The purpose of the work. Compare the effectiveness of PRP and general accepted methods of local therapy for long-term unhealed wounds in patients with diabetic foot syndrome. Materials and methods. A study was performed in 33 long-term patients unhealed wounds on the foot and leg in the neuropathic form of diabetic foot syndrome. Patients were divided into two groups depending on the nature of the received therapies - PRP and local therapy according to generally accepted principles. The effectiveness of therapy was assessed by the nature of changes in the microflora and c wound cell composition, as well as wound surface area on the 1st day, 8th and 22nd after starting treatment. Results. The use of PRP allowed to observe on the 8th day regenerative-inflammatory type of cytogram, have manifestations of vascularization and epithelialization, reduce the number of patients with infected wounds by 2.7 times and reducing the wound surface area by 1.7 cm, which is 3.4 times more than in the second group (0.5 cm). The introduction of the second dose of PRP is even more stimulating reparative changes in the wound, manifested by the regenerative type of cytogram, reducing the number of infected wounds by 8 times, and reducing the area wound surface 2 times from the first measurement, while in the second group only on the 22nd day there were positive changes that were characteristic of the first group on the 8th day. Conclusion. Thus, the use of PRP in therapy is long unhealed wounds in diabetic foot syndrome, is a promising area of regenerative therapy. PRP is a way to obtain a natural concentration of internal factors of growth with minimal invasiveness and low costs. Proposed method of biological therapy in such patients is simple and affordable for both patient and for the doctor.
Objective. The aim of the study was to analyze the effectiveness of modern treatments in 485 patients with chronic hemorrhoids stage II-III-IV over the past 3 years. Results. An individual-combined approach to the treatment of hemorrhoids has been introduced, as many patients can have nodules at different stages of the disease at the same time. Used a combination of methods with different ways to influence the pathogenesis of hemorrhoids. Thanks to the introduction of a set of systemic measures, good results were obtained, namely the healing time of postoperative wounds was reduced by 35-40% and the intensity of postoperative pain was reduced by 3-4 points on a 10-point analog visual scale. Conclusions. The use of an individual integrated approach to each patient in choosing the tactics of surgical treatment of hemorrhoids and the widespread introduction of modern techniques, has reduced the duration of the postoperative period, preserve radical intervention and reduce the likelihood of recurrence.
Purpose of the study. Investigate the possibility of using ultrasound in the early postoperative period to identify complications in patients after the imposition of colon anastomoses. Methods. 183 patients who underwent surgery with the imposition of primary continuous two-line СA on the left parts of the colon were treated. With suspicion of anastomosis failure from this group examined 75 (40.9%) patients, which are divided into 2 groups, depending on the inability of СA: 1 group - 32 patients with recorded failure of СA - median age of patients - 65 (57; 75) years, group 2 (control) - 43 patients, without inability to anastomosis, (median age of patients - 63.5 (58.5; 70.5) years. Results. The most reliable ultrasound signs of CA failure were the presence of gas outside the intestinal lumen, which was observed in 9 (28.1%) patients of group 1 on the 3rd day and 5 (15.6%) - on the 7th day after surgery, and also the presence of fluid formation in the area of CA in 6 (18.8%) and 12 (37.5%) patients, respectively. Both of these ultrasound signs were absent in patients of group 2. Restoration of intestinal peristalsis in the area of CA at its capacity was also significantly more frequent and earlier, which was found in 14 (32.5%) patients of group 2 on the 3rd and in 29 (67.4%) patients on the 7th day after surgery, respectively, while in the inability of СA this sign on the 3rd day, was not observed in patients of group 1, and on the 7th was registered only in 7 (21.9%; χ2 = 31.2; P < 0.05) patients. Thus, ultrasound signs of СA failure on day 3 were found in 15 (46.8%) patients of group 1, 8 (53.4%) of whom were treated conservatively, 7 (46.6%) patients required changes in treatment tactics. These patients underwent 2 relaparotomies for peritonitis, 3 removal of colostomy from the mini-access, 2 puncture drainage of fluid accumulation under ultrasound control. On the 7th day in 4 (53.1%) patients, 13 (76.5%) of whom were treated conservatively, 4 (23.5%) patients required changes in treatment tactics, respectively. These patients underwent 3 removal of colostomy from mini access, 1 puncture drainage of fluid accumulation under ultrasound control. Conclusion. Early diagnosis of complications allowed to change the tactics and scope of intensive care to prevent further complications. Ultrasound patients in the early postoperative period allows to detect signs of failure of СA in 46.8% of patients on the 3rd day and is the basis for correction of treatment tactics in 46.6% of these patients and 53.1% of patients on the 7th day, which led to change the tactics of treatment in 23.5% of them, respectively. Timely diagnosis of early signs of anastomosis failure allows to predict the further course of the disease, which reduces the number of complications and the severity of their course.
Purpose of the study. Was to reveal the peculiarities of surgical treatment of acute paraproctitis in patients with diabetes mellitus. Materials and methods. The analysis of results of treatment in 1591 patients for the last 8 years is carried out. In 90 (6,8%) patients, the process proceeded against the background of diabetes mellitus. Results. The criteria for choosing the mode of operation are based on the location of the abscess and the main purulent course, its relation to the elements of the external anal sphincter, the nature of the cicatricle process in the zone of the internal opening and the function of the rectum apparatus. Conclusion. In complex cases, surgical treatment should be two-stage and organ-preserving. To the possibility and timing of the removal of the inner hole should be approached individually. Keywords: acute paraproctitis, diabetes mellitus, surgical treatment.
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