bluuebunny/crossref_metadata_2025_split huggingface dataset:
The differential diagnostics and sepsis surgical treatment and induced metabolically diseases in diabetic foot lesions patients
Authors: Podpryatov S. E. , Korchak V. P. , Podpriiatov S. S. , Nikolska V. V. , Nikolsky I. S. 
Published: June 2019

Purpose of the study. The sepsis differentiation criteria and metabolically induced diabetic foot lesions must be established.
Material and methods. The 115 patients were observed.
Results and discussion. Sepsis by the qSOFA criteria was diagnosed in 3, heart failure of 3–4 class by NYHA classification estimated in 39 cases. High limb amputation had been performed to 18 patients, surgery on the foot to 97. Foot lesion relapse accompanied by unstable glycaemia had been observed in 25 cases. For the surgical correction of the diabetes ileoduodenoplasty had been performed in 7 cases, which resulted in uncomplicated wound healing in all patients.
Conclusion. Sepsis progression in patient with diabetic foot case proof indicates the necessity high lower limb amputation. Foot lesion relapse after the effective surgical sanitation indicate on metabolic disorder, not on sepsis. Surgical correction of the diabetes by mean of ileoduodenoplasty performing seems to be the reliable method of foot lesion relapse preventing.
Personalized approach to acute peritonitis treatment based on genetic studies
Authors: Polianskyi I. Yu. , Moskaliuk V. I. 
Published: June 2019

The research presents treatment results of patients with peritonitis by using the personalized medicine principles, which are based on the choice of diagnostic, treatment and preventive measures taking in to account genetic, physiological, biochemical and other features of the patient.
Purpose of the study. The treatment results improvement of patients with peritonitis, the reduction of the complications frequency.
Materials and methods. 226 patients with signs of acute peritonitis had complex examination with serum cytokines and serotonin levels determination and analysis of the polymorphic sites alleles of IL1ß (-511C / T) and 5-HTTLPR genes by polymerase chain reaction evaluated the treatment outcomes using the developed algorithms. The treatment results with the use of developed algorithms were evaluated.
Results. The processes of peroxide oxidation, antioxidant protection, proteolysis, fibrinolytic activity and their role in systemic disorders of homeostasis are shown. The connection between the nature of inflammatory reactions, its distribution in the peritoneal cavity and variants of the IL1ß gene (-511C/T) was proved. The relationship between the character of intestinal motility disorders in the postoperative period and variants of the 5-HTTLPR gene, which regulates the serotoninergic mechanisms of intestinal contractility, is shown. The algorithms for personalized approach to the peritonitis diagnostics, prognosis of and choice of treatment tactics were developed on the basis of the identified genetically determined individual characteristics of the inflammatory process. Advanced stages of surgical intervention were developed.
Conclusion. Predictionofthecourseofperitonitis and the development of various complications based on genetic research allows developing algorithms of personalized therapeutic tactics, significantly improving the results of its treatment.
Step-up approach for acute infected necrotizing pancreatitis
Authors: Dronov O. I. , Kovalska I. O. , Gorlach A. I. , Lubenets T. V. 
Published: June 2019

Purpose of the study. The role of interventional methods of the treatment of acute infected necrotic pancreatitis depending on the morphological characteristics of the disease was determined.
Material and methods. In present prospective cohort study, we included 96 patients with acute infected necrotizing pancreatitis. All patients were stratified according to morphologic features. Stepup approach with following steps of interventions was applied: percutaneous drainage of infected fluid collections, increasing of drainages diameter and number of it and open or minimally invasive necrosectomy. Clinical, laboratory, and instrumental monitoring were the defining indicators for the stopping of the treatment or for the passing to the next step of the treatment.
Results. At the first step 7 of 96 patients with superficial focal necrosis, a necrosis index of 2 points and a category D were successfully treated. Other 89 patients were passed to the second step of treatment, of which 23 patients with superficial subtotal necrosis, necrosis index of 2 points and category E were successfully treated. Another 66 patients had undergone a third step of treatment. A multivariate regression analysis was conducted that allowed to identify predictive factors of inefficiency of using of percutaneous drainage interventions (stages I and II) as a final stage of treatment: transmural subtotal or total necrotizing pancreatitis (OR = 1,58; 95% CI 1,03–3,88; p = 0,033); Necrosis index of 4 or more points (OR = 3.19, 95% CI 1.57–8.37; p = 0,003); heterogeneous peripancreatic fluid collection (OR = 4,15, 95% CI 1,49–5.19; p = 0,001); The CT-index of severity of acute pancreatitis of 7 or more points (OR = 1,89, 95% CI: 1,03–3,43; p = 0,029).
Conclusion. Step-up approach showed following results: 7,3% patients were treated at the first step, 24% – at the second step. Third step of treatment was applied in 68,7% of patients, of witch 12,5% was treated with laparoscopic necrosectomy. Predictors of ineffectiveness of ultrasound guided percutaneous drainage as the final treatment method are: necrosis index of 4 or more, heterogeneous paripancreatic fluid collections, subtotal and transmural necrotizing pancreatitis.
The deep femoral artery as a inflow source for distal reconstruction
Authors: Rusyn V. I. , Korsak V. V. , Rusyn V. V. , Horlenco F. V. , Dobosh V. M. 
Published: June 2019

Purpose of the study. To improve the treatment outcomes of patients with occlusion-stenotic lesions of the femoral-popliteal-tibial segment, long-term results of the profundafemorispopliteal autologous vein bypass surgery have been studied.
Material and methods. In the surgical clinic of A. Novak Regional Clinical Hospital during the last 10 years has been performed 300 isolated profundoplasty at chronic limb ischemia. In 16 patients with deep femoral popliteal autologous vein bypass, a distal segment of arteria profunda femoris was used as the «tidal» artery, which varied from 0,51 to 0,63 in diameter (0,58 cm in average).
Results. In the immediate and long-term follow-up period, no thrombosis of profunda femoris popliteal autologous vein shunt was observed in 5 years. The ankle-brachial pressure index after surgery increases almost twice and approaches 0,9 on posterior tabial artery. The mean profunda popliteal collateral index score decreased to 0,301 ± 0,099 in all patients after surgery. Ifwecomparethequalityoflifeafterprofunda femoris popliteal autologous vein reconstruction, it should be noted that the quality of life in our patients before the operation was 21,8 ± 4,9 points, after the operation − 45,6 ± 4,9 points.
Conclusion. Profundafemorispopliteal autologous vein bypass by a length of up to 15 cm provides blood supply to the limb with stenoticocclusive lesions of the femoral-popliteal-tibial segment, with the passage of at least one artery of the leg and the arteries of the pedis.
Endotoxicosis indices as means of prognosis in surgical sepsis caused by purulent-necrotic complications of sugar diabetes
Authors: Pavliak A. Ya. , Pyptiuk O. V. 
Published: June 2019

Purpose of the study. to study how the consequences of surgical sepsis caused by purulent-necrotic complications of sugar diabetes depend on the dynamics of endotoxicosis indices in the course of treatment.
Material and methods. The research included 30 patients with the symptoms correlating with the criteria for surgical sepsis caused by purulentnecrotic complications of sugar diabetes. The patients had their level of endotoxicosis measured and the severity of their condition evaluated according to the scale.
Results. 26 patients were discharged from hospital due to their recovery, 4 patients died. The purulent-necrotic complications lead to the development of intoxication syndrome and sepsis causing, in its turn, the decompensating of the disease, poly-organic insufficiency and the high lethality. Despite the conservative and surgical treatment carried out, the high indices of endogenic intoxication in the dynamics of the treatment proved to be a bad prognostic sign.
Conclusion. the monitoring of endogenous intoxication in patients with surgical sepsis caused by the purulent-necrotic complications of sugar diabetes in the treatment dynamics proves to be an important diagnostic and prognostic element helping to correct the treatment tactics and diminish the lethality.
Multidisciplinary treatment of ischemic forms of diabetic foot
Authors: Ivanova Y. V. , Klimova O. M. , Kryvoruchko I. A , Korobov A. M. , Prasol V. O. , Pityk O. I. 
Published: June 2019

Purpose of the study. The phototherapy, platelet growth factor and coating materials in the treatment complex using for improve the results of wound treatment in patients with the ischemic form of diabetic foot.
Materials and methods. The analysis of the results of treatment of 48 patients with ischemic forms of diabetic foot syndrome has been performed in the work. The patients were divided into the study and comparative groups. The patients were treated at the clinic of the State institution «V.I. Zaitsev Institute of General and Emergency Surgery National Academy of Medical Sciences of Ukraine» from 2012–2018, and all patients had II stage diabetes mellitus and IV degree of ischemia by Fontaine. Patients in both groups performed open and hybrid reconstructions. In the patients of the study group, the developed treatment technology was applied, containing phototherapy and photodynamic therapy with a range of: λ 470, 525 or 405 nm in the preoperative period, closure with synthetic coating with application plasma enriched of transforming growth factor.
The implementation of the developed tactics allowed to achieve complete wound healing in 91,7% of patients, partial healing – in 8,3% of patients. The terms treatment terms for these patients did not exceed 2 months, high amputation was not required.
Conclusions. Plastic closure of the wounds of the lower extremities after revascularization operations in an ischemic diabetic foot syndrome is indicated in cases where wounds do not tend to spontaneous healing. The use of a treatment complex consisting of phototherapy and photodynamic therapy, the closure of wounds with a synthetic coating of transforming growth factor is the effective stimulator of development of granulation tissue in the wound, suitable for further autodermoplasty.
The ankle-brachial index value in patients with purulent-necrotic complications of diabetic foot syndrome
Authors: Matviychuk B. O. , Zaremba V. S. , Fedchyshyn N. R. , Tsymbala O. P. 
Published: June 2019

Diabetes and predetermined him heavy purulent-necrotic complications is actual problem medicine today’s. It is proved that patients with diabetes have big risk to development of heart-vessel disease due to the development of atherosclerosis. Standard of diagnosis peripheral arterial disease of lower limb is finding ankle-brachia index (ABI). This method is good at definition of degree of arterial occlusion.
Purpose of the study. Purpose of the work: to analyse the diagnostic capability of ABI in patients who have purulent-necrotic complications of diabetic foot.
Material and methods. The prospective studies covered 218 patients. The average patients age 54,2 ± 10,3years, 45,5% of them – men. The mild form of disease was in 33,2%, moderate severity – in 45,2%, severe – in 21,6%. The duration of purulent-necrotic complications was 11,5 ± 1,2 days.
Results. We have seen that 128 patients have different degrees of macroangiopathy. in patients who performed amputation at the level of the thigh of ABI was 0,41 ± 0,13; at the level of the leg – 0,59 ± 0,12.
Conclusion. 1. Timely diagnosis is the basis of effective treatment of purulent necrotic complications of diabetic foot. 2. In treatment, it is necessary to take into account the indicators of ABI as the main diagnostic marker of peripheral artery disease of lower limb. 3. Definition of ABI is an objective and valuable predictive marker.
The microbial landscape action on development destructive erysipelas forms
Authors: Vasilevskaya L. A. 
Published: June 2019

Objective. Changes in the monoculture of the pathogen in the microbial association of bacterial pathogens is accompanied, depending on their species composition, the progression of the inflammatory process with the development of destructive forms. The object was to install the value of microbial landscape in predicting the development of destructive forms of erysipelas.
Material and methods. The diseases histories and cultures of wound secretions with the definition of sensitivity of microorganisms to antibiotics were analyses.
Results. Of our studies indicate that the microflora of the primary cells in destructive forms of the erysipelas changed both quantitatively and qualitatively. Detected microbial pathogens in bacteriological studies of soft tissue exudates allowed installing criteria for forecasting the development of purulent complications.
Conclusion. Bacteriological studies indicate that necrotizing skin lesions are preceded by the presence of S. Pyogenes in the exudates.
Experimental justification of the effectiveness of cord blood stem cell transplantation in chronic myocardial injury
Authors: Gabrielyan A. V. , Domansky T. M. 
Published: June 2019

Purpose of the study. Determination of transplantation efficiency of cord blood stem cells (CB SC) for damage to the myocardium and assessment of the repair of its disturbed functions in the experiment.
Materials and methods. The experiment was conductedonmiceofthe FVBlineattheageof5 months, with a body weight of 25–30 g. Animals were divided into experimental groups of 5 animals in each. The animals of the study group were derived from the experiment before the SC suspension injection, after 2 days, 4 and 8 weeks after cell transplantation.
Results. Analysis of morphofunctional changes after the introduction of cord blood cells in 4 and 8 weeks compared to the original state (3 weeks after modeling of the isoproterenol induced myocardial injury model) has established a clear tendency to improve the investigated parameters. The confirmed phenomenon of self-referral of cord blood nto the lesion zone proves the expediency of transplantation by intravenous injection of a suspension of CB SC. It has been established that transplantation of CB SC causes a temporary deterioration of morphofunctional features, which may be a manifestation of the body's response to xenotransplantation. The CB SC transplantation has a positive effect on the isoproterenol-induced myocardial injury model.
Conclusions: 1. Accumulation of CBSC in the zone of injury after transplantation, proved by experimental research. 2. CB SC transplantation accelerates the processes of myocardial regeneration on the model of injury in laboratory animals. 3. Intravenous injection of the CB SC suspension to the models of myocardial injury proved to be effective. 4. The experimental results obtained can serve as the basis for further clinical studies in patients with heart failure.
Evaluation of dynamics of inflammatory process in patients with flegmones of shell-facial plants
Authors: Malanchuk V. A. , Sidoryako A. V. 
Published: June 2019

Modern and glance at the methods of diagnosis and treatment of patients with odontogenic inflammatory diseases of the maxillofacial area and neck was and remains one of the pressing problems that are frequent complications that lead to disorders in the tooth-jaw system, and can be a direct life-threatening ill.
Purposeofthestudy. Toincreasetheeffectiveness of treatment of phlegmon of maxillofacial area and neck due to the active evaluation of the dynamics of the inflammatory process comparing a specific patient with standard indicatorschanges in the limits of edema of infiltration.
Materials and methods. We carried out diagnostics and complex treatment of 120 patients with odontogenic phlegmons, who were in hospital treatment. The patients were divided into 2 groups: group I – 60 patients, treatment of which was carried out by the traditional method. Group II – 60 patients, modern treatment methods regional administration of attibiotics, vacuum drainage of purulent wound and plasmolifting at the stage of reparation, were added to their standard therapy.
Conclusions: The proposed method is simple, reliable and does not require expensive equipment and makes it possible to predict the development of the disease only by clinical measurements of the volume of inflammation.
Sepsis as a cause of fatal cases after the lower limbs amputation at the hip level due to gangrene in patients with a diabetic foot syndrome
Authors: Kapshitar A. V. , Kapshitar A. A. 
Published: June 2019

Purpose of the study. To study frequency of fatal sepsis, the causes and severity of diabetes patients complicated by diabetic foot syndrome of the gangrene limb, after amputation of the lower limb at the hip level.
Material and methods. Amputation of the lower limb at the hip level was performed in 180 patients with diabetic foot, gangrene of the limb. 15 (8,3%) died. Results. From the 15 patients who died, 9 died from sepsis. The age was 54–78 years old. On admission, sepsis was diagnosed in 5 and septic shock – in 4 patients. After examination and preparation, emergency surgeries were performed in 4 patients and urgent surgeries – in 5. Twoand three-step surgeries were performed in 5 patients. They first performed the removal of the toes of the gangrene, osteomyelitis, opened deep phlegmon of the foot and the lower leg was completed by amputation of the lower limb. Primary amputations were performed in 4 patients. Sepsis was the cause of death in 5 patients from 11 to 60 days and the combinations of sepsis with acute myocardial infarction or repeated myocardial infarction – in 4 from 5 to 17 days. During the autopsy, pathological changes of severe diabetes, complicated diabetic foot syndrome, its mixed form, sepsis with manifestations of septicemia or septicopyjemia, and all organs and systems were revealed.
Conclusions. The unsatisfactory organization of medical care for patients with diabetes and diabetic foot syndrome at the pre hospital stage, ineffective sanitary and educational work, systemic pathological changes led to sepsis and death after the amputation of the lower limb at the hip level.
Tactical and technical aspects of complex treatment of patients with acute destructive cholecystitis complicated with peritonitis and billary sepsis
Authors: Zaporozhchenko A. S. , Kravets K. V. , Bondarets D. A. , Zubkov O. B. , Kirpichnikova K. P. 
Published: June 2019

Purpose of the study. To clarify the clinical and diagnostic criteria of BS, caused by complicated acute destructive cholecystitis for the development of optimal treatment tactics.
Material and methods. 193 patients with acute destructive cholecystitis and choledocholithiasis, complicated by peritonitis, had surgery on the basis of Odessa regional clinical center in the clinic of surgery № 2. All patients with BS were divided into two groups. In the first group, 115 non-invasive laparoscopic surgical interventions were performed. In the second group, 78 patients were performed laparotomy, cholecystectomy, choledochotomy and external drainage of choledoch duct, as well as external drainage of CAL.
Results. In patients with BS and obstructive jaundice, prior emphasis was placed on active surgical tactics, the use of noninvasive technologies in combination with intensive infusion and antibiotic therapy. Of great importance in the treatment of BS was also given to hemodynamic and respiratory support, detoxification with the use of efferent methods (hemosorption, plasmapheresis), rational antibiotic therapy, immunocorrection, antioxidants, and vitamin therapy.
Conclusions. Adequately initiated treatment with the use of modern methods of diagnosis and conservative therapy, surgical interventions in the early stages, reduces the percentage of development of severe complications and the number of fatal cases in this pathology. In perspective, it is necessary to determine more precise markers of biliary sepsis at an early stage, to improve methods of endoscopic surgery and detoxification treatment.
The wound process variants course in patients with diabetic foot syndrome in the vacuum therapy background
Authors: Gerasymchuk P. O. , Shidlovskyi V. O. , Fira D. B. 
Published: June 2019

Purpose of the study. Study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion.
Materials and methods. The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 2014–2017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area around the wound.
Results. Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p < 0,05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization.
Inpatientswithischemiclesions(chronicarterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 70–80 mm Hg, which makes it possible to stop pain during the day. At 2–3 days of the postoperative period, negative pressure is established at standard values.
Conclusion. Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduce the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average 4,3 ± 1,7 bed-days, and patients with ischemic form on average 4,1 ± 1,9 bed-days, which has both medical and social significance.