This article is dedicated to the outstanding Russian scientist, endocrinologist-surgeon Arian Pavlovich Kalinin. Doctor of medical Sciences, Professor, founder of the Russian surgical endocrinology, whose main research areas were-surgery of the adrenal glands, primary and secondary hyperparathyroidism, and the thyroid gland. During his long-term career, A. P. Kalinin was the author of about 800 scientific papers, 18 doctoral and 43 PhD theses were completed under his supervision. Ariana Pavlovich is considered the Patriarch of domestic endocrine surgery, he was the first to introduce the concept of «diabetic foot», which became a separate section of diabetology. A. P. Kalinin was a high-class surgeon and scientist, was an example for colleagues in relation to their profession.
No abstract
Objective. To evaluate the results of complex conservative treatment of patients with diabetic foot syndrome using immunohistochemical methods of studying tissue bioptates of the affected foot regions. Materials and methods. Examination and treatment of 129 patients (aged 16 to 80 years) with 1 and 2 type diabetes mellitus, whose course of the disease was complicate by the development of diabetic foot syndrome (DFS) was carried out. The main group (group 1) included 89 patients, who underwent complex conservative treatment added by the preparations mexidol and roncoleukin. Mexidol was used intravenously 10 ml for 10 days, and then tableted drugs in the dose of 125 ml. Roncoleukin was administered intravenously in the dose of 1.00.500 units: the 1st day after admission to hospital as a preoperative preparation; after the surgery on the 3rd day. The comparison group (group 2) enclosed 40 persons. They received a standard conservative treatment of DFS including sugar-containing, hypotensive and hypolipidemic drugs as well as a local therapy using sorption bandages. Before treatment and two weeks after, the tissue bioptates of the affected regions were taken from patients. For morphological study of bioptates, histochemical methods were applied: Mallorys toluidine blue staining in Heidenhain modification, PAS reaction. The number of leukocytes, lymphocytes, Ki-67 protein proliferation index, P53 protein expression were calculated. Results. The morphological study before the onset of treatment showed that the inflammation had a marked character in all the bioptates. The margins of the ulcerous defect were infiltrated with polymorphonuclear leukocytes. The number of neutrophils was 75 %, lymphocytes 25 %. The results of immunohistochemical analysis were the following: Ki-67 protein proliferation index was 2 %, P53 protein expression 2.9 %. Treatment of the control group (group 2) with the standard method resulted in a complete purification of the trophic ulcer from necrotic mass on the day 21st. In the infiltrate, there prevailed lymphocytes (70 %), the number of neutrophils decreased to 30 %. The result of immunohistochemical study was an increase in Ki-67 biomarker expression up to 7 %, P53 biomarker expression 5 %. Combined treatment of DFS applying mexidol and roncoleukin (group 1) demonstrated a maximum restorative effect already on the 614 day. In the infiltrate, the number of lymphocytes was 85 %, neutrophile leukocytes fell to 15 %, Ki-67 biomarker proliferation index grew to 15 %, P53 biomarker expression to 5.9 %. Conclusions. The use of immunohistochemical methods of research of ulcer bioptates in treatment of DFS makes it possible to reliably evaluate the dynamics of wound process. The application of original preparations roncoleukin and mexidol in complex treatment contributes to a faster reduction of inflammatory process and purification of wounds that is confirmed by an increase in Ki proliferation index and P53 apoptosis.
Желудочно-кишечные безоары представляют собой скопление непереваренного материала, который можно найти в желудочно-кишечном тракте человека и некоторых животных. Состав и строение данных образований могут быть различными. Этиология внутрижелудочного безоара многофакторна, включает определенные факторы риска и предрасполагающие факторы, такие как сопутствующие медицинские расстройства, анатомические аномалии и нарушения моторики желудка, которые способствуют развитию внутрижелудочного безоара. Различают четыре типа безоаров: фитобезоары, трихобезоары, фармакобезоары и лактобезоары. Наиболее распространенным типом являются фитобезоары, состоящие из непереваренной клетчатки овощей или фруктов. Фитобезоар – безоар, в основе которого чаще всего лежит растительная клетчатка. Формирование фитобезоара в желудке происходит в результате употребления в пищу больших количеств кедровых орехов, дикой груши, винограда. Отдельно описаны диспиросбезоары, формирующиеся из хурмы, вязкие свойства которой приводят к слипанию частей хурмы в плотную массу с последующим формированием комка. Наиболее часто фитобезоары образуются у пациентов, которые подверглись оперативному вмешательству на желудке. В статье рассмотрен клинический случай удаления гигантского безоара культи желудка, который был обнаружен спустя 19 лет после субтотальной резекции данного органа по поводу злокачественного новообразования желудка T3N0M0 III стадии. Размер удаленного фитобезоара – 15 × 9 см, плотной, неэластической консистенции, овальной формы. До удаления из полости культи желудка безоар легко смещался при пальпации желудка. На поперечном разрезе образования имеются кусочки непереваренных растительных волокон. По данным гистологического исследования было обнаружено, что инородное тело представлено волокнистыми структурами с крупными включениями, содержащими клетчатку. Описанная картина более всего соответствует растительному происхождению безоара. Удаленное образование культи желудка привело к истощению пациентки (масса тела – 39 кг, рост – 163 см, индекс массы тела – 15 кг/м2), анемии III степени тяжести и проявлялось нетипичной клинической картиной. Таким образом, авторы данной статьи напоминают клиницистам о возможности образования безоаров в полости желудка, особенно у лиц, употребляющих в большом количестве волокнистые растительные продукты, прежде всего хурму и апельсины. Gastrointestinal bezoars are an aggregation of undigested material that can be found in the gastrointestinal tract of humans and some animals. The composition and structure of these formations may be different. The etiology of an intragastric bezoar is multifactorial, including certain risk factors and predisposing factors such as comorbid medical disorders, anatomical abnormalities, and gastric motility disorders that contribute to the development of an intragastric bezoar. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars and lactobesoars. The most common type are phytobezoars, which consist of undigested fiber from vegetables or fruits. Phytobezoar is a bezoar, which is most often based on vegetable fiber. The formation of a phytobezoar in the stomach occurs as a result of eating large amounts of pine nuts, wild pears, and grapes. Separately, dispyrosbezoars are described, they are formed from persimmon, the viscous properties of which lead to the sticking of persimmon parts into a dense mass, followed by the formation of a lump. Most often, phytobezoars are formed in patients who had undergone surgery on the stomach. The article considers a clinical case of removal of a giant bezoar of the stomach stump, which was discovered 19 years after subtotal resection of the stomach because of a malignant neoplasm of the stomach T3N0M0 stage III. The size of the removed phytobezoar was 15 × 9 cm, it was dense, not elastic in consistency, oval in shape. Before removal from the cavity of the stomach stump, the bezoar was easily displaced by palpation of the stomach. On the cross section of the formation there were pieces of undigested plant fibers. According to the histological examination, it was found that the foreign body is represented by fibrous structures with large inclusions containing fiber. The described picture most of all corresponds to the vegetable origin of the bezoar. The remote formation of the stomach stump led to the exhaustion of patient, her body weight was 39 kg with a height of 163 cm, body mass index was 15 kg/m2, the anemia of III severity was diagnosed. The authors of this article remind clinicians of the possibility of the formation of bezoars in the stomach cavity, especially in individuals who consume large amounts of fibrous plant foods, primarily persimmons and oranges.
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