SURGICAL PREVENTION AND TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM IN PATIENTS OPERATED ON THYROID GLAND.

The objective of the research was to develop and evaluate the algorithm of prevention and treatment of postoperative hypoparathyroidism (PHPT) based on determining parathyroid glands (PTG) viability and the use of antihypoxant-antioxidant therapy in the postoperative period. The research was based on the results of a comprehensive examination and treatment of 60 patients who were operated for thyroid gland diseases. The patients underwent inpatient treatment at the surgical department of Ivano-Frankivsk Central City Clinical Hospital and Ivano-Frankivsk Regional Oncology Center from 2015 to 2017. We proposed an algorithm for surgical prevention and treatment of PHPT during thyroid gland surgeries which consisted in the following. We performed a visual assessment of PTG intraoperatively and evaluated each gland from 0 to 3 points according to the degree of its viability affection. If the gland was evaluated at 0-2 points, we left it in situ, since there was a high probability of maintaining its function. If it was evaluated at 3 points, its autotransplantation was performed. Cytoflavin drug was applied in a dose of 10 ml per 200 0.9% NaCl intravenously once a day during 7 days in the postoperative period for the purpose of antihypoxant-antioxidant therapy. 2 groups of patients were formed in order to evaluate the effectiveness of the algorithm. Each group consisted of 30 people. Patients of Group I underwent surgery on thyroid gland according to generally accepted rules. Patients of Group II underwent interventions according to the above-mentioned algorithm. The use of our proposed algorithm (intraoperative assessment of PTG viability and antihypoxant-antioxidant therapy in the postoperative period) significantly reduces the frequency of permanent PHPT justifying indications to its application.

[EFFICACY OF CYTOFLAVIN IN COMPLEX TREATMENT OF DIABETIC FOOT SYNDROME].

The study involved 97 patients with severe diabetic foot syndrome (DFS) subcompensated type 2 diabetes. All patients were available mediacalcification foot and lower leg arteries of different severity. Depending on the treatment, all patients were divided into 2 groups by stratified randomization. The І group received standard therapy, which is indicated for the DFS. A ІІ group of patients additionally received basic therapy drug Cytoflavin 10 ml 0,9% NaCl 200 ml for 10 days, followed by transfer to tablet form Cytoflavin 2 tablets 2 times per day orally for one month. We noted a positive trend of treatment of patients who, in addition to standard therapy received the drug Cytoflavin. Thus, the use of complex surgical treatment of patients with mixed form of DFS Cytoflavin reduces the severity of distal polyneuropathy, improves oxygenation of tissues and restores the enzyme activity of antioxidant system, that manifested neuroprotective, antioxidant and anti-hypoxic effects of drugs, which substantiates the indications for its use in the this pathology.

DYNAMICS OF CHANGES IN INDICES OF ENDOGENOUS INTOXICATION IN PATIENTS WITH ACUTE SMALL INTESTINAL OBSTRUCTION IN CASE OF REAMBERIN USE IN THE COMPREHENSIVE TREATMENT.

The objective of this research was to study changes in parameters, characterizing endogenous intoxication in patients with acute small bowel obstruction with Reamberin included into therapy scheme. Full physical examination and surgical treatment of 202 patients with acute small bowel obstruction were conducted. The control group included 30 healthy individuals. Dynamics of such clinical biochemical parameters as medium mass molecules (MMM), malondialdehyde (MDA), diene conjugates (DC) in blood serum were analyzed in preoperative period and on the 1st, 5th and 14th day of postoperative period. Significant free radical production occurred both in preoperative period and after surgical intervention. This was the reason to include antioxidant therapy using Reamberin (STPF «POLYSAN¼) in addition to basic treatment. The drug is approved for use by Central Formulary Committee of the Ministry of Health of Ukraine. All patients were divided into 2 groups depending on the treatment scheme. Group I consisted of 100 patients with acute small bowel obstruction who underwent the comprehensive treatment according to recommendations of the Ministry of Health of Ukraine № 297 dated 02.04.2010 (Standards of medical care for patients with urgent surgical diseases of the abdominal cavity). 102 patients of group II received the comprehensive treatment of antihypoxant and antioxidant therapy with Reamberin added to basic scheme. The main active ingredient of Reamberin is succinic acid. The drug was administered intravenously by drop infusion in a dose of 400 ml a day during 7-day period. Administration rate did not exceed 90 drops per minute. The medicine administration was started during complex preoperative preparation and then was done immediately after the completion of surgical treatment under resuscitation conditions. It was shown that the use of Reamberin promotes effective correction of free radical imbalance, reduction of endogenous intoxication and postoperative complications.

[Optimization of treatment of elderly patientswith diabetic foot syndrome and mediakaltsinozom arteries].

The objective of the research was to study the effectiveness of the drug Cytoflavin in the comprehensive treatment of mixed form diabetic foot syndrome with media calcification arteries in 75 elderly patients with type 2 diabetes. Depending on the regimen, patients were divided into two groups: control received basic therapy; main group in addition to the base, received the drug Cytoflavin 10 ml 0,9 % NaCl 200 ml for 10 days, followed by a transition to the tablet form of the drug - 2 tablets 2 times per day orally for one month. The inclusion of the drug Cytoflavin in the treatment regimen increased the effectiveness of treatment, which was shown to improve tissue oxygenation due to the normalization of the basal oxygen tension, restoring the activity of antioxidant enzymes and, consequently, in an authentic decrease in the average time of hospital treatment and a decrease in the number of repeated surgical interventions and reamputatsy over the next year.

[Correction of early liver dysfunction in patients with acute small bowel obstruction].

Conducted a comprehensive examination and surgical treatment for acute obstruction of the small intestine (SI). It is established that, both before and after surgery to restore patency of SI is a significant violation of the functional state of the liver. This became the basis for the appointment of antioxidant therapy in the complex standard treatment. Using the solution reamberin promotes effective correction protein syntesis function disorders of the liver, reduces the severity of inflammation and stagnation in the hepatocytes, the severity of endogenous intoxication and the incidence of postoperative complications.