RESUMEN
Chronic pain syndrome in patients presenting with lower-limb critical ischaemia may have considerable significance in progression of the degree of limb ischaemia, and quality of life of patients appears to be largely determined by adequate analgesia. Currently, there is no 'gold standard' of therapy for chronic pain syndrome in critical lower-limb ischaemia, which makes it necessary to search for new effective and safe methods of analgesia. The purpose of this study was to evaluate efficacy and safety of paravertebral analgesia compared with epidural analgesia in therapy of chronic pain syndrome in critical lower-limb ischaemia. Our prospective randomized double-centre study included a total of 40 patients suffering from atherosclerotic-genesis critical lower-limb ischaemia and pronounced unilateral pain syndrome. The patients were randomized into two equal groups comprising 20 patients each. They were comparable by the main clinical and demographic parameters, as well as by the scope of the comprehensive treatment performed. In the study group, therapy of chronic pain syndrome was provided by the method of paravertebral analgesia, with the comparison group patients receiving epidural analgesia. Paravertebral analgesia was performed with the use of ultrasound navigation, in the prolonged mode by means of using microinfusion elastomeric pumps, epidural analgesia - according to the standard technique. The use of various methods of analgesia was accompanied by a decrease in chronic pain syndrome according to the visual analogue scale by 60% within the first 24 hours, and by 65% at 72 hours thereafter, with the differences being statistically insignificant. The use of prolonged paravertebral analgesia was accompanied by neither considerable haemodynamic reactions nor the development of the motor block, however requiring significant expenditure of a local anaesthetic. The conclusion was drawn that paravertebral analgesia in lower-limb critical ischaemia turned out to be a safe and efficient method of comprehensive therapy of chronic pain syndrome.
Asunto(s)
Dolor Crónico , Bloqueo Nervioso , Dolor Crónico/terapia , Humanos , Dolor Postoperatorio , Estudios Prospectivos , Calidad de VidaRESUMEN
The study was aimed at assessing possibilities and determining diagnostic significance of the method of contrast-free magnetic resonance phlebography (MR phlebography) in diagnosis of diseases of the inferior vena cava (IVC) and its basin. Presented herein is experience with examining a total of 74 patients at two therapeutic-diagnostic facilities: the National Medical Surgical Centre named after N.I. Pirogov and the Medical Diagnostic Centre "Ramsey Diagnostics". The studies were carried out on magnetic resonance tomographs "Philips Intera Nova" and "GE Optima MR360", using a special protocol of contrast-free MR-phlebography in consequences at free breathing, followed by 3D reconstruction and processing of the obtained images as MIP and 3D. According to the obtained results our method makes it possible to visualize the anatomical passage of the vessels of the IVC basin, interrelationship with adjoining structures and osseous elements, to determine localization of the thrombus, its length, diameter of the vessel and degree of its narrowing at the level of the lesion, as well as to assess the collateral outflow without contrast enhancement. The sensitivity of the method in thromboses of the IVC basin veins amounted to 92%, with the specificity amounting to 90%. Hence, contrast-free MR phlebography is the most optimal screening method requiring no contrast medium, short in time and absolutely safe procedure in diagnosing the causes of extra- and intravasal pathology of the IVC and its basin as compared with ultrasonographic examination, contrast-enhanced phlebography, computed tomography (CT) and contrast-enhanced magnetic resonance tomography.
Asunto(s)
Angiografía por Resonancia Magnética/métodos , Flebografía/métodos , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Adulto , Anciano , Investigación sobre la Eficacia Comparativa , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Sensibilidad y Especificidad , Vena Cava Inferior/patología , Trombosis de la Vena/fisiopatologíaRESUMEN
The authors assessed the effect of a micronized purified flavonoid fraction (MPFF) on the course of the postoperative period after endovenous thermal ablation (EVTA). The patients of the Study Group matching by the main studied parameters to the Control Group patients were given the MPFF according to the suggested regimen for 7 days. The obtained results were analysed by means of questionnaires (CIVIQ, VCSS, VAS) and ultrasound angioscanning. The obtained findings were statistically processed by means of the program Statistica 6.0 and reliability of the results was assessed with the help of the Student t-test. Patients of the both groups showed complete stable obliteration of the target veins. No statistically significant differences of the items of the questionnaires CIVIQ and VCSS at the beginning of the study and at the last examination were revealed, differences were noted on days 2-14 after EVTA and were not statistically significant (p>0.05). Phlebotrophic therapy in the postoperative period after EVTA helps to decrease phlebitic alterations in the coagulated vein, to improve motor activity and mental psychoemotional state of the patients.
Asunto(s)
Embolización Terapéutica , Flavonoides/administración & dosificación , Coagulación con Láser , Dolor Postoperatorio/prevención & control , Flebitis , Várices , Insuficiencia Venosa , Adulto , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Femenino , Humanos , Coagulación con Láser/efectos adversos , Coagulación con Láser/métodos , Masculino , Persona de Mediana Edad , Flebitis/etiología , Flebitis/prevención & control , Periodo Posoperatorio , Recuperación de la Función/efectos de los fármacos , Vena Safena/diagnóstico por imagen , Encuestas y Cuestionarios , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex/métodos , Várices/complicaciones , Várices/terapia , Insuficiencia Venosa/etiología , Insuficiencia Venosa/terapiaRESUMEN
Presented herein are the results of studying the optical density of water, blood, and venous-wall tissue for various-wavelength laser radiation, with determining the peaks of absorption of radiation by the above-mentioned media. The absorption peaks in water and blood correspond to wavelengths of 1,450 and 1,935 nm, respectively. Peaks of absorption in the venous-wall tissue are within the intervals equaling 650-950 nm, 1,445-1,455 nm, and more than 1,900 nm. Also determined was the optical density of the veins for the most frequently used in clinical practice wavelengths, i. e. 1,030 and 1,470 nm, with the calculation of the portion of the absorbed energy depending on thickness of the layer of the absorbing substance. Based on the obtained findings, a conclusion was drawn on better utilization of the energy of one-and-a-half-micron range laser radiation and on its preferable use for endovenous laser obliteration (EVLO).
Asunto(s)
Colágeno/efectos de la radiación , Procedimientos Endovasculares/métodos , Hemoglobinas/efectos de la radiación , Terapia por Láser , Rayos Láser , Venas/efectos de la radiación , Colágeno/fisiología , Diseño de Equipo , Hemoglobinas/fisiología , Humanos , Terapia por Láser/instrumentación , Terapia por Láser/métodos , Terapia por Láser/normas , Rayos Láser/clasificación , Rayos Láser/normas , Fenómenos Ópticos , Várices/patología , Venas/fisiologíaRESUMEN
This article deals with the problem of venous wall perforation during endovenous laser ablation (EVLA). The sinusoidal type of painful syndrome which arises on 4-7 days after EVLA was shown. A series experiments on the isolated veins using two different lasers were performed. It was demonstrated that vein is squeezed around the fiber during injection of tumescent liquid, which leads to the formation of isolated intimal sinuses. When the blood closed in such sinuses is exposed to laser radiation, it is released of large amounts of gas, which in turn leads to the rupture of the venous wall. Of the earlier idea of perforation of the venous wall with over heated fibre tip has not received confirmation.
Asunto(s)
Procedimientos Endovasculares/efectos adversos , Terapia por Láser/efectos adversos , Dolor/etiología , Várices/cirugía , Venas/lesiones , Humanos , Dolor/diagnóstico , Dolor/fisiopatología , SíndromeRESUMEN
The new method for microbiological analysis of blood in patients with pyoseptic infections is based on separate inoculations of plasma, erythrocyte mass, and leukocyte layer in nutrient medium providing conditions for growth of a wide spectrum of aerobes and obligate anaerobes. The method in general ensures a more rapid result and permits differentiation between true and false-positive bacteremia and between stages of septic process (bacteremia and septicemia).
Asunto(s)
Bacteriemia/microbiología , Endocarditis Bacteriana/microbiología , Sepsis/microbiología , Bacterias/aislamiento & purificación , Técnicas Bacteriológicas/normas , Técnicas Bacteriológicas/estadística & datos numéricos , Medios de Cultivo , HumanosRESUMEN
Great surgical aggression in operations on the heart and resulting immunodeficiency create prerequisites for the appearance and grave course of infectious complications. The authors have analyzed results of operative treatment of 100 patients with acquired valvular diseases. It has been established that low parameters of the resistance index of organism (RIO) before operation can be estimated as an unfavourable prognostic sign of the development of infectious complications. The RIO dynamics at the postoperative period in many aspects reflects the character of its course. RIO and the indices of the adaptation reaction show the degree of intoxication, make the clinical estimation objective, allow the assessment of efficiency of therapy and correction of medical prescriptions.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Infección de la Herida Quirúrgica/diagnóstico , Adaptación Fisiológica , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/inmunología , Endocarditis Bacteriana/fisiopatología , Endocarditis Bacteriana/cirugía , Femenino , Humanos , Inmunidad Innata , Masculino , Pronóstico , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/inmunología , Cardiopatía Reumática/fisiopatología , Cardiopatía Reumática/cirugía , Factores de TiempoRESUMEN
The review deals with the causes and main agents of the hospital infection occurring in surgical units. Special attention is given to the formation of the hospital isolate of the agent. A method of prevention of postoperative infective complications by vaccines prepared of these particular isolated has been proposed.