ASSESSMENT OF QUALITY OF LIFE IN PATIENTS AFTER THE TREATMENT OF ACUTE ASCENDING THROMBOPHLEBITIS OF THE GREAT SAPHENOUS VEIN WITH OF HIGH-FREQUENCY ENDOVENOUS WELDING.

Acute thrombophlebitis of the superficial veins is an urgent problem as it can spread to the deep veins with the subsequent development of pulmonary embolism. The social implications of varicotrombophlebitis are the long-term disability of most patients up to complete disability, so finding the least invasive methods of correction of the discussed disease is a pressing issue of modern phlebology. The research objective is to carry out a comparative analysis of the quality of life of patients with acute ascending thrombophlebitis of the great sapheneous vein after treatment with high-frequency endovenous welding and standard phlebectomy. The results of treatment of 63 patients with acute ascending thrombophlebitis of great saphenous vein (GSV) with III and IV class of thrombophlebitis, who were hospitalized in the surgical wards of the Municipal Clinical Hospital No. 8 of Kyiv from 2017 to 2018, were analyzed. Welding of the thrombotic vein segment was performed using an endovenous welding catheter (WC). Quality of life (QOL) results were assessed using CIVIQ2 (Chronic Venous Insufficiency Questionnaire). According to ultrasound duplex scanning, complete vein ablation occurred in 97.22% of patients after endovenous welding (EW) of thrombotic GSV. In all patients of Group I already on day 2, the total rate of QOL by all factors (pain, physical, social, psychological) significantly (p<0.05) exceeded the presurgery values and was 79.3%, when before treatment this indicator was 4.3% higher. At follow-up, QOL values continued to improve over all observation periods compared to the previous term (p <0.05). Quality of life restriction in connection with pain, social and psychological factors after EW decreased 2.1 times(p<0.05), when in control group patients - only 1.2 times. The revealed advantages of the method of high-frequency endovenous welding by all indicators of quality of life over standard phlebectomy allow recommending this method for wide practical application.

[ЕNDOVENOUS ELECTRIC WELDING OBLITERATION OF LARGE SUBCUTANEOUS VEIN IN TREATMENT OF VARICOSE DISEASE].

Possibility of application of the living tissues electric welding technologies in the treatment of varicose disease of lower extremities, using endovenous electric welding (EVEW) of large subcutaneous vein (LSV), was studied, its optimal parameters were determined. ЕVEW have provided effective impact on venous vessel, and guaranteed secure obliteration of LSV. The method may be used successfully in the treatment of varicose disease. Optimal parameters of EVEW, secure and safe in clinical conditions, were determined in experiment. Absence of negative impact of EVEW towards adjacent tissues have permitted to perform intervention without tumescent anesthesia. Further improvement and introduction of the EVEW method opens new possibilities for enhancing of quality of the varicose disease surgical treatment.

[THE COMPARATIVE ANALYSIS RESULTS OF ENDOVASCULAR LASER COAGULATION AND A STANDARD PHLEBECTOMY IN THE TREATMENT OF CHRONIC DISEASES OF THE LOWER EXTREMITIES VEINS].

The results of treatment of 58 patients, suffering chronic diseases of the lower extremities veins, were analyzed. In 28 patients a vertical reflux was eliminated using endovascular laser coagulation, in 32 patients--a standard phlebectomy in accordance to Babcock method was performed. The complications rate was compared as well as the term of the patients' stationary treatment. After elimination of endovascular laser coag- ulation the complications rate and severity is significantly lesser, than after a standard phiebectomy. In accordance to the ultrasonographic duplex scanning data in 12 mo in one patient a partial recanalization of large subcutaneous vein was noted. A total fibrous transformation of the coagulated venous trunks was achieved in 95.24% of the patients. Duration of postoperative stationary treatment have had reduced from (4.8 ± 0.8) to (1.2 ± 0.1) days (p < 0.001).

[Subfascial endoscopic dissection of perforant veins in ambulatory surgery of varicose disease].

The results of ambulatory application of subfascial endoscopic dissection of perforant veins (SEDPV) in 47 patients, suffering C4-C5 functional class varicose disease (according to CEAP classification) were presented. In all the patients SEDPV was performed in combination with miniinvasive methods of vertical reflux and varicosely changed tributaries elimination. The complications have had occurred in 6 (12.77%) patients, but they were not severe, did not need secondary hospitalisation of the patients, did not impact essentially restoration of ability to work and did not worsened the treatment outcome. Duration of inability to work period have lasted 12 - 25 days after the operation, 14.7 days at average. There was proved, that SEDPV permits to perform radical surgical intervention in patients, suffering chronic venous insufficiency class C4-C5 in ambulatory conditions.

[Ambulatory sclerosurgical treatment of varicose disease of the lower extremities].

The results of ambulatory sclerosurgical treatment of 258 patients, suffering varicose disease of the lower extremities (VDLE), were analyzed. The complications revealed are not severe and do not worsen the treatment results in whole. Application of intraoperative microfoam scleroobliteration of the stem veins have had guaranteed their complete occlusion in 97.5% of the patients. Sclerosurgical treatment have promoted a trustworthy (P < 0.0001) reduction of rate of chronic venous insufficiency (CHVI) class C2-C5 (in accordance with CEAP classification), and estimation of the CHVI severity classes C0, C1 witnesses the efficacy of this method of the VDLE treatment.

[Algorithm of modern technologies for outpatient surgical treatment of varicose disease of the lower extremities].

The results of ambulatory surgical treatment for the 2007 - 2012 yrs period of 736 patients, suffering varicose disease of lower extremities (VDLE) with chronic venous insufficiency Class C0-C6, according to CEAP (Clinical Etiological Anatomical Pathophysiological) classification, were analyzed. In 258 patients intraoperative truncal scleroobliteration was used and in 124 -endovenous laser coagulation, in 47 - subfascial endoscopic dissection of perforant veins, in 307 - microsclerotherapy, compressive treatment, medicinal therapy. The treatment algorithm of ambulatory surgery of VDLE was elaborated, basing on the analysis of the results of treatment.

[Determination of volume and choice of the surgical intervention method, performed for varicose disease of the lower extremities in ambulatory conditions].

The results of ambulatory surgical treatment in 215 patients, aged 23-76 yrs old, for varicose disease of the lower extremities, were analyzed. In accordance with international CEAP classification of chronic venous insufficiency, the functional class C2 was diagnosed in 119 (55.35%) patients, C3--in 51 (23.72%), C4--in 29 (13.49%), C5--in 16 (7.44%). On one lower extremity the operation was performed in 187 patients, simultaneously on both lower extremities--in 28, in 215 patients a total quantity of the operations performed was 243. The role of ultrasound duplex angioscanning in determination of the operative intervention volume and the method choice was shown.

[Diagnostic algorithm of ambulatory treatment of varicose disease of the lower extremities].

There were analyzed the results of the ambulatory examination, using clinical and ultrasonographic methods of investigation, of 1532 patients, suffering the diseases or symptoms concerning the lower extremities vessels in 2008-2012 yrs. Chronic insufficiency of the lower extremities veins was revealed in 1386 (90.5%) patients. Diagnostic algorithm of ambulatory treatment of the low extremities varicose disease was elaborated, basing on the analysis of the patients examination data.

[Crossectomy conduction under local anesthesia in conjunction with mini-invasive methods of a varicose disease treatment].

Experience of treatment of 135 patients for varicose disease (VD) of lower extremities (VLE) was analyzed. The investigation objective was the elimination of adverse reactions of general anesthesia and minimization of surgical trauma without loss of the operation radicalism. In 112 (83%) patients a crossectomy (upper and/or lower) was conducted under local infiltrating anesthesia. The criterion for the patients choice for the operation in conditions of local anesthesia was the presence of a VD, independent of its stage. In the investigation were not included the patients, suffering a VD recurrence and its decompensated forms. Our experience witness, that in a certain level of a surgeon qualification present, in a majority of patients, suffering VDLE, including its complicated forms, crossectomy may be performed in conditions of a local anesthesia.

[Clinico-morphologic evaluation of the course of the wound process after treatment of suppurative wounds with the CO2 laser]. / Kliniko-morfologicheskaia otsenka techeniia ranevogo protsessa posle obrabotki gnoinykh ran s pomoshch'iu CO2 lazera.

The complex examination and treatment of 238 patients with suppurative wounds of the soft tissues were carried out. Treating a suppurative wound by means of CO2-laser leads to reduction in microbial colonization of the tissues in its depth, accelerates maturation of granulations, wound cicatrization. The use of CO2-laser permitted to achieve primary healing of 94.3% of the wounds. The average duration of hospital stay of the patients was (9.2 +/- 1.4) days, in control--(11.8 +/- 1.6) days.

[Use of CO2 lasers in the surgical treatment of suppurative wounds of soft tissues]. / Primenenie CO2-lazera v khirurgicheskom lechenii gnoinykh ran miagkikh tkanei.

Treatment of a purulent wound by means of a 400-500 J/cm2 power density CO2-laser after preliminary ordinary debridement improves the results of the last-named by reducing the level of microbial dissemination in the tissues to minimum (10(1) microbial bodies per 1 g tissue). This improves the conditions for the development of the wound process and leads to sharp shortening of the duration of its phases and wider indications for the application of primary and primary-postponed sutures to the purulent wound. If primary sutures cannot be applied in the first postoperative days due to unfavourable conditions, open management of the wound is indicated to prepare it for application of primary-postponed sutures. Closure of a purulent wound with primary-postponed sutures after its treatment with a CO2-laser creates favourable conditions for its healing by first intention.

[Use of carbon dioxide laser in the treatment of acute lactation mastitis]. / Ispo'lzovanie uglekislotnogo lazera v lechenii ostrogo laktatsion- nogo mastita.

A total of 155 women with acute lactation mastitis were followed up. The patients were divided into 3 groups: Group 1 included 53 patients in whom purulent wounds were treated with CO2 laser followed by primary and primary-delayed sutures; Group 2-52 patients were treated with primary-delayed sutures without laser therapy; Group 3-50 women were treated by the traditional open method. In 50 (94.3%) Group 1 patients the wounds healed by primary tension with the mean bed-day being 9.6. In Group 2 primary healing was achieved in 46 (88.4%) patients, with the mean bed-day being 11.8. In Group 3 patients the mean bed-day made up 8.2. The wounds healed by secondary tension on days 28-34 after surgery followed by outpatient treatment.

[Choosing a method of treating suppurative lactational mastitis]. / Vybor metoda lecheniia gnoinogo laktatsionnogo mastita.

The abscessing form of lactation mastitis as well as subaureolar abscesses with small foci (not more than 3-4 cm) should be expediently treated by a puncture method. In large foci permanent drainage should be used. Limited foci (up to 1-1.5 quadrants) in phlegmonous-abscessing form of mastitis must be carefully dissected. Treatment by incisions is indicated in cases with infiltrative-abscessing form of mastitis. Local treatment must be supplemented by antibacterial and detoxication therapy and by the means enhancing the organism resistance.

[Evaluation of the diagnostic value of a modified hemolysis inhibition test in staphylococcal diseases]. / Otsenka diagnosticheskoi znachimosti modifitsirovannoi reaktsii tormozheniia gemoliza pri stafilokokkovykh zabolevaniiakh.

Blood serum samples from 602 healthy adults and 430 patients with suppurative lactation mastitis were studied with the use of the hemolysis inhibition test in the authors' modification, suitable for work with small amounts of blood serum. In most of the healthy adults (80.4%), the content of staphylococcal antitoxin in the blood serum did not exceed 1 antitoxic unit (AU), while in 3/4 of the suppurative mastitis patients a pronounced increase in antibody titers (up to 4--32 AU) was observed. The hemolysis inhibition test may serve as an additional criterion in the diagnosis of staphylococcal infections in adults.