Hemorrhoidal disease (HD) is a pathological enlargement of the external and/or internal hemorrhoidal piles, which may be accompanied by the bleeding and prolapse of haemorrhoids outside the anal canal. The incidence of HD among the population of the Russian Federation is 130–145 patients per 1000 people, occurring mainly in patients 45–65 years old. Among all coloproctological diseases in Russia, haemorrhoids became the reason for visiting a coloproctologist in 35–41.9% of cases. In outpatient department, the disease occurs with a frequency of 694 per 100,000 population. The treatment of hemorrhoids often begins at the coloproctologist’s office during outpatient visits. Typical clinical presentations of hemorrhoids include a complex of symptoms: periodic rectal bleeding during defecation, prolapsed hemorrhoids requiring manual reduction. Pain and itching are much less common symptoms. The treatment of hemorrhoidal disease consists of a complex of conservative measures, minimally invasive and surgical treatments, or a combination of above methods. Systemic phlebotropic drugs that affect various pathogenesis links of hemorrhoidal disease hold one of the first rightful places at the very core of modern conservative therapy regimens. Phlebotropic drugs are a large group of biologically active substances that are products of chemical synthesis or plant processing. The venotonic drugs containing flavonoids diosmin and hesperidin are the most studied ones. Various effects of diosmin and hesperidin from anti-ulcerogenic and antitumor to antioxidant and anti-inflammatory ones have been studied in clinical and experimental studies. Its venotonic and angioprotective effects are the most important actions for the treatment of hemorrhoidal disease. This review of literature is aimed determining the place of phlebotonics in outpatient practice for the treatment of haemorrhoidal disease.
{"title":"Phlebotonics for conservative treatment of haemorrhoids: when, to whom, how?","authors":"D. Shlyk, I. Tulina, P. Tsarkov","doi":"10.21518/akh2023-011","DOIUrl":"https://doi.org/10.21518/akh2023-011","url":null,"abstract":"Hemorrhoidal disease (HD) is a pathological enlargement of the external and/or internal hemorrhoidal piles, which may be accompanied by the bleeding and prolapse of haemorrhoids outside the anal canal. The incidence of HD among the population of the Russian Federation is 130–145 patients per 1000 people, occurring mainly in patients 45–65 years old. Among all coloproctological diseases in Russia, haemorrhoids became the reason for visiting a coloproctologist in 35–41.9% of cases. In outpatient department, the disease occurs with a frequency of 694 per 100,000 population. The treatment of hemorrhoids often begins at the coloproctologist’s office during outpatient visits. Typical clinical presentations of hemorrhoids include a complex of symptoms: periodic rectal bleeding during defecation, prolapsed hemorrhoids requiring manual reduction. Pain and itching are much less common symptoms. The treatment of hemorrhoidal disease consists of a complex of conservative measures, minimally invasive and surgical treatments, or a combination of above methods. Systemic phlebotropic drugs that affect various pathogenesis links of hemorrhoidal disease hold one of the first rightful places at the very core of modern conservative therapy regimens. Phlebotropic drugs are a large group of biologically active substances that are products of chemical synthesis or plant processing. The venotonic drugs containing flavonoids diosmin and hesperidin are the most studied ones. Various effects of diosmin and hesperidin from anti-ulcerogenic and antitumor to antioxidant and anti-inflammatory ones have been studied in clinical and experimental studies. Its venotonic and angioprotective effects are the most important actions for the treatment of hemorrhoidal disease. This review of literature is aimed determining the place of phlebotonics in outpatient practice for the treatment of haemorrhoidal disease. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"489 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116693299","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 prevalence of hemorrhoidal disease is 200 people per 1000 adult population, of which 75% are professionally active people. The choice of anesthetic support affects not only the effectiveness of the operation, but also the course of the early postoperative period. At the same time, regardless of the use of various variants of neuroaxial blockades, most authors indicate the development of complications such as acute urinary retention and severe postoperative pain syndrome in the postoperative period.Aim. To substantiate and evaluate the effectiveness of the proposed system of anesthesiological support for proctological operations.Material and methods. The study was conducted in 100 patients who were divided into two groups of 50 people. The operations were performed under conditions of combined anesthesia (spinal anesthesia + medical sedation). Spinal anesthesia was achieved with 0.5% isobaric bupivacaine solution, the average dose was 8.5 ± 0.12 mg. For drug sedation, a continuous infusion of propofol was used at a target concentration of 5–4–3 mg/kg per hour. The criterion for including patients in the main group was the appointment in the early postoperative period of the alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day.Results and discussion. The system of anesthetic support, including a combination of spinal anesthesia using an isobaric solution of bupivacaine at a dose of 7.5 to 10.0 mg and intravenous sedation with propofol at a target concentration of 5–4–3 mg/kg per hour, program of postoperative anesthesia based on a combination of multidirectional drug action and the appointment of alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day allows for high-quality and safe surgical treatment.Conclusion. The administration oftamsulosin hydrochloride at a dose of 0.4 mg prevented the development of acute urinary retention of patients.
{"title":"The system of anesthesiological support for coloproctological operations","authors":"G. A. Myshkov, M. V. Abritsova, N. R. Torchua","doi":"10.21518/akh2023-007","DOIUrl":"https://doi.org/10.21518/akh2023-007","url":null,"abstract":"Introduction. The prevalence of hemorrhoidal disease is 200 people per 1000 adult population, of which 75% are professionally active people. The choice of anesthetic support affects not only the effectiveness of the operation, but also the course of the early postoperative period. At the same time, regardless of the use of various variants of neuroaxial blockades, most authors indicate the development of complications such as acute urinary retention and severe postoperative pain syndrome in the postoperative period.Aim. To substantiate and evaluate the effectiveness of the proposed system of anesthesiological support for proctological operations.Material and methods. The study was conducted in 100 patients who were divided into two groups of 50 people. The operations were performed under conditions of combined anesthesia (spinal anesthesia + medical sedation). Spinal anesthesia was achieved with 0.5% isobaric bupivacaine solution, the average dose was 8.5 ± 0.12 mg. For drug sedation, a continuous infusion of propofol was used at a target concentration of 5–4–3 mg/kg per hour. The criterion for including patients in the main group was the appointment in the early postoperative period of the alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day.Results and discussion. The system of anesthetic support, including a combination of spinal anesthesia using an isobaric solution of bupivacaine at a dose of 7.5 to 10.0 mg and intravenous sedation with propofol at a target concentration of 5–4–3 mg/kg per hour, program of postoperative anesthesia based on a combination of multidirectional drug action and the appointment of alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day allows for high-quality and safe surgical treatment.Conclusion. The administration oftamsulosin hydrochloride at a dose of 0.4 mg prevented the development of acute urinary retention of patients. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117291110","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}
V. Khryshchanovich, N. Rogovoy, N. Skobeleva, O. Krasko
Introduction. Pregnancy is the leading cause of varicose veins(VVs) in women. Therapeutic measures during pregnancy include the wearing of compression hosiery and the phlebotropic therapy.Purpose. To evaluate the clinical effectiveness of graduated elastic compression and phlebotropic therapy in pregnant women with VVs.Materials and methods. A total of 88 pregnant women were included, 30 of whom used compression stockings (group 1), 28 women received phlebotonics together with compression (group 2) and 30 were controls. VVs severity was determined using the Venous Clinical Severity Score (VCSS). Quality of life (QoL) was calculated using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20). The calf circumference was measured with a measuring tape in an orthostatic position.Results and discussion. At the end of the study there was a decrease in VCSS (p < 0.001 and p < 0.008) in both treatment groups, whereas the control group showed an increase in VCSS severity (p < 0.001). At the end of follow-up the QOL score in the treatment groups showed a tendency to improve while the control group showed a decrease in QOL. A bilateral decrease in tibial circumference (p < 0.001) was seen in groups 1 and 2 and the adjuvant phlebotropic treatment was found to be superior in controlling the oedema.Conclusions. The combined use of elastic compression and phlebotonics is more effective in eliminating venous oedema in pregnant women with VVs.
{"title":"Efficacy of compression and phlebotropic therapy varicose veins in pregnant women","authors":"V. Khryshchanovich, N. Rogovoy, N. Skobeleva, O. Krasko","doi":"10.21518/akh2022-007","DOIUrl":"https://doi.org/10.21518/akh2022-007","url":null,"abstract":"Introduction. Pregnancy is the leading cause of varicose veins(VVs) in women. Therapeutic measures during pregnancy include the wearing of compression hosiery and the phlebotropic therapy.Purpose. To evaluate the clinical effectiveness of graduated elastic compression and phlebotropic therapy in pregnant women with VVs.Materials and methods. A total of 88 pregnant women were included, 30 of whom used compression stockings (group 1), 28 women received phlebotonics together with compression (group 2) and 30 were controls. VVs severity was determined using the Venous Clinical Severity Score (VCSS). Quality of life (QoL) was calculated using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20). The calf circumference was measured with a measuring tape in an orthostatic position.Results and discussion. At the end of the study there was a decrease in VCSS (p < 0.001 and p < 0.008) in both treatment groups, whereas the control group showed an increase in VCSS severity (p < 0.001). At the end of follow-up the QOL score in the treatment groups showed a tendency to improve while the control group showed a decrease in QOL. A bilateral decrease in tibial circumference (p < 0.001) was seen in groups 1 and 2 and the adjuvant phlebotropic treatment was found to be superior in controlling the oedema.Conclusions. The combined use of elastic compression and phlebotonics is more effective in eliminating venous oedema in pregnant women with VVs. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117283882","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}
E. Burleva, J. V. Babushkina, A. V. Peshkov, S. Tyurin
Trophic ulcers (TU) associated with venous circulation pathology or diabetes mellitus are considered chronic wounds with all the attributes of the complex extracellular matrix (ECM) reorganization and tissue remodelling of the edges and bed of these wounds. It was therefore determined that only a comprehensive step-wise approach to the treatment of TU can produce a stable clinical result. The article presents the experience of comprehensive management of venous and diabetic TUs. Three clinical cases of management of patients with lower limb TUs are described. The treatment of patients was planned taking into account the accepted algorithms for the management of TU associated venous circulation pathology or diabetes mellitus. The topical therapy included advanced wound coverings. The choice of dressing was determined by the clinical course of wound process. Alginate dressings were used on stages I and II wounds; hydrocolloid dressings were used on stages II and III wounds. Effects resulting from treatment included almost complete healing or readiness of a TU for skin grafting. The topical therapy of venous and diabetic TUs is part of the comprehensive treatment. During phase 1 wound process, the topical drugs should have antimicrobial, necrolytic, draining, osmotic and analgesic action. During phase 2, the granulation tissue should be induced and the balanced moist environment should be created to promote tissue regeneration. The wound coverings specified in the above clinical examples are fully consistent with the principles of the TIME concept, their ease of use and comfort for the patient are pointed out.
{"title":"Experience in complex therapy of lower limb trophic ulcers of venous and diabetic origin","authors":"E. Burleva, J. V. Babushkina, A. V. Peshkov, S. Tyurin","doi":"10.21518/akh2023-014","DOIUrl":"https://doi.org/10.21518/akh2023-014","url":null,"abstract":"Trophic ulcers (TU) associated with venous circulation pathology or diabetes mellitus are considered chronic wounds with all the attributes of the complex extracellular matrix (ECM) reorganization and tissue remodelling of the edges and bed of these wounds. It was therefore determined that only a comprehensive step-wise approach to the treatment of TU can produce a stable clinical result. The article presents the experience of comprehensive management of venous and diabetic TUs. Three clinical cases of management of patients with lower limb TUs are described. The treatment of patients was planned taking into account the accepted algorithms for the management of TU associated venous circulation pathology or diabetes mellitus. The topical therapy included advanced wound coverings. The choice of dressing was determined by the clinical course of wound process. Alginate dressings were used on stages I and II wounds; hydrocolloid dressings were used on stages II and III wounds. Effects resulting from treatment included almost complete healing or readiness of a TU for skin grafting. The topical therapy of venous and diabetic TUs is part of the comprehensive treatment. During phase 1 wound process, the topical drugs should have antimicrobial, necrolytic, draining, osmotic and analgesic action. During phase 2, the granulation tissue should be induced and the balanced moist environment should be created to promote tissue regeneration. The wound coverings specified in the above clinical examples are fully consistent with the principles of the TIME concept, their ease of use and comfort for the patient are pointed out. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134117450","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}
Laser (Light Amplification by the Stimulated Emission of Radiation) is a technical device that emits electromagnetic radiation focused in the form of a beam in the range from infrared to ultraviolet, with high energy and biological effect. In the first quarter of the 20th century, A. Einstein laid the foundation for its creation, believing that when atoms are excited from an external radiation source, a multiple increase in the released photons occurs, and the result of this process is recorded as light energy. Back in the late twentieth century, lasers in coloproctology were used as a scalpel, in fact, they performed traditional surgical interventions, but using energy tools, however, this did not deprive patients of extensive wounds and, as a result, pronounced pain sensations. The modern use of laser in proctology is really minimally invasive. An optical fiber is carried through small punctures on the skin or fistula, through which the laser energy flows directly to the target and acts aiming. In coloproctology, lasers are used to treat hemorrhoidal disease, rectal fistulas and pilonidal sinus this isrecorded in clinical guidelines. The use of laser treatment with these nosologies can reduce the severity of pain after surgery, significantly reduce the healing time of wounds, shorten the period of disability, without reducing the quality of life of patients. At the same time, these interventions are almost as effective as classical operations, in some cases even superior. But despite these encouraging data, it is necessary to conduct further research in order to develop clear technical regulations for the use of laser techniques and tracking long-term results.
{"title":"The role of laser technologies in coloproctology","authors":"N. R. Torchua, M. V. Abritsova, A. V. Matinyan","doi":"10.21518/akh2023-010","DOIUrl":"https://doi.org/10.21518/akh2023-010","url":null,"abstract":"Laser (Light Amplification by the Stimulated Emission of Radiation) is a technical device that emits electromagnetic radiation focused in the form of a beam in the range from infrared to ultraviolet, with high energy and biological effect. In the first quarter of the 20th century, A. Einstein laid the foundation for its creation, believing that when atoms are excited from an external radiation source, a multiple increase in the released photons occurs, and the result of this process is recorded as light energy. Back in the late twentieth century, lasers in coloproctology were used as a scalpel, in fact, they performed traditional surgical interventions, but using energy tools, however, this did not deprive patients of extensive wounds and, as a result, pronounced pain sensations. The modern use of laser in proctology is really minimally invasive. An optical fiber is carried through small punctures on the skin or fistula, through which the laser energy flows directly to the target and acts aiming. In coloproctology, lasers are used to treat hemorrhoidal disease, rectal fistulas and pilonidal sinus this isrecorded in clinical guidelines. The use of laser treatment with these nosologies can reduce the severity of pain after surgery, significantly reduce the healing time of wounds, shorten the period of disability, without reducing the quality of life of patients. At the same time, these interventions are almost as effective as classical operations, in some cases even superior. But despite these encouraging data, it is necessary to conduct further research in order to develop clear technical regulations for the use of laser techniques and tracking long-term results. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132626123","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}
D. I. Pozdnyakov, V. V. Kozlova, A. A. Karmanovich, I. E. Rybalko
Introduction. Chronic venous diseases are a common group of diseases with a significant risk of complications requiring timely correction. As a rule, phlebotonic drugs based on flavonoid complexes are used for the treatment and prevention of venous diseases.Aim. To evaluate the effectiveness of the use of various phlebotonic drugs in the conditions of experimental chronic venous insufficiency.Materials and methods. Varicose veins were modeled in Wistar rats by partial stricture of the deep femoral vein. The studied medicines were administered orally in a course of 30 days from the moment of surgery. During the work, the change in the following parameters was evaluated: the rate oflocal blood flow in the skin in dynamics, the degree of vascular permeability, the concentration of proinflammatory cytokines (TNF-α, IL-6) and matrix metalloproteinase 9 (MMP9) in the vascular wall. The rate of local blood flow was assessed by ultrasound Dopplerography. The change of vascular permeability was studied by the degree of extravasation of the Evans blue dye in the Miles test. The content of proinflammatory cytokines and MMR9 was determined by enzyme-linked immunoassay. The results were statistically processed.Results. The study showed that the course oral administration of all the studied venotonizing drugs led to the restoration of hemodynamics and a significant (p˂ 0.05) decrease in the degree of vascular permeability in relation to untreated animals. It is worth noting that the use of a micronised purified flavonoid fraction 1 contributed to the development of a more pronounced vasal effect, which was reflected in an increase in blood flow velocity and a decrease in vascular permeability compared to the rest of the studied drugs. At the same time, the administration of micronised purified flavonoid fraction 1 to animals led to a statistically significant decrease in the concentration of proinflammatory cytokines, which was not observed when using other drugs.Conclusion. The course administration of the micronised purified flavonoid fraction 1leads to the development of a pronounced phlebotonic effect, expressed in the restoration of microcirculation, a decrease of the inflammation in the vascular wall.
{"title":"Comparative study of the effectiveness of phlebotonic drugs in the experiment","authors":"D. I. Pozdnyakov, V. V. Kozlova, A. A. Karmanovich, I. E. Rybalko","doi":"10.21518/akh2022-002","DOIUrl":"https://doi.org/10.21518/akh2022-002","url":null,"abstract":"Introduction. Chronic venous diseases are a common group of diseases with a significant risk of complications requiring timely correction. As a rule, phlebotonic drugs based on flavonoid complexes are used for the treatment and prevention of venous diseases.Aim. To evaluate the effectiveness of the use of various phlebotonic drugs in the conditions of experimental chronic venous insufficiency.Materials and methods. Varicose veins were modeled in Wistar rats by partial stricture of the deep femoral vein. The studied medicines were administered orally in a course of 30 days from the moment of surgery. During the work, the change in the following parameters was evaluated: the rate oflocal blood flow in the skin in dynamics, the degree of vascular permeability, the concentration of proinflammatory cytokines (TNF-α, IL-6) and matrix metalloproteinase 9 (MMP9) in the vascular wall. The rate of local blood flow was assessed by ultrasound Dopplerography. The change of vascular permeability was studied by the degree of extravasation of the Evans blue dye in the Miles test. The content of proinflammatory cytokines and MMR9 was determined by enzyme-linked immunoassay. The results were statistically processed.Results. The study showed that the course oral administration of all the studied venotonizing drugs led to the restoration of hemodynamics and a significant (p˂ 0.05) decrease in the degree of vascular permeability in relation to untreated animals. It is worth noting that the use of a micronised purified flavonoid fraction 1 contributed to the development of a more pronounced vasal effect, which was reflected in an increase in blood flow velocity and a decrease in vascular permeability compared to the rest of the studied drugs. At the same time, the administration of micronised purified flavonoid fraction 1 to animals led to a statistically significant decrease in the concentration of proinflammatory cytokines, which was not observed when using other drugs.Conclusion. The course administration of the micronised purified flavonoid fraction 1leads to the development of a pronounced phlebotonic effect, expressed in the restoration of microcirculation, a decrease of the inflammation in the vascular wall. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126835111","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}
M. A. Melnikov, S. Katorkin, M. Y. Kushnarchuk, P. F. Kravtsov
Introduction. Treatment of thrombophlebitis should be complex and, along with mandatory compression, include both systemic and local use of drugs.Aim. To evaluate the efficacy and safety of the standardized use of the combined drug gel containing heparin sodium, aescin and essential phospholipids in real clinical practice in the treatment of superficial vein thrombophlebitis.Materials and methods. The study included 68 patients with varicose veins complicated by superficial vein thrombophlebitis. In group 1 patients (n = 33), topical drugs were not used. In group 2 patients (n = 35), combined gel was used daily. The drug was applied to the skin of the lower extremities three times a day, 1 g of gel. Its total daily amount did not exceed 4 g of gel. The observation period was 10 days. A dynamic scoring of clinical symptoms was performed using alinear analog scale and thermometry of the skin of the lower extremities.Results. On day 10, patients of the main group showed a statistically significant decrease in thermographic parameters in the area of thrombophlebitis: Tmin 33.23 ± 0.12 °C, Tmax 39.86 ± 0.24 °C, Tmean 40.01 ± 0.16 °С (p ≤ 0.05). When assessing the symptoms of thrombophlebitis using alinear analog scale after 10 days of treatment, there was a general decrease in the number of points in the control group to 16.4 ± 0.12 and in the main group to 12.3 ± 0.16 points (p ≤ 0.05).Conclusion. A combined gel is an effective and safe drug for the treatment of patients with thrombophlebitis of the superficial veins of the lower extremities.
{"title":"Use of a combined topical preparation in the complex treatment of thrombophlebitis of the superficial veins of the lower extremities","authors":"M. A. Melnikov, S. Katorkin, M. Y. Kushnarchuk, P. F. Kravtsov","doi":"10.21518/akh2023-001","DOIUrl":"https://doi.org/10.21518/akh2023-001","url":null,"abstract":"Introduction. Treatment of thrombophlebitis should be complex and, along with mandatory compression, include both systemic and local use of drugs.Aim. To evaluate the efficacy and safety of the standardized use of the combined drug gel containing heparin sodium, aescin and essential phospholipids in real clinical practice in the treatment of superficial vein thrombophlebitis.Materials and methods. The study included 68 patients with varicose veins complicated by superficial vein thrombophlebitis. In group 1 patients (n = 33), topical drugs were not used. In group 2 patients (n = 35), combined gel was used daily. The drug was applied to the skin of the lower extremities three times a day, 1 g of gel. Its total daily amount did not exceed 4 g of gel. The observation period was 10 days. A dynamic scoring of clinical symptoms was performed using alinear analog scale and thermometry of the skin of the lower extremities.Results. On day 10, patients of the main group showed a statistically significant decrease in thermographic parameters in the area of thrombophlebitis: Tmin 33.23 ± 0.12 °C, Tmax 39.86 ± 0.24 °C, Tmean 40.01 ± 0.16 °С (p ≤ 0.05). When assessing the symptoms of thrombophlebitis using alinear analog scale after 10 days of treatment, there was a general decrease in the number of points in the control group to 16.4 ± 0.12 and in the main group to 12.3 ± 0.16 points (p ≤ 0.05).Conclusion. A combined gel is an effective and safe drug for the treatment of patients with thrombophlebitis of the superficial veins of the lower extremities. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121964950","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}
V. Bogachev, B. Boldin, O. A. Alukhanyan, P. Turkin, V. N. Lobanov
Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area.
{"title":"Hyperpigmentation after sclerotherapy: modern possibilities for prevention and treatment","authors":"V. Bogachev, B. Boldin, O. A. Alukhanyan, P. Turkin, V. N. Lobanov","doi":"10.21518/akh2023-012","DOIUrl":"https://doi.org/10.21518/akh2023-012","url":null,"abstract":"Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125666435","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. Bleomycin is a cytotoxic antibiotic that is used as a sclerosing agent for sclerotherapy of vascular anomalies. Bleomycin is characterized by complications: nausea, vomiting, fever, the development of allergies/anaphylaxis, skin discoloration (hyperpigmentation), damage to lung tissue.Aim. To study the frequency of hyperpigmentation after administration of bleomycin for sclerotherapy of vascular malformations with slow flow characteristics. To present our own clinical observation of the development of skin hyperpigmentation after sclerotherapy of venous malformation with bleomycin.Materials and methods. A systematic review was conducted in foreign (PubMed, Web Of Science, Google Scholar, Scirus) and domestic databases (eLibrary) for the period from 2012 to 2022. As a result of the selection, 17 full-text articles remained suitable for their inclusion in the analysis.Results. In the first part of the review, 12 articles were analyzed, describing clinical observations of the development of “flaggelate” hyperpigmentation after chemotherapy of various neoplasms. In the second part of the review, an analysis of 4 articles describing clinical observations of the development of hyperpigmentation after intralesional administration of bleomycin into vascular malformation in 19 patients was carried out. Discussion. The occurrence of specific “flaggelate” hyperpigmentation after administration of bleomycin for sclerotherapy of vascular anomalies with slow flow characteristics is a rare complication. In the analysis carried out, there is no clear connection between the occurrence of hyperpigmentation and excess dosage.Conclusion. To prevent the appearance of hyperpigmentation, it is necessary to avoid excessive traumatization on time and immediately after sclerotherapy, including with ECG electrodes; avoid excessive oxygenation during the provision of anesthesia; it is necessary to avoid excessive insolation within 24–48 hours after sclerotherapy.
介绍。博莱霉素是一种细胞毒性抗生素，用作血管异常硬化治疗的硬化剂。博莱霉素的特点是并发症:恶心，呕吐，发烧，过敏/过敏反应的发展，皮肤变色(色素沉着)，肺组织损伤。目的探讨博来霉素硬化治疗慢血流特征血管畸形后色素沉着的发生率。介绍博来霉素硬化治疗静脉畸形后皮肤色素沉着的临床观察。材料和方法。对2012 - 2022年国外(PubMed、Web Of Science、Google Scholar、scius)和国内数据库(eLibrary)进行系统综述。作为选择的结果，17篇全文文章仍然适合纳入分析。回顾的第一部分，我们分析了12篇文章，描述了各种肿瘤化疗后发生“鞭状”色素沉着的临床观察。在回顾的第二部分，我们分析了4篇描述19例血管畸形患者局部给予博来霉素后发生色素沉着的临床观察。讨论。博来霉素用于慢血流特征的血管异常硬化治疗后出现特异性“鞭状”色素沉着是一种罕见的并发症。在分析中，色素沉着的发生与过量剂量之间没有明确的联系。为了防止色素沉着的出现，有必要在硬化治疗后及时避免过度创伤，包括使用ECG电极;麻醉过程中避免过量氧合;硬化治疗后24-48小时内避免过度暴晒。
{"title":"The development of flagellate hyperpigmentation after use of bleomycin for sclerotherapy slow flow vascular malformations","authors":"D. Safin, D. Agibalov","doi":"10.21518/akh2022-003","DOIUrl":"https://doi.org/10.21518/akh2022-003","url":null,"abstract":"Introduction. Bleomycin is a cytotoxic antibiotic that is used as a sclerosing agent for sclerotherapy of vascular anomalies. Bleomycin is characterized by complications: nausea, vomiting, fever, the development of allergies/anaphylaxis, skin discoloration (hyperpigmentation), damage to lung tissue.Aim. To study the frequency of hyperpigmentation after administration of bleomycin for sclerotherapy of vascular malformations with slow flow characteristics. To present our own clinical observation of the development of skin hyperpigmentation after sclerotherapy of venous malformation with bleomycin.Materials and methods. A systematic review was conducted in foreign (PubMed, Web Of Science, Google Scholar, Scirus) and domestic databases (eLibrary) for the period from 2012 to 2022. As a result of the selection, 17 full-text articles remained suitable for their inclusion in the analysis.Results. In the first part of the review, 12 articles were analyzed, describing clinical observations of the development of “flaggelate” hyperpigmentation after chemotherapy of various neoplasms. In the second part of the review, an analysis of 4 articles describing clinical observations of the development of hyperpigmentation after intralesional administration of bleomycin into vascular malformation in 19 patients was carried out. Discussion. The occurrence of specific “flaggelate” hyperpigmentation after administration of bleomycin for sclerotherapy of vascular anomalies with slow flow characteristics is a rare complication. In the analysis carried out, there is no clear connection between the occurrence of hyperpigmentation and excess dosage.Conclusion. To prevent the appearance of hyperpigmentation, it is necessary to avoid excessive traumatization on time and immediately after sclerotherapy, including with ECG electrodes; avoid excessive oxygenation during the provision of anesthesia; it is necessary to avoid excessive insolation within 24–48 hours after sclerotherapy. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128567860","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}
This article provides a review of the current literature on the current principles of symptomatic treatment of lymphovenous insufficiency. Lymphovenous insufficiency is an urgent problem of modern phlebology, the prevalence of this pathology reaches 50% among the world population. Underlying the pathogenesis is venous hypertension, which is caused by venous valve insufficiency, venous outflow obstruction, or combined causes. The use of compression knitwear and symptomatic therapy for lymphovenous insufficiency is an important component of the treatment at the initial stages of the disease — pharmacotherapy based on the use of venoactive drugs. The most promising to date are preparations of the micronized purified flavonide fraction (MPFF) group, which consist of micronized diosmin and flavonides. The use of МОФФ drugs reduces venous hypertension by increasing venous tone, reducing venous capacity, and extensibility of the vessel wall. MPFF also improves lymph conversion by increasing the contractility of the lymphatic capillaries and has an effect on the microcirculation of the vessels of the lower extremities, having an effect on the resistance and permeability of the capillaries. Thus, the use of preparations of the micronized purified fraction of flavonides has a more pronounced effect on the etiology and pathogenesis of the disease, thereby increasing the clinical effect and leading to a more effective result in the treatment of lymphovenous insufficiency. And as presented in this review, drugs containing micronized purified flavonoid fraction are an excellent candidate to be further studied as therapeutic agents for the treatment of lymphovenous insufficiency, because the mechanism of action of the micronized purified flavonoid fraction is directly connected with its pathophysiology and high clinical efficacy.
{"title":"Current principles of symptomatic treatment of lymphovenous insufficiency","authors":"S. Dunaevskaya","doi":"10.21518/akh2022-004","DOIUrl":"https://doi.org/10.21518/akh2022-004","url":null,"abstract":"This article provides a review of the current literature on the current principles of symptomatic treatment of lymphovenous insufficiency. Lymphovenous insufficiency is an urgent problem of modern phlebology, the prevalence of this pathology reaches 50% among the world population. Underlying the pathogenesis is venous hypertension, which is caused by venous valve insufficiency, venous outflow obstruction, or combined causes. The use of compression knitwear and symptomatic therapy for lymphovenous insufficiency is an important component of the treatment at the initial stages of the disease — pharmacotherapy based on the use of venoactive drugs. The most promising to date are preparations of the micronized purified flavonide fraction (MPFF) group, which consist of micronized diosmin and flavonides. The use of МОФФ drugs reduces venous hypertension by increasing venous tone, reducing venous capacity, and extensibility of the vessel wall. MPFF also improves lymph conversion by increasing the contractility of the lymphatic capillaries and has an effect on the microcirculation of the vessels of the lower extremities, having an effect on the resistance and permeability of the capillaries. Thus, the use of preparations of the micronized purified fraction of flavonides has a more pronounced effect on the etiology and pathogenesis of the disease, thereby increasing the clinical effect and leading to a more effective result in the treatment of lymphovenous insufficiency. And as presented in this review, drugs containing micronized purified flavonoid fraction are an excellent candidate to be further studied as therapeutic agents for the treatment of lymphovenous insufficiency, because the mechanism of action of the micronized purified flavonoid fraction is directly connected with its pathophysiology and high clinical efficacy.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122035048","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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