Vol 17, No 3 (2024)

Introduction. Despite the achievements in the treatment of abdominal hernias, the incidence of postoperative complications is still high, which entails an increased probability of hernia recurrence, repeated surgical interventions, and an increased mortality rate. Detection of the precursors of the above complications will allow for their timely diagnosis and treatment; this will improve the prognosis of the course of the disease.

The aims of the study was to determine blood plasma C-reactive protein concentrations correlated with the presence and severity of early surgical complications according to the Clavien-Dindo classification (1992) in cases of prosthetic repair of the anterior abdominal wall.

Materials and methods. This was a clinical prospective multicenter study conducted in 2018-2022. Patients with a non-strangulated hernia of the anterior abdominal wall (n=89) underwent a hernia defect repair with a "conventional" polypropylene mesh implant. The patients were divided into two groups depending on the presence of early surgical complications according to the Clavien-Dindo classification (1992). In the postoperative period, the patients underwent enzyme immunoassay of blood plasma for C-reactive protein, ultrasound scanning of the anterior abdominal wall tissues, and monitoring of local changes in the wound area. In 5 days after surgery, the groups were compared based on the criterion of blood plasma C-reactive protein concentration (within the reference values or exceeding them for more than > 5 mg/l).

Results. The excessive reference level of C-reactive protein in blood plasma (more than 5 mg/l) on the 5th day after prosthetic plastic surgery of the anterior abdominal wall correlated with a 30.3% (p<0.001, Fisher's exact test) higher rate of early surgical complications; of these, 73.1% of cases (p=0.014, Fisher's exact test) required invasive interventions (grade II complications according to the Clavien-Dindo classification). The presence of early surgical complications according to the the Clavien-Dindo classification correlated with an 8-fold (p<0.001, Mann-Whitney U test) higher concentration of C-reactive protein in blood plasma on the 5th day after prosthetic plastic surgery of the anterior abdominal wall (13.31 [6.12; 26.67] versus 1.68 [0.89; 3.99] in their absence).

Conclusions. C-reactive protein of blood plasma level exceeding > 5 mg/l on the 5th day after prosthetic repair of the anterior abdominal wall is a precursor of early surgical complications.

Introduction. The main cause of ischemic wounds is peripheral arterial disease (PAD). The overall prevalence of PAD varies within 3-10%, increasing to 15-20% among patients over 70 years of age. The PAD prevalence is slightly higher in men than in women. This problem is crucial for healthcare, since such wounds can lead to the need to amputate the lower extremities in case of ulcerative-necrotic processes and gangrene, being one of the common causes of increased disability and mortality in the population.

The aim of the study was to investigate features of the wound process when healing ischemic skin wounds with local application of a unique mixture of benzalkonium chloride, dexpanthenol and pentoxifylline in combination with magnetotherapy.

Materials and methods. Ischemic skin wounds were simulated on the hind limbs of 90 male Wistar rats (RU Patent for Invention No. 2807383). The animals were divided into three groups based on the features of the treatment performed. In animals of the 1st group, a unique mixture of benzalkonium chloride, dexpanthenol and pentoxifylline was applied to the skin defect; in animals of the 2nd group, magnetotherapy was used; in animals of the 3rd group, the unique medicinal mixture and magnetotherapy were used simultaneously. The analysis of the results included an assessment of the wound area, microcirculation, pH of the wound surface and the local temperature. The results were recorded on the 1st, 3rd, 5th, 8th and 10th days of the study. Microsoft Excel 2014 and Statistica 13.0 programs with the Kruskal-Wallis test were used to process data statistically. Significant differences were considered at p<0.05.

Results. A combination of benzalkonium chloride, dexpanthenol and pentoxifylline with the simultaneous use of magnetic therapy is effective in the treatment of ischemic wounds. The third group showed the greatest effectiveness, where the area of wounds significantly decreased on the 10th day by 1.9 times compared to group 1 and 9.4 times compared to group 2, respectively. The healing rate was also significantly higher in group 3 compared to group 1 (1.3 times) and group 2 (1.7 times), respectively. The third group also showed the best result during the assessment of microhemocirculation and a shift in pH to the slightly acidic side already on the 3rd day; only on the 8th day there were significant differences of 1.1 times between the 1st and 3rd groups.

Conclusions. The use of the specifically developed unique medicinal combination of drugs applied together with magnetic therapy has confirmed its effectiveness if compared with the control treatment groups. This treatment option has a beneficial effect on the healing process of ischemic skin wounds and allows recommending it for further preclinical studies.

Difficulties in determining effective treatment tactics for acute pancreatitis are associated with a complex multifactorial pathophysiological mechanism of the disease development. The central part in the pathogenesis of acute pancreatitis is taken by disorders of pancreatic microcirculation. Regardless of the etiology, increasing changes in microcirculation enhance the degree of pancreatic ischemia, thus intensifying the systemic inflammatory response syndrome and resulting in multisystem organ failure. Initial treatment of patients with moderate-to-severe and severe acute pancreatitis combined with transient or persistent organ failure should be carried out in intensive care units. Currently, there are no drugs effective for the treatment of acute pancreatitis in clinical practice. Initial treatment of various forms of acute pancreatitis is essentially supportive and aimed at relieving pain, nausea and vomiting, infusion therapy and early enteral nutrition. Indications for the use of antibacterial therapy in necrotizing acute pancreatitis are cases of infected pancreatic necrosis confirmed by CT or fine-needle aspiration biopsy, or clinical suspicion of infecting necrotic accumulations. To assess the severity and treat patients with severe acute pancreatitis, coordinated work of a multidisciplinary team of specialists is necessary. In the early stage of severe acute pancreatitis, responsibility for coordinating such multidisciplinary work should be borne by specialists of the intensive care units, at a late stage (in 2 weeks), such a role should be played by surgeons, determining the tactics of treating complications of necrotizing forms of acute pancreatitis and the use of various options for invasive interventions.