PROBLEMS OF THE PREOPERATIVE DIAGNOSIS OF LOW-GRADE THYROID CANCER SPREADING TO CERVICAL LYMPH NODES AND WAYS OF THEIR SOLUTION

To estimate the regional spread of low-grade thyroid cancer (TC) is a topical problem. The paper analyzes the problems of preoperative diagnosis of low-grade TC metastasizing to cervical lymph nodes (LN), which an oncologist faces. Primary ultrasonography (USG) of the neck is noted to have a low quality. The authors propose to use repeat (duplicate) USC of the neck during the clarifying diagnosis of TC and their developed method for USG of the cervical LN and the improved technique for determining the level of thyroglobulin in the cervical LN biopsy specimens. Introduction of these techniques could improve the preoperative diagnosis of low-grade TC metastases to the cervical LN

Multicomponent coating in purulent wound healing: A randomised controlled experimental study

Background. Purulent wound healing is a pressing surgical challenge relevant in 30−35% of patient cases. To the more, wound infectious agents elaborate resistance to available drugs warranting the development of new drug combinations exserting a multidirectional effect on the wound process.Objective. Using a purulent wound model to experimentally evaluate the efficiency of a new multicomponent wound coating comprised of polyethylene oxide and carboxymethylcellulose sodium-immobilised dioxidine, methyluracil, metronidazole and lidocaine hydrochloride in comparison with a legal approved wound coating drug preparation of beeswax and propolis-based dioxidine ointment.Methods. The antimicrobial activity range (disk-diffusion method) and local anaesthetic effect (Rainier’s method) of the developed wound coating have been assessed. The healing process was studied in a purulent wound model with 72 Wistar rats divided between two equal groups. The following methods were applied: visual wound inspection (wound cleansing time, absence of wound-surrounding tissue oedema, granulation and epithelisation), planimetric parameter estimation (wound area, healing rate, wound area reduction ratio), wound contamination and pH measurement, wound section cell morphometry (granulocyte, macrophage, lymphocyte and fibroblast counts, cell index estimation). Daily dressings were applied for 15 days.Results. The developed wound coating exhibited high efficiency against Gram-positive and Gram-negative bacteria in the zone of inhibition tests. Its local anaesthetic effect was significantly superior to the approved drug by the duration of action. The wound area reduction was 94.2 (93.7; 94.8)% in the experimental group and 86 (84.2; 88.8)% in the control (differences statistically significant) already on day 10. A maximal healing rate in both groups was registered in phase 1 of the wound process being 1.4 times higher in experiment compared to the control. The wound contamination was significantly lower in experiment vs. control on day 8 (p = 0.0075). Wound pH negatively correlated with the fibroblast count and positively — with the contamination level.Conclusion. The study demonstrates high efficiency of the developed wound coating against infectious agents and its positive healing impact via reducing phase 1 and stimulating proliferation in phase 2 of the wound process

Многокомпонентное раневое покрытие в лечении экспериментальной гнойной раны

Objectives. To substantiate the effectiveness of the wound coating developed by us, which combines broad-spectrum antimicrobial effect, sorption activity, analgesic effect and prolonged action on a purulent wound.Materials and methods. The material for the study was wound coating in the form of a film developed at Kursk State Medical University (Russian patent number 2605343). Experimental animals (Wistar rats) were divided into 2 groups (comparative and experimental) of 36 animals in each. In all the experimental animals a purulent wound was modeled according to the method proposed by P.I. Tolstikh. Local anesthetic activity was determined on rabbits of the Chinchilla breed (20 individuals in each group). In the course of the study, the following methods were used: microbiological method (identification of the areas of growth retardation and wound contamination), visual assessment of the wounds, planimetric method, pH evaluation of the wounds, and Renier’s technique (for determination of the anesthetic activity). The data were processed statistically, and the statistical significance of the differences was determined using the nonparametric Mann – Whitney test. The differences were considered statistically significant at p ≤ 0.05.Results. Before the experiment on animals, high efficacy of the developed film was proven for the most common test strains of microorganisms capable of causing wound infection, using the microbiological method of investigation. Using the Renier’s method, the ability of the film to provide a local anesthetic effect was demonstrated, which was significantly higher than that of the 2% lidocaine ointment. Following visual evaluation of the wound, it was found that purification and regeneration of the wounds occurred earlier in the animals from the experimental group. The speed of wound healing in the experimental group was 1.3 times higher at 1–3 days, whereas at 5–8 days the situation was reversed in favor of the comparison group. In addition, at day 8 wound contamination in the experimental group was 1.2 times lower than in the comparison group. According to the results of the pH evaluation, significant differences between the groups were noted at days 5, 8, 15. Approximation of pH values to those of intact skin also proved the effectiveness of using the developed film.Conclusion. The results of the conducted studies confirmed broad-spectrum antimicrobial activity of the developed film, its local anesthetic activity and efficacy in treatment of experimental purulent wounds, which allows to recommend it for further preclinical trials. Цель. Обосновать эффективность применения разработанного нами раневого покрытия, которое сочетает в себе противомикробный эффект широкого спектра, сорбционную активность, обезболивающее влияние, пролонгированное действие, на модели гнойной раны в эксперименте.Материалы и методы. Материалом для исследования послужило раневое покрытие в виде пленки, разработанное на базе Курского государственного медицинского университета (патент на изобретение РФ № 2605343). Экспериментальные животные (крысы породы Вистар) были распределены на две группы (сравнения и опытная) по 36 животных в каждой. Всем подопытным животным моделировалась гнойная рана по методике П.И. Толстых. Местно-анестезирующую активность определяли на кроликах породы шиншилла (по 20 особей в каждой группе). В ходе исследования применялись следующие методы: микробиологический (определение зон задержки роста и обсемененности ран), визуальная оценка состояния ран, планиметрический, рН-метрия ран, метод Ренье (для определения анестезирующей активности). Данные обработаны статистически, достоверность отличий определяли по непараметрическому критерию Манна – Уитни. Различия между группами считались статистически значимыми при р ≤ 0,05.Результаты. До начала эксперимента на животных на основании микробиологического метода исследования была показана высокая эффективность разработанной пленки в отношении наиболее распространенных тест-штаммов микроорганизмов, способных вызывать раневую инфекцию. Также на основании метода Ренье показана ее способность оказывать местно-анестезирующее действие, достоверно превосходящее по эффективности 2%-ю лидокаиновую мазь. На основании визуальной оценки раны выявлено, что очищение и регенерация ран наступали раньше у животных в опытной группе. Скорость заживления ран в опытной группе была в 1,3 раза выше на сроке 1–3-и сут, а на 5–8-е сут ситуация была обратной в пользу группы сравнения. Кроме того, обсемененность ран в опытной группе была в 1,2 раза ниже на 8-е сут, нежели в группе сравнения. По результатам рНметрии достоверные различия между группами были отмечены на 5-, 8-, 15-е сут. Приближение значений рН к значениям неповрежденной кожи также доказывала эффективность применения разработанной пленки.Заключение. Результаты проведенных исследований подтвердили широкий спектр противомикробного действия разработанной пленки, ее местно-анестезирующую активность, эффективность при лечении экспериментальных гнойных ран, что позволяет рекомендовать ее для дальнейших доклинических испытаний.

Применение многокомпонентной пленки в лечении ран в эксперименте

Objectives. To optimize treatment of purulent wounds with the help of a wound coating with a multidirectional action that combines broad-spectrum antimicrobial effect, stimulation of regeneration, sorption activity and local anesthetic action. Materials and methods. The material for the study was a wound covering in the form of a film developed by the authors at Kursk State Medical University (Russian patent No. 2601897). Theexperiment was performed on laboratory animals (Wistar rats), which were divided into 2 groups (comparison and experimental), each group containing 36 animals. Purulent wound was modeled in the animals according to the method of P.I. Tolstykh. To evaluate the effectiveness of the treatment, the following methods were used: microbiological method (determination of areas of growth retardation and bacterial contamination in the wounds), Renier’s method (determination of local anesthetic activity), visual assessment of wounds, planimetric method (measurement of the wound area, percentage of area reduction and healing speed) and measurement of pH in the wounds. The statistical significance of the differences was determined with the nonparametric Mann–Whitney test. The differences were considered statistically significant at p ˂ 0.05. Results. Initially, high efficiency of the film was detected in vitro for the most common strains of test organisms, which werewound infection pathogens. The Renier index was 1.2 times higher in the film with chlorhexidine than in 2% lidocaine ointment, and the duration of general anesthesia was 25% longer. Following visual assessment of the wounds we revealed that purification and regeneration of the wounds first occurred in the animals in the experimental group; however, no statistical significance was detected. The maximal differences in the healing speed (1.6 times) were observed at 3–5 days, and the contamination of the wounds was 1.3 times lower in the experimental group than in the comparison group. According to the results of pH assessment, significant differences between the groups were noted only on day 15. Approximation of pH values to intact skin values also proved the effectiveness of treatment. Conclusion. The developed contact wound covering has high antimicrobial activity against a broad spectrum of wound infection pathogens, creates a fairly good local anesthetic effect, significantly speeds up the healing process and reduces bacterial contamination of the wound area. Thus, the developed wound covering can be recommended for further studies in the clinical setting for treatment of inflammatory processes in soft tissues.Цель. Оптимизировать лечение гнойных ран с помощью разработанного раневого покрытия с разнонаправленным действием, которое сочетает в себе противомикробный эффект широкого спектра, стимуляцию регенерации, сорбционную активность, местное анестезирующее действие. Материалы и методы. Материалом для исследования явилось разработанное нами на базе Курского государственного медицинского университета раневое покрытие в виде пленки (патент на изобретение РФ № 2601897). Эксперимент выполнен на лабораторных животных (самцы крыс породы Вистар), которые были разделены на две группы (сравнения и опытная) по 36 животных в каждой. Животным моделировалась гнойная рана по методике П.И. Толстых. Для оценки эффективности лечения применялись следующие методы: микробиологический (определение зон задержки роста и обсемененности ран), Ренье (для определения местной анестезирующей активности), планиметрический (измеряли площадь ран, долю (%) уменьшения площади и скорость заживления). Проводили визуальную оценку состояния ран и их рН-метрию. Статистическую значимость различий определяли по непараметрическому критерию Манна – Уитни. Различия считались достоверными при р ˂ 0,05. Результаты. Изначально в эксперименте in vitro была выявлена высокая эффективность разработанной пленки в отношении наиболее распространенных тест-штаммов микроорганизмов – возбудителей раневой инфекции. Индекс Ренье был в 1,2 раза выше у разработанной пленки с хлоргексидином, чем у 2%-й лидокаиновой мази, а длительность общей анестезии – на 25% дольше. На основании визуальной оценки раны показано, что очищение и регенерация ран наступали раньше у животных в опытной группе, однако статистическая достоверность различий не выявлена. Максимальные различия по скорости заживления в 1,6 раза и отмечены на сроке 3–5-е сут, а обсемененность ран была в 1,3 раза ниже в опытной группе, чем в группе сравнения. По результатам рН-метрии достоверные различия между группами выявлены лишь на 15-е сут. Приближение значений рН к значениям неповрежденной кожи также доказывала эффективность лечения. Заключение. Разработанное нами раневое покрытие обладает высокой противомикробной активностью в отношении широкого спектра возбудителей раневой инфекции, создает достаточно хороший местно-анестезирующий эффект, статистически значимо ускоряет процесс сокращения площади и обсемененности ран. Таким образом, разработанное нами раневое покрытие можно рекомендовать для дальнейших исследований в клинике для лечения гнойно-воспалительных процессов мягких тканей.

Морфологическая оценка эффективности применения хитозан-коллагенового комплекса с наночастицамисеребра и химотрипсином при гнойно-некротическом процессе в мягких тканях

One of the urgent problems of modern surgery continues to be the increasing number of patients with purulent-inflammatory and purulentnecrotic processes of soft tissues – about 60.0 % of patients in the structure of specialized hospitals of a surgical profile. This is due to the adaptation of microorganisms – pathogens of wound infection to existing means for treating wounds. In addition, the number of patients with diabetes mellitus increases annually, and as a result, the number of people suffering from diabetic foot syndrome. Thus, the relevance of developing new modern tools for the local treatment of purulent-necrotic processes of the skin and soft tissues is not reduced.Materials and methods. The material for the study was a highly porous biodegradable sponge (chitosan-collagen) in the ratio of chitosan: collagen 2: 1 with the inclusion of colloidal particles of metallic silver and chymotrypsin. The experiment was performed on 50 Wistar rats that simulated a purulent necrotic wound. During the treatment, the state of the wounds was visually evaluated, the morphological features of the course of the wound process were evaluated after animals were withdrawn from the experiment and the wound material was taken on days 1, 5, 10, 15 and 21, the sections were stained with hematoxylin-eosin and/or according to Van Gieson.Results. By visual assessment, by the 10th day it was noted that necrotic tissues underwent lysis, the wound defect was covered with a scab, swelling of the surrounding tissues was not noted, and on the 21st day of treatment the wound defect was covered with epithelium and had an area of about 3 mm2 with the initial - in 250 mm2. When describing micropreparations, it was noted that on the 10th day the exudation phase passed its peak and the activity of proliferation processes increased from the center of the wound to its periphery and from the granulation surface in depth. On the 15th day, the proliferative phase of inflammation was at its height, and on the 21st day, the proliferation phase was completed and the processes of remodeling of dense fibrous connective tissue began.Conclusion. Based on a visual assessment of the state of wounds and a morphological study, the effectiveness of a chitosan-collagen complex with silver nanoparticles and chymotrypsin was shown to be applied locally to a purulent necrotic wound in an experiment.Одной из насущных проблем современной хирургии продолжает оставаться все возрастающее число пациентов с гнойно-воспалительными и гнойно-некротическими процессами мягких тканей – около 60,0 % больных в структуре специализированных стационаров хирургического профиля. Это обусловлено адаптацией микроорганизмов – возбудителей раневой инфекции к имеющимся средствам для лечения ран. Кроме того, ежегодно увеличивается число больных сахарным диабетом и, как следствие, число лиц, страдающих синдромом диабетической стопы. Таким образом, значимость разработки новых современных средств для местного лечения гнойно-некротических процессов кожи и мягких тканей не снижается.Материалы и методы исследования. Материалом для исследования послужила высокопористая биодеградируемая губка (хитозан-коллагеновая) в соотношении 2 части хитозана к 1 части коллагена с включением коллоидных частиц металлического сере- бра и химотрипсина. Эксперимент был выполнен на 50 крысах породы Вистар, которым моделировали гнойно-некротическую рану. В процессе лечения визуально оценивали состояние ран, а морфологические особенности течения раневого процесса оцени- вали после вывода животных из эксперимента и забора материала раны на 1, 5, 10, 15 и 21-е сутки, срезы окрашивали гематоксилин-эозином и/или по Ван Гизону.Результаты исследования. При визуальной оценке уже к 10-м суткам было установлено, что некротические ткани подверглись лизису, раневой дефект покрыт струпом, отек окружающих тканей не зафиксирован, а на 21-е сутки лечения раневой дефект был покрыт эпителием и имел площадь около 3 мм2 при исходной – в 250 мм2. При описании микропрепаратов было отмечено, что на 10-е сутки фаза экссудации прошла свой пик и активность пролиферационных процессов нарастала от центра раны к ее периферии и от поверхности грануляций – в глубину. На 15-е сутки пролиферативная фаза воспаления достигла своей кульминации, а на 21-е сутки происходило завершение фазы пролиферации и начались процессы ремоделирования плотной волокнистой соединительной ткани.Заключение. На основании визуальной оценки состояния ран и морфологического исследования показана эффективность хитозан-коллагенового комплекса с наночастицами серебра и химотрипсином при местном лечении гнойно-некротических ран (в эксперименте)

New methods of local medical treatment of purulent wounds

Purpose of the study. To study experimental model of purulent wounds efficiency of the combined effects of benzalkonium chloride and metronidazole immobilized on various bases.Materials and methods. The material was in vitro studies and experimental animals (Wistar rats), which was modeled a purulent wound and then divided into 3 groups according to the treatment method with the three studied combinations, each of which contained benzalkonium chloride and metronidazole, the combinations differed in bases, which were polyethylene oxide or sodium salt of carboxymethylcellulose, or polymethylsiloxane polyhydrate. Research methods: in an in vitro experiment, growth retardation zones were determined for the most common pathogens of wound infection using the standard disc method. In an in vivo experiment the healing process was evaluated by Popov's planimetric method, the contamination of the wounds was studied by sowing the biopsy of wounds on nutrient media with subsequent counting of the grown up colonies. The data were processed statistically, the reliability of the differences was assessed by the Kruskal-Wallis test.Results. All test combinations showed high growth retardation areas for all test strains of microorganisms. Objectively, the highest results were observed with a combination of polyethylene oxide (Staphylococcus aureus 30 (29; 30), Bacillus cereus 27 (27; 28), Escherichia coli 20.5 (20; 21), Proteus vulgaris 21.5 (20; 22), Pseudomonas aeruginosa 17 (16; 17), Candida albicans 25.5 (25; 26)). In determining the healing rate, it was noted that the maximum values in the groups when using combinations based on the sodium salt of carboxymethylcellulose and polymethylsiloxane polyhydrate occurred on day 1–3 (29.6 (27.6; 31) and 20.2 (18.8; 24.2) mm2/day, respectively), and in the group using a combination on polyethylene oxide — for 3–5 days (20.6 (17.3; 22.8) mm2/day).Conclusion. Our studies have shown the high antimicrobial activity of all the developed combinations for all the strains of microorganisms studied. It is also possible to recommend combinations on polyethylene oxide and sodium salt of carboxymethylcellulose for further preclinical studies at all times of treatment, and a combination based on polymethylsiloxane polyhydrate only in the first phase of the wound process

Seasonal Variability of Nutrients and Radium Isotope Fluxes from Submarine Karstic Spring at the Southwest of Crimea, Black Sea

The groundwaters of the southwestern region of Crimea are formed on the karst plateaus of the Crimean Mountains, and a significant amount of them is discharged into the Black Sea. The Crimean Peninsula is a water-deficient region; therefore, the study of its hydrogeology is an urgent task, since groundwater is a valuable freshwater resource. Through submarine groundwater discharge (SGD), the transfer of chemical compounds to the sea in the event of anthropogenic interference may also occur. In this work the fluxes of submarine groundwaters in the area of Cape Peleketo in different seasons, and also the fluxes of nutrients within them, are evaluated for the first time, as well as the factors determining their variability. During the study, hydrological (temperature, salinity (S), current velocity) and hydrochemical (concentration of biogenic elements) parameters, as well as the concentration of long-lived isotopes of 226Ra and 228Ra, were measured. The SGD fluxes were estimated through the mixing formula. As the endmember, we used groundwater concentrations of nutrients or radiotracers, defined by extrapolation of nutrients or radium concentrations to zero salinity. Significant differences in the studied region’s SGD flux values (from 4100 to 13,900 m3/day) are shown; maximum values are in winter and summer, and minimum values are in autumn and spring. The relationship between the seasonal variability of the discharge intensity and the amount of precipitation in the groundwater formation area is shown. The data obtained show that this source makes a significant contribution to the local supply of nutrients. Substantial amounts of nitrates come from the karst cavity, which can lead to eutrophication and limit the primary production of phosphorus in the local coastal sea region

Multicomponent wound coating in treatment of an experimental, purulent wound

Objectives. To substantiate the effectiveness of the wound coating developed by us, which combines broad-spectrum antimicrobial effect, sorption activity, analgesic effect and prolonged action on a purulent wound.Materials and methods. The material for the study was wound coating in the form of a film developed at Kursk State Medical University (Russian patent number 2605343). Experimental animals (Wistar rats) were divided into 2 groups (comparative and experimental) of 36 animals in each. In all the experimental animals a purulent wound was modeled according to the method proposed by P.I. Tolstikh. Local anesthetic activity was determined on rabbits of the Chinchilla breed (20 individuals in each group). In the course of the study, the following methods were used: microbiological method (identification of the areas of growth retardation and wound contamination), visual assessment of the wounds, planimetric method, pH evaluation of the wounds, and Renier’s technique (for determination of the anesthetic activity). The data were processed statistically, and the statistical significance of the differences was determined using the nonparametric Mann – Whitney test. The differences were considered statistically significant at p ≤ 0.05.Results. Before the experiment on animals, high efficacy of the developed film was proven for the most common test strains of microorganisms capable of causing wound infection, using the microbiological method of investigation. Using the Renier’s method, the ability of the film to provide a local anesthetic effect was demonstrated, which was significantly higher than that of the 2% lidocaine ointment. Following visual evaluation of the wound, it was found that purification and regeneration of the wounds occurred earlier in the animals from the experimental group. The speed of wound healing in the experimental group was 1.3 times higher at 1–3 days, whereas at 5–8 days the situation was reversed in favor of the comparison group. In addition, at day 8 wound contamination in the experimental group was 1.2 times lower than in the comparison group. According to the results of the pH evaluation, significant differences between the groups were noted at days 5, 8, 15. Approximation of pH values to those of intact skin also proved the effectiveness of using the developed film.Conclusion. The results of the conducted studies confirmed broad-spectrum antimicrobial activity of the developed film, its local anesthetic activity and efficacy in treatment of experimental purulent wounds, which allows to recommend it for further preclinical trials