spinal or epidural anesthesia. From 2000 we are planning performance of two-, three- or multistage treatment of patients because there exists possibility to preserve the foot, using several stages to excise nonviable tissues and to perform plastic operations. Right from the moment when conversion to multistaged operations happened, new demands occurred for quality of local measures of struggle against infection and for application of technology for preservation of viability in the skin-free foot tissues. Analysis of the case records of 62 patients with DM, to whom in other medical institutions operation for purulent-necrotic affection of the foot was performed, witnesses the necessity of spreading of the experience of the specialized division work among surgeons and endocrinologists.

[Antibacterial therapy of purulent necrotic foot lesions in patients with diabetes mellitus]. / Antybakterial'na terapiia hniino-nekrotychnoho urazhennia stopy u khvorykh na tsukrovyi diabet.

Efficacy of antibacterial therapy was analyzed in 266 patients with diabetes mellitus and purulent-necrotic affection of the foot. In presence of affection of bones and joints good effect was achieved while conduction of antibacterial therapy and in the cases of open wound--while local administration of systemic antibacterial preparations.

[Changes of the glycemia level in surgical treatment of purulent-necrotic affection of the foot in patients with diabetes mellitus]. / Zminy rivnia glikemiï pry khirurhichnomu likuvanni hniino-nekrotychnoho urazhennia stopy u khvorykh na tsukrovyi diabet.

Of 266 patients with diabetes mellitus (DM) 240 were operated on for purulent-necrotic affection of foot. The carbohydrate metabolism state before the operation and the postoperative course of DM do not influence the surgical intervention volume and the operative wound healing. The glycemia level exceeding 11 mmol/l 3 days after the operation trusts the nonviability of the tissues resided and the need for reoperation.

[Strategies of the diabetic foot treatment]. / Taktyka likuvannia diabetychnoï flehmony stopy.

Clinical course and efficacy of treatment of the diabetic foot phlegmon in 47 patients were analyzed. The phlegmon opening was the definitive intervention in 85% of patients, the phlegmon opening with fingers amputation--in 67%, the phlegmon opening and Sharp operation--in 87%. The bearing function of foot was preserved in 73% patients.

[The performance of cholecystectomy using a small access]. / Vikonannia kholetsistektomiï z vykorystanniam maloho dostupu.

The indications for application, technique of performance and results of cholecystectomy, conducted through a small access in right epigastric region, were adduced in 19 patients.