[АNALYSIS OF LETHALITY IN COMPLICATED DIABETIC FOOT SYNDROME AND SEPSIS].

There were examined in dynamics 724 patients, in whom complicated diabetic foot syndrome (DFS) was diagnosed, and in 71 (9.8%) of them the disease was complicated by sepsis. The state severity in a DFS patients have depended upon duration of purulent-necrotic process on the foot, in septic patients such dependence was not revealed. All the DFS patients without sepsis were operated on. In total 36 died (lethality 5.5%), in presence of sepsis - 42 (lethality 59.1%). The cause of sepsis in the patients, suffering complicated DFS, was predominantly a wet gangrene of the lower extremities. Among those, who were not operated on, 13 (30.9%) septic patients died, of them 5 ­ who refused operative intervention performance - died in first hours after admittance to hospital due to irreversible injury of organs and systems.

[АRTERIAL PRESSURE ON THE FIRST TOE AS A PROGNOSIS CRITERION OF THE COMPLICATION OCCURRENCE IN THE DIABETIC FOOT SYNDROME ON BACKGROUND OF MENKEBERG'S SCLEROSIS].

In the patients, suffering diabetes mellitus type ІІ, treated in 2015 - 2016 yrs for complicated diabetic foot syndrome, a systolic arterial pressure (SAP) on level of the first toe was determined, and roentgenography of the foot in two projections done. The SAP value from 120 to 200 mm Hg and higher have had witness the presence of Menkeberg?s sclerosis stages III - V. Prognostically favorable is a SAP value of 80 mm Hg and higher, and unfavorable data ­ the SAP value lowering lesser than 80 mm Hg. The SAP value lower than 30 mm Hg have had witness the vessel obliteration and thrombosis occurrence.

[SOME PARAMETERS OF THE IMMUNE STATE OF PATIENTS WITH DIABETIC FOOT SYNDROME AND SEPSIS].

The analysis of changes in the specific immunity in patients with purulent­necrotic complications of diabetic foot syndrome (DFS) and sepsis was presented. Complicated DFS was diagnosed in 436 patients, of whom 29 (6.6%) ­ weighed down by sepsis. The concentration of the major classes of immunoglobulins IgA, IgM, IgG were determined by enzyme­linked immunosorbent assay (ELISA). To evaluate the immune state was determined lymphocyte subpopulations (CD4+, CD3+, CD8+, CD25+) with monoclonal antibodies to antigens use by flow cytometry. It was found that in patients with DFS indicators specific cellular immunity were in a state of suppression, which deepened at complication of sepsis. Based on the derived formula with DFS marked disorders of the immune system I degree, in sepsis ­ II degree. Thus, the cellular and humoral immune system in patients with both DFS and sepsis qualified as a general immune depression.

[Prolonged blockade of nervus ischiadicus in a system of complex treatment of patients, suffering complicated diabetic foot syndrome].

General principles of treatment in patients, suffering diabetic foot syndrome, are adduced. There was proved, that reconvalescence of the patients depends not only on quality of complex treatment, but from optimal choice of anesthesia method, its impact on postoperative period course. Application of prolonged blockade of n. ischiadicus gives possibility to perform operative intervention on the lower extremity in full volume, guarantees sufficient motor and sensory block, permits patients to reject from application of narcotic analgetics, to reduce the dose of strong nonnarcotic analgetics, the terms of transition of the wound process phase I into phase II, promotes early activization of patients postoperatively, constitutes alternative for other methods of anesthesiological support.

[Peculiarities of the lower extremities perfusion in patients with complicated diabetic foot syndrome].

Analysis of the microcirculation indices in 246 patients, suffering diabetic foot syndrome (DFS), was presented. For a neuropathic form of DFS characteristic is lowering of the arterioles tone and enhancement of the blood volume in them, witnessed by raising of constant component of the blood flow. General worsening of perfusion is caused by lowering of endothelial secretion activation, and as well as neurogenic and myogenic control mechanisms. Occurrence of neurogenic regulation disorder is witnessed by the neurogenic oscillations lowering, the neurogenic and myogenic tone raising. In ischemic form of DFS there was noted the perfusion disorder, connected with reduction of the arterial inflow volume. The indices changes witness the disorder of sympathetic regulation of microcirculation and arteriole-venular reactions. The change of the perfusion indices, caused by a congestion processes in arterioles and venules, is characteristic for the mixed form of DFS. The perfusion control mechanisms was noted, as a consequence of the endothelial secretion lowering and the neurogenic and myogenic mechanisms activation of a control. The neurogenic and myogenic tone raising occurs depending on the sympathetic component activity, causing the arterioles diameter reduction.

[The attempt of clinical classification of the complicated diabetic foot syndrome].

The experience of surgical treatment of 1532 patients with the complicated forms of diabetic foot syndrome (DFS) was analyzed. The original clinical classification of the complicated DFS was suggested. The classification considered the clinical form (symbol "C"), anatomic localization (symbol "Z") and etiology (symbol "E"). The classification allows to define surgical tactics depending on concrete complications of the DFS, frames conditions for the unification and uniform registration of the form and severity of the disease and volume of the surgical treatment.

[Correction of the immune disorders in patients with diabetes mellitus type II with complicated diabetic foot syndrome].

There were examined 86 patients, suffering mixed form of diabetic foot syndrome. In all the patients diabetes mellitus type II was diagnosed, the disease duration have constituted (12.3 +/- 2.5) yrs at average. The immune status was estimated, using determination of the lymphocytes subpopulations with the help of the monoclonal antibodies towards antigens reaction by the flowcytometry method, as well as concentration of the main classes of immunoglobulins IgA, IgM, IgG. The investigation was performed in dynamics: immediately after a patient admittance to hospital, on the 7 - 8th, 12 - 16th and 25 - 30th day. Basing on the analysis of the data obtained, there was conclusion made, that immediately after admittance to the hospital in the patients, suffering complicated diabetic foot syndrome, the disorders of cellular immunity of degree II and of humoral immunity of I degree were revealed. The indices improvement were noted while application of certain immunocorrecting therapy.

[Original clinical classification of a complicated diabetic foot syndrome].

Original clinical classification of a complicated diabetic foot syndrome (DFS), based on summarizing of experience, concerning surgical treatment of 1532 patients, suffering complicated DFS, was proposed, necessitating determination of clinical form (symbol C), anatomic localization (symbol Z) and etiological factor (symbol E) of the lower extremity tissues affection. The classification applied permits to choose a surgical tactics depending on presence of specific complication of DFS, and this creates conditions for unification and universal registration of form and severity of a complicated DFS, as well as the volume of a surgical aid

[Complicated course of diabetic foot syndrome. An attempt to create the new classification concerning necrotic-purulent complications severity].

There was analyzed in detail a current state of diabetic foot syndrome (DFS) problem. In spite of that DFS constitutes the discrete nosological entity, it is not included into International Classification of the Diseases (ICD-10). The absence of classification of complicated DFS does not permit to elaborate protocols of the patients treatment standards and to determine real terms of their stationary treatment. Basing on analysis of the work experience of Purulent-septic center, owing hospital beds for the treatment of patients, suffering DFS, concerning diagnosis and treatment of more than 1500 patients with the DFS complications, the original classification of complicated DFS was presented by the authors, which is proposed for discussion in a wide round of specialists.

[Application of discrete plasmapheresis in complex treatment of patients with sepsis].

There were examined 226 patients, in whom sepsis had occurred as a consequence of purulent-inflammatory diseases of soft tissues. The discrete plasmapheresis application in complex of intensive therapy had promoted the rapidest elimination of homeostasis disorders in the survived patients, but the influence on the lethality level was not revealed.