Steady growth of frequency of defeat stops at a diabetes causes a urgency of a problem. Death rate from complications of a diabetes takes the third place among the direct reasons of death, therefore this problem gets social value.
By the author it is analyzed results of inspection and treatment of 1895 patients which were divided into 4 groups. Control (first) group compose 125 patients; 728 patients with “diabetic foot” which received treatment in hospital formed 2 group; 723 patients by whom economical amputations foots and exarticulation fingers compose 3 group; 319 patients by whom complex treatment was included in long intraarterial catheter therapy formed 4 group.
The analysis of unsatisfactory results of control group has allowed the author to reveal, that a principal cause of progressing is purulent - necrotic defeats stops at a diabetes arc tendon-sinews formations. In view of anatomic features sparing operative interventions arc offered at various localizations of defeat stops which essence consist at a distance interested tendon-sinews environments of fingers stop in view of the developed factor proximo-distal a gradient microbic impurities.
The system of the integrated medical aid by the ill diabetes, consisting of 3 parts with concrete functional duties and including experts of a various structure (diabctologists, surgeons, cardiologists, chiropodists et al.) is developed and introduced.
The technique of realization long intraarterial catheter therapies is advanced at generalization purulently-nccrotic process. She consists in constant drop introduction of 50 % of daily volume and 3-4 times per day strcamly 50 % of daily volume of an antibiotic. The basic components were the preparations improving rcological properties of blood, antibiotics of a wide spectrum of action, spazmolitics. The volume daily solution did not exceed 1-1,4 litres. Thus duration catheter therapies have made 7-10 days.
Application of the developed ways of surgical treatment of a diabetic gangrene of the lower extremities at various localizations of defeat has allowed to reduce frequency of high amputations from 40,8 up to 8,4% and to lower mortality from 12,0 to 3,0%. In the remote period of supervision till 5 years frequency of preservation of basic function of the lower extremities has increased from 38,4 up to 75,2%. It has allowed to improve quality of life due to what mortality in terms till 5th years has decreased from 72,2 up to 24,5%.
Complex treatment of a diabetic gangrene of the lower extremities with use of the advanced technique of realization long intraarterial catheter therapies has allowed to raise in the nearest terms of supervision safety of basic function of the lower extremities from 59,2 up to 78,0%. Lethal outcomes thus has decreased from 12,0 up to 3,2%. In the remote term of supervision (5 years) the number of patients with safe basic function of the lower extremities has increased from 38,4 up to 54,5%. The survival rate of patients thus has increased from 28,8 up to 48,2%.
Актуальность вопросов лечебной коррекции различной этиологии рубцовых деформаций кожи обусловлена широким распространением данной патологии без тенденции к снижению (Озерская О.С., 2002, 2004; Ахтямов С.Н., Бутов Ю.С., 2003; Жукова О.В., 2008; Стенько А.Г., 2012, 2013). Активизация внимания хирургов к проблеме рубцовых деформаций кожи лица способствовало развитие пластической хирургии, а также всё большее понимание обществом цивилизованных стран важнейшей роли внешнего вида в жизни человека (Трыкова И.А., 2013). В исследованиях, проведенных Monstrey S., Middelkoop E., Vranckx J.J. (2014) указано, что каждый год у 100 миллионов человек по всему миру появляются шрамы после травм и хирургических вмешательств, и 15 миллионов из них будут имеют неэстетические или гипертрофические и келоидные рубцы. По мнению Нельга И.О., Петинати Я.А., Ткаченко С.Б. (2014), внешний вид оказывает существенное влияние на социальное благополучие, адаптацию в обществе и качество жизни человека. При этом, возникновение грубых рубцов часто приводит к развитию нервно-психических расстройств вплоть до случаев тяжелой депрессии, развитию постоянной нетрудоспособности (Ahmed Samir Edriss, V. Smrcka., 2011). Профилактика развития патологических рубцов кожи лица (при хирургических вмешательствах) и лечение (коррекция) рубцов представляет собой важную медико-социальную проблему (Кирьянова В.В., Максимов А.В., 2012). Профилактике и лечению келоидных и гипертрофических рубцов посвящено много работ и исследований отечественными и зарубежными учёными (Владимирова О.В., 2011; Ogawa R., 2012; Филиппова О.В., Красногорский И.В., 2013).
Лечение цинковой недостаточности - комплексное. Это прежде всего лечение основного заболевания. Очень важно, чтобы ребенок получал достаточное количество животных белков (если нет ограничений по основному заболеванию)
Рахит, устойчивый к витамину D заболевание, вызывающее нарушения минерализации твердых тканей, костей, а так же осложняет молочный, сменный и постоянный зубной ряд. Стоматологические признаки рахита включают увеличенные рога и камеры пульпы, дефект ткани эмали, дентина, пульпит, некроз пульпы, периапикальные рецидивирующие абсцессы и периапикальные осложнения без кариеса или травмы. Однако иногда трещины эмали и гипоплазия эмали можно наблюдать у пациентов. Профилактическое лечение пульпы, эндодонтическое лечение, консервативное в этих случаях может применяться лечение и удаление зубов. Хотя профилактическая пульпотомия является одним из варианты лечения случаев ВДРР, не рекомендуется из-за отсутствие достаточных доказательств хорошего прогноза. Наконец, после терапевтического, общеукрепляющие и профилактические аппликации, больной был отозван для периодического осмотра протеза, общее состояние зубов, ортодонтическое обследование и кариес профилактические процедуры.
The objective of this study was to assess the efficacy of a complex therapeutic approach, which included retrobulbar catheterisation and magnetic stimulation of the optic nerve, in patients with ChASN of diverse aetiologies. This was achieved by analysing the clinical and functional characteristics of the eye in these patients.
The methodology employed in this study is outlined below. A total of 105 patients (155 eyes) with a diagnosis of partial optic nerve atrophy of different genesis (PAN) were included in the study. These patients received conventional treatment, treatment by the method of retrobulbar catheterisation, as well as the method of retrobulbar catheterisation combined with MS for 10 days. The dynamics of OD, visual field parameters, electrophysiological studies, ophthalmoscopy and ultrasound Dopplerography were investigated.
The results demonstrated that the combined method of treatment was more effective than the conventional method alone. The analysis of the obtained data indicates that the effectiveness of the proposed methods of treatment depends on the degree of MN destruction. Therefore, the treatment is more effective in the second degree of ChASN. However, in the group of patients treated by the combined method, the efficiency is equally high in both the second and third degrees of ChASN.
The data on the dynamics of visual acuity of patients with II stage of ChASN during treatment indicates that if in the group of patients treated by the traditional method the effect was observed in only 64.3% of cases, in the group of patients treated by the method of retrobulbar catheterisation the efficiency was observed in 89.3%.
The efficacy of the combined method of retrobulbar catheterisation in combination with MS in treating patients with ChASN was also demonstrated by the observed improvement in OZ in comparison with the control group. In this group, the effectiveness of the treatment was 90.9%.
The visual field boundaries in patients with the II degree of ChASN of the II and III main groups expanded in comparison with the control group by more than 51-60° in the periphery. The number of absolute central and paracentral scotomas decreased in comparison with the control group by 4.7 and 5 conventional units.
In the group of patients with ChASN stage III, the borders of the visual field in groups II and III, in comparison with the control group, exhibited a peripheral widening of 69° and 70°. The number of scotomas decreased by 6 and 11.6 conventional units in comparison with group I.
The ocular fundus condition under the proposed methods of treatment underwent the following changes due to the short period of observation (2-3 weeks): dilation of CAC vessels, reduction of capillary tortuosity, reduction of retinal oedema, as well as appearance of foveal and macular reflexes distinctness.
The data from ultrasound Dopplerography demonstrated a significant improvement in haemodynamic parameters in the central artery of the retina (CAC) in patients with central artery syndrome of different aetiology in the early stages following treatment. An improvement in systolic pressure indices was observed. In each case of the examined patients, an improvement in haemodynamic resistance index (Ri) towards normalisation was revealed. Consequently, there was a significant increase in diastolic pressure.