Amputation of extremity in patients with atherosclerotic gangrene

Aim of investigation — to analyze the results of treatment of patients with atherosclerotic gangrene of a limb, to identify the causes of adverse outcomes amputation. Materials and methods: We analyzed the results of examination and treatment of 218 patients with atherosclerotic gangrene of the limb. Good outcome of amputation was considered the primary surgical wound healing of the stump. Suppuration, secondary healing, re-amputation and death we attributed to the adverse results of amputation. Results: The adverse outcomes of amputation due to technical errors in surgery, properly chosen level, inadequate drainage of the wound stump, an unsuccessful operation on the arteries of a limb, inadequate empirical antibiotic therapy, patient's age, functional capabilities of myocardium, the duration of critical ischemia, as well as the lack of psychological adaptation of patients before amputation. Conclusion: To decide the need for amputation in patients with atherosclerotic gangrene follows the assessment of possible vascular reconstructive surgery. In determining the level of amputation is necessary to objectively assess the degree of disruption of regional blood flow using multilevel manometry and laser Dopplerflowmetry. In preparation for amputation should be paid special attention to the correction of rheological and coagulation properties of blood, normalization of the functional state of the myocardium, as well as specialized psychotherapeutic training for timely and adequate psychological adaptation of the patien

Refraction of dispersive shock waves

We study a dispersive counterpart of the classical gas dynamics problem of the interaction of a shock wave with a counter-propagating simple rarefaction wave often referred to as the shock wave refraction. The refraction of a one-dimensional dispersive shock wave (DSW) due to its head-on collision with the centred rarefaction wave (RW) is considered in the framework of defocusing nonlinear Schr\"odinger (NLS) equation. For the integrable cubic nonlinearity case we present a full asymptotic description of the DSW refraction by constructing appropriate exact solutions of the Whitham modulation equations in Riemann invariants. For the NLS equation with saturable nonlinearity, whose modulation system does not possess Riemann invariants, we take advantage of the recently developed method for the DSW description in non-integrable dispersive systems to obtain main physical parameters of the DSW refraction. The key features of the DSW-RW interaction predicted by our modulation theory analysis are confirmed by direct numerical solutions of the full dispersive problem.Comment: 45 pages, 23 figures, minor revisio

CLINICAL USE OF MODERN FLUOROQUINOLONES IN DENTAL IMPLANTATION AND MAXILLARY SINUS LIFTING

New fluoroquinolones like levofloxacine, with broad-spectrum of effect which is also active against anaerobic bacteria, is a prospective drug for the prevention of the inflammatory complications in implant dentistry and maxillary sinus augmentation. 34 patients have been selected for this study, including 16 women and 18 men aged 18-65. All the patients have been classified into the main and control groups. Patiens of the first group have been prescribed 500 mg of levofloxacine before and after the operation two times a day for 10 days. Patients of the control group have been treated with amocxicilline. In the control group, which has used amoxicilline, Streptococcus sanguis, Streptococcus salivarius and anaerobic bacteria have been identified. The amount of Prevotella intermedia is insignificant. The same picture has been found with Fusobacterium spp. The rate of Actinomyces spp. was insignificant over the whole period of study. Patients of the experimental group had a slightly different distribution of bacteria. On the 10th day after the operation in the main patient group no periodontal pathogenesis, which may cause inflammatory complications have been identified. During the early post-operative period no significant differences have been observed among the patients of both groups