ABSTRACT
Follow-up results of 162 patients with necrotic suppurative forms of the diabetic foot syndrome (DFS) are studied in a period of 6 months to 7 years. 51.35% of patients with neuropathic form of DFS (NPDFS) relapsed, whereas among patients with neuroischemic form (NIDFS) relapse was reported in 61.36% of cases. High amputations were performed in 31.58% of patients with NPDFS and in 34.09% in patients with NIDFS. Lethality after five years of follow-up was 25.81% after shank-level amputation and 50% after hip-level amputation in patients with NPDFS, and in the group of NIFDS these numbers amount 57.84% and 72.12%, respectively. Authors conclude that compensation of diabetes and its late complications is crucial for patients with DFS. Surgical treatment should be maximal sparing, with possible foot preservation. Vascular reconstructive surgery should be preferred in NIDFS for critical limb ischemia reduction. The level of high limb amputations in patients of both groups should be limited by shank when possible.
Subject(s)
Amputation, Surgical , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Diabetic Foot/surgery , Amputation, Surgical/methods , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Diabetic Foot/classification , Diabetic Foot/drug therapy , Diabetic Foot/mortality , Follow-Up Studies , Humans , Recurrence , Time Factors , Treatment OutcomeABSTRACT
The new osteomyelitis classification was worked out on the strength of treatment results of 361 patients. Four types of long bones lesions are marked out: medullar, superficial, focal and diffuse. The kind of surgical treatment is determined according to the lesion type. Authors worked out a modification of osteoplastic trepanation--a "grip-sack" technique, which is used for medullar and focal femoral and tibial osteomyelitis. Long term follow-up results are obtained in 271 (77,7%) cases. The developed classification eases the standardization of follow-up results and permits treatment planning.
Subject(s)
Debridement/methods , Femur , Osteomyelitis/surgery , Osteotomy/methods , Tibia , Adult , Follow-Up Studies , Humans , Treatment OutcomeABSTRACT
During 2005-2007 128 patients at the age from 21 to 80 years with extensive trophic ulcers of legs were treated in the contaminated surgery department of A.V. Vishnevsky Surgery Institute and Korolenko Hospital. In 87 patients (69.9%) varicosity was the cause of venous insufficiency, in 41 patients--post-thrombotic disease. 23 patients (17.97%) had double-sided throphic ulcers. In 50 patients (39.1%) ulcer area exceeded 40 cm2. In microscopical analysis fungi were discovered in 87 patients (89.06%). In the remaining 15 patients diagnosis was verified culturally. System etiotropic antimycotic antibacterial treatment including hyposensitizative, anti-inflammatory, antihistamine drugs was carried out. 34 patients (26.57%) received broad spectrum antibiotic from terbinafine group (Terbizil) in dosage 250 mg once a day during 3 moths with concurrent use of topical antimycotics. 34 patients (26.56%) recieved pulse therapy with broad spectrum antibiotic Rumicoz 400 mg a day during 7 days in combination with topical antimycotics. Nizoral 400 mg a day during 30 days was prescribed to 26 patients (20.3%). 34 patients (26.56%) were treated only with topical antimycotics. After preoperative preparation and reduction of inflammatory process 64 patients had underwent excision of trophic ulcers whereupon the therapy was continued. In these patients regress of varicose eczema manifestation was achieved on the 10th day. In patients who hadn't received surgical cure regress of varicose eczema was signed on the 23-25th day after onset of treatment. Question of plastic closing of throphic ulcers and wounds after their excision was solved particularly. 14 patients needed recurring surgical management becose inflammatory process was continued. Comprehensive approach to therapy taking into account mycotic semination appears to be appropriate and effective. Proactive surgical tactics (excision of throphic ulcer) allows to quicken preoperative preparation for correction of venous blood flow.
Subject(s)
Antifungal Agents/therapeutic use , Dermatomycoses/complications , Leg Ulcer/therapy , Varicose Veins/complications , Vascular Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Dermatomycoses/drug therapy , Female , Follow-Up Studies , Humans , Leg Ulcer/etiology , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultSubject(s)
Anti-Bacterial Agents/therapeutic use , Cellulitis/microbiology , Debridement/methods , Drainage/methods , Klebsiella Infections/microbiology , Klebsiella/isolation & purification , Skin Transplantation/methods , Adult , Cellulitis/diagnosis , Cellulitis/therapy , Diagnosis, Differential , Follow-Up Studies , Humans , Klebsiella Infections/diagnosis , Klebsiella Infections/therapy , Male , Thigh , Wound HealingABSTRACT
Severe hypercoagulation syndrome was diagnosed in patients with various forms of diabetic foot. Pathology at coagulogram parameters reflects systemic metabolic and inflammatory disturbances. Anticoagulant therapy should be combined with correction of glycemia, treatment of infection and critical ischemia. Only this complex therapy can normalize coagulation parameters and reduce the risk of thrombotic complications.
Subject(s)
Blood Coagulation Disorders/etiology , Diabetic Foot/blood , Hemostasis/physiology , Blood Coagulation Disorders/blood , Diabetic Foot/complications , Follow-Up Studies , Humans , Middle Aged , Prognosis , Retrospective Studies , Severity of Illness Index , Suppuration/blood , Suppuration/complicationsSubject(s)
Anti-Bacterial Agents/therapeutic use , Aza Compounds/therapeutic use , Bacteria/drug effects , Bacterial Infections/drug therapy , Quinolines/therapeutic use , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/pharmacology , Aza Compounds/pharmacokinetics , Aza Compounds/pharmacology , Bacterial Infections/microbiology , Fluoroquinolones , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Humans , Moxifloxacin , Quinolines/pharmacokinetics , Quinolines/pharmacology , Spores, Bacterial , Surgical Wound Infection/drug therapy , Surgical Wound Infection/microbiologyABSTRACT
Anaerobic infection is one of the most complicated problems of pyosurgery. The algorithm of examination of patients with anaerobic infection including intraoperative diagnosis is proposed. Surgical treatment playing also diagnostic role is the basis of combined treatment of soft tissues anaerobic infection. Early diagnosis and active surgical policy is one of the main ways of problem solving.
Subject(s)
Bacteria, Anaerobic/isolation & purification , Bacterial Infections/microbiology , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , HumansABSTRACT
Endoscopic subfascial dissection was performed in patients with chronic venous insufficiency of CEAP class 4-6. 76 surgeries were performed in 68 patients. Mean age of the patients was 56 years. The causes of chronic venous insufficiency were varicose (37) and postthrombotic diseases. Trophic ulcers were in 46 patients. Thirty patients underwent earlier various phlebectomies, including Linton's surgery (6 patients). In 33 patients endoscopic subfascial dissection of venous perforants was combined with various phlebectomy, in 37 patients -- with excision of ulcer with following autodermoplasty few days after surgery. Endoscopic subfascial dissection was carried out with special surgical R.Wolf endoscope with 6 mm instrumental canal, and also standard laparoscopic optical devices "Olympus". Complications during surgery were seen in 2 patients: bleeding in subfascial space (1.3%) and perforation of tissues in ulcer zone (1.3%). In postoperative period long (up to 14 days) lymphorrhea and suppuration of surgical wound were in 2 (2.6%) patients. It is concluded that endoscopic approach is optimal for elimination of pathological reflux through venous perforants in complicated forms of chronic venous insufficiency of the lower extremities, including trophic ulcers resistant to treatment.
Subject(s)
Angioscopy/methods , Varicose Ulcer/surgery , Adult , Aged , Aged, 80 and over , Fasciotomy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Saphenous Vein/surgery , Treatment OutcomeSubject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Ciprofloxacin/therapeutic use , Levofloxacin , Ofloxacin/therapeutic use , Skin Diseases, Bacterial/drug therapy , Soft Tissue Infections/drug therapy , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacology , Anti-Infective Agents/adverse effects , Anti-Infective Agents/pharmacology , Central Nervous System Diseases/chemically induced , Ciprofloxacin/adverse effects , Ciprofloxacin/pharmacology , Gastrointestinal Diseases/chemically induced , Humans , Microbial Sensitivity Tests , Ofloxacin/adverse effects , Ofloxacin/pharmacology , Skin Diseases/chemically induced , Skin Diseases, Bacterial/metabolism , Soft Tissue Infections/metabolism , Urea/metabolismABSTRACT
Three hundred and fifteen patients with necrotic forms of diabetic foot were examined and treated. Neuropathic infected form of diabetic foot was diagnosed in 45.7% patients, neuro-ischemic form--in 54.3%. Mixed aerobic-anaerobic infection in foot's necrotic focus was detected in 87.6% diabetic patients, only aerobic--in 12.4%. High level of intoxication was seen in these patients. Algorithm of complex surgical treatment of different forms of diabetic foot is presented.
Subject(s)
Diabetic Foot/pathology , Diabetic Foot/surgery , Bacterial Infections/pathology , Bacterial Infections/surgery , Diabetic Foot/microbiology , Humans , Retrospective Studies , Surgical Procedures, Operative/methods , Treatment OutcomeSubject(s)
Health Status Indicators , Health Status , Adult , Aged , Aged, 80 and over , Evaluation Studies as Topic , Humans , Middle AgedABSTRACT
Early studies have demonstrated that the unique phenomenon ATP aerobic synthesis on neutrophilic plasma membranes is observed when neutrophils are activated with the chemoattractive peptide FMLP. This paper presents the results of the study of a possible association of ATP plasma membranous synthesis with priming, with the occurrence of respiratory explosion and apoptosis of the neutrophils isolated from the blood of donors and patients with surgical infection of different severity. The interaction of neutrophilic plasma membranes with FMLP and with hTNF (was attended by ATP synthesis. Examining the level of FMLP-stimulated production of superoxide in patients with surgical infection revealed that the amount of the superoxide produced by neutrophils noticeably decreased and droppped by more than 5 times in sepsis. The FMLP-stimulated plasma membranous synthesis of ATP was determined in the same patients. A decrease in the production of superoxide was simultaneously accompanied by a reduction in the plasma membranous synthesis of ATP. Both the plasma membranous synthesis of ATP and the production of superoxide declined in sepsis at the most. The neutrophils isolated from peripheral blood of the same patients showed DNA damage whose degree was directly related to the condition of a patient. The maximum DNA damages were observed in sepsis. The findings suggest that apoptosis is induced in surgical infection in the peripheral neutrophils. The DNA damage and the FMLP-stimulated plasma membranous synthesis of ATP was estimated in the neutrophils isolated from the inflammation focus. It turned out that in local surgical infection, there were the maximum DNA damages and the FMLP-stimulated plasma membranous synthesis of ATP was lower than that in the peripheral neutrophils. It can be suggested that the FMLP-stimulated plasma membranous synthesis of ATP may be a regulators of neutrophilic functional states in surgical infection and sepsis.
Subject(s)
Adenosine Triphosphate/biosynthesis , Neutrophils/metabolism , Surgical Wound Infection/blood , Adenosine Triphosphate/blood , Adult , Aged , Cell Membrane/metabolism , Female , Humans , Male , Middle Aged , N-Formylmethionine Leucyl-Phenylalanine/metabolismABSTRACT
Long-term and severe pyonecrotic processes in diabetic patients testify to severe disorders of immune system in this disease. High titer of antibodies to tested autostrain demonstrated its etiologic role in infectious process. The study group consisted of 29 patients (with diabetic pyonecrotic foot lesions), control group--17 patients with burns of III a, b--IV stage affecting from 20 to 60% of body surface. In diabetic patients antibodies titer to the most encountered infectious agents Staphilococcus aureus and Pseudomonas aeroginosa was lower than in burn patients with immunity deficiency. Decrease of antibodies titer in diabetic patients testifies to high insufficiency of B-immunity.
Subject(s)
Burns/immunology , Diabetes Mellitus, Type 1/immunology , Diabetic Foot/immunology , Leg , Adolescent , Adult , Burns/pathology , Diabetes Mellitus, Type 1/complications , Diabetic Foot/etiology , Diabetic Foot/microbiology , Female , Humans , Leg/pathology , Male , Middle Aged , Necrosis , Pseudomonas Infections/microbiology , Staphylococcal Infections/microbiologyABSTRACT
AIM: To evaluate effectiveness of sulodexide in patients with pyonecrotic complications of diabetic foot. MATERIAL AND METHOD: Sulodexide was given to 15 patients which were examined for blood fibrinogen, foot tissues saturation with oxygen, microbic contamination of the wound tissue. In addition, ultrasound dopplerography of foot arteries, laser doppler flowmetry were performed. RESULTS: Fibrinogen in peripheral blood fell, arteriovenous shunting diminished, capillary blood flow and oxygen saturation of the tissues improved. CONCLUSION: Even early sulodexide treatment is effective at different stages of the pathological process in diabetic patients with severe pyonecrotic lesion of the lower limbs as it recovers microcirculatory blood flow.
Subject(s)
Diabetic Foot/drug therapy , Glycosaminoglycans/therapeutic use , Hypoglycemic Agents/therapeutic use , Diabetic Foot/pathology , Diabetic Foot/physiopathology , Glycosaminoglycans/administration & dosage , Humans , Hypoglycemic Agents/administration & dosage , Microcirculation , Necrosis , Suppuration , Time FactorsABSTRACT
The immunological study was made in which the drug sensitivity index according to S. M. Demyanenko was estimated in 76 patients (24 women and 52 men aged 17-73 years): in patients with soft tissue purulent infection (group 1, n = 46) and surface thermal burns (degree III-IV) of 40% body surface (group 2, n = 30). Patients with satisfactory drug tolerance served control (16 patients of group 1 and 10 ones of group 2). Correlations between humoral and cellular immunity parameters and drug sensitivity index were studied. The results may serve a basis for development of early and adequate correction of immunological disorders in the above patients, of drug-related complications caused by immunological imbalance.