Pregnancy is an important specific risk factor for the development of chronic vein diseases  in women. In addition  to the superficial veins of the lower limbs, transformation often affects the pelvic veins. The management of pregnant women with vulvar and perineal varicose veins is one of the urgent  problems of nowadays at the intersection of phlebology  and obstetrics-gynecology. The article discusses possible options for conservative treatment of women with vulvar and perineal varicose veins during pregnancy, including the possibility  and feasibility of using systemic venoactive drugs.

RETRACTED ARTICLE

The article  is devoted  to Aescusan, a well-studied preparation that  is traditionally used in clinical practice  for the  treatment of chronic  diseases  of veins,  hemorrhoids, postoperative and post-traumatic edema.  The main  active  substance is aescin  that  is contained in horse  chestnut seed  extract  - Aesculus hippocastanum. The paper  presents data  of a randomized  controlled  study demonstrating the  efficacy of Aescusan in the  treatment of chronic venous  diseases  and chronic venous  edema  along with the compression  therapy.  A number of in vitro and in vivo experimental studies provided convincing proof of efficacy of Aescusan. In particular, they proved the anti-edema, anti-inflammatory and venotonic effect of the preparation. Aescusan improves calcium ions entry into the smooth muscle cell channels  in the vascular wall, which increases  the venous vascular tone.  The anti-inflammatory effect of Aescusan is associated with blockade of prostaglandin F2 (PGF2) release from the venous wall, 5-hydroxytryptamine (5-HT) and histamine antagonism, decreased  catabolism of tissue  mucopolysaccharides. Conclusion: Aescusan has a pluripotent effect  on various pathogenetic mechanisms  of chronic venous diseases. It is known for its good tolerability and ease of use, which makes it possible  to use the preparation in patients with chronic venous diseases, hemorrhoids, and peripheral post-traumatic edema.

This review examines the development of endothelial dysfunction in chronic venous diseases  (СVD), the multifactority of this process. The important role of the nitric oxide system as a universal modulator of various biochemical reactions and realization of many important physiological  functions is shown. The need for early pharmacotherapy of phleboprotectors with endothelioprotective activity is discussed  in order to slow the progression  of CVD. Effects of flavonoids as perspective endothelioprotectors on various links in the pathogenesis of endothelial dysfunction are considered. On the example of the micronized purified  flavonoid fraction (MPFF), the effect of flavonoid compounds on endothelial dysfunction in CVD is demonstrated, and the mechanisms of action have been examined in detail. In addition, the pharmacological  effects  of individual components of the MPFF and their synergism in the focus on the effect on endothelial dysfunction are also discussed.  Features  of the micronized form that affect bioavailability and, ultimately, determine the pharmacological  effectiveness of the drug are considered.

The review presents literature on the epidemiology  of chronic venous diseases  (CVD) and chronic venous insufficiency (CVI). The main approaches to the  choice of conservative  therapy  for CVD and CVI are presented. The rationality of symptomatic treatment of this category of patients is justified. Data on clinical effects  and mechanisms  of their realization in the preparation of calcium dobesilate are given. The results  of preclinical and clinical studies to assess the efficacy and safety of calcium dobesilate in relation to the  symptomatic treatment of CVD and CVI are presented. On the  basis  of the  analysis  of literary  sources  the  conclusion  on expediency of wide application of calcium dobesilate in phlebological practice is presented.

Aim of the study. To evaluate  the clinical efficacy of sulodexide in the daily dosage of 500 LSU in patients with chronic lower limb vein diseases  of clinical classes C1-C3 according to CEAP.

Patients and methods.  This study included 35 patients with chronic C1-C3 CEAP lower limb vein disease  who took 500 LSU of Sulodexide for 90 days. In order to evaluate the effectiveness of the treatment we used: a questionnaire to assess the quality of patient’s life with chronic venous insufficiency  CIVIQ 20; visually – analogue scale of pain assessment VAS; clinical scale of venous diseases VCSS severity assessment; measuring the circumference of the limbs on the hip and shin.

Results of the study. The study was completed  by 32 patients. As a result of the performed  treatment the convulsive syndrome in calf muscles completely  regressed, though on the first visit it was registered in 22,4% of patients (p  =  0,0481), the frequency of complaints  about severity and fatigue in the lower limbs at static loads decreased  significantly from 28,1% to 9,6% (p  = 0,2414). The circumference of the femur in the middle third of the limb decreased  from 53.7 cm to 51.1 cm (p<0.05), in the middle third of the tibia from 36.8 cm to 33.8 cm (p<0.05) and in the lower third of the tibia from 23.4 cm to 21.5 cm (p<0.05). VAS pain syndrome decreased  from 35.36 ± 24.71  mm to 16.44  ± 17.07  mm (p  = 0.0005). The global CIVIQ 20 quality of life index increased  by 25.3% compared to the initial parameters (p  =  0.0001), the VCSS index decreased  from 5.93  ± 1.79  points  to 4.79  ± 2.01  points  (p  = 0.0002).

Conclusion. Sulodexide, causing a pronounced  clinical effect, is an effective and pathogenetically justified drug for the treatment of initial forms of chronic lower limb vein disease.

In the review article various indications for the use of adjustable inelastic compression bandage circaid are considered, and an actual clinical example of its successful  application is given. The authors  draw a conclusion about the universality  of circaid bandage and the expediency of its wide use in real clinical practice.

The article  presents classification, diagnostic  principles  and  modern  technique of phlebosclerosing treatment  of lower limbs telangiectasias.

One of the  variants  of CLaCS  therapy  is presented - the  method  of treatment of reticular  varicosity  based  on the  combined application of injectable sclerotherapy and transdermal neodymium laser in combination  with skin cooling. This CLaCS variant is the most understandable, logical and easy to use.

Percutaneous laser  coagulation (selective photothermolysis) is currently  the  «gold  standard» for the  treatment of «port-wine stains». However, complete removal of the vascular lesion is rarely possible,  and in 20% of cases there is resistance to laser attack. The article  presents clinical cases of «port-wine stains» treatment in two patients. On the basis of own experience and literature data the analysis of treatment results, side effects  of lasers application was carried out, and also alternative perspective methods of treatment were considered.

One of the main problems of modern surgery is treatment of trophic skin and soft tissues defects due to the ambiguity of the pathogenesis, tendency  to recurrence, deterioration in the  patients’  quality  of life,  complexity  and duration  of treatment, large economic costs  of treatment and rehabilitation. The article  describes  an algorithm  for outpatient treatment of patients with trophic skin and soft tissues defects  in diabetic  foot syndrome. Debridement  the wound from necrosis, purulent-fibrinous pellicles,  wound biofilms is produced by a chemical necrectomy. A method of closing the wound defects by the means of high-tech biomaterials based on collagen type 1 is described.

The work describes  a new antibiotic from the oxazolidinone group – tedizolid.  The results  of the clinical studies have shown a high efficacy of tedizolid in complicated  skin and soft tissue infections. The use of tedizolid phosphate was accompanied by high activity against antibiotic-resistant microflora in combination  with good tolerability and low frequency of side effects.

The article  presents the  results  of the  clinical  study  on the  assessment of the  preventive  clinical  effectiveness of the  topical combined antibacterial drug bacitracin/neomycin in the prevention  of infection during surgical intervention.

The study included 112 patients whose average age was 42.4+7.4 years. Patients were divided into groups according to the risk of infection of the surgical area (SSI) according to the criteria of D.C. Classen et al. and into subgroups according to whether standard antiseptic therapy or topical antibacterial therapy with bacitracin/neomycin was used in the postoperative period.

The study demonstrated high preventive  efficacy of the topical drug bacitracin/neomycin in the prevention  of various clinical forms of SSI and, probably, in the prevention  of seromas of postoperative wounds.

The problem  of treating pain in patients with diseases  of the  musculoskeletal system  and its  injuries  is highly relevant, which is associated with the  high  prevalence  of this  pathology.  The basis  of pain  is always inflammation. In order  to  influence  the inflammatory  process as quickly as possible,  therapy  should be comprehensive, safe, and as effective  as possible.  In recent  years, complex bioregulatory preparation Traumeel C, produced as an ointment and gel, has been widely used in the treatment of diseases of the musculoskeletal system and injuries.  The article presents data on the mechanism of action of the drug, as well as the results of studies that  examined  the efficacy and safety  of Traumeel C ointment and gel for diseases  of the musculoskeletal system  and injuries of the musculoskeletal system.

The paper presents the basic principles of accelerated reabiletacii patient in the practice of ambulatory surgery. Pathophysiological mechanisms  revealed  organism  response   to  surgical  trauma.   Pain,  as  a  powerful  trigger  of  surgical  stress  response   due  to neurohumoral, endocrine,  immune,  Hemostatic  and metabolic  mechanisms  largely determines the  results  of surgical  treatment. The most  commonly used  ketorolac  (Ketanov)  having  the  form parenteralnuju. The summary of the  application of both  drug ketorolac  argued with pronounced analgesic effect. Intra-operative use of ketorolac  is justified, as the drug reduces the total dose of anesthetics and Narcotic  analgesics. Improving  the  quality  of postoperative analgesia  has  predetermined creation  protocol analgesia, as basic drugs used non-steroidal anti-inflammatory drugs.

Hemorrhoidal  disease  has been  known since  ancient  times  and remains  one of the  most  common human  diseases. This review presents the results  of tribenoside and lidocaine combinations used in the conservative therapy of hemorrhoids, which give grounds to  recommend  combination  therapy  with tribenoside and lidocaine  in the  form of rectal  cream and rectal  suppositories as an effective  and safe method of local treatment of hemorrhoids  and moderate  severity in different categories of patients, allowing to achieve rapid clinical improvement.

The article is devoted to the topical issue of increasing prevalence of hemorrhoid disease in modern society. It provides the detailed description of pathogenesis of the  disease  and clinical manifestations of hemorrhoids. Particular  attention is paid to diagnostic tests and procedures  that help physicians to diagnose a disease  and choose a therapy,  including diet, improvement  of bowel habits and function,  normalization of the blood flow rate in haemorrhoidal  plexuses  by prescription of phlebotropic drugs. Among them, the combined topical drugs that have a thrombolytic, anti-inflammatory and hemostatic effect hold pride of place in the treatment of hemorrhoid disease.

The article  presents the  results  of conservative  therapy  of patients with acute  hemorrhoids, with a 10-day follow-up period,  the purpose of which is to improve the results  of treatment of this category of patients. The patients of Group I received conservative therapy with heparin ointment and Relief Pro® suppositories; Group II received local therapy with heparin ointment without rectal suppositories.

Design: a single-center randomized controlled  follow-up study.

The study showed the  efficacy of Relief Pro® suppositories in patients with acute  haemorrhoids. The use of suppositories allowed to statistically reliably reduce the level of pain (2.59 ± 0.6 points in Group I versus 3.87 ± 0.7 points in Group II (p < 0.05)) on Day 3 of the therapy, reduce the frequency of blood excretion on Day 2 of the therapy (83% and 32% of patients, respectively (p <0.05)) and eliminate the discomfort in the anus (100% observations in Group I by Day 5 of the therapy and 67% in Group 2 by Day 10 of the therapy (p <0.05)).

Acute and chronic hemorrhoids  and coexisting  conditions  remain  an important medical problem  at  the  intersection of medical specialties. Among the  proposed  approaches to  therapy  is the  use  of immunomodulating agents, which allows to  ensure  the influence  on several  pathogenetic mechanisms  of development and progression  of the  disease. Ointments  containing  bacterial cultural suspension of E. coli (BCS) as an active component  have a solid experience in clinical practice  and a strong evidence base, including meta-analysis of multicenter randomized trials.

This clinical review describes  the patient’s  history of a third degree  lymphedema of the right lower extremity, who underwent  33 surgical interventions in the form of lipodermatofasciectomy, complicated  by frequent recurrent episodes  of erysipelas. The article describes  the tactics  of treatment and the specifics of the selection of knitwear for such a patient.

The article describes the experience of application of the combined antiscar agent containing boswellic acid, cepalin, hyaluronic acid and allantoin with the subsequent application of the prolonged action pressing patch with the matrix of active release of cepalin and allantoin at the early stages of formation and maturation of scars in the patients with postoperative, post-burn scars and traces after cosmetic manipulations in the form of persistent skin redness.  A comparison of the efficacy of two therapy schemes for 43 patients aged 18 to 45 in two groups was shown. When evaluating the effectiveness of the therapy by analyzing the data of evaluation scales, ultrasound, dermatoscopy, a greater  effectiveness of the combined antiscar  agent and pressure  patch in comparison with the use of hydrating agents and silicone patches  was noted.

Objective. Evaluate the efficacy of the treatment of purulent skin and soft tissue  wounds using modern interactive dressings  and conventional wound care dressings.

Material and methods.  The study included 160 patients, who were treated at the outpatient department of the Clinic of the SamGMU for the period from September  2018 to January 2019 after an autopsy,  necrosectomy  and drainage  of purulent foci in the surgical hospital.

Group I (n  = 82) included patients, who applied Sorbalgon® interactive dressing (Paul Hartmann, Germany) during the first phase of the wound healing and Branolind®  N atraumatic mesh dressing (Paul Hartmann, Germany) during the second phase of the wound healing  for topical  treatment of wounds in the  postoperative period.  Patients of Group II (n   =  78)  applied  ointment dressings using Levomekol ointment during the first phase of the wound healing and Methyluracil ointment during the second phase of the wound healing.

Patients in both groups received the same broad spectrum  antibacterial therapy.

In Group I, the dressings  were applied once per 2 days, in Group II the dressings  were applied on a daily basis.

The researchers studied  the  following indicators:  the  nature  of the  wound discharge;  the  presence  of edema  and hyperemia  of tissues; timing of the wound defect cleansing; temperature and leukocyte reactions  of the body; crops on microflora and sensitivity to antibiotic therapy.

Results.  The study showed more pronounced  dynamics of the  temperature reaction normalization, reduction of the  local inflammatory reaction and the leukocytosis  level in patients of Group I. The wound cleansing  from pus and fibrin,  the development of granulation tissue on Day 5 were reported  in 87.8% of patients of Group I and in 35.9% of patients of Group II, on Day 10 in 100% and 88.5% of patients, respectively.

Conclusion. The use of Sorbalgon® and Branolind® N dressings  improves the  results  of treatment of patients with purulent soft tissues pathology and reduces the risk for secondary infection, and improves the quality of life due to increase of interval between the dressings.