RESUMEN
AIM: Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. MATERIAL AND METHODS: It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. RESULTS: Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.
Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Biguanidas/administración & dosificación , Pie Diabético/cirugía , Necrosis/cirugía , Procedimientos Quirúrgicos Ultrasónicos , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/tratamiento farmacológico , Pie Diabético/patología , Humanos , Persona de Mediana Edad , Necrosis/tratamiento farmacológico , Necrosis/patología , Soluciones/administración & dosificaciónRESUMEN
The results of calculation the average cost of complex surgical treatment of 52 patients with neuroischemic form of diabetic foot syndrome (Wagner 3, 4) are presented in the article. Calculation was performed in the program "Computer-aided system for calculation of patient's treatment cost" developed in A.V. Vishnevsky Institute of Surgery. This program permits you to analyze such components as hospital-stay duration, cost of surgery, pre- and postoperative management, pharmacotherapy, laboratory and instrumental research methods. Actual cost necessary to prevent high lower extremity amputations in patients with neuroischemic form of diabetic foot syndrome is 458 387.8 rubles per person that 10.02 times higher than amount allocated from the state budget.
Asunto(s)
Angiopatías Diabéticas/complicaciones , Pie Diabético/cirugía , Nefropatías Diabéticas/complicaciones , Costos de la Atención en Salud/estadística & datos numéricos , Procedimientos Quirúrgicos Vasculares/economía , Adulto , Anciano , Pie Diabético/economía , Pie Diabético/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Federación de Rusia , SíndromeRESUMEN
The traumatologist's automatic information retrieval system (TAIRS) is a package of programmes and a database, which are implemented on the basis of informational models of mechanical and thermal injuries of the locomotor apparatus and hyperreactive adaptation syndromes in posttraumatic emergencies. TAIRS envisages operation in the following areas: 1) topometameric classification of locomotor mechanical injuries and recommendations on their treatment; 2) tabular models of hyperreactive adaptation syndromes and ways of their correction in posttraumatic emergencies; 3) terminological and eponymic glossaries.
Asunto(s)
Sistemas de Información , Traumatología , Adaptación Fisiológica , Urgencias Médicas , Humanos , Síndrome , Terminología como Asunto , Heridas y Lesiones/clasificación , Heridas y Lesiones/terapiaRESUMEN
A topometameric classification of mechanical injuries of the locomotor apparatus has been developed specially for the traumatologist's automatic information and retrieval system (TAIRS). The classification is intended for formalized characterization of mechanical injuries. The purpose of making this formalized diagnosis of an injury is to obtain an injury code by which, on the basis of laid expert assessments, TAIRS gives recommendations how to treat a patient by taking into account the specialization of a health institution.
Asunto(s)
Huesos/lesiones , Articulaciones/lesiones , Heridas y Lesiones/clasificación , Fracturas Óseas/clasificación , Humanos , Sistemas de Información , Traumatismos de los Nervios Periféricos , Heridas no Penetrantes/clasificación , Heridas Penetrantes/clasificaciónRESUMEN
The traumatologist's automatic informational and retrieval system permits one to make a diagnosis of injuries in a patient and to have recommendations on their treatment, as well as to analyze injury-related nonspecific adaptation syndromes of the locomotor apparatus, which are laid into the system of informational models.
Asunto(s)
Simulación por Computador , Modelos Teóricos , Choque Traumático , Heridas y Lesiones , Urgencias Médicas , Humanos , Choque Traumático/diagnóstico , Choque Traumático/terapia , Factores de Tiempo , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapiaRESUMEN
Magnetotherapy effects on visual functions (vision acuity and field), on retinal bioelectric activity, on conductive vision system, and on intraocular circulation were studied in 88 patients (160 eyes) with optic nerve atrophy. A Soviet Polyus-1 low-frequency magnetotherapy apparatus was employed with magnetic induction of about 10 mT, exposure 7-10 min, 10-15 sessions per course. Vision acuity of patients with its low (below 0.04 diopters) values improved in 50 percent of cases. The number of patients with vision acuity of 0.2 diopters has increased from 46 before treatment to 75. Magnetotherapy improved ocular hemodynamics in patients with optic nerve atrophy, it reduced the time of stimulation conduction along the vision routes and stimulated the retinal ganglia cells. The maximal effect was achieved after 10 magnetotherapy sessions. A repeated course carried out in 6-8 months promoted a stabilization of the process.