[Regional intraosseous thrombolytic therapy in comprehensive treatment of patients with diabetic foot syndrome]. / Regionarnaia vnutrikostnaia tromboliticheskaia terapiia v kompleksnom lechenii sindroma diabeticheskoi stopy.

The authors assessed efficacy of regional intraosseous administration of urokinase medac in comprehensive treatment of patients with complicated forms of diabetic foot syndrome by means of analysing therapeutic results in a total of 65 patients presenting with pyonecrotic complications of diabetic foot. The patients were subdivided into 2 groups. The control group was composed of 35 patients receiving basic therapy. The study group comprised 30 patients subjected to comprehensive treatment including regional intraosseous (into the heel bone of the affected limb) administration of urokinase medac at a dose of 100 thousand IU for 5 days. Efficacy of treatment was evaluated by the course of the wound process, indices of haemostasis, free radical oxidation, results of surgical treatment. In patients of the Study Group the terms of wound purification from pyonecrotic masses amounted to 9.8±0.3 days, which was by 4.7 days less than in the Control Group patients (p<0.01), marginal epithelialization of wounds also occurred averagely by 6.4 days faster. On day 22 of using the basic therapy alone, the haemostasis system preserved the condition of coagulation activity. The Study Group patients as early as on day 5 of treatment demonstrated shifts towards normocoagulation. In the Control Group by day 22 of treatment, the level of malonic dialdehyde decreased by 18.5%, the index of catalase activity increased by 24.6% (p<0.05); in the Study Group the level of malonic dialdehyde decreased by 42.6% and catalase activity increased by 69.4% (p<0.01). On the background of using urokinase the number of high amputations decreased by 18% and the number of operations with the supporting function preserved decreased by 12% as compared with basic therapy alone. A conclusion was made that additional use of regional intraosseous administration of urokinase medac as compared with basic therapy alone promoted a more significant decrease in the coagulation activity of blood and the level of free-radical lipid oxidation, stimulation of regenerative processes, as well as improvement of outcomes of surgical treatment.

[Intra-arterial thrombolytic therapy of ischaemic complications of lower-limb diabetic angiopathy].

Based on the parameters of haemostasis, free radical oxidation and endogenous intoxication the study was aimed at assessing efficacy of intra-arterial administration of urokinase medac in complicated forms of lower-limb diabetic angiopathy. The authors assessed the outcomes of treating a total of 32 patients with complicated forms of lower-limb diabetic angiopathy on the background of basic therapy and 30 patients whose combined therapy included intra-arterial administration of the thrombolytic agent urokinase medac, also studying the indices of haemostasis, endogenous intoxication, free-radical oxidation and antioxidant defence. At admission to hospital, patients were found to have shifts of the coagulogram towards hypercoagulation. The group of patients receiving intra-arterial administration of urokinase showed that the examined parameters on day 20 of treatment as compared with basic therapy alone increased: those of coagulability by 6% (p<0.05), activated partial thromboplastin time by 14% (p<0.01), thrombin time by 9.2% (p<0.01), antithrombin III by 7% (p<0.001). The fibrinogen level decreased by 9% (p<0.05), malonic dialdehyde concentration dropped by 30% (p<0.001), the concentrations of catalase and superoxide dismutase elevated by 55% (p<0.001) and 42%, respectively (p<0.05). The effective concentration of albumin by day 20 increased up to 42.03±0.36 g/L and was by 5% higher as compared with the basic therapy alone (p<0.005). The toxicity index fell to 0.04+0.1 which was by 50% less than after basic therapy. Conclusion. Intra-arterial administration of urokinase medac in treatment of lower-limb diabetic angiopathy considerably normalizes elevated processes of coagulation, accompanied by decreased intensity of free-radical oxidation and followed by elevated concentration of the antioxidant protection enzymes and a decrease in the degree of endogenous intoxication.