Pub Date : 2022-11-19DOI: 10.21518/1995-1477-2022-19-2-50-60
S. Katorkin, E. Krivoshchekov, E. Elshin, M. Y. Kushnarchuk
The most common clinical manifestation of peripheral arterial disease is intermittent claudication due to insufficient blood supply to the affected limb. The article summarizes and systematizes the latest achievements in the field of conservative treatment of patients with intermittent claudication. In accordance with the requirements of evidence-based medicine, an overview of modern promising trends in conservative therapy presented in the latest Russian and foreign consensus documents, is given. The basis of the complex treatment of patients with peripheral arterial diseases is: non-drug and drug treatment to relieve the symptoms of chronic ischemia, pharmacotherapy for the secondary prevention of cardiovascular complications, open or endovascular revascularization to increase the distance of painfree walking. With the development of atherosclerosis, disturbances in the peptide composition of the endothelium occur, which reduce the ability of the vascular wall to resist inflammation and the associated triggering of pathological processes. It has been experimentally proven that the use of a complex of peptides obtained from the vessels of healthy and young animals in this situation restores the endothelial function of the arteries, affecting the main links of pathogenesis. Decrease in oxidative stress, decrease in atherogenic and lipidemic action, normalization of vascular tone and blood coagulation parameters, increase in the microvascular bed – these are the mechanisms that justify the indication of peptides to patients with atherosclerosis obliterans. Angioprotector based on a complex of polypeptides isolated from blood vessels can become an important part of the treatment of patients with obliterating diseases of the arteries of the lower extremities, providing a complex pathogenetic effect. It is necessary to further study in multicenter clinical trials the duration of the therapeutic effect of a drug in a longer period after a course of treatment, its effect on long-term outcomes of the disease, the possibility of using repeated courses, in chronic obliterating diseases of the arteries of the lower extremities III-IV stages according to the Fontaine classification, as well as the use drug for the treatment of systemic atherosclerosis of various arterial basins.
{"title":"Modern possibilities and prospects of conservative treatment of patients with peripheral arterial diseases","authors":"S. Katorkin, E. Krivoshchekov, E. Elshin, M. Y. Kushnarchuk","doi":"10.21518/1995-1477-2022-19-2-50-60","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-50-60","url":null,"abstract":"The most common clinical manifestation of peripheral arterial disease is intermittent claudication due to insufficient blood supply to the affected limb. The article summarizes and systematizes the latest achievements in the field of conservative treatment of patients with intermittent claudication. In accordance with the requirements of evidence-based medicine, an overview of modern promising trends in conservative therapy presented in the latest Russian and foreign consensus documents, is given. The basis of the complex treatment of patients with peripheral arterial diseases is: non-drug and drug treatment to relieve the symptoms of chronic ischemia, pharmacotherapy for the secondary prevention of cardiovascular complications, open or endovascular revascularization to increase the distance of painfree walking. With the development of atherosclerosis, disturbances in the peptide composition of the endothelium occur, which reduce the ability of the vascular wall to resist inflammation and the associated triggering of pathological processes. It has been experimentally proven that the use of a complex of peptides obtained from the vessels of healthy and young animals in this situation restores the endothelial function of the arteries, affecting the main links of pathogenesis. Decrease in oxidative stress, decrease in atherogenic and lipidemic action, normalization of vascular tone and blood coagulation parameters, increase in the microvascular bed – these are the mechanisms that justify the indication of peptides to patients with atherosclerosis obliterans. Angioprotector based on a complex of polypeptides isolated from blood vessels can become an important part of the treatment of patients with obliterating diseases of the arteries of the lower extremities, providing a complex pathogenetic effect. It is necessary to further study in multicenter clinical trials the duration of the therapeutic effect of a drug in a longer period after a course of treatment, its effect on long-term outcomes of the disease, the possibility of using repeated courses, in chronic obliterating diseases of the arteries of the lower extremities III-IV stages according to the Fontaine classification, as well as the use drug for the treatment of systemic atherosclerosis of various arterial basins.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"32 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":"125567828","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 : 2022-11-18DOI: 10.21518/1995-1477-2022-19-2-22-28
B. A. Danelyan, H. Manjikian, Z. A. Adyrkhaev, S. Sapelkin, A. M. Isaev
Introduction. The development of phlebology and mainstreaming of ultrasonic techniques has led to the emergence of microfoam sclerotherapy, which proved itself as a more effective technique. In the world literature, there are isolated publications that say about the effectiveness and safety of the microfoam sclerotherapy combined with mini-phlebectomy, but no specific studies comparing the combination treatment for the elimination of varicose syndrome with separate use of each of the techniques are described.Aim. To increase the effectiveness of invasive treatment and to reduce the rate of complications in patients with varicose veins using a combination of microfoam sclerotherapy and mini-phlebectomy of tributaries after endovenous laser ablation.Material and methods. Simple single- center, non-randomized, retrospective study was conducted at the A.K. Eramishantsev Moscow State Hospital. It included 52 patients with varicose veins (a total of 77 lower limbs, 22 patients had bilateral disease), who had no previous invasive treatment for this disease. They underwent endovenous laser ablation of truncal vein combined with microfoam sclerotherapy and mini-phlebectomy of tributaries. Microfoam sclerotherapy was performed with 0.5–2.0% of polidocanol foam, and mini-phlebectomy per Varady technique. The patients had a postprocedural follow-up clinical examination and duplex ultrasound the day after the intervention, then at 1, 6, and 12 months.Results. Endovenous laser ablation of truncal veins was acutely successful in all cases. No cases of great saphenous vein recanalization were detected in follow-up period. In the early postprocedural period, the combined microfoam sclerotherapy and miniphlebectomy also showed 100% success rate, however redo sclerotherapy was required in 4 (5.2%) cases for new varicose tributaries developed in late postprocedural period.Conclusion. Combined microfoam sclerotherapy and mini-phlebectomy, as a method of treatment for various veins syndrome, can provide additional benefit such as reducing the volume of mini-phlebectomy and the resultant tissue damage, the varicosity recurrence rate, the number of subcutaneous hematomas and ecchymoses, the discomfort of the tumescent anesthesia, the risk of postprocedural varicose veins thrombosis and pigmentation rate.
{"title":"Combined microfoam sclerotherapy and miniphlebectomy as an optimal method of treating varicose vein tributaries after endovenous laser ablation","authors":"B. A. Danelyan, H. Manjikian, Z. A. Adyrkhaev, S. Sapelkin, A. M. Isaev","doi":"10.21518/1995-1477-2022-19-2-22-28","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-22-28","url":null,"abstract":"Introduction. The development of phlebology and mainstreaming of ultrasonic techniques has led to the emergence of microfoam sclerotherapy, which proved itself as a more effective technique. In the world literature, there are isolated publications that say about the effectiveness and safety of the microfoam sclerotherapy combined with mini-phlebectomy, but no specific studies comparing the combination treatment for the elimination of varicose syndrome with separate use of each of the techniques are described.Aim. To increase the effectiveness of invasive treatment and to reduce the rate of complications in patients with varicose veins using a combination of microfoam sclerotherapy and mini-phlebectomy of tributaries after endovenous laser ablation.Material and methods. Simple single- center, non-randomized, retrospective study was conducted at the A.K. Eramishantsev Moscow State Hospital. It included 52 patients with varicose veins (a total of 77 lower limbs, 22 patients had bilateral disease), who had no previous invasive treatment for this disease. They underwent endovenous laser ablation of truncal vein combined with microfoam sclerotherapy and mini-phlebectomy of tributaries. Microfoam sclerotherapy was performed with 0.5–2.0% of polidocanol foam, and mini-phlebectomy per Varady technique. The patients had a postprocedural follow-up clinical examination and duplex ultrasound the day after the intervention, then at 1, 6, and 12 months.Results. Endovenous laser ablation of truncal veins was acutely successful in all cases. No cases of great saphenous vein recanalization were detected in follow-up period. In the early postprocedural period, the combined microfoam sclerotherapy and miniphlebectomy also showed 100% success rate, however redo sclerotherapy was required in 4 (5.2%) cases for new varicose tributaries developed in late postprocedural period.Conclusion. Combined microfoam sclerotherapy and mini-phlebectomy, as a method of treatment for various veins syndrome, can provide additional benefit such as reducing the volume of mini-phlebectomy and the resultant tissue damage, the varicosity recurrence rate, the number of subcutaneous hematomas and ecchymoses, the discomfort of the tumescent anesthesia, the risk of postprocedural varicose veins thrombosis and pigmentation rate.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133983898","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 : 2022-11-18DOI: 10.21518/1995-1477-2022-19-2-30-35
A. Chernookov, M. R. Kuznetsov, S. Kandyba, S. Dolgov, A. Atayan, А. A. Ramazanov
Introduction. True doubling of great saphenous vein is observed in 1.6–2.1% of patients with varicose veins and may be one of the reasons for the development of postoperative relapse of the disease. Performing endovasal laser coagulation (EVLC) of both great saphenous vein trunks makes it possible to increase the radicality of the intervention and reduce the likelihood of a recurrence of varicose veins.Aim. Based on the study of immediate and long-term results, to substantiate the expediency of using EVLC of the main and true additional stem of great saphenous vein in patients with varicose veins.Materials and methods. From 2014 to 2020, 24 patients with a true doubling of great saphenous vein were treated. Among the applicants there were 12 women and 12 men aged 23 to 62 years with clinical class C2–C4 according to the CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification. All patients under tumescent anesthesia underwent simultaneous EVLC of the main and accessory trunk of the BPV, followed by miniflebectomy or sclerobliteration of varicose tributaries.Results and discussion. The use of simultaneous coagulation of both trunks was performed by all patients, thus the technical success of the operation was observed in 100% of cases. There were no intraoperative complications. The use of such a volume of intervention is accompanied by an increase in the duration of the operation by 29.3%. Hyperpigmentation in the projection of the coagulated trunk was observed in 2 (8.3%) patients, neurological disorders – in 1 (4.2%) patient. During the examination of patients 1–2 years after the operation, no relapses of the disease were detected, and the cosmetic result of the intervention on a ten-point scale, patients on average estimated at 7.6 points.Conclusions. True doubling of the great saphenous vein is rare and may increase the likelihood of relapses of the disease. EVLC of the main and additional BPV trunks is accompanied by an increase in the duration of surgery by an average of 29.3%, and the number of patients with hyperpigmentation by 1.5 times. Simultaneous EVLC of both tables with true duplication of BPV makes it possible to reliably block a potential source of varicose disease recurrence and reduce the likelihood of recurrent veins.
{"title":"Prevention of relapses of varicose veins in patients with true doubling of the great saphenous vein","authors":"A. Chernookov, M. R. Kuznetsov, S. Kandyba, S. Dolgov, A. Atayan, А. A. Ramazanov","doi":"10.21518/1995-1477-2022-19-2-30-35","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-30-35","url":null,"abstract":"Introduction. True doubling of great saphenous vein is observed in 1.6–2.1% of patients with varicose veins and may be one of the reasons for the development of postoperative relapse of the disease. Performing endovasal laser coagulation (EVLC) of both great saphenous vein trunks makes it possible to increase the radicality of the intervention and reduce the likelihood of a recurrence of varicose veins.Aim. Based on the study of immediate and long-term results, to substantiate the expediency of using EVLC of the main and true additional stem of great saphenous vein in patients with varicose veins.Materials and methods. From 2014 to 2020, 24 patients with a true doubling of great saphenous vein were treated. Among the applicants there were 12 women and 12 men aged 23 to 62 years with clinical class C2–C4 according to the CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification. All patients under tumescent anesthesia underwent simultaneous EVLC of the main and accessory trunk of the BPV, followed by miniflebectomy or sclerobliteration of varicose tributaries.Results and discussion. The use of simultaneous coagulation of both trunks was performed by all patients, thus the technical success of the operation was observed in 100% of cases. There were no intraoperative complications. The use of such a volume of intervention is accompanied by an increase in the duration of the operation by 29.3%. Hyperpigmentation in the projection of the coagulated trunk was observed in 2 (8.3%) patients, neurological disorders – in 1 (4.2%) patient. During the examination of patients 1–2 years after the operation, no relapses of the disease were detected, and the cosmetic result of the intervention on a ten-point scale, patients on average estimated at 7.6 points.Conclusions. True doubling of the great saphenous vein is rare and may increase the likelihood of relapses of the disease. EVLC of the main and additional BPV trunks is accompanied by an increase in the duration of surgery by an average of 29.3%, and the number of patients with hyperpigmentation by 1.5 times. Simultaneous EVLC of both tables with true duplication of BPV makes it possible to reliably block a potential source of varicose disease recurrence and reduce the likelihood of recurrent veins.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127660089","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 : 2022-11-18DOI: 10.21518/1995-1477-2022-19-2-36-42
N. Sergeev, A. Sergeev, A. Morozov, M. Belyak
Introduction. Trophic ulcers of venous etiology are a severe complication of chronic venous insufficiency of the lower extremities. At the same time, in most cases, ulcerative defects do not heal for a long time and are prone to recurrence, which leads to a significant deterioration in the quality of life of patients.Aim. To clarify the features of the effect of low-intensity laser radiation to determine the optimal conditions for conservative treatment of venous ulcerative defects.Materials and methods. A randomized prospective clinical trial was performed in which 126 patients with chronic venous insufficiency were monitored. During the conservative treatment of 44 patients of the comparison group, phlebotropic drugs, compression therapy, wound coverings and ointment dressings were used in the conservative treatment of trophic ulcers. In 82 patients of the main group, lowintensity laser radiation was used along with the methods described above.Results. Laser therapy in the complex treatment of venous trophic ulcers helps to reduce the number of microbial bodies vegetating on the surface of ulcerative defects, but does not significantly affect the sensitivity of microflora to antibacterial drugs. Low-intensity laser radiation certainly contributed to a significant and earlier increase in the number of neutrophils, monocytes and macrophages on the surface of trophic ulcers, as well as activation of phagocytic activity of cells.Conclusion. Low-intensity laser radiation improves the results of conservative treatment of venous trophic ulcers, does not adversely affect the sensitivity of the isolated microflora to antibiotics and does not have a “direct” bactericidal effect.
{"title":"Features of laser therapy of venous trophic ulcers of the lower extremities in outpatient surgery","authors":"N. Sergeev, A. Sergeev, A. Morozov, M. Belyak","doi":"10.21518/1995-1477-2022-19-2-36-42","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-36-42","url":null,"abstract":"Introduction. Trophic ulcers of venous etiology are a severe complication of chronic venous insufficiency of the lower extremities. At the same time, in most cases, ulcerative defects do not heal for a long time and are prone to recurrence, which leads to a significant deterioration in the quality of life of patients.Aim. To clarify the features of the effect of low-intensity laser radiation to determine the optimal conditions for conservative treatment of venous ulcerative defects.Materials and methods. A randomized prospective clinical trial was performed in which 126 patients with chronic venous insufficiency were monitored. During the conservative treatment of 44 patients of the comparison group, phlebotropic drugs, compression therapy, wound coverings and ointment dressings were used in the conservative treatment of trophic ulcers. In 82 patients of the main group, lowintensity laser radiation was used along with the methods described above.Results. Laser therapy in the complex treatment of venous trophic ulcers helps to reduce the number of microbial bodies vegetating on the surface of ulcerative defects, but does not significantly affect the sensitivity of microflora to antibacterial drugs. Low-intensity laser radiation certainly contributed to a significant and earlier increase in the number of neutrophils, monocytes and macrophages on the surface of trophic ulcers, as well as activation of phagocytic activity of cells.Conclusion. Low-intensity laser radiation improves the results of conservative treatment of venous trophic ulcers, does not adversely affect the sensitivity of the isolated microflora to antibiotics and does not have a “direct” bactericidal effect.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129051349","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 : 2022-11-17DOI: 10.21518/1995-1477-2022-19-2-8-12
D. S. Zubkov
.
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{"title":"Wait impossible to operate. Rules of surgical punctuation","authors":"D. S. Zubkov","doi":"10.21518/1995-1477-2022-19-2-8-12","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2-8-12","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"60 12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128346559","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 : 2022-10-05DOI: 10.21518/1995-1477-2022-19-2
V. Bogachev, B. Boldin, P. Turkin, O. Dzhenina
Introduction. SARS-CoV-2 is accompanied by the development of venous endothelial dysfunction, which can lead to the development of persistent phlebopathy of the lower limbs, reducing the quality of life of patients.Objective. To evaluate the efficacy of pharmacological therapy in patients with postcocclusive phlebopathy.Materials and methods. 178 patients (125 women), mean age 34.8 ± 3.2 years, who underwent SARS-CoV-2, for their first veno-specific complaints received micronized purified flavonoid fraction (MPFF) 1,000 mg per day for 90 days. Complaints were monitored using a 10-cm visual analog scale and the CIVIQ-20 questionnaire. All patients underwent ultrasound examination of the venous system of both lower extremities and photoplethysmography. Laboratory biochemical examination with determination of endothelial dysfunction marker levels was performed in 30 patients before and after treatment.Results. After 90 days of phlebotropic therapy, there was a significant reduction in the severity of all venous-specific complaints, except for intradermal vein dilation. The global quality of life index increased from 64.4 ± 11.2 to 86.6 ± 9.1% (p < 0.001). There was an improvement in photoplethysmography (PPG) scores. Return blood-flow time and tibial venous muscle pump strength increased significantly (p < 0.05) by 4.3 s and 3.5%, respectively. The 30 patients who underwent biochemical examination in the first blood samples obtained from the great saphenous vein showed a significant increase in IL-1 concentration (7.8 ± 0, 7 pg/ml), IL-6 (18.7 ± 1.8 pg/ml), VEGF (187.8 ± 11.6 pg/ml), TNF (7.8 ± 0.9 pg/ml), histamine (22.4 ± 11.4 nmol/L) and hsCRB (5.4 ± 0.3 mg/L), indicating that a proinflammatory phenotype of venous endothelium was formed. After 90 days of MOFF administration, these indices significantly decreased. The levels of IL-1 and IL-6 decreased by 3.2 and 10.4 pg/ml, respectively, the values of VEGF and TNF decreased by 114.6 pg/ml and 2.9 pg/ml. There was a gradual normalization of histamine and hsCRB to 6.1 ± 4.1 nmol/L and 1.1 ± 0.9 mg/L.Conclusions. The data obtained indicate that the appearance of veno-specific symptoms and syndromes in patients who have undergone SARS-CoV-2 may be due to the development of phlebopathy, the correction of which requires the use of pharmacological drugs with relevant mechanisms of action.
{"title":"COVID-19-associated phlebopathy as a current problem of modern phlebology","authors":"V. Bogachev, B. Boldin, P. Turkin, O. Dzhenina","doi":"10.21518/1995-1477-2022-19-2","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-2","url":null,"abstract":"Introduction. SARS-CoV-2 is accompanied by the development of venous endothelial dysfunction, which can lead to the development of persistent phlebopathy of the lower limbs, reducing the quality of life of patients.Objective. To evaluate the efficacy of pharmacological therapy in patients with postcocclusive phlebopathy.Materials and methods. 178 patients (125 women), mean age 34.8 ± 3.2 years, who underwent SARS-CoV-2, for their first veno-specific complaints received micronized purified flavonoid fraction (MPFF) 1,000 mg per day for 90 days. Complaints were monitored using a 10-cm visual analog scale and the CIVIQ-20 questionnaire. All patients underwent ultrasound examination of the venous system of both lower extremities and photoplethysmography. Laboratory biochemical examination with determination of endothelial dysfunction marker levels was performed in 30 patients before and after treatment.Results. After 90 days of phlebotropic therapy, there was a significant reduction in the severity of all venous-specific complaints, except for intradermal vein dilation. The global quality of life index increased from 64.4 ± 11.2 to 86.6 ± 9.1% (p < 0.001). There was an improvement in photoplethysmography (PPG) scores. Return blood-flow time and tibial venous muscle pump strength increased significantly (p < 0.05) by 4.3 s and 3.5%, respectively. The 30 patients who underwent biochemical examination in the first blood samples obtained from the great saphenous vein showed a significant increase in IL-1 concentration (7.8 ± 0, 7 pg/ml), IL-6 (18.7 ± 1.8 pg/ml), VEGF (187.8 ± 11.6 pg/ml), TNF (7.8 ± 0.9 pg/ml), histamine (22.4 ± 11.4 nmol/L) and hsCRB (5.4 ± 0.3 mg/L), indicating that a proinflammatory phenotype of venous endothelium was formed. After 90 days of MOFF administration, these indices significantly decreased. The levels of IL-1 and IL-6 decreased by 3.2 and 10.4 pg/ml, respectively, the values of VEGF and TNF decreased by 114.6 pg/ml and 2.9 pg/ml. There was a gradual normalization of histamine and hsCRB to 6.1 ± 4.1 nmol/L and 1.1 ± 0.9 mg/L.Conclusions. The data obtained indicate that the appearance of veno-specific symptoms and syndromes in patients who have undergone SARS-CoV-2 may be due to the development of phlebopathy, the correction of which requires the use of pharmacological drugs with relevant mechanisms of action.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131184646","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 : 2022-05-20DOI: 10.21518/1995-1477-2022-19-1-113-123
E. Fomina, R. V. Akhmetzianov, M. N. Tukhbatullin
Introduction. Nowadays radiological diagnostics dives particular attention to the research of the pelvic veins in women. Absence of diagnostic criteria for identifying norms do not make it possible to establish the initial disease manifestations. It is also not sufficient enough to make a proper forecast about the formation of pelvic varicose veins.Objective: To study the ultrasound criteria of diagnostic parameters of pelvic veins in women of reproductive age without stated venous pathology.Materials and methods. This research examined 80 young, relatively healthy nulliparous women. The ultrasound criteria of diagnostic parameters of the following veins such as the left renal vein, ovarian veins, cluster-shaped and uterine veins, the angle between the aorta and the superior mesenteric artery, elasticity indices of the common femoral and popliteal veins were studied. Profound data analysis revealed that all patients had significant differences in the left renal vein indices. Based on this data 2 groups were formed: Group 1 (mean age 25.00 ± 3.31 years) 60 people, quite homogeneous according to the studied indices; Group 2 (mean age 24.25 ± 2.61 years) 20 people, quite heterogeneous according to the studied indices. Ultrasonography (Ultrasound examination) was performed using Logiq E9 (GE, USA) and AIXPLORER Super-Sonik Imagine, with convex, endovaginal, and linear sensors. Statistics processing was accom-plished using the StatSoft Statistica 10 software package.Results. In the general sample of patients, positive correlations were found for the following pelvic veins: ovarian veins on both sides, and cerebellar veins on the right side; and cerebellar and uterine veins on the right side. The results of the studied ultrasound parameters in Groups 1 and 2 showed that they differ significantly (p < 0.05). Almost all diagnostic parameters in Group 2 were significantly higher (p < 0.05), all women had anatomical aorto-mesenteric pincer.Conclusion. Ultrasonography of pelvic veins provides information on the anatomical-functional and hemodynamic state of the veins. That is important for prognostication of pelvic varicose veins and revealing asymptomatic forms of this disease.
{"title":"Ultrasound diagnosis of pelvic veins in women of reproductive age","authors":"E. Fomina, R. V. Akhmetzianov, M. N. Tukhbatullin","doi":"10.21518/1995-1477-2022-19-1-113-123","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-1-113-123","url":null,"abstract":"Introduction. Nowadays radiological diagnostics dives particular attention to the research of the pelvic veins in women. Absence of diagnostic criteria for identifying norms do not make it possible to establish the initial disease manifestations. It is also not sufficient enough to make a proper forecast about the formation of pelvic varicose veins.Objective: To study the ultrasound criteria of diagnostic parameters of pelvic veins in women of reproductive age without stated venous pathology.Materials and methods. This research examined 80 young, relatively healthy nulliparous women. The ultrasound criteria of diagnostic parameters of the following veins such as the left renal vein, ovarian veins, cluster-shaped and uterine veins, the angle between the aorta and the superior mesenteric artery, elasticity indices of the common femoral and popliteal veins were studied. Profound data analysis revealed that all patients had significant differences in the left renal vein indices. Based on this data 2 groups were formed: Group 1 (mean age 25.00 ± 3.31 years) 60 people, quite homogeneous according to the studied indices; Group 2 (mean age 24.25 ± 2.61 years) 20 people, quite heterogeneous according to the studied indices. Ultrasonography (Ultrasound examination) was performed using Logiq E9 (GE, USA) and AIXPLORER Super-Sonik Imagine, with convex, endovaginal, and linear sensors. Statistics processing was accom-plished using the StatSoft Statistica 10 software package.Results. In the general sample of patients, positive correlations were found for the following pelvic veins: ovarian veins on both sides, and cerebellar veins on the right side; and cerebellar and uterine veins on the right side. The results of the studied ultrasound parameters in Groups 1 and 2 showed that they differ significantly (p < 0.05). Almost all diagnostic parameters in Group 2 were significantly higher (p < 0.05), all women had anatomical aorto-mesenteric pincer.Conclusion. Ultrasonography of pelvic veins provides information on the anatomical-functional and hemodynamic state of the veins. That is important for prognostication of pelvic varicose veins and revealing asymptomatic forms of this disease.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127806569","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 : 2022-05-20DOI: 10.21518/1995-1477-2022-19-1-90-96
M. V. Abritsova, N. R. Torchua, E. Bogdanova, M. A. Markina
Introduction. Sphincterotomy is a pathogenetically justified method of surgical treatment of chronic anal fissures with spasm of the sphincter, but the risk of anal incontinence can reach 44%. Therefore, other methods are being sought to eliminate spasm of the sphincter, and the greatest interest is the medical relaxation of the internal sphincter.Aim. To determine the efficacy and limitations of the use combined preparation in the form of a gel of 0.3% nifedipine and 2.0% lidocaine for the treatment of chronic anal fissure.Materials and methods. All patients included in the study were recommended to apply gel 2 times a day with an interval of 12 hours on the skin of the anus and inside the anal canal. In total, the results of treatment of 40 patients were analyzed.Results. Before the start of treatment, the average pain during defecation was 5 (4.5; 7), on the third day of treatment – 4 (4; 5), and on the 10th day – 2 (2; 3). By day 10, 80% (32) of patients refused to take painkillers. On day 21, complete epithelialization was observed in 31 (77.5%) patients. The average healing time of anal fissures was 17 ± 3 days. In patients with complete epithelization of anal fissures, according to the results of EMG on the 21st day of therapy, spontaneous wave activity was absent. In 9 patients, despite the reduction of pain, sphincter spasm persisted after therapy and cracks in the anal canal did not heal.Discussion. When analyzing the reasons that led to the ineffectiveness of the use of gel, it was revealed that in all cases, according to ultrasound studies, there were fibrous changes in the internal anal sphincter.Conclusion. Summarizing the above-mentioned, we can state that the use of a fixed-dose combination of 0.3% nifedipine and 2.0% lidocaine is effective for the treatment of chronic anal fissure with sphincter spasm.
{"title":"Non surgical therapy for chronic anal fissure","authors":"M. V. Abritsova, N. R. Torchua, E. Bogdanova, M. A. Markina","doi":"10.21518/1995-1477-2022-19-1-90-96","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-1-90-96","url":null,"abstract":"Introduction. Sphincterotomy is a pathogenetically justified method of surgical treatment of chronic anal fissures with spasm of the sphincter, but the risk of anal incontinence can reach 44%. Therefore, other methods are being sought to eliminate spasm of the sphincter, and the greatest interest is the medical relaxation of the internal sphincter.Aim. To determine the efficacy and limitations of the use combined preparation in the form of a gel of 0.3% nifedipine and 2.0% lidocaine for the treatment of chronic anal fissure.Materials and methods. All patients included in the study were recommended to apply gel 2 times a day with an interval of 12 hours on the skin of the anus and inside the anal canal. In total, the results of treatment of 40 patients were analyzed.Results. Before the start of treatment, the average pain during defecation was 5 (4.5; 7), on the third day of treatment – 4 (4; 5), and on the 10th day – 2 (2; 3). By day 10, 80% (32) of patients refused to take painkillers. On day 21, complete epithelialization was observed in 31 (77.5%) patients. The average healing time of anal fissures was 17 ± 3 days. In patients with complete epithelization of anal fissures, according to the results of EMG on the 21st day of therapy, spontaneous wave activity was absent. In 9 patients, despite the reduction of pain, sphincter spasm persisted after therapy and cracks in the anal canal did not heal.Discussion. When analyzing the reasons that led to the ineffectiveness of the use of gel, it was revealed that in all cases, according to ultrasound studies, there were fibrous changes in the internal anal sphincter.Conclusion. Summarizing the above-mentioned, we can state that the use of a fixed-dose combination of 0.3% nifedipine and 2.0% lidocaine is effective for the treatment of chronic anal fissure with sphincter spasm.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"329 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134555714","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 : 2022-05-20DOI: 10.21518/1995-1477-2022-19-1-132-139
O. Shirinbek, G. V. Mnatsakanyan, S. N. Odinokova
Introduction. Over the past decade, thermal tumescent (TT) ablation became the “gold standard” treatment of varicose veins. Non-thermal non-tumescent (NTNT) methods emerged in response to minimize the interventional invasion.Aim. To evaluate the two-year results of cyanoacrylate adhesive closure (CAC).Methods. Between July 2019 and July 2021, CAC was performed in 457 patients (average age 57.8 ± 15.7 years), on 634 limbs and 725 saphenous veins. Patient distribution according to CEAP was: C2 – 38%; C3 – 37%; C4 – 19%; C5 – 4%; C6 – 2%. The inclusion criteria were: incompetence of sapheno-femoral/popliteal junction and axial reflux > 0.5 sec, diameter of saphenous trunk > 6 mm, presence of varicosities. CAC was performed according to the protocol of the American Vein Closure System In more than 2/3 of cases (76.2%), CAC was performed selectively without tributary treatment . The pain was assessed by visual-analogue scale (VAS). The control ultrasound was performed on the 3rd day, 1, 3, 6, and 12 months post-intervention.Results. Anatomical success was achieved in 100%. The VAS pain score was < 3 in 93% of patients. Partial recanalization occurred in 4 (0.6%) patients. Distal deep vein thrombosis was detected in 2 (0.3%) patients, migration of glue – in 7 (1%) patients, phlebitislike skin reaction – in 50 (11%), superficial thrombophlebitis – in 20 (4.4%) and soft tissue granuloma at the access site was diagnosed in 6 (1.3%) patients.Conclusion. CАC is a highly effective and safe treatment method with 99.4% occlusion rate in s. two-year follow-up period.
{"title":"Cyanoacrylate Adhesive Closure in the Real-World Practice: 2-Year Results of Varicose Vein Treatment","authors":"O. Shirinbek, G. V. Mnatsakanyan, S. N. Odinokova","doi":"10.21518/1995-1477-2022-19-1-132-139","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-1-132-139","url":null,"abstract":"Introduction. Over the past decade, thermal tumescent (TT) ablation became the “gold standard” treatment of varicose veins. Non-thermal non-tumescent (NTNT) methods emerged in response to minimize the interventional invasion.Aim. To evaluate the two-year results of cyanoacrylate adhesive closure (CAC).Methods. Between July 2019 and July 2021, CAC was performed in 457 patients (average age 57.8 ± 15.7 years), on 634 limbs and 725 saphenous veins. Patient distribution according to CEAP was: C2 – 38%; C3 – 37%; C4 – 19%; C5 – 4%; C6 – 2%. The inclusion criteria were: incompetence of sapheno-femoral/popliteal junction and axial reflux > 0.5 sec, diameter of saphenous trunk > 6 mm, presence of varicosities. CAC was performed according to the protocol of the American Vein Closure System In more than 2/3 of cases (76.2%), CAC was performed selectively without tributary treatment . The pain was assessed by visual-analogue scale (VAS). The control ultrasound was performed on the 3rd day, 1, 3, 6, and 12 months post-intervention.Results. Anatomical success was achieved in 100%. The VAS pain score was < 3 in 93% of patients. Partial recanalization occurred in 4 (0.6%) patients. Distal deep vein thrombosis was detected in 2 (0.3%) patients, migration of glue – in 7 (1%) patients, phlebitislike skin reaction – in 50 (11%), superficial thrombophlebitis – in 20 (4.4%) and soft tissue granuloma at the access site was diagnosed in 6 (1.3%) patients.Conclusion. CАC is a highly effective and safe treatment method with 99.4% occlusion rate in s. two-year follow-up period.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122269475","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 : 2022-05-20DOI: 10.21518/1995-1477-2022-19-1-81-88
V. Skvortsov, A. Eremenko, N. V. Eremenko
This paper highlights the problem of chronic constipation, their epidemiology, etiology, clinical features in some concomitant diseases, diagnostics and approaches to therapy with a focus on sodium picosulfate preparations. Based on several scientific papers, an analysis of a group of sodium picosulfate preparations was performed, indications, dosage, efficacy and possible side effects were considered. The paper also provides a clinical example of managing a patient with chronic constipation. Who received therapy with sodium picosulfate. Constipation is a violation of the act of defecation less than 3 times a week or more than three days. At the same time, it is possible to say about chronic constipation if such symptoms persist for 6 months. To date, the discussion about constipation as a nosological unit continues. The study of the epidemiology of constipation in various scientific sources indicates the wide spread of this disease. The diagnosis of “Constipation” is based on the Rome Criteria IV adopted in 2016. By origin, constipation can be primary and secondary, and among the factors provoking them are not only gastroenterological diseases, but diseases of other organ systems, as well as environmental factors and the intake of certain groups of medicines. Therapy of chronic constipation is carried out both medicamentally and non-medicamentally (surgical methods today have no proven effectiveness). The analysis of sodium picosulfate preparations proved their effectiveness and safety, which was also noted in our clinical case.
{"title":"Regulation of a delicate problem in patients with rectal diseases","authors":"V. Skvortsov, A. Eremenko, N. V. Eremenko","doi":"10.21518/1995-1477-2022-19-1-81-88","DOIUrl":"https://doi.org/10.21518/1995-1477-2022-19-1-81-88","url":null,"abstract":"This paper highlights the problem of chronic constipation, their epidemiology, etiology, clinical features in some concomitant diseases, diagnostics and approaches to therapy with a focus on sodium picosulfate preparations. Based on several scientific papers, an analysis of a group of sodium picosulfate preparations was performed, indications, dosage, efficacy and possible side effects were considered. The paper also provides a clinical example of managing a patient with chronic constipation. Who received therapy with sodium picosulfate. Constipation is a violation of the act of defecation less than 3 times a week or more than three days. At the same time, it is possible to say about chronic constipation if such symptoms persist for 6 months. To date, the discussion about constipation as a nosological unit continues. The study of the epidemiology of constipation in various scientific sources indicates the wide spread of this disease. The diagnosis of “Constipation” is based on the Rome Criteria IV adopted in 2016. By origin, constipation can be primary and secondary, and among the factors provoking them are not only gastroenterological diseases, but diseases of other organ systems, as well as environmental factors and the intake of certain groups of medicines. Therapy of chronic constipation is carried out both medicamentally and non-medicamentally (surgical methods today have no proven effectiveness). The analysis of sodium picosulfate preparations proved their effectiveness and safety, which was also noted in our clinical case.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125756746","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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