Зоряна Кіт

У статті проаналізовано діагностичний клінічний досвід комплексного ультразвукового обстеження в контексті верифікації пухлиноподібних захворювань яєчників у жінок репродуктивного віку. На основі аналізу даних джерел наукової літератури та матеріалів 158 медичних карт пацієнток репродуктивного віку, обстежених та пролікованих протягом останніх трьох років стверджено валідність діагностичних заходів. Усім пацієнткам проведена комплексна трансабдомінальна і трансвагінальна ультрасонографія на апаратах, забезпечених функцією кольорового доплерівського картування та імпульсно-хвильовою доплерометрією. Сучасними дослідженнями доведено, що діагностика пухлиноподібних ураження яєчників повинна включати, за необхідності, особливо для визначення проростання пухлини в прилеглі органи, тривимірне ультразвукове сканування, яке має більшу чутливість та специфічність і дозволяє з більшою ймовірністю визначати морфологічну структуру утворення, що є вирішальним у виборі тактики і методу лікування.

In the pathogenesis of chronic infectious fungal processes, an important role is determined by the weakening of the body's protective factors. There are "endogenous and exogenous factors" that contribute to the transformation of fungi from vegetation to pathogenic. Endogenous factors (age, general infections, metabolic diseases, hypo- and avitaminosis, metabolic syndrome, gastrointestinal diseases, neuropathy) are define some clinical variants. Destructive fungal lesions predominate in middle-aged and elderly people, in elderly patients "surgical nail pathology" is half of all observations of purulent-necrotic chronic lesions of the distal parts of the hand and foot. The purpose of the work was to introduce minimally invasive nail removal or resection of nails by block-shaped eponychectomy access with the use of pedicure instruments, study of biochemical changes in the background of pathology, detection of correlations between hypo- and avitaminosis with the development of destructive onychomycosis. It has been established that conservative, podiatric and orthopedic treatment of mycotic surgical lesions and secondary nail incarnation are not very effective, while some classical methods are Dupuytren's nail removal, Emmert-Schmiden operation and others in 2-20% of cases (depending on the absence or presence of onychocryptosis and associated fungal lesions) determine recurrences. Instead, the proposed low-trauma removal or resection of nails by block-shaped eponychectomy access using pedicure instruments, excision of dermatophytoma with partial marginal matrixectomy, which significantly reduces the number of recurrences of ingrowth (respectively 1-3% in the early stages and, 3,25% та 6,42% periods of growth, χ2 = 28,17, p<0,01) and determines the improvement of quality of life. The study of endothelial function revealed the presence of endothelial dysfunction in most patients, which confirms our previous studies and literature data. Blood lipid spectrum was significantly higher in both groups of patients (main and comparison group), compared with almost healthy individuals (p<0.01 for both groups, compared with controls), which is consistent with the literature. It was found that the supply of vitamins B1, B2, PP, B6 and C directly correlated with the severity of the underlying disease. In patients with polyonychomycosis with significant symptoms of background polyhypovitaminosis, some purulent complications of mycotic onychodestruction were detected – subungual abscess / panaritium, complicated nail incarnation and mycotic-associated paronychia with purulent onychia / onycholysis of more than three nail plates. For comparison, in the other half of the sample of persons with less pronounced symptoms of polyhypovitaminosis, some purulent complications were found in only 37.5% of the subsample, which suggests that there is a relationship between the manifestations of multivitamin deficiency and the severity of necrotic complications. Low-traumatic mobilization of the nail through a block-like eponihectomy and nail plates removal or resection (some nail incarnation) of through areas of onycholysis/onychomadesis, or resection of nails through hyperkeratosis / onycholized structures using our methods, according to our complex analysis, due to reduction of intraoperative injury, determines increasing the rate of wound healing (χ2=32,14, p<0,01) and statistically significant minimization of the risk of mixed and reinfection of adjacent anatomical structures.

It is known that the main causes of decubital ulcers (bedsores) are ischemia and neurotrophic soft tissue pathology caused by chronic local compression, nutritional disorders, urinary and fecal incontinence, metabolic disorders. Significant risk factors are the presence of diabetes mellitus, a condition after suffering a cerebral circulation disorder, and other neurological pathology, in patients with insufficient or inadequate care. In addition to decompression of problem areas, periodic changes in the spatial position of the body in combination with antiseptic treatment in complex therapy should take into account the nutritional state, circulation, microcirculation and oxygenation in tissues, skin moisture (excessive humidity increases the risk), neurodegeneration, the stage of process, local diaper rash and maceration. The aim of the work. To optimize and improve the results of treatment of stage I-II bedsores with diaper rash, maceration, exematisation and epidermis desquamation by local therapy using clinoptilolite-based powders and to substantiate the prospects of using this method in clinical practice. The main study group over 3-year period consisted of the results of complex treatment of 28 patients, age 72-87 years: 17 women and 11 men with I-II stages of bedsores with diaper rash, maceration, local exematisation and desquamation of the epidermis and formation of superficial ulcer. The control sample consisted of the results of the treatment of 32 patients with decubital ulcers I and II stages, who were treated inpatient in the palliative care departament of the municipal non-profit enterprise "4th City Clinical Hospital" in Lviv with the use of antiseptic remediation, use of streptocid and metronidazole containing powder according to generally accepted recommendations, clinical strategies, and local protocols.Patients in the main group performed sequential repair of the wound surface with a 3% solution of hydrogen peroxide, 20% chlorhexidine bigluconate solution and sprinkling extratemporally prepared powder containing fucorcin (17 patients) or brilliant green (11 other observations). Patients in the control group were sequentially sanitized with a 3% solution of hydrogen peroxide, 1% polyvidone iodine solution, and an extratemporally prepared powder, which, in addition to the adsorbent, contained powdered white streptocide and powdery metronidasole. During daily dressings repeated repairs were carried out – washing with antiseptics of maceration sites, drying with sterile gauze wipes and filling with powder. Patients with type II diabetes have insulin resistance and deviations from laboratory parameters. The criterion for the effectiveness of care and treatment was to reduce exudation with marginal epithelialization, and (or) crust formation. In the patients of the main group, the rate of healing of wounds and macerated areas was 4.8±0.12%, in the control group – 3.2±0.25% (χ2=28.62, p<0,01). In patients of the main group with cytological examination on 3, 5 and 12 days after the initial debridement in the smears of maceration areas consistently decreased the leukocytes, appeared macrophages and fibroblasts. In the control group at 5 days after primary debridement, segmental leukocytes were prevailed, cytological signs of regeneration were less pronounced (degree of exposure, χ2=31.12, significance level, p<0.01). On day 15, we observed the correction of sites of bedsores I and II stages with maceration and local epidermis desquamation in all patients of the main group and 60.71% of the of the control group. It is stated that clinoptilolite actively adsorbs of the wound secretions and bacterial toxins from the maceration surface and superficial I and II stages decubital ulcers, releases into the wound pre-adsorbed antiseptics, which are part of the proposed powders and have a pronounced antibacterial development, when is optimal for reparative processes and the healing environment that promotes healing of the superfitial pressure ulcers.Key words: pressure ulcers, stage I-II bedsores, diaper rash with maceration sites, exematisation and desquamation, clinoptilolite-containing powder, complex treatment