[Study of the microbial spectrum of ulcerative-and-necrotic lesions in gerontological patients with lower limb chronic ischaemia].

The present work deals with a comprehensive study of the microbial spectrum of an ischaemic trophic ulcer in gerontological patients with degree IV lower limb chronic ischaemia in order to improve therapeutic outcomes by means of selecting individual antibacterial therapy for a possible prognosis of the results of treatment for an ulcerative-and-necrotic lesion of distal portions of the lower extremities depending on the spectrum of the microflora vegetating in the wound. Based on examining a total of 130 patients aged 70 years and older suffering from lower limb chronic critical ischaemia, we revealed that the pathogen of secondary wound infection isolated in trophic ulcers of the lower extremities influences the total outcomes of surgical management. A conclusion was made on the necessity of a compulsory dynamic scrutiny of the microbial flora of the lower-limb atherosclerotic ulcer, which makes it possible to carefully select individual antibacterial bactericidal therapy with due regard for microbial sensitivity to bactericidal agents.

[Diagnostic and therapeutic policy in gerontological patients with atherosclerotic lesions of lower limb].

Discussed herein are priorities of appropriate application of a special instrumental examination of the arterial bed of the lower extremities in elderly and aged patients presenting with chronic critical ischaemia on the background ofatherosclerosis obliterans. Also analysed are the findings ofan ultrasonographic examination of the lower-limb arterial system as afundamental methodfor diagnosis of an atherosclerotic lesion thereoffollowed by comparing the findings of the preoperative examination with the intraoperative data obtained during revision of the femoropopliteal segment. The obtained results made it possible to formulate conclusions on the preferable use ofultrasonographyfor examining gerontological patients suffering from lower limb chronic critical ischaemia as a simple, rapid, informative, and most importantly, non-invasive method, which is extremely importantfor elderly and aged people. It is underlined that in a series of cases contrast-enhanced aortoangiography can be used for examining the vascular status in gerontological patients; however, preference should still be given to an ultrasonographic examination of the lower-limb arterial bed or even direct visualisation of the affected arterial segment during intraoperative revision thereof.

[Short- and long-term complications of arterial reconstructions in gerontological patients].

The present work deals with analysing complications and causes of their development in the immediate and remote (5-year) period of dispensary follow-up after reconstructive arterial operations interventions in patients aged 70 years old and over, suffering from atherosclerosis obliterans of the lower-limb arteries. Based on considerable clinical material, the authors consider the main vascular, non-vascular and systemic complications, their incidence rate and character, depending upon the type of revascularization of the extremity involved. Also formulated herein are the conclusions on profitability and rationale of a particular surgical policy in treatment for chronic ischaemia of the lower limbs in elderly and aged patients.

[Surgical policy in patients aged 70 years and over presenting with grade iv chronic ischaemia of lower limbs].

The present work deals with a currently important problem concerning surgical decision-making in treatment of lower-limb critical ischaemia in elderly and aged people. A total of fifty-three 70-and-more-year-old patients presenting with an ulcerative-and-necrotic lesion of soft tissue of the crus and foot underwent treatment at Hospital of War Veterans No?2. They were subdivided into two groups depending on the level (height) of occlusion, and each of the groups was further subdivided into subgroups of patients subjected to the classical for the given localization of the lesion shunting operations, to compare the latter with less traumatic but at the same time less effective minor and non-anatomical reconstructions. Statistical analysis of the therapeutic outcomes in the immediate and remote (2-year) follow-up period revealed that comparing the iliac-femoral and cross femoro-femoral reconstructions, the best results were obtained after extra-anatomical operations. While comparing the femoropopliteal bypasses and profundoplasty showed that the obtained therapeutic outcomes were similar with certain advantage of the routinely performed shmting reconstructions. Based on the obtained findings, a conclusion was made on efficacy the principle of not maximal but sufficient revascularisation of lower-limb tissues owing to a predominant use of minor and non-anatomical reconstructions.

[Lower limb distal atherosclerotic gangrene--is high amputation always necessary?].

The results of treatment of patients with systemic atherosclerosis, complicated by foot and ankle soft tissue destruction. The majority of such patients are amenable to an incapacitating operation--a high femoral amputation. The results of arterial reconstructive measures do not always lead to a desirable effect, on the contrary, it can worsen the process and lead to a secondary amputation. The results of reconstructive treatment of 133 elderly and senile patients showed, that arterial reconstructive measures, amplified with necrectomy and minor amputation, allow to keep the limb and thus, the quality of life.

[Surgical treatment of atherosclerotic lower limb ischemia with ulcers and necrotic lesions at the patients aged 70 years and older].

Overall 133 patients aged 70 years and older with critical lower limb ischemia and necrotic lesions were treated. It is demonstrated that arterial reconstructive surgery is the effective method for limb salvage, life prolongation and improvement of life quality.

[Influence of various pectins on production of staphylococcal enterotoxins types A and B].

Experimental in vitro study of influence of 2% solution of pectins (red beet, apple, citrus, manufactured by "Vitaline" company, citrus high- and low-etherified pectins, manufactured by "Hercules" company, Unipectine OB 700, and biologically active supplement "Pecto") on growth of staphylococci and production by them of type A and B enterotoxins was performed. It was shown that red beet, citrus high- and low-etherified pectins, as well as biologically active supplement "Pecto" render bactericidal effect on staphylococci and inhibit synthesis of types A and B staphylococcal enterotoxins. Citrus pectin "Vitaline" and Unipectine OB 700 don't have such influence. The most effective pectins, which were able to inhibit synthesis of types A and B staphylococcal enterotoxins, were red beet, apple, and citrus low-etherified pectins as well as biologically active supplement "Pecto".

[Detection rate of enterotoxigenic Staphylococcus aureus isolated from children with intestinal disbacteriosis].

Detection rate of enterotoxigenic Staphylococcus aureus isolated from faeces of 62 children aged from 3 months old to 7 years old with intestinal dysbacteriosis was studied by indirect hemagglutination assay and enzume immunoassay. It was shown that strains of S.aureus producing staphylococcal enterotoxin A (SEA) are prevailed (40.3%) in children with disturbances of intestinal microflora while staphylococcal enterotoxin B (SEB)-producing strains were detected in 20.9% of children. Amount of produced enterotoxin varied for SEA from 125 ng/ml to 2000 ng/ml and for SEB--from 125 ng/ml to 250 ng/ml. Inverse dependence of detection rate of enterotoxin-producing strains in faeces on age of children was established. The most number of enterotoxigenic strains of S.aureus was detected in infants. These data point to expediency of determination of enterotoxin-producing ability of S. aureus strains isolated from children with dysbacteriosis as measure of danger of this microorganism for children's health and indication for adequate actions for its elimination.