Objective: to evaluate the results of specialized treatment of uncomplicated and complicated trophic ulcer (TU) and osteomyelitis (OM) of diabetic osteoarthropathy (DOAP).Materials and methods. The results of treatment in 114 patients (127 feet) with DOAP were analyzed: There were 52 (45.6 %) men, 62 (54.4 %) women. The type 1 diabetes mellitus (DM) was diagnosed in 36 (31.6 %) patients (average age 43.0 years old); type 2 diabetes – in 78 (68.4 %) people (average age – 58.0 years old). The acute and subacute stages of DOAP were detected in 55.9 % of cases, chronic – in 44.1 % of cases. The defeat of the middle part of the foot prevailed in 66.9 % of cases. Patients are ranked by the University of Texas classification. DOAP without TU – 71 (55.9 %) cases, with TU – 56 (44.1 %) observations. Stage BIII (OM) – 22 (17.3 %) cases: 8 (6.2 %) – in the subacute stage of DOAP, 14 (11.2 %) – in the chronic stage of DOAP. The examination protocol for DOAP included clinical data (+ sounding of the adjacent bone in TU), thermometry, radiography, and magnetic resonance imaging (MRI) of the feet, as well as laboratory data. A diagnostic algorithm has been developed for the optimal choice of tactical decisions in case of DOAP (TU–/OM–) and DOAP (TU+/OM+).Results. 80 patients were treated on an outpatient basis under the supervision of a podiatrist. Patients with acute or subacute DOAP (TU−/OM−) received conservative treatment in the form of unloading the limb using an individual discharge bandage until the transition to the chronic stage. In the chronic stage of DOAP (TU–/OM–) recommended the manufacture of complex orthopedic shoes for an individual block. In addition to the correction of hyperglycemia, patients with DOAP (TU+) (AI, AII, BI) used local treatment in accordance with the stage of the wound process. 34 patients (BII, BIII) were treated in a hospital. 27 patients of these underwent surgical procedures, osteonecrectomy, 7 patients underwent arthrodesis. All patients with DOAP (TU–/OM–) (n = 71) limb saved. With DOAP (TU+/OM+) (n = 56): 8 (14.3 %) people – the result is unknown, 7 (12.5 %) patients – retention of TU, 35 (62.5 %) patients – complete epithelization, 2 (3.6 %) cases – small amputations, 4 (7.2 %) – high amputations.Conclusion. Differentiated specialized treatment of uncomplicated and complicated by trophic ulcers or osteomyelitis DOAP in its various clinical stages made it possible to avoid high amputation in 96.6 % of cases.
The study was carried out to analyze database of registered diseases of peripheral arteries in patients of Yekaterinburg during 2009-2013. The database of the territorial foundation of mandatory medical insurance of the Sverdlovsk region in 2009-2013 was used as study material. The number of registered cases of treatment of diseases of peripheral arteries was analyzed. The sampling of patients with diseases of peripheral arteries taking treatment in twenty-four-hours and day-time hospitals. The statistical processing was applied to all cases ranged by years: patients with compensated blood circulation, critical ischemia of extremities and mortification. The audit was applied to randomly selected 40 medical records of patients with diseases of peripheral arteries, receiving treatment in twenty-four-hours and day-time hospitals during 2014 and 50 medical records ofpatients with diseases ofperipheral arteries against the background of diabetes mellitus from register of the oblast podiatry consulting room. The total number of treated patients with diseases ofperipheral arteries in Yekaterinburg during five years made up to 31,309, including 19% ofpatients with diabetic affection of lower extremities. In twenty-four-hours hospital 12,716 (40.6%) patients were treated and 18,593 (59.4%) were treated in day-time hospital. The study established increasing in day-time hospitals number of patients with arteriosclerosis obliterans up to 1.8 times, with diabetic angiopathy up to 3.6 times. At increasing of number of treated patients number ofpatients with critical ischemia of lower extremities during 5 years decreased insignificantly and number of large amputations have a certain trend to decreasing (up to 2.5%). The study established deviations under application of medicinal therapy in patients with diseases of peripheral arteries at pre-specialized stage and absence of achievement of target values of main laboratory parameters. The database of registered diseases of peripheral arteries can be used as a tool for data analysis and further management decision making with purpose of enhancing quality of medical care of patients residing in municipality.
ЦЕЛЬ РАБОТЫ -изучение эффективности метода термокоагуляции (ТКГ) аппаратом ТС-3000 для лечения телеангиэктазий кожи нижних конечностей. МАТЕРИАЛЫ И МЕТОДЫ. В течение 2 лет метод ТКГ применен у 145 пациентов (223 случая) с телеангиэктазиями (ТА) и ретикулярными венами (РВ) нижних конечностей. 17 пациентов (11,7 %) имели классы С 1, 2 хронических заболеваний вен (ХЗВ), до ТКГ им проводилась коррекция патологических рефлюксов в подкожных и перфорантных венах. Из 128 пациентов с классом С1 ХЗВ в прошлом про цедуры микросклеротерапии (МСТ) выполнены у 25 человек (19,5 %), непосредственно перед процедурой ТКГ или в сочетании с ней МСТ проведена у 46 (35,9 %). МСТ проводилась для РВ вне зон или в зонах ТА, а также выполнялась для ТА от 0,6 до 1,0 мм в диаметре. Для про цедур ТКГ использован аппарат ТС-3000 (Бельгия), принцип работы которого основан на воздействии на расширенные сосуды кожи высокочастотного электромагнитного поля (4 МГц). Применялись иглы из никеля с диаметром рабочей части 0,150 мм. Термокоагуляции подвергали ТА диаметром от 0,3 мм до 0,6 мм. Результаты оценены в сроки: 3 месяца (64 пациента / 97 конечностей), 6 месяцев (72 / 110), 12 месяцев (70 / 107). РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ. Через 3 месяца пациенты отметили результат как «без перемен и хуже» в 73,4 % случаев, пигментация выявлена в 73,2 %, а резидуальные ТА -в 81,4 % случаев. Через 6 месяцев субъективно результаты «отлично» + «лучше» составили 47,2 %, явления пигментации и резидуальные ТА наблюдали в 50,0 % и в 50,9 % случаев. Через 12 месяцев субъективно результаты «отлично» + «лучше» составили 75,7 %, пигментация -14,9 %, резидуальные ТА -13,1 %, рецидивы ТА -14,0 %. ЗАКЛЮЧЕНИЕ. Толерантность к ТКГ выявлена у 13,1 % пациентов с ТА. Позитивным эффектом было отсутствие зарегистрированных некрозов кожи через 3 месяца, а также атрофических и гипертрофических рубцов кожи через 12 месяцев.Ключевые слова: телеангиэктазии, ретикулярные вены, микросклеротерапия, термокоагуляция, ТС-3000.Objective: this paper aims at studying the efficacy of the thermocoagulation (TCG) method using TC-3000 apparatus for the treatment of lower extremity telangiectasias. Materials and methods. The TCG method has been used in 145 patients (223 cases) with telangiectasias (TA) and reticular veins (RV) of the lower extremities for 2 years. 17 patients (11.7%) had classes C1, 2 chronic venous diseases (CHV), and they underwent correction of pathological refluxes in the subcutaneous and perforating veins prior to TCG. Out of 128 patients with class C1 CHV, 25 people (19.5%) underwent microsclerotherapy (MST) in the past, just before the TCG procedure or in combination with it, MST was performed in 46 (35.9%). MST was performed for RV situated outside or within TA areas, and also was performed for TA from 0.6 to 1.0 mm in diameter. The TCG procedures were performed using TC-3000 (Belgium) apparatus, which operation is based on the impact of high-frequency electromagnetic field (4 MHz) on the dilated vessels in the skin. Needles made of nickel with a working diameter of 0.150 mm were use...
This literature review deals largely with the evolution of the views on the stripping of the great saphenous vein as a surgical procedure for the treatment of large varicose veins in the lower extremities. Various opinions, both positive and negative, as regards the advantages and disadvantages of this method for the open surgical intervention are discussed including its character and scope of applications with special reference to the effectiveness of elimination of pathological reflux on the one hand and the safety of this procedure on the other hand. The role of varicose vein stripping in modern phlebology is discussed taking into consideration the ever increasing contribution of endovasal technologies to the medical practice. The authors emphasize that the endovasal intervention could be the first-line treatment of the patients presenting with varicose veins. However, there are a number of clinical and technical limitations on the application of this method arising from the peculiar features of the anatomical structure of the main subcutaneous veins and related to the patient's condition at which open surgery should be preferred over the endovasal procedures. The main approach to the treatment of varicose veins still remains the open surgical intervention, the «short» stripping technique being the best treatment option for the majority of the patients suffering from varicose veins. The paper contains data extracted from the Russian-language and foreign literature publications concerning the choice of the optimal extent of the great saphenous vein stripping and the fate of the residual segment of the GSV trunk at the calf level after partial stripping.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.