[Complex health service for treatment of patients with diabetic foot syndrome].

Complex service for treatment for patients, suffering diabetic foot syndrome, was created on the base of Dnipropetrovskiy Regional Clinical Hospital with the objective for application of high technologies. Creation of such a service have permitted to improve the results of the patients treatment. Enhancement of the performance rate of small operations on the foot have permitted to increase by 34.4% the quantity of patients, in whom a supportive function of the foot was preserved, and to reduce the conduction rate of the lower extremity amputation on a hip level, preserving a knee joint, by 39.5%, what is very important for the prosthesis. Widespread propaganda among population and primary link of the health service permit to reveal and eliminate complications of diabetes mellitus on earlier stages.

[The symptoms and surgical tactics for complicated forms of the abdominal cavity tuberculosis].

The results of treatment of 12 patients, suffering complicated forms of abdominal tuberculosis and external intestinal fistulas, were presented. Late diagnosis of abdominal tuberculosis in the patients, suffering the complications phase of the disease, is caused by unclear symptoms presence in early stages of the disease. Clinical and laboratory indices in peritonitis of a phthisis origin are nonspeciphic. In 91% of patients, admitted to the hospital for complicated forms of abdominal tuberculosis and external intestinal fistulas, the operative treatment was indicated. Surgical intervention (more frequently right-sided hemicolectomy, enterostomy, the abscesses opening, the caseously-changed lymph nodes excision, formation of anastomosis) was performed in 11 patients for peritonitis and external intestinal fistulas. The method of a secure invagination anastomoses formation was elaborated, permitting to perform primary restoration operations. An early diagnosis, early effective therapy and radical surgical intervention conduction for complicated abdominal tuberculosis promote the patients to survive.

[Treatment of purulent wounds using vacuum-therapy].

The results of treatment of complex wounds in 115 patients, in 56 of whom vacuum-therapy was conducted, were analyzed. The duration of a bandage holding constitutes 1 - 3 days at average. The peculiarities of clinical course, the dynamics of the wounds microbic spillage, cellular content in the wounding prints, phagocytic activity and phagocytic number, the phagocytosis completeness index were estimated and calculated. Application of vacuum-therapy have promoted the earlier cleansing and epithelization of the wounds as well as the tissues reparation occurrence and the laboratory indices normalization.

[The splenic abscess: alternative surgery].

The experience of treatment of patients for splenic abscess, using the abscess cavity puncture and drainage under ultrasonographic guidance, was summarized. The authors consider the method applied as a perspective one, noting, yet, its risks and a need for further studying.

[Pathogenetic aspects of surgical treatment of destructive pancreatitis].

Analysis of treatment efficacy in 270 patients suffering an acute pancreatitis was conducted. The main factor, which determines the choice of treatment, is etiology, pathogenesis and the form of an acute pancreatitis substantiation. The acute pancreatitis course phases, the main principles of diagnosis and treatment, depending on its phase, are discussed. This had permitted to lower lethality to 7.2%.

[Minimally invasive surgical procedures in the treatment of destructive pancreatitis]. / Miniinvazivnye khirurgicheskie vmeshatel'stva pri lechenii destruktivnogo pankreatita.

Results of treatment of 83 patients with destructive pancreonecrosis were analyzed. Miniinvasive method of transcutaneous introduction of a drain under ultrasonographic control was applied in 16 patients. The method is relatively simple, of a small traumaticity, permits to sanate and to drain purulent cavity quickly. Usage of miniinvasive technologies with low risk for the patient's life and minimal economic expense had permitted to reduce the treatment duration and the frequency of the complications occurrence.

[Improvement strategies in the treatment of high small intestinal fistula]. / Sovershenstvovanie taktiki lecheniia vysokogo tonkokishechnogo svishcha.

The experience of treatment of 54 patients with external small intestinal fistula was summarized. The method of surgical treatment was choosen basing on estimation of the fistula localization, its occlusion possibility and in accordance with state of homeostasis. Early performance of operative intervention according to vital indications is necessary in presence of unformed fistula with massive and uncontrolled loss of intestinal contents. Application of rational surgical tactics and complex treatment of patients with high external small intestinal fistula have allowed to lower lethality from 30 to 19%.

[Vast purulent necrotic lesions in patients with diabetes mellitus]. / Obshirnoe gnoino-nekroticheskoe porazhenie u bol'nykh sakharnym diabetom.

New complex method of surgical treatment of spacious purulent-necrotic affection (SPNA) was elaborated. Isolation of cutaneous-subcutaneous flap in accordance with anatomic structure and vascularization of the affected region guarantees the conditions for conduction of effective sanation using composition, made of mixture of hydrogen peroxide and spirituous solution of iodine. Application of method in complex of treatment of SPNA in patients with diabetes mellitus permits to preserve cutaneous flaps, to shorten the duration of treatment and to reduce lethality from 50 to 8%.

[Non-clostridial epi-fascia phlegmon]. / Neklostridial'naia épifastsial'naia flegmona.

Complex method of surgical treatment of epifascial phlegmon is elaborated. The flaps tailoring and dividing in accordance to anatomic site and its blood supply permits to do radical cleansing and sanitation of focus with mixture of hydrogen peroxide and spirituous solution of iodine preserving the viable skin maximally. In contrast to conventional "stripe" incisions, application of the proposed method permits to preserve the wound from significant lympho--and plasma losses, causing the wound exhaustion, secures the possibility of visual control of the necrotic process course. The wound coverage with cutaneo-subcutaneous flap of the full value assists reducing of the pain intensity. The flap fixation prevents its shortening, that's why good cosmetic effect is noted after the wound healing concludes. Complex program of the necrotic fascitis treatment proposed had permitted to reduce the hospitalization duration of patients twice and to lower the mortality rate more than in 3 times.