[Features of angenesis against the background of negative pressure wound therapy in patients with neuropathic and neuroischemic forms of diabetic foot ulcers].

The authors analyzed clinical (size, tissue oxygenation), histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) features of reparative processes of soft tissue of lower extremities in patients with diabetes mellitus against the background of vacuum therapy in comparison with standard local treatment. Patients (31 cases) with diabetic foot ulcers were followed-up after surgical d-bridement and before plastic closure of the wound. During perioperative period 13 patients obtained the negative pressure wound therapy (NPWT of 90-120 mmHg) and 18 patients had the standard care. Given results supported higher efficacy of NPWT as compared with standard local care. The therapy caused rapid reduction of wound and its depth, increased local microcirculation and reduced inflammation. These data were confirmed by the histological and immunohistochemical studies. The high efficacy of the method of local treatment could significantly reduce the time of wound preparation for the next step of surgical treatment.

[Single-step endovascular revascularization of the kidney, lower limb and endovascular reconstruction of abdominal aortic aneurysm in a patient with type 2 diabetic mellitus].

Presented in the article is a clinical example of surgical treatment of a patient with a severe course of type 2 diabetes mellitus, multiple lesions of coronary arteries, lower-limb arteries with the development of lower-limb ischaemia, bilateral lesions of renal arteries and chronic renal insufficiency, the presence of an aneurysm of the infrarenal portion of the aorta. The unique nature of the case report consists in joint work of endocrinologists, cardiologists, specialists in purulent surgery and reoentgenovascular surgeons, also in carrying out simultaneous endovascular reconstructive operation on various vascular basins: stenting of the right renal artery, balloon angioplasty and stenting of the left leg arteries and endovascular prosthetic repair of the abdominal aortic aneurysm. The comprehensive treatment of the patient resulted in safe performance of the endovascular intervention, saving the supporting function of the limb, improvement of glycemic control, decreasing the risk of sudden death on the background of abdominal aortic aneurysm rupture, decreased rate of progression of renal insufficiency, better control of symptoms of angina pectoris and cardiac failure. Also the article reflects importance of rendering medical care for patients with multifocal atherosclerosis and diabetes mellitus, also showing the necessity of creating multi-modality medical centres and working out of algorithms for treatment of this patient cohort.

[Osteopathy in diabetic foot syndrome]. / Osteopatiia pri sindrome diabeticheskoi stopy.

Morphological characteristics of bone tissues were studied in the feet of patients with diabetes mellitus type 1 and 2 (DM1 and DM2). Osteoblasts and osteoclasts prevalence, the presence of collagen type III in the composition of newly formed bone were characteristic for DM1. Osteocytes prevalence and abundant granulation tissue in newly formed bone was a feature of DM2. The analysis of bone tissue resorption suggests that lacunar osteoclastic resorpsion is the main type in DM1 while periosteocytic osteolysis and smooth resorption are typical for DM2. Thus, osteolysis genesis and synthesis of bone tissue in DM1 and DM2 may be different.

[The thromboxane-synthesis inhibitor Ibustrin in the treatment of diabetic angiopathies]. / Ingibitor sinteza tromboksana ibustrin pri lechenii diabeticheskikh angiopatii.

16 patients with insulin-dependent diabetes mellitus (IDDM) lasting 8-19 years had pronounced diabetic nephropathy (proteinuria stage), retinopathy (stage I, II or III), disturbed circulation in the lower limbs detected at foot dopplerography. For 3 months these patients received ibustrin (inhibitor of cyclooxigenase, blocker of tromboxane A2 synthesis and platelet aggregation) before renal function underwent positive changes: glomerular filtration rate increased in 13 patients (81%), 24-h proteinuria decreased in 12 patients (75%). Retinal vascular condition improved in 5 of 6 patients with nonproliferative retinopathy and in 2 of 5 patients with preproliferative retinopathy, in 1 and 3 patients stabilization occurred, respectively. In proliferative retinopathy improvement and stabilization were registered in 1 and 3 of 5 patients, respectively. According to feet artery dopplerography the improvement, no changes and moderate aggravation occurred in 10(62%), 3(19%) and 3(19%) of patients, respectively The conclusion is made that ibustrin effectively inhibits progression of IDDM vascular complications, especially at early angiopathy stages.

[The biochemical markers of bone metabolism in differential diagnosis of hematogenic osteomyelitis of foot bones and acute stage of diabetic osteoarthropathy]. / Biokhimicheskie markery kostnogo metabolizma v differentsial'noi diagnostike gematogennogo osteomielita kostei stopy i ostroi stadii diabeticheskoi osteoartropatii.

The determination of the level of leukocytes and ESR in 25 patients was shown to be of low informative value in differential diagnostics of destructive injuries of feet in patients with diabetes mellitus. An analysis of the biochemical markers of the bone remodeling has demonstrated high informative value of this method in differential diagnostics of acute stage of diabetic osteoarthropathy and osteomyelitis that allows to use it in complex examinations of osteomyelitis suspects.

[Comparative assessment of conservative therapy methods in patients with the diabetic foot syndrome]. / Sravnitel'naia otsenka metodov konservativnoi terapii bol'nykh s sindromom diabeticheskoi stopy.

Fifty patients with types I and II diabetes complicated by the diabetic foot syndrome were examined. The patients were divided into two groups: Group I patients were administered x-ray therapy of the feet and shins, group 2 ones were treated by angioprotectors and antiaggregants. Complaints and objective data, findings of ultrasonic examination of the lower limb vessels and biothesiometry, x-ray picture before and 6 months after the treatment were assessed. 36 normal subjects made up the control group. The authors emphasize a marked effect of x-ray therapy as against drug treatment.