Pub Date : 2022-11-20DOI: 10.21518/1995-1477-2022-19-2-142-151
A. Khitaryan, A. Abovyan, A. Mezhunts, A. Orekhov, D. Melnikov, А. V. Sarkisyan, S. A. Adizov, A. Rogut, G. Ziegler, C. M. Amegninou
Introduction. Despite the great popularity of Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the treatment of morbid obesity, the problem of the development and progression of sarcopenia in patients with type 2 diabetes mellitus in the postoperative period remains insufficiently studied.Aim. To study the prevalence and dynamics of sarcopenia in patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the long term.Materials and methods. Our prospective study included 257 bariatric patients (170 Roux-en-Y gastric bypass and 87 laparoscopic sleeve gastrectomy) with type 2 diabetes mellitus. All patients underwent a standard set of preoperative examination with obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. After 6, 12, 18 and 24 months, control examinations were carried out.Results. At the preoperative stage, 28 patients (16.5%) with signs of moderate sarcopenia were identified in the Roux-en-Y gastric bypass group and 15 patients (17.2%) in the laparoscopic sleeve gastrectomy group. According to the bioelectrical impedance analysis, 24 months after the operation, 37 patients (25.9%) with signs of moderate sarcopenia and 2 patients (1.4%) with severe sarcopenia were identified in the first group. 24 months after surgery in the second group there was no statistical difference in the number of patients with signs of sarcopenia in comparison with the preoperative period.Conclusion. The frequency of development and progression of signs of sarcopenia after Roux-en-Y gastric bypass is statistically higher than after laparoscopic sleeve gastrectomy. In this regard, in our opinion, when choosing a method of surgical treatment of morbid obesity with concomitant type 2 diabetes mellitus, a detailed assessment of the state of protein metabolism by the bioelectrical impedance analysis is necessary.
{"title":"Risk of sarcopenia after bariatric surgery in patients with type 2 diabetes mellitus","authors":"A. Khitaryan, A. Abovyan, A. Mezhunts, A. Orekhov, D. Melnikov, А. V. Sarkisyan, S. A. Adizov, A. Rogut, G. Ziegler, C. M. Amegninou","doi":"10.21518/1995-1477-2022-19-2-142-151","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-142-151","url":null,"abstract":"Introduction. Despite the great popularity of Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the treatment of morbid obesity, the problem of the development and progression of sarcopenia in patients with type 2 diabetes mellitus in the postoperative period remains insufficiently studied.Aim. To study the prevalence and dynamics of sarcopenia in patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the long term.Materials and methods. Our prospective study included 257 bariatric patients (170 Roux-en-Y gastric bypass and 87 laparoscopic sleeve gastrectomy) with type 2 diabetes mellitus. All patients underwent a standard set of preoperative examination with obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. After 6, 12, 18 and 24 months, control examinations were carried out.Results. At the preoperative stage, 28 patients (16.5%) with signs of moderate sarcopenia were identified in the Roux-en-Y gastric bypass group and 15 patients (17.2%) in the laparoscopic sleeve gastrectomy group. According to the bioelectrical impedance analysis, 24 months after the operation, 37 patients (25.9%) with signs of moderate sarcopenia and 2 patients (1.4%) with severe sarcopenia were identified in the first group. 24 months after surgery in the second group there was no statistical difference in the number of patients with signs of sarcopenia in comparison with the preoperative period.Conclusion. The frequency of development and progression of signs of sarcopenia after Roux-en-Y gastric bypass is statistically higher than after laparoscopic sleeve gastrectomy. In this regard, in our opinion, when choosing a method of surgical treatment of morbid obesity with concomitant type 2 diabetes mellitus, a detailed assessment of the state of protein metabolism by the bioelectrical impedance analysis is necessary.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117171722","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}
Pub Date : 2022-11-20DOI: 10.21518/1995-1477-2022-19-2-128-133
S. Jain, C. Singla, S. Toor, D. Bhatti, P. Gupta
Dog bites injuries are a significant cause of morbidity and mortality. Conventionally, it was suggested to leave the wounds open due to probable increased risk of infections and occurrence of rabies with suturing.Recent publications indicate that primary closure does not necessarily affect the chances of infection but definitely helps in improving the quality of scar. We are presenting our experience and protocol for primary closure of all dog bite wounds. From March 2020 to February 2021, 10 consecutive patients of all ages coming to the emergency of our hospital with category 3 dog bite that penetrated the epidermis and dermis and presenting within 48 hours of injury were included. Every patient was administered first dose of anti rabies vaccine (ARV) (zero dose) for active immunisation and was also given injection tetanus intramuscularly. Mean age of patients in our study was 20.9 with range from 2 years to 90 years. Only 2/10 patients developed infections which were managed conservatively with drainage of abscess and antibiotics. Rest all patients recovered without complications. Primary closure of dog bite wounds when associated with debridement, sufficient irrigation, povidine iodine cleansing and antibiotic administration resulted in improved cosmetic appearance without increase in the rate of infection.
{"title":"Management of dog bite wounds: Our protocol and experience with early surgical intervention","authors":"S. Jain, C. Singla, S. Toor, D. Bhatti, P. Gupta","doi":"10.21518/1995-1477-2022-19-2-128-133","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-128-133","url":null,"abstract":"Dog bites injuries are a significant cause of morbidity and mortality. Conventionally, it was suggested to leave the wounds open due to probable increased risk of infections and occurrence of rabies with suturing.Recent publications indicate that primary closure does not necessarily affect the chances of infection but definitely helps in improving the quality of scar. We are presenting our experience and protocol for primary closure of all dog bite wounds. From March 2020 to February 2021, 10 consecutive patients of all ages coming to the emergency of our hospital with category 3 dog bite that penetrated the epidermis and dermis and presenting within 48 hours of injury were included. Every patient was administered first dose of anti rabies vaccine (ARV) (zero dose) for active immunisation and was also given injection tetanus intramuscularly. Mean age of patients in our study was 20.9 with range from 2 years to 90 years. Only 2/10 patients developed infections which were managed conservatively with drainage of abscess and antibiotics. Rest all patients recovered without complications. Primary closure of dog bite wounds when associated with debridement, sufficient irrigation, povidine iodine cleansing and antibiotic administration resulted in improved cosmetic appearance without increase in the rate of infection.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132447451","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}
Pub Date : 2022-11-20DOI: 10.21518/1995-1477-2022-19-2-152-158
O. Alukhanyan, R. E. Gabibullaev, A. O. Alukhanyan, O. V. Kurganskiy, D. Aristov
Introduction. This article presents a clinical case of successful and single-stage endovenous laser coagulation combined with miniphlebectomy in a patient with extensive and combined varicose lesion of all major subcutaneous veins of the lower limbs with significant symptoms of chronic venous insufficiency.Aim. To determine the possibilities of simultaneous elimination of all main subcutaneous veins and their varicose tributaries on both lower limbs using minimally invasive methods.Materials and methods. A 44-year-old female patient complained of gastrocnemius muscle cramps, swollen shins, feeling of heaviness at the end of the working day and the presence of varicose veins in both lower extremities. The severity of the chronic vein disease before the intervention according to the VCSS (Venous clinical Severity Score) was 8. As a result, patency of deep veins and condition of their valve apparatus, insufficiency of valves of the sapheno-femoral and sapheno-popliteal annexes on both sides with reflux through large and small saphenous veins and anterior accessory large saphenous vein on the right, insufficiency of perforating veins of both tibias were determined. Endovenous laser coagulation of the great and small saphenous veins on both sides and the right anterior accessory great saphenous vein, miniphlebectomy of dilated tributaries within both lower limbs was performed. The symptoms of chronic venous insufficiency decreased markedly. Swelling of the lower legs and cramps in the gastrocnemiu muscles have almost completely disappeared, and the feeling of heaviness in the legs after static loads has significantly decreased.Conclusion. Endovenous laser coagulation with miniphlebectomy should be given preference in varicose vein disease with combined affection of all great saphenous veins of both lower limbs. Their application provides an opportunity to eliminate simultaneously incompetence of all target veins and to remove varicose dilated tributaries, providing good therapeutic and cosmetic effect without hospitalization and detachment of the patient from his or her work activity.
{"title":"The significance of minimally invasive treatment methods in the single-stage elimination of varicose vein disease of the great and small saphenous veins of the lower limbs and their branches","authors":"O. Alukhanyan, R. E. Gabibullaev, A. O. Alukhanyan, O. V. Kurganskiy, D. Aristov","doi":"10.21518/1995-1477-2022-19-2-152-158","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-152-158","url":null,"abstract":"Introduction. This article presents a clinical case of successful and single-stage endovenous laser coagulation combined with miniphlebectomy in a patient with extensive and combined varicose lesion of all major subcutaneous veins of the lower limbs with significant symptoms of chronic venous insufficiency.Aim. To determine the possibilities of simultaneous elimination of all main subcutaneous veins and their varicose tributaries on both lower limbs using minimally invasive methods.Materials and methods. A 44-year-old female patient complained of gastrocnemius muscle cramps, swollen shins, feeling of heaviness at the end of the working day and the presence of varicose veins in both lower extremities. The severity of the chronic vein disease before the intervention according to the VCSS (Venous clinical Severity Score) was 8. As a result, patency of deep veins and condition of their valve apparatus, insufficiency of valves of the sapheno-femoral and sapheno-popliteal annexes on both sides with reflux through large and small saphenous veins and anterior accessory large saphenous vein on the right, insufficiency of perforating veins of both tibias were determined. Endovenous laser coagulation of the great and small saphenous veins on both sides and the right anterior accessory great saphenous vein, miniphlebectomy of dilated tributaries within both lower limbs was performed. The symptoms of chronic venous insufficiency decreased markedly. Swelling of the lower legs and cramps in the gastrocnemiu muscles have almost completely disappeared, and the feeling of heaviness in the legs after static loads has significantly decreased.Conclusion. Endovenous laser coagulation with miniphlebectomy should be given preference in varicose vein disease with combined affection of all great saphenous veins of both lower limbs. Their application provides an opportunity to eliminate simultaneously incompetence of all target veins and to remove varicose dilated tributaries, providing good therapeutic and cosmetic effect without hospitalization and detachment of the patient from his or her work activity. ","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134157352","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}
Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-44-49
R. Kamaltdinov, R. V. Akhmetzianov, R. Bredikhin, R. K. Dzhordzhikiya
Acute aortic dissection of type A is still one of the most difficult diseases faced by doctors of all specialties. The current review is based on an analysis of current literature data and clinical guidelines. It covers various aspects of outpatient patient management and focuses on conservative therapy. The lack of an adequate diagnostic algorithm often leads to complications and, ultimately, death. The dynamic nature of the disease, the variability of clinical manifestations and the course of the pathological process require special attention. Both short-term and long-term survival of the patient depends on careful observation. Postoperative management of patients with acute aortic dissection of type A is entirely entrusted to the outpatient unit, which, due to the absence of the main aspects of the strategy in modern clinical recommendations, is not always prepared for the curation of this complex cohort of patients. The lack of experience in managing this pathology by outpatient hospital doctors causes significant difficulties in interpreting instrumental diagnostic methods, which leads to further erroneous tactics with the development of long-term complications. Due to the lack of a unified scheme of drug therapy, the question of prescribing drugs in these patients, who often receive a fairly large range of medications for concomitant pathology, remains open. These factors contribute to polyprogmasia or vice versa – insufficient volume of drug therapy, which further leads to the progression of the disease. As a result of insufficient emphasis on the basics of outpatient management of this cohort of patients, a whole complex of problems arises, leading to unsatisfactory treatment results and increased healthcare costs for their subsequent solution. The purpose of the review is to highlight the main problems of this issue from the point of view of evidence-based medicine.
{"title":"Outpatient management of patients after surgical operations for acute aortic dissection of type A","authors":"R. Kamaltdinov, R. V. Akhmetzianov, R. Bredikhin, R. K. Dzhordzhikiya","doi":"10.21518/1995-1477-2022-19-2-44-49","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-44-49","url":null,"abstract":"Acute aortic dissection of type A is still one of the most difficult diseases faced by doctors of all specialties. The current review is based on an analysis of current literature data and clinical guidelines. It covers various aspects of outpatient patient management and focuses on conservative therapy. The lack of an adequate diagnostic algorithm often leads to complications and, ultimately, death. The dynamic nature of the disease, the variability of clinical manifestations and the course of the pathological process require special attention. Both short-term and long-term survival of the patient depends on careful observation. Postoperative management of patients with acute aortic dissection of type A is entirely entrusted to the outpatient unit, which, due to the absence of the main aspects of the strategy in modern clinical recommendations, is not always prepared for the curation of this complex cohort of patients. The lack of experience in managing this pathology by outpatient hospital doctors causes significant difficulties in interpreting instrumental diagnostic methods, which leads to further erroneous tactics with the development of long-term complications. Due to the lack of a unified scheme of drug therapy, the question of prescribing drugs in these patients, who often receive a fairly large range of medications for concomitant pathology, remains open. These factors contribute to polyprogmasia or vice versa – insufficient volume of drug therapy, which further leads to the progression of the disease. As a result of insufficient emphasis on the basics of outpatient management of this cohort of patients, a whole complex of problems arises, leading to unsatisfactory treatment results and increased healthcare costs for their subsequent solution. The purpose of the review is to highlight the main problems of this issue from the point of view of evidence-based medicine.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131110939","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}
Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-82-94
B. Boldin, P. Turkin, A. Oettinger, V. Bogachev, N. O. Somov, S. G. Kuzmin, V. Loschenov, L. Mikhaleva, K. Midiber
Introduction. Today, antimicrobial photodynamic therapy (a-PDT) becomes more and more popular, because of it pronounced bactericidal activity, anti-inflammatory effect. At the same time, no animal model studies have been conducted on morphological changes in cells after exposure to PDT on venous ulcers (VU) when using different types of photosensitizers (PS). The problem of comparing morphological changes in tissues when using a-PDT vs conventional PDT have not yet been resolved.Aim. Evaluation of the effectiveness of PDT and APDT in a comprehensive examination of trophic ulcers in an in vivo experiment and compare them with standard methods for the treatment of VLU.Materials and мethods. A series of experiments was conducted on 21 rabbits, separated into 3 equal groups of 7 rabbits each. Venous trophic ulcer was originally modeled for all rabbits. To obtain a VU, we performed an additional ligation of v. femoralis. The control group received standard therapy for VU. The PDT group had PDT with Photosens. The a-PDT group underwent a-PDT using Cholosens. Every 3 days, picture of local inflammation, regeneration rate and ulcer volume were determined. A morphological study of VLU was carried out on the first, 9th and 15th days.Results. The a-PDT group, day 15: 100% wound epithelization. Control group, day 21st: The volume of wounds decreased on average by 50%. The PDT group: 100% wound epithelization. The morphological study indicated a positive trend in the a-PDT group compared with PDT and control groups, which resulted in a decrease in the total mass of necrotic detritus, a change in the quantitative and qualitative composition of inflammatory infiltrate.Conclusion. The data obtained indicate that the use of a-PDT is recommended in treatment of VLU. Both PDT and a-PDT methods showed better results in comparison with standard therapy.
{"title":"Efficacy of photodynamic therapy in the treatment of venous trophic ulcers: results from the experiment","authors":"B. Boldin, P. Turkin, A. Oettinger, V. Bogachev, N. O. Somov, S. G. Kuzmin, V. Loschenov, L. Mikhaleva, K. Midiber","doi":"10.21518/1995-1477-2022-19-2-82-94","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-82-94","url":null,"abstract":"Introduction. Today, antimicrobial photodynamic therapy (a-PDT) becomes more and more popular, because of it pronounced bactericidal activity, anti-inflammatory effect. At the same time, no animal model studies have been conducted on morphological changes in cells after exposure to PDT on venous ulcers (VU) when using different types of photosensitizers (PS). The problem of comparing morphological changes in tissues when using a-PDT vs conventional PDT have not yet been resolved.Aim. Evaluation of the effectiveness of PDT and APDT in a comprehensive examination of trophic ulcers in an in vivo experiment and compare them with standard methods for the treatment of VLU.Materials and мethods. A series of experiments was conducted on 21 rabbits, separated into 3 equal groups of 7 rabbits each. Venous trophic ulcer was originally modeled for all rabbits. To obtain a VU, we performed an additional ligation of v. femoralis. The control group received standard therapy for VU. The PDT group had PDT with Photosens. The a-PDT group underwent a-PDT using Cholosens. Every 3 days, picture of local inflammation, regeneration rate and ulcer volume were determined. A morphological study of VLU was carried out on the first, 9th and 15th days.Results. The a-PDT group, day 15: 100% wound epithelization. Control group, day 21st: The volume of wounds decreased on average by 50%. The PDT group: 100% wound epithelization. The morphological study indicated a positive trend in the a-PDT group compared with PDT and control groups, which resulted in a decrease in the total mass of necrotic detritus, a change in the quantitative and qualitative composition of inflammatory infiltrate.Conclusion. The data obtained indicate that the use of a-PDT is recommended in treatment of VLU. Both PDT and a-PDT methods showed better results in comparison with standard therapy.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131503271","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}
Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-62-71
K. Lobastov, M. Shaldina, D. Borsuk, I. Schastlivtsev, L. Laberko, А. Fokin
Venous thromboembolic complications (VTEO) after modern minimally invasive superficial vein interventions are an infrequent but very dramatic event. This article presents a review of the literature, covering the issues of prevalence, prognosis and pharmacological prevention of VTEO. The performed studies demonstrate that the incidence of symptomatic thrombotic complications after endovenous thermal obliteration does not exceed 0,5%, but taking into account asymptomatic thermally induced thromboses and subclinical occlusions of the muscular veins of the lower leg, this figure can exceed 10%. There is a high heterogeneity of the data, possibly due to differences in the individual risk of VTEO. The most validated tool for assessing the latter is the Caprini Scale, which has not been sufficiently studied in the surgical treatment of varicose veins. The administration of prophylactic doses of anticoagulants after thermal obliteration of saphenous veins is widely used in routine clinical practice, despite the lack of convincing evidence for the appropriateness of this approach. In recent years, the use of direct oral anticoagulants against the official instruction (off-label) has gained great popularity as an alternative to heparin. The largest evidence base has accumulated for the use of rivaroxaban 10 mg, which is associated with high efficacy and safety. Based on completed clinical trials, it is not possible to formulate unequivocal recommendations for prophylactic anticoagulant doses after thermal obliteration of superficial veins at this time. Additional studies are required to identify patients with an individually increased risk of thrombosis in whom prophylactic doses of anticoagulants may be of maximum benefit.
{"title":"Current state of the problem of risk assessment and prevention of venous thromboembolic complications after thermal obliteration of superficial veins","authors":"K. Lobastov, M. Shaldina, D. Borsuk, I. Schastlivtsev, L. Laberko, А. Fokin","doi":"10.21518/1995-1477-2022-19-2-62-71","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-62-71","url":null,"abstract":"Venous thromboembolic complications (VTEO) after modern minimally invasive superficial vein interventions are an infrequent but very dramatic event. This article presents a review of the literature, covering the issues of prevalence, prognosis and pharmacological prevention of VTEO. The performed studies demonstrate that the incidence of symptomatic thrombotic complications after endovenous thermal obliteration does not exceed 0,5%, but taking into account asymptomatic thermally induced thromboses and subclinical occlusions of the muscular veins of the lower leg, this figure can exceed 10%. There is a high heterogeneity of the data, possibly due to differences in the individual risk of VTEO. The most validated tool for assessing the latter is the Caprini Scale, which has not been sufficiently studied in the surgical treatment of varicose veins. The administration of prophylactic doses of anticoagulants after thermal obliteration of saphenous veins is widely used in routine clinical practice, despite the lack of convincing evidence for the appropriateness of this approach. In recent years, the use of direct oral anticoagulants against the official instruction (off-label) has gained great popularity as an alternative to heparin. The largest evidence base has accumulated for the use of rivaroxaban 10 mg, which is associated with high efficacy and safety. Based on completed clinical trials, it is not possible to formulate unequivocal recommendations for prophylactic anticoagulant doses after thermal obliteration of superficial veins at this time. Additional studies are required to identify patients with an individually increased risk of thrombosis in whom prophylactic doses of anticoagulants may be of maximum benefit.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"188 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134058847","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}
Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-111-118
E. A. Shcheglov, N. N. Alontseva
Introduction. Chronic vein diseases in general and varicose veins of the lower extremities in particular represent a serious medical and social problem.The aim was to study the influence of the therapy of venous outflow disorders on the treatment results of osteoarthritis of the knee joints in patients with varicose veins in combination with osteoarthritis of the knee joints.Materials and methods. The study included 105 patients with varicose veins combined with knee osteoarthritis who had previously received treatment for osteoarthritis of the knee joints but had not received or had received extremely irregular therapy for varicose veins. The follow-up period for the patients was 12 months. The patients underwent the first course of phlebotropic drugs for 2 months from the start of the study. Then this course was repeated twice at 3-month intervals. The standard phlebotropic drug was a micronized purified flavonoid fraction. Compression knitwear was recommended in all patients. Class 2 stockings or tights with an ankle pressure of 23–32 mmHg were used in the vast majority of cases. Treatment of osteoarthritis included the use of nonsteroidal anti-inflammatory drugs, disease-modifying agents (chondroitin sulfate, glucosamine sulfate), and physical therapy.Results. The VCSS scale reduced the degree of chronic venous insufficiency in the clinical group. At inclusion in the study, the average score in the clinical group was 7.1 ± 1.9, after 6 months the result was 6.1 ± 1.5, and after 12 months – 6.0 ± 1.2 points. In the control group, where patients did not receive therapy for varicose veins, there were no dynamics. The results of joint syndrome against the background of correction of venous outflow disturbances – decrease of Leken and WOMAC index values, decrease of pain syndrome according to the visual analogue scale. All this led to a decrease in the patients' need for taking analgesics.Conclusions. Out of 100 patients with joint pathology, 68 patients were diagnosed with varicose veins. These diseases aggravate each other, but we can assume that the venous pathology is primary. A vicious circle is set in motion – progression of osteoarthritis due to the disturbances of venous outflow, and varicosity due to the deterioration of muscular-venous pump functioning.
{"title":"Chronic vein insufficiency correction in patients with lower extremities varicosity and knee osteoarthritis","authors":"E. A. Shcheglov, N. N. Alontseva","doi":"10.21518/1995-1477-2022-19-2-111-118","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-111-118","url":null,"abstract":"Introduction. Chronic vein diseases in general and varicose veins of the lower extremities in particular represent a serious medical and social problem.The aim was to study the influence of the therapy of venous outflow disorders on the treatment results of osteoarthritis of the knee joints in patients with varicose veins in combination with osteoarthritis of the knee joints.Materials and methods. The study included 105 patients with varicose veins combined with knee osteoarthritis who had previously received treatment for osteoarthritis of the knee joints but had not received or had received extremely irregular therapy for varicose veins. The follow-up period for the patients was 12 months. The patients underwent the first course of phlebotropic drugs for 2 months from the start of the study. Then this course was repeated twice at 3-month intervals. The standard phlebotropic drug was a micronized purified flavonoid fraction. Compression knitwear was recommended in all patients. Class 2 stockings or tights with an ankle pressure of 23–32 mmHg were used in the vast majority of cases. Treatment of osteoarthritis included the use of nonsteroidal anti-inflammatory drugs, disease-modifying agents (chondroitin sulfate, glucosamine sulfate), and physical therapy.Results. The VCSS scale reduced the degree of chronic venous insufficiency in the clinical group. At inclusion in the study, the average score in the clinical group was 7.1 ± 1.9, after 6 months the result was 6.1 ± 1.5, and after 12 months – 6.0 ± 1.2 points. In the control group, where patients did not receive therapy for varicose veins, there were no dynamics. The results of joint syndrome against the background of correction of venous outflow disturbances – decrease of Leken and WOMAC index values, decrease of pain syndrome according to the visual analogue scale. All this led to a decrease in the patients' need for taking analgesics.Conclusions. Out of 100 patients with joint pathology, 68 patients were diagnosed with varicose veins. These diseases aggravate each other, but we can assume that the venous pathology is primary. A vicious circle is set in motion – progression of osteoarthritis due to the disturbances of venous outflow, and varicosity due to the deterioration of muscular-venous pump functioning.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"423 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126714435","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}
Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-96-105
B. M. Belik, A. Kovalev
Introduction. Elimination of manifestations of functional constipation and normalization of the stool to date remain a complex and finally unresolved problem during typical surgical interventions in outpatient coloproctology.Aim. To evaluate the clinical efficacy of the laxative agent sodium picosulfate in the surgical treatment of non-tumor diseases of the anal canal and rectum in outpatient settings.Materials and methods. The results of surgical treatment of 566 patients with non-tumor diseases of the anal canal and rectum, which were divided into two groups, were analyzed. In 275 patients (group 1), laxative agents were not used during treatment or were used indiscriminately. In 291 patients (group 2), the laxative agent sodium picosulfate was used to normalize colon emptying and soften stools during treatment. Comparison criteria: level of pain syndrome after surgery, degree of inflammatory manifestations in the field of surgical intervention, shape, and nature of fecal masses (based on the Bristol scale), frequency of wound inflammatory complications and recovery time for patients.Results. In the early stages after surgery, the stool had a softened consistency (type 5 and 6) in a much larger number of group 2 patients (89.7 ± 4.1 – 94.2 ± 5.1%) compared with group 1 patients (67.3 ± 4.8 – 76.7 ± 4.9%). At the same time, in group 2 patients, pain syndrome was less pronounced, inflammatory manifestations in the area of surgical intervention regressed faster, incidence of wound inflammatory complications decreased 2.8 times (from 16.4 to 5.8%) and work capacity was recovered earlier than in group 1 patients.Conclusion. The use of the laxative agent sodium picosulfate in coloproctological patients when performing typical surgical interventions on the rectum and anal canal on an outpatient basis eliminates the manifestations of symptomatic constipation, ensures the formation of a softened stool in perioperative periods, reduces mechanical injury to the mucous membrane of the rectum by feces, reduces the level of pain syndrome, which improves the results of surgical treatment by reducing the number of wound inflammatory complications.
{"title":"Modern approach to the choice of laxative agent in surgical interventions in outpatient coloproctology","authors":"B. M. Belik, A. Kovalev","doi":"10.21518/1995-1477-2022-19-2-96-105","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-96-105","url":null,"abstract":"Introduction. Elimination of manifestations of functional constipation and normalization of the stool to date remain a complex and finally unresolved problem during typical surgical interventions in outpatient coloproctology.Aim. To evaluate the clinical efficacy of the laxative agent sodium picosulfate in the surgical treatment of non-tumor diseases of the anal canal and rectum in outpatient settings.Materials and methods. The results of surgical treatment of 566 patients with non-tumor diseases of the anal canal and rectum, which were divided into two groups, were analyzed. In 275 patients (group 1), laxative agents were not used during treatment or were used indiscriminately. In 291 patients (group 2), the laxative agent sodium picosulfate was used to normalize colon emptying and soften stools during treatment. Comparison criteria: level of pain syndrome after surgery, degree of inflammatory manifestations in the field of surgical intervention, shape, and nature of fecal masses (based on the Bristol scale), frequency of wound inflammatory complications and recovery time for patients.Results. In the early stages after surgery, the stool had a softened consistency (type 5 and 6) in a much larger number of group 2 patients (89.7 ± 4.1 – 94.2 ± 5.1%) compared with group 1 patients (67.3 ± 4.8 – 76.7 ± 4.9%). At the same time, in group 2 patients, pain syndrome was less pronounced, inflammatory manifestations in the area of surgical intervention regressed faster, incidence of wound inflammatory complications decreased 2.8 times (from 16.4 to 5.8%) and work capacity was recovered earlier than in group 1 patients.Conclusion. The use of the laxative agent sodium picosulfate in coloproctological patients when performing typical surgical interventions on the rectum and anal canal on an outpatient basis eliminates the manifestations of symptomatic constipation, ensures the formation of a softened stool in perioperative periods, reduces mechanical injury to the mucous membrane of the rectum by feces, reduces the level of pain syndrome, which improves the results of surgical treatment by reducing the number of wound inflammatory complications.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131278831","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}
Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-119-126
D. I. Pozdnyakov, N. B. Shabanova, A. Gerashchenko, K. K. Sarkisyan
Introduction. Varicose veins are a common disease with a chronic course and a high risk of complications and cosmetic defects. Venotonic drugs are widely used in conservative treatment of varicose veins.Aim. To study the comparative efficacy of venotonic drugs for local application in experimental conditions.Materials and Methods. Varicose veins were modeled in Wistar rats by partial stricture of the deep femoral vein. The studied drugs were applied in the course of 14 days from the operation. The assessed parameters were the change of local blood flow velocity in the skin in the dynamics and the degree of vascular permeability. The rate of local blood flow was assessed by Doppler ultrasound. Changes in vascular permeability were studied by the degree of extravasation of Evans blue dye in the Miles test. The results were processed using the methods of variation statistics.Results. The study showed that under the conditions of experimental chronic venous insufficiency, a course of application of all the analyzed drugs resulted in an increase in the rate of local blood flow in the skin and a decrease in the degree of vascular permeability. It was noted that application of the investigated gel based on escin, heparin and essential phospholipids to the skin of animals resulted in reliably (p < 0,05) lower indices of vascular permeability in comparison with the rats which received a course therapy with the heparin-containing gel; combined cosmetic agent as well as the gel based on troxerutin, heparin and dexpanthenol.Discussion. The results obtained testify that application of external dosage forms of combined venotonic drugs promotes the regression of chronic venous insufficiency manifestations. Maximum evident effect was registered while applying the studied drug, that can be related to its complex composition including essential phospholipids, heparin and aescin. It is known that aescin is a phlebotonic with a high degree of percutaneous absorption, the effect of which is significantly potentiated by the phospholipid component.Conclusions. The application of the combined product based on heparin, aescin and essential phospholipids provided an optimum rate of onset of pharmacological effect compared to the other analysed compositions.
{"title":"Comparative evaluation of the effectiveness of phlebotonic gels","authors":"D. I. Pozdnyakov, N. B. Shabanova, A. Gerashchenko, K. K. Sarkisyan","doi":"10.21518/1995-1477-2022-19-2-119-126","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-119-126","url":null,"abstract":"Introduction. Varicose veins are a common disease with a chronic course and a high risk of complications and cosmetic defects. Venotonic drugs are widely used in conservative treatment of varicose veins.Aim. To study the comparative efficacy of venotonic drugs for local application in experimental conditions.Materials and Methods. Varicose veins were modeled in Wistar rats by partial stricture of the deep femoral vein. The studied drugs were applied in the course of 14 days from the operation. The assessed parameters were the change of local blood flow velocity in the skin in the dynamics and the degree of vascular permeability. The rate of local blood flow was assessed by Doppler ultrasound. Changes in vascular permeability were studied by the degree of extravasation of Evans blue dye in the Miles test. The results were processed using the methods of variation statistics.Results. The study showed that under the conditions of experimental chronic venous insufficiency, a course of application of all the analyzed drugs resulted in an increase in the rate of local blood flow in the skin and a decrease in the degree of vascular permeability. It was noted that application of the investigated gel based on escin, heparin and essential phospholipids to the skin of animals resulted in reliably (p < 0,05) lower indices of vascular permeability in comparison with the rats which received a course therapy with the heparin-containing gel; combined cosmetic agent as well as the gel based on troxerutin, heparin and dexpanthenol.Discussion. The results obtained testify that application of external dosage forms of combined venotonic drugs promotes the regression of chronic venous insufficiency manifestations. Maximum evident effect was registered while applying the studied drug, that can be related to its complex composition including essential phospholipids, heparin and aescin. It is known that aescin is a phlebotonic with a high degree of percutaneous absorption, the effect of which is significantly potentiated by the phospholipid component.Conclusions. The application of the combined product based on heparin, aescin and essential phospholipids provided an optimum rate of onset of pharmacological effect compared to the other analysed compositions.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125678180","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}
Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-72-81
V. Bregovskiy, A. Demina, I. Karpova
Local treatment of diabetic foot ulcers is one of the most controversial topics in surgery. The choice of a dressing or bandage is still heavily influenced by many subjective factors and is often based on the personal preferences of the medical staff. Based on literature data and practical experience, the article presents the shortcomings of the current domestic practice of using gauze dressings with various drugs, as well as the reasons for the insufficient use of special so-called “outpatient” dressings with special properties. The main classes of modern dressings with special properties (mesh, hydrocolloids, hydroalginates, hydrogels, alginates and sponges or foams) and their areas of application are characterized. The concept of wound treatment in a humid environment with maintaining an optimal moisture balance is highlighted. The key areas of treatment of diabetic foot ulcers in accordance with the modern recommendations of the International Working Group on the Diabetic Foot and the Ministry of Health of the Russian Federation are given: infection control, adequate blood supply, regular debridement and offloading of the affected limb. Special attention is paid to immobilization as the most important factor ensuring healing. On clinical cases, the methodology and tactics of local treatment of postoperative wound and diabetic foot ulcer with alginate dressing and silicone coated sponges are analyzed. Alternative options for local treatment of patients in both clinical cases are discussed.
{"title":"The use of modern dressings for the local treatment of diabetic foot ulcers in out-patient setting","authors":"V. Bregovskiy, A. Demina, I. Karpova","doi":"10.21518/1995-1477-2022-19-2-72-81","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-72-81","url":null,"abstract":"Local treatment of diabetic foot ulcers is one of the most controversial topics in surgery. The choice of a dressing or bandage is still heavily influenced by many subjective factors and is often based on the personal preferences of the medical staff. Based on literature data and practical experience, the article presents the shortcomings of the current domestic practice of using gauze dressings with various drugs, as well as the reasons for the insufficient use of special so-called “outpatient” dressings with special properties. The main classes of modern dressings with special properties (mesh, hydrocolloids, hydroalginates, hydrogels, alginates and sponges or foams) and their areas of application are characterized. The concept of wound treatment in a humid environment with maintaining an optimal moisture balance is highlighted. The key areas of treatment of diabetic foot ulcers in accordance with the modern recommendations of the International Working Group on the Diabetic Foot and the Ministry of Health of the Russian Federation are given: infection control, adequate blood supply, regular debridement and offloading of the affected limb. Special attention is paid to immobilization as the most important factor ensuring healing. On clinical cases, the methodology and tactics of local treatment of postoperative wound and diabetic foot ulcer with alginate dressing and silicone coated sponges are analyzed. Alternative options for local treatment of patients in both clinical cases are discussed.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131463265","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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