Long-term observations indicate an increased risk of developing venous thromboembolic conditions in people with the human immunodeficiency virus, their tendency to relapse or a widespread nature. In addition, the incidence of thrombosis increases several times in HIV-infected people compared to the average rates characteristic of people of the same age. A clinical case of multiple bilateral lesions of the subcutaneous veins of the upper and lower extremities in a young patient with HIV infection is presented. Ineffective outpatient treatment and ascending superficial thrombophlebitis of the lower extremities required emergency hospitalization and surgical treatment of the patient to prevent thromboembolic complications. In the postoperative period, in order to prevent the progression of the thrombotic process, as well as to relieve the symptoms of an acute inflammatory reaction of the venous wall and paravasal tissues, a complex application of compression therapy, modern oral anticoagulant drugs, phlebotropic drugs with proven efficacy was carried out. The postoperative period proceeded without complications. In the next few days, the patient’s condition improved, there was a clear regression of thrombotic limb damage. Conclusion: In case of multiple thrombotic lesions of the subcutaneous veins of the upper and lower extremities on the background of HIV infection, the combination of timely surgical intervention with systemic anticoagulant therapy and phlebotropic agents of general and topical use has significant effectiveness in the medical rehabilitation of the patient.
{"title":"Multifocal superficial thrombophlebitis of the extremities in HIV infection","authors":"P. N. Myshentsev, S. Katorkin","doi":"10.21518/akh2024-009","DOIUrl":"https://doi.org/10.21518/akh2024-009","url":null,"abstract":"Long-term observations indicate an increased risk of developing venous thromboembolic conditions in people with the human immunodeficiency virus, their tendency to relapse or a widespread nature. In addition, the incidence of thrombosis increases several times in HIV-infected people compared to the average rates characteristic of people of the same age. A clinical case of multiple bilateral lesions of the subcutaneous veins of the upper and lower extremities in a young patient with HIV infection is presented. Ineffective outpatient treatment and ascending superficial thrombophlebitis of the lower extremities required emergency hospitalization and surgical treatment of the patient to prevent thromboembolic complications. In the postoperative period, in order to prevent the progression of the thrombotic process, as well as to relieve the symptoms of an acute inflammatory reaction of the venous wall and paravasal tissues, a complex application of compression therapy, modern oral anticoagulant drugs, phlebotropic drugs with proven efficacy was carried out. The postoperative period proceeded without complications. In the next few days, the patient’s condition improved, there was a clear regression of thrombotic limb damage. Conclusion: In case of multiple thrombotic lesions of the subcutaneous veins of the upper and lower extremities on the background of HIV infection, the combination of timely surgical intervention with systemic anticoagulant therapy and phlebotropic agents of general and topical use has significant effectiveness in the medical rehabilitation of the patient.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"104 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. A. Lichman, S. Katorkin, P. S. Andreev, O. E. Davydova
Introduction. Anal contact or conduction in the anal canal and rectum is a common condition in the coloproctological field, occurring in 5% of the population that affects this country. Treatment consists of hygiene and the use of topical steroids, antibacterial and antifungal agents. No generally accepted attitude towards a private person has been developed.Aim. To study the effectiveness of using homeopathic ointment in the treatment of patients with anal itching.Material and methods. A prospective comparative randomized study was conducted in a specialized advisory center of the Clinics of Samara State Medical University. The study included 96 patients with anal itching without fungal infection of the perianal skin and concomitant purulent pathology. In the main group (n = 46), treatment was carried out using homeopathic ointment in the perianal area 2–3 times a day for 14 days. In the control group (n = 50), treatment was carried out with topical steroid ointments 2–3 times a day for 14 days.Results and discussion. From the data obtained on the use of homeopathic ointment, it follows that it is not inferior in effectiveness to topical steroid ointments in reducing symptoms of the disease (Student’s t-test = 0.35; p > 0.05 and Student’s t-test = 0.28; p > 0.05), and by the number of relapses (χ2 = 0.535; p > 0.05).Conclusion. The use of homeopathic ointment for topical application appears to be a promising new treatment for patients with anal itching and is as effective as topical steroid ointments.
{"title":"Experience of using homeopathic ointment in the treatment of patients with anal itching","authors":"L. A. Lichman, S. Katorkin, P. S. Andreev, O. E. Davydova","doi":"10.21518/akh2024-016","DOIUrl":"https://doi.org/10.21518/akh2024-016","url":null,"abstract":"Introduction. Anal contact or conduction in the anal canal and rectum is a common condition in the coloproctological field, occurring in 5% of the population that affects this country. Treatment consists of hygiene and the use of topical steroids, antibacterial and antifungal agents. No generally accepted attitude towards a private person has been developed.Aim. To study the effectiveness of using homeopathic ointment in the treatment of patients with anal itching.Material and methods. A prospective comparative randomized study was conducted in a specialized advisory center of the Clinics of Samara State Medical University. The study included 96 patients with anal itching without fungal infection of the perianal skin and concomitant purulent pathology. In the main group (n = 46), treatment was carried out using homeopathic ointment in the perianal area 2–3 times a day for 14 days. In the control group (n = 50), treatment was carried out with topical steroid ointments 2–3 times a day for 14 days.Results and discussion. From the data obtained on the use of homeopathic ointment, it follows that it is not inferior in effectiveness to topical steroid ointments in reducing symptoms of the disease (Student’s t-test = 0.35; p > 0.05 and Student’s t-test = 0.28; p > 0.05), and by the number of relapses (χ2 = 0.535; p > 0.05).Conclusion. The use of homeopathic ointment for topical application appears to be a promising new treatment for patients with anal itching and is as effective as topical steroid ointments.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. “One-day surgery” expands the possibilities of providing surgical care in a polyclinic with hospitalization for just one day. This area of medicine allows you to use the most effective method of treating hemorrhoids in a polyclinic – the operation hemorrhoidectomy.Aim. To substantiate the effectiveness of performing hemorrhoidectomy surgery in patients with stage 3–4 hemorrhoids in a day hospital of a polyclinic under the program “One-day surgery” with accelerated recovery of patients.Materials and methods. The main principle for performing hemorrhoidectomy surgery in a day hospital is a careful selection of patients. Closed hemorrhoidectomy with restoration of the anal canal mucosa (by Parks – Milligan – Morgan’s in the second modification of the State Research Center of Coloproctology) under spinal or general anesthesia is the surgery of choice for hemorrhoids treatment in the day patient department of a clinic. 138 surgeries were performed in the day patient department during 2 years and 10 months. After surgery, patients were placed in the surgical day-patient department wards for 3–5 hours until full activation. Then they were allowed to go home without being accompanied by a medical worker. The satisfaction of patients with the program was analyzed by a survey with a 5-point scale.Results. The timing of scheduled operations for patients has been shortened. The number of complications after hemorrhoidectomy in the early postoperative period was decreased, without long-term postoperative complications. The treatment of such patients in the surgical day-patient department demonstrated a good economic effect. The overall satisfaction with the one-day surgery program was very high (4.82). The results confirmed the effectiveness of this area of medicine.Discussion. Our experience of performing hemorrhoidectomy operations in a day surgical hospital for 3 years confirms the existence of a number of advantages over treating patients in a 24-hour hospital.Conclusions. The “One-day Surgery” and accelerated patient recovery programs expand the possibilities for treating patients with stage 4 hemorrhoids directly in the polyclinic, and thus reduce the burden on the surgical hospital.
{"title":"One-day surgery: treatment of grade 3–4 hemorrhoids in a day patient department","authors":"M. Burikov, A. G. Kulikov, S. V. Savchenko","doi":"10.21518/akh2024-007","DOIUrl":"https://doi.org/10.21518/akh2024-007","url":null,"abstract":"Introduction. “One-day surgery” expands the possibilities of providing surgical care in a polyclinic with hospitalization for just one day. This area of medicine allows you to use the most effective method of treating hemorrhoids in a polyclinic – the operation hemorrhoidectomy.Aim. To substantiate the effectiveness of performing hemorrhoidectomy surgery in patients with stage 3–4 hemorrhoids in a day hospital of a polyclinic under the program “One-day surgery” with accelerated recovery of patients.Materials and methods. The main principle for performing hemorrhoidectomy surgery in a day hospital is a careful selection of patients. Closed hemorrhoidectomy with restoration of the anal canal mucosa (by Parks – Milligan – Morgan’s in the second modification of the State Research Center of Coloproctology) under spinal or general anesthesia is the surgery of choice for hemorrhoids treatment in the day patient department of a clinic. 138 surgeries were performed in the day patient department during 2 years and 10 months. After surgery, patients were placed in the surgical day-patient department wards for 3–5 hours until full activation. Then they were allowed to go home without being accompanied by a medical worker. The satisfaction of patients with the program was analyzed by a survey with a 5-point scale.Results. The timing of scheduled operations for patients has been shortened. The number of complications after hemorrhoidectomy in the early postoperative period was decreased, without long-term postoperative complications. The treatment of such patients in the surgical day-patient department demonstrated a good economic effect. The overall satisfaction with the one-day surgery program was very high (4.82). The results confirmed the effectiveness of this area of medicine.Discussion. Our experience of performing hemorrhoidectomy operations in a day surgical hospital for 3 years confirms the existence of a number of advantages over treating patients in a 24-hour hospital.Conclusions. The “One-day Surgery” and accelerated patient recovery programs expand the possibilities for treating patients with stage 4 hemorrhoids directly in the polyclinic, and thus reduce the burden on the surgical hospital.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"103 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Khitaryan, A. Mezhunts, K. S. Oplimakh, A. Orekhov, D. Melnikov, S. A. Adizov, V. N. Kislyakov, A. A. Abovyan
In recent years, the number of performed bariatric interventions has increased significantly. Despite the high effectiveness of this method of treatment, the occurrence of complications is not uncommon. The most common complications are stapler line leaks, occurring in 1.5–2.4% of cases; anastomotic leakage after One Anastomosis Gastric Bypass – in 2.2–8% of cases. The problem with all methods is the increased duration of treatment and the need to go without food for significant periods of time, which means starting parenteral nutrition and risking malnutrition. The article demonstrates the effectiveness of biological therapy for complications of bariatric surgery in a series of clinical cases. Clinical cases of 2 patients with anastomotic leakage after One Anastomosis Gastric Bypass are described; also 2 patients with incompetent staple line after laparoscopic Sleeve Gastrectomy. PRP therapy, stromal vascular fraction (SVF) and fibrin glue were used. Platelet-rich plasma is an autologous blood serum containing high concentrations of platelets and growth factors. As a result, after 4 courses of PRP therapy, the patient with the failure of the upper third of the stapler line received an application of twocomponent fibrin glue “Kriofit” with a positive effect. In addition, positive dynamics was observed in the patient with the use of threecomponent therapy of anastomotic leakage. Based on the above facts, it can be concluded, that biological therapy demonstrates great potential value in the treatment of bariatric surgery complications such as stapler line leaks, and anastomotic leakage.
{"title":"Biological therapy of bariatric surgery complications","authors":"A. Khitaryan, A. Mezhunts, K. S. Oplimakh, A. Orekhov, D. Melnikov, S. A. Adizov, V. N. Kislyakov, A. A. Abovyan","doi":"10.21518/akh2024-011","DOIUrl":"https://doi.org/10.21518/akh2024-011","url":null,"abstract":"In recent years, the number of performed bariatric interventions has increased significantly. Despite the high effectiveness of this method of treatment, the occurrence of complications is not uncommon. The most common complications are stapler line leaks, occurring in 1.5–2.4% of cases; anastomotic leakage after One Anastomosis Gastric Bypass – in 2.2–8% of cases. The problem with all methods is the increased duration of treatment and the need to go without food for significant periods of time, which means starting parenteral nutrition and risking malnutrition. The article demonstrates the effectiveness of biological therapy for complications of bariatric surgery in a series of clinical cases. Clinical cases of 2 patients with anastomotic leakage after One Anastomosis Gastric Bypass are described; also 2 patients with incompetent staple line after laparoscopic Sleeve Gastrectomy. PRP therapy, stromal vascular fraction (SVF) and fibrin glue were used. Platelet-rich plasma is an autologous blood serum containing high concentrations of platelets and growth factors. As a result, after 4 courses of PRP therapy, the patient with the failure of the upper third of the stapler line received an application of twocomponent fibrin glue “Kriofit” with a positive effect. In addition, positive dynamics was observed in the patient with the use of threecomponent therapy of anastomotic leakage. Based on the above facts, it can be concluded, that biological therapy demonstrates great potential value in the treatment of bariatric surgery complications such as stapler line leaks, and anastomotic leakage.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Superficial vein thrombosis, which is mostly caused by lower extremity varicose vein disease, can be complicated by pulmonary embolism. At the same time, the optimal duration of anticoagulant therapy for pulmonary embolism originated from varicose vein thrombosis is still under debate. On the one hand, the presence of varicose veins is considered a small risk factor for the development of venous thromboembolic events, which persistence determines an increased risk of relapse and requires prolonged anticoagulant therapy. On the other hand, elimination of varicose veins is associated with reduced risk of subsequent venous thromboembolic events. The article describes a clinical case of recurrent pulmonary embolism after surgical treatment of varicose vein disease, which caused primary pulmonary embolism. A 45-year-old patient suffering from left lower extremity varicose vein disease for 5 years was admitted to the intensive care unit with suspected pulmonary embolism. The further examination revealed signs of thrombotic occlusion of the segmental and subsegmental branches of the pulmonary arteries bilaterally and the middle lobe branch of the right pulmonary artery, as well as signs of the right-sided heart overload. In this case, pulmonary embolism was found to originate from thrombosis of the trunk of the great saphenous vein ofthe left lower extremity with a proximal border at the level of the lower leg. No signs of deep vein involvement were detected. The parenteral anticoagulant therapy initiated in the hospital was followed by switching to therapeutic doses of rivaroxaban. The signs of recanalization of involved veins were identified after 6 months of treatment, and it was decided to perform endovenous laser coagulation of the trunk of the great saphenous vein combined with mini-phlebectomy of varicose tributaries on continuous oral anticoagulant therapy. The rivaroxaban therapy was completed a month after intervention. However, 7 days later the patient was diagnosed with repeated symptomatic pulmonary embolism, which originated from thrombosis of the left popliteal vein. It was recommended to resume anticoagulant therapy of indefinite duration. The article discusses the issues of optimal duration of treatment for pulmonary embolism originated from thrombosis of superficial varicose veins, as well as the possible timing of completion of anticoagulant therapy after the intervention.
{"title":"Is it safe to discontinue anticoagulant after surgical treatment of varicose vein disease, which caused pulmonary embolism?","authors":"T. G. Kipiani, V. V. Kozlova, K. Lobastov","doi":"10.21518/akh2024-005","DOIUrl":"https://doi.org/10.21518/akh2024-005","url":null,"abstract":"Superficial vein thrombosis, which is mostly caused by lower extremity varicose vein disease, can be complicated by pulmonary embolism. At the same time, the optimal duration of anticoagulant therapy for pulmonary embolism originated from varicose vein thrombosis is still under debate. On the one hand, the presence of varicose veins is considered a small risk factor for the development of venous thromboembolic events, which persistence determines an increased risk of relapse and requires prolonged anticoagulant therapy. On the other hand, elimination of varicose veins is associated with reduced risk of subsequent venous thromboembolic events. The article describes a clinical case of recurrent pulmonary embolism after surgical treatment of varicose vein disease, which caused primary pulmonary embolism. A 45-year-old patient suffering from left lower extremity varicose vein disease for 5 years was admitted to the intensive care unit with suspected pulmonary embolism. The further examination revealed signs of thrombotic occlusion of the segmental and subsegmental branches of the pulmonary arteries bilaterally and the middle lobe branch of the right pulmonary artery, as well as signs of the right-sided heart overload. In this case, pulmonary embolism was found to originate from thrombosis of the trunk of the great saphenous vein ofthe left lower extremity with a proximal border at the level of the lower leg. No signs of deep vein involvement were detected. The parenteral anticoagulant therapy initiated in the hospital was followed by switching to therapeutic doses of rivaroxaban. The signs of recanalization of involved veins were identified after 6 months of treatment, and it was decided to perform endovenous laser coagulation of the trunk of the great saphenous vein combined with mini-phlebectomy of varicose tributaries on continuous oral anticoagulant therapy. The rivaroxaban therapy was completed a month after intervention. However, 7 days later the patient was diagnosed with repeated symptomatic pulmonary embolism, which originated from thrombosis of the left popliteal vein. It was recommended to resume anticoagulant therapy of indefinite duration. The article discusses the issues of optimal duration of treatment for pulmonary embolism originated from thrombosis of superficial varicose veins, as well as the possible timing of completion of anticoagulant therapy after the intervention.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"6 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Varicose veins of the lower extremities are one of the most common diseases, affecting 20 to 40% of the population. One of the most common treatment methods is endovenous laser coagulation (EVLC).Aim. To evaluate the effectiveness of local gel therapy based on escin, heparin and essential phospholipids in the postoperative administration of patients after endovenous laser coagulation.Materials and methods. A complex treatment of 53 patients with varicose veins of the lower extremities of classes C2-C3 according to the CEAP nomenclature was carried out. Patients were divided into 2 statically homogeneous groups with an equal number. All patients underwent endovenous laser obliteration of the trunk of the great saphenous vein in combination with miniphlebectomy of tributaries on the thigh and lower leg.Results. In both groups, the largest number were patients with incompetence of the GSV trunk up to the border in /3 and c/3 of the lower leg, with further discharge along the tributaries of the GSV along the medial surface of the lower leg. The failure of the GSV trunk to the level of the knee joint gap was accompanied by the presence of varicose-transformed tributaries along the anterior surface of the thigh, in the area of the knee joint. The addition of Detragel led to the relief of phlebitis and hematomas, a pronounced decrease in pain and edematous syndrome.Discussion. Transdermal drug delivery has great promise as an alternative to oral and intravenous treatment, especially for patients suffering from chronic diseases. The three-component composition allows you to influence all parts of the pathogenesis of the disease.Conclusion. The data obtained on the use of local gel therapy based on escin, heparin and essential phospholipids after EVLO of the GSV indicate the need for local therapy to improve the quality of life of patients, their rapid rehabilitation and improve immediate and long-term results.
{"title":"Local therapy in the postoperative management of patients with lower limb varicose vein disease","authors":"I. N. Mokhamad","doi":"10.21518/akh2024-008","DOIUrl":"https://doi.org/10.21518/akh2024-008","url":null,"abstract":"Introduction. Varicose veins of the lower extremities are one of the most common diseases, affecting 20 to 40% of the population. One of the most common treatment methods is endovenous laser coagulation (EVLC).Aim. To evaluate the effectiveness of local gel therapy based on escin, heparin and essential phospholipids in the postoperative administration of patients after endovenous laser coagulation.Materials and methods. A complex treatment of 53 patients with varicose veins of the lower extremities of classes C2-C3 according to the CEAP nomenclature was carried out. Patients were divided into 2 statically homogeneous groups with an equal number. All patients underwent endovenous laser obliteration of the trunk of the great saphenous vein in combination with miniphlebectomy of tributaries on the thigh and lower leg.Results. In both groups, the largest number were patients with incompetence of the GSV trunk up to the border in /3 and c/3 of the lower leg, with further discharge along the tributaries of the GSV along the medial surface of the lower leg. The failure of the GSV trunk to the level of the knee joint gap was accompanied by the presence of varicose-transformed tributaries along the anterior surface of the thigh, in the area of the knee joint. The addition of Detragel led to the relief of phlebitis and hematomas, a pronounced decrease in pain and edematous syndrome.Discussion. Transdermal drug delivery has great promise as an alternative to oral and intravenous treatment, especially for patients suffering from chronic diseases. The three-component composition allows you to influence all parts of the pathogenesis of the disease.Conclusion. The data obtained on the use of local gel therapy based on escin, heparin and essential phospholipids after EVLO of the GSV indicate the need for local therapy to improve the quality of life of patients, their rapid rehabilitation and improve immediate and long-term results.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. The combination of endovasal laser coagulation and miniphlebectomy is actively used in the treatment of Chronic venous diseases, however, the question of improving the management of such patients in the postoperative period remains actual.Aim. To evaluate the effectiveness of the combined use of oral and topical forms of phlebotonics after endovasal laser coagulation.Materials and methods. The study was conducted in 60 patients after surgery divided into 2 comparable (n = 30). The group 1 was treated with MPFF 1000 mg (Detralex) once a day during the perioperative period (10 days before surgery and up to 2 months after) and additionally topical Detragel daily 3 times a day for 10 days after the intervention. The group 2 used heparin topical form for 10 days after surgery. Control was carried out on the 1st day, 10th day after surgery, as well as after 3 and 6 months.Results. In group 1, there was a statistically more significant decrease in the level of pain on days 1 and 10 after surgery (p ≤ 0.05), while the frequency of hyperpigmentation at months 3 and 6 after surgery was also less presented.Conclusions. The combination of endovasal laser coagulation and miniphlebectomy while taking MPFF and a gel based on heparin, escin and essential phospholipids is accompanied by less severe pain and the level of hyperpigmentation in the postoperative period.
{"title":"Combined use of oral and topical forms of phlebotonics after endovasal laser coagulation","authors":"Yu. M. Chubirko, I. O. Kasyanov","doi":"10.21518/akh2024-010","DOIUrl":"https://doi.org/10.21518/akh2024-010","url":null,"abstract":"Introduction. The combination of endovasal laser coagulation and miniphlebectomy is actively used in the treatment of Chronic venous diseases, however, the question of improving the management of such patients in the postoperative period remains actual.Aim. To evaluate the effectiveness of the combined use of oral and topical forms of phlebotonics after endovasal laser coagulation.Materials and methods. The study was conducted in 60 patients after surgery divided into 2 comparable (n = 30). The group 1 was treated with MPFF 1000 mg (Detralex) once a day during the perioperative period (10 days before surgery and up to 2 months after) and additionally topical Detragel daily 3 times a day for 10 days after the intervention. The group 2 used heparin topical form for 10 days after surgery. Control was carried out on the 1st day, 10th day after surgery, as well as after 3 and 6 months.Results. In group 1, there was a statistically more significant decrease in the level of pain on days 1 and 10 after surgery (p ≤ 0.05), while the frequency of hyperpigmentation at months 3 and 6 after surgery was also less presented.Conclusions. The combination of endovasal laser coagulation and miniphlebectomy while taking MPFF and a gel based on heparin, escin and essential phospholipids is accompanied by less severe pain and the level of hyperpigmentation in the postoperative period.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"106 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Morozov, A. Sergeev, V. Chervinets, J. V. Chervinets, O. N. Guskova, O. N. Skaryakina, E. N. Egorova
Healthcare-associated infections are the most common and relevant to all healthcare facilities of all types. Surgical site infections are the most frequently reported type of healthcare-associated infections. Surgical site infections are also one of the main causes of prolonged hospital stays, prolonged antibiotic therapy, unplanned re-hospitalizations, worsened long-term patient outcomes and the prescription of additional surgical interventions. At present, it is prevention that has been identified as the single most important strategy to combat surgical site infection. The proposed three-stage model combines perioperative interventions as well as interdisciplinary collaboration to continuously improve the quality of care. This approach includes preoperative, intraoperative, and postoperative prevention methods. Current preoperative strategies for the prevention of surgical site infections can significantly reduce the risk of developing this nosology; one important aspect of preoperative prophylaxis includes the identification, elimination, and/or correction of modifiable as well as non-modifiable risk factors. In addition, it is possible to identify intraoperative risk factors, of which the duration of surgical intervention is fundamentally important. Postoperative risk factors include hyperglycemia and diabetes mellitus, postoperative wound care and blood transfusion. Many effective ways of preventing surgical site infections have been developed, which include separate methods of preoperative, intraoperative and postoperative prophylaxis, however, only through the implementation of a comprehensive model that combines all perioperative measures, health care institutions will be able to effectively reduce the incidence of healthcare-associated infections and improve patient outcomes. Despite the fact that currently there is an active development of new methods of surgical site infections prophylaxis, the direct implementation of these technologies in the practical activity of specialists is of primary importance.
{"title":"Methods of preventing surgical site infections","authors":"A. Morozov, A. Sergeev, V. Chervinets, J. V. Chervinets, O. N. Guskova, O. N. Skaryakina, E. N. Egorova","doi":"10.21518/akh2024-013","DOIUrl":"https://doi.org/10.21518/akh2024-013","url":null,"abstract":"Healthcare-associated infections are the most common and relevant to all healthcare facilities of all types. Surgical site infections are the most frequently reported type of healthcare-associated infections. Surgical site infections are also one of the main causes of prolonged hospital stays, prolonged antibiotic therapy, unplanned re-hospitalizations, worsened long-term patient outcomes and the prescription of additional surgical interventions. At present, it is prevention that has been identified as the single most important strategy to combat surgical site infection. The proposed three-stage model combines perioperative interventions as well as interdisciplinary collaboration to continuously improve the quality of care. This approach includes preoperative, intraoperative, and postoperative prevention methods. Current preoperative strategies for the prevention of surgical site infections can significantly reduce the risk of developing this nosology; one important aspect of preoperative prophylaxis includes the identification, elimination, and/or correction of modifiable as well as non-modifiable risk factors. In addition, it is possible to identify intraoperative risk factors, of which the duration of surgical intervention is fundamentally important. Postoperative risk factors include hyperglycemia and diabetes mellitus, postoperative wound care and blood transfusion. Many effective ways of preventing surgical site infections have been developed, which include separate methods of preoperative, intraoperative and postoperative prophylaxis, however, only through the implementation of a comprehensive model that combines all perioperative measures, health care institutions will be able to effectively reduce the incidence of healthcare-associated infections and improve patient outcomes. Despite the fact that currently there is an active development of new methods of surgical site infections prophylaxis, the direct implementation of these technologies in the practical activity of specialists is of primary importance.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"7 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. M. Belik, A. N. Kovalev, Ya. B. Mirkin, M. E. Ponomarenko, A. A. Kryachko, V. V. Skorlyakov, V. F. Babiev, A. Kivva
Introduction. Currently, along with the improvement of the scheme of combined drug therapy with first-line anti-inflammatory drugs, important importance is attached to adjuvant topical methods of treating diseases of the distal colon of various inflammatory genesis.Aim. Evaluate the clinical efficacy of the drug on sodium hyaluronate as an adjuvant topical agent in the complex treatment of patients with diseases of the distal colon.Materials and methods. A comparative analysis of the results of drug treatment of 97 patients with diseases of the distal colon of various inflammatory genesis, which were divided into two groups, was carried out. In 46 (47.4%) patients of the I (control) group, standard drug therapy with basic anti-inflammatory drugs was performed; 51 (52.6%) patients – II (main) group, the standard program of drug treatment was supplemented with instillations into the rectum of the drug on sodium hyaluronate (0.8 mg of hyaluronic acid in 1 ml). The comparative assessment of the results of treatment took into account the severity of clinical, laboratory and endoscopic manifestations of the disease.Results. In patients of the main group, there was a significant reduction in the healing time of erosions and ulceration of the mucous membrane of the distal colon compared with patients in the control group (29.4 ± 5.7 days, respectively, versus 52.8 ± 6.2 days). Also, in patients of the main group, it was possible to achieve stable clinical and laboratory remission of the disease at an earlier time, restoration of patients’ ability to work, and improvement of their quality of life.Conclusion. The results obtained by us allow us to recommend the drug on sodium hyaluronate as an additional topical drug for the medical treatment of chronic diseases of the distal colon of various inflammatory genesis in outpatient settings.
{"title":"Supportive local treatment of diseases of the distal colon of various inflammatory genesis in the outpatient department","authors":"B. M. Belik, A. N. Kovalev, Ya. B. Mirkin, M. E. Ponomarenko, A. A. Kryachko, V. V. Skorlyakov, V. F. Babiev, A. Kivva","doi":"10.21518/akh2024-003","DOIUrl":"https://doi.org/10.21518/akh2024-003","url":null,"abstract":"Introduction. Currently, along with the improvement of the scheme of combined drug therapy with first-line anti-inflammatory drugs, important importance is attached to adjuvant topical methods of treating diseases of the distal colon of various inflammatory genesis.Aim. Evaluate the clinical efficacy of the drug on sodium hyaluronate as an adjuvant topical agent in the complex treatment of patients with diseases of the distal colon.Materials and methods. A comparative analysis of the results of drug treatment of 97 patients with diseases of the distal colon of various inflammatory genesis, which were divided into two groups, was carried out. In 46 (47.4%) patients of the I (control) group, standard drug therapy with basic anti-inflammatory drugs was performed; 51 (52.6%) patients – II (main) group, the standard program of drug treatment was supplemented with instillations into the rectum of the drug on sodium hyaluronate (0.8 mg of hyaluronic acid in 1 ml). The comparative assessment of the results of treatment took into account the severity of clinical, laboratory and endoscopic manifestations of the disease.Results. In patients of the main group, there was a significant reduction in the healing time of erosions and ulceration of the mucous membrane of the distal colon compared with patients in the control group (29.4 ± 5.7 days, respectively, versus 52.8 ± 6.2 days). Also, in patients of the main group, it was possible to achieve stable clinical and laboratory remission of the disease at an earlier time, restoration of patients’ ability to work, and improvement of their quality of life.Conclusion. The results obtained by us allow us to recommend the drug on sodium hyaluronate as an additional topical drug for the medical treatment of chronic diseases of the distal colon of various inflammatory genesis in outpatient settings.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Boldin, V. Bogachev, S. V. Rodionov, P. Turkin, A. A. Slesareva, P. Y. Golosnitskiy, I. M. Dizengof, G. A. Varich
The problem of finding an ideal method for the correction of vertical venous reflux in lower extremity varicose disease is highly relevant due to the rapid development of technologies and the opening of new treatment methods, including minimally invasive ones. According to many researchers, the main parameters for choosing the optimal surgical technique should be low invasiveness, compliance with the anatomical, including ultrasound, picture, the possibility of using local anesthesia, taking into account concomitant pathology and individual intolerance of various drugs by patients, effectiveness of venous vessel obliteration, and minimal risk of possible complications. The review considers a comparative characterization of endovascular treatment methods for varicose disease, as well as lists the main possible complications of each of them. In terms of obliteration effectiveness and the least pronounced complications, the leading position is occupied by the method of cyanoacrylate obliteration. There is an increasing amount of information in the literature about the use of cyanoacrylate composite in the treatment of lower extremity varicose disease. Since this method is relatively new, the number of publications describing complications of this procedure is increasing. We describe a number of specific adverse events that occur during this surgery (extravasation of cyanoacrylate composite with the formation of aseptic granulomas and, in some cases, phlebitis-like phenomena, formation of rigid subcutaneous bands limiting mobility in the knee joint, migration of cyanoacrylate into the deep venous system of the lower extremities), possible mechanisms of their occurrence, and various approaches to treatment. Special attention is paid to proximal migration of cyanoacrylate composite into the area of the saphenofemoral junction, with a description of a specific clinical case and a discussion of further management tactics for this category of patients.
{"title":"Possible complications associated with the use of cyanoacrylate obliteration in patients with varicose veins","authors":"B. Boldin, V. Bogachev, S. V. Rodionov, P. Turkin, A. A. Slesareva, P. Y. Golosnitskiy, I. M. Dizengof, G. A. Varich","doi":"10.21518/akh2024-002","DOIUrl":"https://doi.org/10.21518/akh2024-002","url":null,"abstract":"The problem of finding an ideal method for the correction of vertical venous reflux in lower extremity varicose disease is highly relevant due to the rapid development of technologies and the opening of new treatment methods, including minimally invasive ones. According to many researchers, the main parameters for choosing the optimal surgical technique should be low invasiveness, compliance with the anatomical, including ultrasound, picture, the possibility of using local anesthesia, taking into account concomitant pathology and individual intolerance of various drugs by patients, effectiveness of venous vessel obliteration, and minimal risk of possible complications. The review considers a comparative characterization of endovascular treatment methods for varicose disease, as well as lists the main possible complications of each of them. In terms of obliteration effectiveness and the least pronounced complications, the leading position is occupied by the method of cyanoacrylate obliteration. There is an increasing amount of information in the literature about the use of cyanoacrylate composite in the treatment of lower extremity varicose disease. Since this method is relatively new, the number of publications describing complications of this procedure is increasing. We describe a number of specific adverse events that occur during this surgery (extravasation of cyanoacrylate composite with the formation of aseptic granulomas and, in some cases, phlebitis-like phenomena, formation of rigid subcutaneous bands limiting mobility in the knee joint, migration of cyanoacrylate into the deep venous system of the lower extremities), possible mechanisms of their occurrence, and various approaches to treatment. Special attention is paid to proximal migration of cyanoacrylate composite into the area of the saphenofemoral junction, with a description of a specific clinical case and a discussion of further management tactics for this category of patients.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"121 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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