[The follow-up results of patients with necrotic suppurative forms of diabetic foot syndrome].

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.

[Surgical tactics in treatment of osteomyelitis of long bones].

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.

[Modern approach to treatment of trophic ulcers of legs with perifocal varicose eczema, associated with mycotic infection].

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.

[Hemostasis system disturbances and their correction in patients with pyonecrotic forms of diabetic foot].

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.

[Clinical importance of early diagnosis of anaerobic non-clostridial infection].

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.

[Endoscopic subfascial dissection of venous perforants in treatment of venous trophic ulcers of the legs].

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.

[Pathogenesis and combined surgical treatment of the pyonecrotic diabetic foot]. / Voprosy patogeneza i taktiki kompleksnogo khirurgicheskogo lecheniia gnoino-nekroticheskikh form sindroma diabeticheskoi stopy.

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.

[Neutrophilic respiratory response in surgical infection and an association with plasma membranous synthesis of ATP]. / Respiratornyi otvet neitrofilov pri khirurgicheskoi infektsii i sviaz' s plazmamembrannym sintezom ATP.

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.

[Immune status in diabetic patients with pyo-necrotic lesions of lower extremities]. / Sostoianie immuniteta u bol'nykh sakharnym diabetom s gnoino-nekroticheskim porazheniem nizhnikh konechnostei.

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.

[Experience in the use of vessel due F (sulodexide) in patients with suppurative-necrotic forms of diabetic foot without critical ischemia]. / Opyt primeneniia Vessel dué F (sulodeksid) u bol'nykh s gnoino-nekroticheskimi formami diabeticheskoi stopy bez kriticheskoi ishemii.

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.

[Prediction and diagnosis of drug intolerance in patients with purulent infection and burn disease]. / K voprosu prognozirovaniia i diagnostiki lekarstvennoi neperenosimosti u bol'nykh s gnoinoi infektsiei i ozhogovoi bolezn'iu.

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.