An anal fissure is one of the most common diseases of the anal canal with the incident rate of 20–23 cases per 1000 citizens. Most of acute anal fissures are healed spontaneously but a few of them can become chronic process. Chronic anal fissures are characterized by any two of the criteria: pain after defecation lasts longer than 3 months, sentinel pile is present, fibers of internal sphincter at the base of the anoderm.The spasm of the internal sphincter is a guiding pathogenetic mechanism in the development of chronic anal fissures. It leads to circulatory disorder in the anoderm and non-healing wounds. Therefore, the treatment of anal fissures primarily must be focus on eliminating of internal sphincter spasms and then excising of fissures.Recently, botulinum toxin type A injection in treatment of chronic anal fissures has become popular as a noninvasive method of eliminating internal sphincter spasms.Botulinum toxin as a medical agent has been studied since the late 1960s. Botulinum toxin type A has been used to treat of various pathologies including coloproctology diseases for more than 40 years.The botulinum toxin injections make the internal sphincter relax, and as a result create optimal conditions for healing chronic anal fissures.Using of botulinum toxin type A does not cause dangerous complication. Fecal incontinence after using botulinum toxin is transitory.The review describes the use of botulinum toxin type A injections to treat chronic anal fissures.
Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p <0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p < 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p < 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p < 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p < 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p < 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p < 0.05).Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.
Introduction. The simplicity of the sclerotherapy procedure, its high efficiency and low cost along with the possibility of performing the procedure on an outpatient basis stimulate the widespread use of the method.Objective of the study. Examine the current state of actual clinical practice regarding the treatment of patients with varicose veins using the sclerotherapy procedure.Materials and methods. An anonymous survey of 162 doctors, members of the professional community of specialists engaged in the treatment of venous diseases was performed. It comprised 15 questions concerning the features of the sclerotherapy procedure and following up of the patients.Results and discussion. The lack of clear-cut standardization for sclerotherapy in the regulatory documents contributes to the significant heterogeneity in the approaches of specialists to the performance of the procedure. The views on the use of sclerotherapy to remove perineal varicose veins (routinely performed only by 25.3% of physicians) and the upper extremity veins (less than 4%) turned out to be controversial. There were significant differences in the therapeutic approaches to the administration of anticoagulants by the patients (refusal in the procedure – 26.3% of respondents, discontinuation of drugs during sclerotherapy – 7.5%). Approximately a third of the respondents regularly exceed recommended 10 ml-volume of foam per session, there is no consensus on the choice of the needle diameter, drug concentration even in the similar clinical situations. About half of them have experience in using glucose as the sclerosant, every third – in using a transcutaneous laser, 5.6% – in using the mechanochemical obliteration techniques that are not currently certified in the Russian Federation. The use of compression therapy after sclerotherapy is not standardized; the regulatory documents provide contradictory durations of its use, which is due to the weakness of clinical research data on this issue. Up to 99% of physicians observe pigmentation, 83.2% – development of secondary telangiectasias and 60.2% – superficial necrosis in their practice. These circumstances arouse legal suspicion in relation to this type of treatment and the legal vulnerability of physicians. At the same time, physicians need to be more informed about the current requirements for some issues.Conclusion. The current legislation regulating the practical aspects of the sclerotherapy considers it largely through the lens of medicine, ignoring a significant cosmetic component. It is necessary to work out the provisions describing the specifics of cosmetic manipulations performed by the phlebologists, and the need for more detailed familiarization with the regular updates of the guidelines.
Subungual melanoma is a rare malignant tumor, little known to practitioners. Its location makes diagnosis difficult and requires differentiation with conditions such as onychomycosis, panaritium, hematoma, etc. Unsymptomatic onset brings more problems, the error level during visual examination even among experienced oncologists reaches 25–40%, and the average life expectancy of patients with fully manifested melanoma is limited to 3–4 years.So we present a clinical case to emphasize the need for oncological alertness during an outpatient examination of the subungual lesions. A 32-year-old woman came to the reception complaining of a non-healing bleeding, relatively painless wound of the left little toe. The condition was associated with trauma, for about a month she treated the wound herself, “cauterizing” it with antiseptics.After outpatient treatment of a granulating wound, the material was sent for histological diagnosis, which showed the presence of pigmentless melanoma in the stage of active growth. The woman was urgently hospitalized in the oncology department, where 5th finger exarticulation and inguinal-iliac lymphadenectomy were performed successfully. After this, the condition remained stable, but 14 months later there was a formation in the area of the postoperative scar. A study of a new surgical material confirmed the recurrence of malignant melanoma with Clark invasion level 2.In our opinion, outpatient surgeons should not delay histological examination for all ulcerative and granulomatous lesions of the feet, which will improve the differential diagnosis.
Introduction. The adjustable non-extensible compression bandage is a new product recently registered and approved for clinical use in the Russian Federation. The main indications for its use are severe chronic venous insufficiency and lymphedema, which cannot be corrected with traditional bandages and flat knit medical compressions. On the affected limb, an adjustable, non-extensible compression bandage allows high working pressure to be created at low, approaching zero, resting pressure. And depending on the tension of the velcro fastener, the working pressure can be adjusted between 20 and 50 mmHg or more. At the same time, the patient can maintain the actual pressure independently, regardless of the reduction in the volume of the limb. Low resting pressure makes it possible to use this type of bandage all day without the discomfort that is typical for traditional bandages and therapeutic compression knitwear felt by patients during sleep.Clinical case. Patient diagnosed with chronic lymphovenous insufficiency in both lower limbs. CEAP class C5 on the left, CEAP class C5 on the right. After undergoing acute iliofemoral thrombosis on the left, complicated by thromboembolism of small branches of the pulmonary artery, he was treated in a specialized vascular unit, where anticoagulant, antiplatelet and phlebotropic therapy was carried out. After the second episode of deep vein thrombosis, pain in the lower extremities, swelling of the tibia, skin itching and the appearance of small trophic ulcers started to worry, which temporarily closed against the background of increased compression therapy, prescription of phlebotropic drugs and local treatment. Subsequently, large trophic ulcers were formed on the inner surface of both shins above the ankle joint. An adjustable, non-extensible compression bandage was used on the right shin to correct chronic venous insufficiency and heal a trophic ulcer. The use of an adjustable, non-extensible compression bandage within 2 to 4 weeks resulted in the disappearance of chronic swelling, reduction of the pain syndrome, and then 5 months later – led to a reduction in trophic ulcer and the disappearance of infection signs.Conclusions. This clinical case of the successful closure of a large infected trophic ulcer that occurred after deep vein thrombosis against the background of coxarthrosis and which remained unhealed for 7 years clearly illustrates the broad possibilities of an adjustable, nonextensible compression bandage.
Introduction. Russia has a high mortality rate of cutaneous melanoma – 2.5 per 100,000 population whereas the incidence rate is 7.7 per 100,000 population, i.e. one in every three patients dies. In the foreign countries (the USA, Australia), melanoma mortality rate is 10-15%. Such high rates are explained by the fact that patients with early-stage disease do not seek medical advice, as in early stages a tumour does not cause inconvenience to a patient and looks like an ordinary mole.The purpose of the study was to confirm the advisability of removing a progressive dysplastic nevus (grade 3 lentiginous melanocytic dysplasia) with a view to prevent and make early diagnosis of cutaneous melanoma.Materials and methods. The authors removed 180 pigmented lesions that were clinically diagnosed as a progressive dysplastic nevus in the Surgery Department of Central Polyclinic of Literary Fund from 2009 to March 2020. The patients were referred to the Surgery Department by physicians, dermatologists and other specialists of the polyclinic. Following an oncologist consultation, excisional biopsy of a nevus was performed under local anesthesia.Results. Histological examination revealed 29 (16%) dysplastic nevi with grade 3 LMD and 18 (10%) early-stage melanomas.Conclusions. If excisional biopsy of a dysplastic nevus becomes routine in Ambulatory Surgery practice, it will increase the early diagnosis of melanoma and significantly reduce mortality rates of this disease. For excisional biopsy, the authors recommend to excise at a distance of 0.5 to 1.0 cm from the lesion boundaries, since it is not possible to clinically distinguish a progressive dysplastic nevus from early melanoma.
The article provides an overview of modern literature on the problem of etiology, pathogenesis and principles of complex therapy of chronic venous insufficiency. Data on possible surgical correction methods of this pathology are given. Also, modern tactics assign a significant role to pharmacotherapy, and an overview of the phleboprotectants used is given. Efficiency of compression therapy application is evaluated. A critical review of literature of modern compression agents was carried out, advantages and disadvantages of elastic binting, compression knitting and application of variable compression are described. In comparison with elastic bandages, compression knitting has a number of advantages, such as: patients independently and correctly use compression laundry, the created therapeutic pressure does not depend on the correct application of compression, is more convenient and aesthetic when wearing, is air-permeable and can be used at any time of the year. Evaluation of efficiency of application of compression knitwear in therapy of chronic venous insufficiency is given. The effect of the compression article is due to a decrease in capillary permeability, a decrease in blood viscosity, which leads to a decrease in edema, lymphoprotective action and an increase in vascular wall tone. Modern means of compression have proved to be effective due to the polyvalent mechanism of action on all factors of disease pathogenesis, high bioavailability and minimal side effects. Early application of compression knitwear allows to buy or reduce clinical manifestations of venous insufficiency and its complications, as well as to influence indicators of patients quality of life. Detailed study of literary data will help to correctly select the method and type of compression therapy in case of chronic venous insufficiency.
Introduction. Over the last 20 years the widespread introduction of ultrasound imaging into clinical practice and the emergence of new endovascular technologies in the treatment of varicose veins have brought about a paradigm shift in the surgical treatment and the introduction of innovative minimally invasive technologies (thermoobliteration, chemical obliteration, microphlebectomy), which can be performed on outpatient basis under local anesthesia. Therefore, the widespread introduction of these technologies into the outpatient practice is the foremost task.Objective of the study. Analyse the results of the experience gained in the St Petersburg polyclinics concerning the introduction of hospital-replacing surgical treatment of varicose vein diseases and appropriate training. Materials and methods. We have performed 854 surgeries including endo-venous laser coagulation (EVLС), sclerobliteration (SO) and Varadi miniflebectomy (MF) under local infiltration anesthesia: EVLC + MF in 71%, MF in 12%, EVLC + SO in 9%, EVLC + MF + SО in 3%, EVLC in 3% and SО in 2% of cases. The patients operated on ranged in age from 19 to 78 years (53 ± 21 g), among them there were 611 women and 202 men. The clinical distribution of patients was in accordance with CEAP classification: C2 – 62%, C3 – 22%, C4a/b – 12%, C5 – 2.5%, C6 – 1.5%.Results and discussion. The evaluation of treatment results based on a retrospective analysis of patients’ examination findings after 1, 39, 180 and 365 postoperative days has demonstrated that there is no evidence of intra- and postoperative complications requiring hospitalization, disease recurrence. However, ecchymosis in 35% of cases, limited superficial infiltrates - in 18%, limited superficial thrombophlebitis - in 0.8% have been reported after MF. They have been treated using topical agents. According to the questionnaire, after a year of treatment 96% of patients appear to be satisfied with the results obtained. After a year payback financial costs have been achieved. An effective practical training program has been developed and implemented for innovative technologies for surgery of varicose veins of lower extremities. 42 physicians of outpatient clinics underwent the program.Conclusions. It can therefore be concluded that the further introduction of innovative technologies into the polyclinics is reasonably practicable as it is safe, effective, expands the population’s access to modern technologies, is economically feasible and is perceived positively by patients, reduces the burden on surgical hospitals, improves professional qualifications and expands the professional competencies of surgeons in outpatient settings.
Introduction. The market presents a huge amount of topical preparations, which manage the clinical manifestations of hemorrhagic disease, and there is also no shortage of means that affect post-operative pain. However, there is no single consensus of patient management in the preoperative period, and there is no generally recognized protocol for the treatment of pain after hemorrhoidectomy.Aim. To determine the effectiveness of using Fleming’s ointment during pre- and post-surgery in patients with 3–4 grade hemorrhoids.Material and methods. 85 patients with a diagnosis of hemorrhoids III–IV grade were divided into 2 groups. The Milligan-Morgan’s hemorrhoidectomy using standard electrocoagulation methods under intravenous anesthesia was performed in all patients. Fleming ointment was used as a topical agent for 2–3 weeks before the operation and for 2.5 weeks after the operation in Group A (43 patients). In group B (42 patients), depending on the prevalence of symptoms, suppositories with phenylephrine, lidocaine, local, hormonal ointments were used, also Liniment Levomekol was used as a local therapy after surgery in the group B. The results were evaluated according to the following criteria: Pain level, symptoms’ degree of the disease against the background of the use of local agents was evaluated by VAS. The multiplicity of the introduction of NSAIDs in 2 groups was considered. The adequacy of the wound healing correlated with the duration of maintaining inflammation in the wound, we also considered the daystay and days of disability.Results. Pain level according to VAS on the 1, 3, 7, 12 days after surgery in patients from group A is 0,6 points lower than in patients from group B. The average number of NSAIDs intake in the postoperative period in Group A was 1,4 times less than in Group B. There was no significant difference in wound reaction, day-stay and days of disability. The symptoms of hemorrhoids, estimated by VASh, were significantly less pronounced in patients who used Fleming ointment (see table 0)Conclusions. Fleming ointment can be recommended as an adequate topical agent in the perioperative management of patients with 3–4 grade hemorrhoids.
The article is a discussion of the advantages of a patient’s position during an ultrasound examination of the lower-limb venous system. The presented material is intended to objectively assess the advantages of this or that position of an examined patient in order to obtain necessary information about the state of the veins of the lower limbs from the position of doctors who have years of experience in diagnostics and treatment of acute and chronic diseases of the lower-limb venous system. The material of the article is primarily designed for doctors who, in addition to the ability to use an ultrasound scanner to some extent, know about venous hemodynamics and can afford to think outside the generally accepted concepts and clinical recommendations.The characteristics of the state of the lower-limb venous system at vertical and horizontal position of the patient are given. Schemes of venous pressure distribution in the system of the inferior vena cava in the horizontal and vertical position of the patient are presented. Methods of manual compression of the muscular mass and straining at different patient positions are described.The vertical position of the patient (or sitting position) is the most reliable way to identify the peculiarities of anatomical structure and pathological changes of the subcutaneous vein walls, which may be of great importance for planning and carrying out subsequent invasive manipulations, but there is a question about the expediency of making linear measurements in this position, if the invasive intervention is carried out while lying down. Carrying out compression ultrasound, assessment of hemodynamic parameters of venous blood flow, including the use of samples with straining and manual compression of muscle masses of the limb, it is much more convenient to perform in the lying position.
Introduction. Constipation is one of the most common human diseases. Doctors in England consider constipation a “secret national problem” because 50% of the population takes laxatives.The aim of this work was the introduction of chronomedicine approach to the problem of constipation.Method the study was chronoenterographia – week monitoring of the circadian rhythm of defecation.Materials. More than 2,500 people aged 24–75 years, 66% of women, were examined. The frequency and acrophase of the defecation rhythm and quality of life were analyzed.Results: circadian regular defecation rhythm (Euenteria – 7 times/wk) and irregular (Bradyenteria – 1–6 times/week) was isolated. It is shown that the presence of the morning phase of the defecation rhythm contributes to its regularity, and the absence of this phase increases the risk of constipation by 4 times. The earlier defecation occurs – the less often constipation occurs. Euenteria associated with a high level of quality of life, but Bradyenteria – on the contrary. According to the frequency of defecation, there are 3 stages of Bradyenteria: light (5–6 times/week), moderate (3–4 times/week), severe (1–2 times/week, constipation). The Roman-IV criteria for constipation recommend diagnosing only the severe stage of Bradyenteria (less than 3 times/week), and the first 2 stages of it are not diagnosed.Conclusion. Late diagnosis of constipation leads to complications: hemorrhoids, diverticulitis and colorectal cancer. For the regularity of defecation, the contribution of timely stool phase is commensurate with the complex of adequate nutrition, sufficient physical activity and optimal sleep. In order not to suffer from constipation, you need to know about regularity, timeliness and complexity. In outpatient surgery, polyethylene glycol, psyllium and sodium picosulfate are most often used to restore the regular rhythm of defecation.
Hemorrhoids is one of the most common diseases in human. According to the latest data for 2017, the prevalence rates of hemorrhoids per 100 000 population in Russia are 410,3 in adults, 26.7 in children aged 15 to 17 years and 4,0 in children under 14 years old. Quality of life (QoL) is an important non-specific subjective parameter of well-being, representing an integrative characteristic of the physical, psychological, social and emotional status of the patient. Despite the high prevalence of hemorrhoids and the variety of modern methods of surgical treatment, there are very few studies addressing the QoL in this category of patients. There are significant differences between the patient and the Coloproctologist in the perception of HD, which, possibly, can lead to the hypertrophy of indications for surgical treatment. Understanding the effect of HD on social life and the concept of the well-being of a particular patient can help the doctor choose between conservative and surgical approaches in the treatment of hemorrhoids. On the other hand, due to the excessive shyness and mentality in our country, patients with HD tend to adapt to their disease, which leads to later seeking medical help and suboptimal efficacy of conservative therapy and minimally invasive surgical methods.This review presents the first Russian multicenter observational program EQUALISER (impact of different trEatment modalities on QUAlity of life of the patientS with acute and chronic hEmorRhoid disease) aimed at assessing the QoL of patients with HD, as well as the effect of the treatment method and types of surgical treatment on the social adaptation of the population.
Introduction. The vast majority of recommendations for conservative treatment of patients with chronic hemorrhoids contain recommendations for the use of systemic drugs with venotonic and angioprotective properties and the use of topical drugs to treat and prevent exacerbation of the disease. The action of the main components of the topical drugs used is aimed at controlling local inflammation, implemented through various mechanisms. The choice of a drug is mainly subjective.Aim of the study. Comparative clinical evaluation of the effectiveness of topical drugs for the treatment of chronic hemorrhoids.Materials and methods. There are two treatment schemes that are distinguished by the type of the drug that is used. The main group includes patients in treatment of whom a combined preparation based on lidocaine and fluocortolone in the form of rectal suppositories manufactured by Bayer (221 (50.6%) patients) was used. In the control group – a combined preparation on the basis of tribenoside and lidocaine in the form of rectal suppositories by Recordati company (216 (49,4%) people). The rate of suppositories administration and duration of their use was 21 days. Clinical efficacy was estimated by the rate of regression of the main clinical manifestations of the disease: bleeding, pain syndrome, discomfort.Results and discussion. By the 14th day of treatment with Bayer preparation, bleeding as the main sign of disease exacerbation persisted in 15.2% (5) of the main patients against 26.7% (8) of the control group patients. Positive effect was obtained in the majority of patients with the initial prevalence of pain syndrome. On the 14th day the pain remained in 17.0% (8) patients of the main group against 27.9% (12) of the control group. Sense of discomfort was preserved in 10% (4) of the main group patients against 15.8% (6) of the control group patients. Regression of combined clinical manifestations of the disease in the comparison groups showed the fastest elimination of inflammation in the main group in 79.4% of patients against 73.0% in the control group on the 14th day of treatment.Conclusions. Thus, the use of Bayer preparation allowed ensuring the regression of the main clinical manifestations of the disease in a shorter time. This drug can be recommended for use in complex treatment of chronic hemorrhoids in everyday clinical practice.
Recently collated scientific data on the management of C1 clinical class of chronic venous disorders; wide prevalence of the disease and high variability amongst medical practitioners in relation to managing this category of patients and absence of any regulatory documents has prompted the development of clinical guidelines for the treatment of patients with reticular varicose veins and telangiectasias of the lower extremities and various parts of the body. These guidelines have been developed by a self-regulated organization Association “The National College of Phlebology”. The purpose of the de novo guidelines is to systematize the existing evidence and offer minimal standards of care for chronic venous disorders in C1 patients.
An actual problem in surgical practice is paresis of the gastrointestinal tract, the main manifestation of which is constipation after surgical treatment. Treatment of postoperative gastrointestinal paresis, which is manifested primarily by constipation, should be comprehensive and, if necessary, patients are shown taking laxatives to stimulate bowel function.Sodium picosulfate is one of the most commonly used and effective drugs, belongs to the group of synthetic stimulant laxatives. The above review noted the safety and effectiveness of sodium picosulfate for atonic constipation, for regulating stool (hemorrhoids, proctitis, anus cracks), for preparing for surgical operations, instrumental and radiological examinations.The presence of picosulfate in the clinic and hospital surgeon’s arsenal makes it possible to optimize the drug therapy in surgical patients with constipation syndrome at the hospital and outpatient treatment stage.
Introduction. This article is devoted to one of the urgent problems of modern emergency abdominal surgery – the result of surgical treatment of ulcer bleed in patients with ischemic heart disease.Undoubtedly intensive hemostatic conservative therapy and endoscopic hemostasis methods are the main treatment methods for this group of patients. However, in a certain number of patients with NGDK with various variants of IHD, such treatment is ineffective and there is a need to perform surgical hemostasis in an emergency and urgently.Surgical methods of hemostasis of NGDK patients with different variants of IHD are shown only in cases of inefficiency of conservative and endoscopic treatment methods. Among surgical interventions, radical surgeries are more preferable, which, if performed against the background of intensive resuscitation support, allow to achieve reliable hemostasis and thus avoid postoperative recurrent bleeding. Palliative surgery should be used when radical surgery is not possible due to the severity of the patient’s condition or lack of technical skill of surgeons. Finally, it is clear that in order to improve treatment results in patients in this category, correction of changes caused by the accompanying IHD is necessary.Materials and methods: In our research material, 89 out of 997 patients had such a need, which was 8.9%. It mainly corresponds to the modern literature data.Results: An analysis of the results of these patients’ palliative and radical surgical interventions clearly showed that the last ones were more preferable.The basis for this judgment was the high percentage of mortality after palliative care compared to radical care with approximately the same number of postoperative complications.In addition, it is noteworthy that postoperative complications typical of palliative care in the form of recurrent ulcerative bleeding are often fatal, because half of these patients in our observations have not experienced repeated radical interventions.Conclusion: At the same time, the necessary condition for performing radical operations is, firstly, appropriate technical skill of the surgeon, and secondly, providing the latter with intensive resuscitation support. In case of impossibility of performance of these conditions the method of a choice should serve palliative care.
Classic sclerotherapy using drugs in the native (liquid) state is almost the oldest method of minimally invasive treatment of various forms of varicose veins of lower extremities and not only. Despite more than 300 years of development of the sclerotherapy methodology, enormous international experience and almost thorough study of its mechanisms, the development of new sclerosing drugs and technologies of their delivery to the lumen of the target vein continues. Measures aimed at reducing the frequency of undesirable side effects after sclerotherapy and improving the quality of life of patients during treatment and after its completion are discussed separately. Currently, there are several guidelines that regulate phlebosclerosing treatment in various clinical situations in terms of evidence-based medicine. This publication provides a brief historical background on the formation of sclerotherapy technology, presents basic principles for liquid sclerotherapy based on the analysis of international and Russian recommendations for the treatment of chronic venous diseases. Indications, contraindications and the basic methods of carrying out sclerotherapy with the use of officinal, registered in the Russian Federation phlebosclerosing detergent agents are presented, their actual physical and chemical properties, similarities and distinctions, and also optimal concentrations and doses are discussed. The classic sclerotherapy technique which has become known as “empty vein technique” is described in detail and illustrated.In addition, current clinical examples demonstrating successful use of compression sclerotherapy are presented. Again, the authors conclude that liquid sclerotherapy with the use of modern phlebosclerosing agents such as lauromacrogol 400 and sodium tetradecyl sulfate, performed according to the classical “empty vein” technology, demonstrates high efficiency and safety regarding large varicose veins of various localizations.
Introduction: Lower extremity varicose vein disease is one of the common problems in vascular surgery. Clinically, this disease is accompanied by a wide range of complaints and external symptoms, which eventually lead to a worse patients’ quality of life. The integrated approach is being applied to the disease treatment, which involves the use of various phlebotropic drugs as conservative therapy along with minimally invasive surgical correction and sclerotherapy.Objective: to improve the quality of phlebotropic therapy for patients with lower extremity varicose vein disease, based on the study of factors that shape the patient’s compliance with the effective treatment of clinical symptoms. The term «compliance» means the precise and informed implementation of the doctor’s recommendations during the treatment by the patient. Most often, «compliance» is assessed by the drug use index, which is the quotient of dividing the number of days on which the full dose of the drug was taken by the duration of the entire study period. Materials and methods: The analysis of 368 + 111 patients with lower extremity varicose vein disease was carried out. Of these, 111 patients turned out to be beyond the correct study of compliance (a phlebectomy was performed in a hospital). 368 patients were divided into the following groups: Group 1: the patients, who were assigned modern surgical treatment of varicose veins (endovenous laser coagulation, scleroobliteration); Group 2: the patients, who withdrew from assigned interventions. As it turned out, the different groups of patients differed in compliance.Results. The patients who were shown and performed surgical treatment – 320 (86.9%), can be considered highly compliant with the prescribed conservative therapy – the average value of the compliance index is 0.83, compared to the representatives who refused to perform the recommended surgical procedures recommended by them – 48 (13.1%), the compliance index is 0.78.In the course of the investigation, the factors shaping compliance with phlebotropic drugs were identified, a comparative assessment was carried out on the main indicators of the effectiveness of phlebotropic drugs.Conclusion. Thus, the compliance of the patients suffering from LEVVV during the treatment with phlebotropic drugs varies depending on the multiplicity and convenience of the form of the drug, on the effectiveness of the proposed phlebotropic therapy according to the influence on the complaints and symptoms, on the psychological readiness of the patient to entrust the result of the final treatment of the disease to the surgeon.
Introduction. Diagnosis of Mortoan neuroma in some cases does not cause much difficulty and is based on typical signs, but in some cases it presents certain difficulties. Therapeutic tactics for this disease involves the use of conservative or surgical treatment.Aim. Study of the results of differential diagnosis of Morton’s neuroma in the practice of an outpatient surgeon.Material and methods. A study of the results of diagnostics and differential diagnostics in 15 patients with chronic foot pain at the age of 28 to 46 years was conducted. Among them, there were 14 women and 1 man. Differential diagnostics for foot pain syndromes allowed us to distinguish three groups of patients. The first group included 7 patients with Morton’s neuroma. The second group included 4 patients with plantar fasciitis and the third group-4 patients with arthritis, synoviitis of the metatarsophalangeal joints. To conduct differential diagnostics, we used anamnesis, physical examination, and data from instrumental diagnostic methods.Results. Diagnosis of Morton’s neuroma was based on the use of standard research methods (anamnesis, data from a physical instrumental examination of the foot). It should be noted the importance of ultrasound examination of the soft tissues of the foot on the plantar surface for the diagnosis of Morton’s neuroma. This allows for differential diagnosis with foot diseases such as plantar fasciitis and metatarsophalangeal joint synovitis, which may show similar symptoms.Conclusion. Morton’s neuroma is not a rare disease of the foot, which in the initial stages of the disease has a blurred clinical picture, similar to other diseases of the foot. This can lead to diagnostic errors, but the use of modern diagnostic methods, including sonographic methods, allows in most cases to establish an accurate diagnosis and choose an appropriate treatment strategy.
