Современные стандарты хирургического лечения венозных трофических язв нижних конечностей

ВЕНЫ /ПАТОЛОГХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ВЕНХРОНИЧЕСКИЙ ВЕНОЗНЫЙ КОМПАРТМЕНТ-СИНДРОМВЕНОЗНЫЕ ТРОФИЧЕСКИЕ ЯЗВЫ /ХИРЭНДОВЕНОЗНАЯ ТЕРАПИЯSHAVE THERAPYХИРУРГИЯ ВЕНЭНДОСКОПИЧЕСКАЯ ДИССЕКЦИЯ ПЕРФОРАНТНЫХ ВЕНФАСЦИОТОМИЯПОСЛЕОПЕРАЦИОННЫЙ ПЕРИОДУХОД ЗА БОЛЬНЫМУХОД ЗА БОЛЬНЫМИ, ХАРАКТЕРИСТИКАЛЕЧЕНИЯ РЕЗУЛЬТАТОВ АНАЛИЗЛЕЧЕНИЯ ЭФФЕКТИВНОСТЬ, АНАЛИЗОБЗОР ЛИТЕРАТУРЫВ настоящее время предлагается широкий спектр методов хирургического лечения пациентов с рефрактерными персистирующими венозными трофическими язвами нижних конечностей, которые основаны на общепризнанных стандартах. Устранение венозного рефлюкса в нижних конечностях является основной задачей хирургического лечения, решение которой значительно снижает частоту рецидивов трофических язв по сравнению с только консервативной терапией. В дополнение к классической хирургии вен доступны современные варианты эндовенозных вмешательств: лазерное, радиочастотное и механо-химическое облитерирование, пенная склеротерапия или эмболизация цианоакрилатом. Наиболее предпочтительным методом местной хирургической коррекции рефрактерных венозных трофических язв является послойная дерматолипэктомия (shave therapy) в сочетании с одновременной свободной аутодермопластикой расщепленным перфорированным лоскутом. Долгосрочные результаты с частотой заживления более 80% не могут быть достигнуты никаким другим методом. Эндоскопическую субфасциальную диссекцию перфорантных вен (SEPS) при наличии эпителизированной или открытой трофической язвы применяют при недоступности эндовазальных и мини-инвазивных методов облитерации. Фасциотомия голени применяется для снижения повышенного субфасциального давления при диагностировании хронического венозного компартмент-синдрома. Фасциэктомия голени в настоящее время выполняется по особым показаниям для лечения глубокого трансфасциального некроза, рецидивов трофических язв после shave therapy, выраженной кальцификации тканей голени и коррекции хронического венозного компартмент-синдрома. Помимо оптимального выбора хирургического способа лечения, долгосрочные показатели заживления венозных трофических язв зависят от стандартизированного стационарного лечения и ухода за раной в послеоперационном периоде с последующей амбулаторной медицинской реабилитацией.Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standards are proposed. The main aim of surgical therapy is the elimination of the lower extremity venous reflux so that the solution of this problem significantly reduces the incidence rate of recurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation (MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplasty with free split perforated cutaneous flap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery (SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous reflux in the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation

Современные стандарты хирургического лечения венозных трофических язв нижних конечностей

ВЕНЫ /ПАТОЛОГХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ВЕНХРОНИЧЕСКИЙ ВЕНОЗНЫЙ КОМПАРТМЕНТ-СИНДРОМВЕНОЗНЫЕ ТРОФИЧЕСКИЕ ЯЗВЫ /ХИРЭНДОВЕНОЗНАЯ ТЕРАПИЯSHAVE THERAPYХИРУРГИЯ ВЕНЭНДОСКОПИЧЕСКАЯ ДИССЕКЦИЯ ПЕРФОРАНТНЫХ ВЕНФАСЦИОТОМИЯПОСЛЕОПЕРАЦИОННЫЙ ПЕРИОДУХОД ЗА БОЛЬНЫМУХОД ЗА БОЛЬНЫМИ, ХАРАКТЕРИСТИКАЛЕЧЕНИЯ РЕЗУЛЬТАТОВ АНАЛИЗЛЕЧЕНИЯ ЭФФЕКТИВНОСТЬ, АНАЛИЗОБЗОР ЛИТЕРАТУРЫВ настоящее время предлагается широкий спектр методов хирургического лечения пациентов с рефрактерными персистирующими венозными трофическими язвами нижних конечностей, которые основаны на общепризнанных стандартах. Устранение венозного рефлюкса в нижних конечностях является основной задачей хирургического лечения, решение которой значительно снижает частоту рецидивов трофических язв по сравнению с только консервативной терапией. В дополнение к классической хирургии вен доступны современные варианты эндовенозных вмешательств: лазерное, радиочастотное и механо-химическое облитерирование, пенная склеротерапия или эмболизация цианоакрилатом. Наиболее предпочтительным методом местной хирургической коррекции рефрактерных венозных трофических язв является послойная дерматолипэктомия (shave therapy) в сочетании с одновременной свободной аутодермопластикой расщепленным перфорированным лоскутом. Долгосрочные результаты с частотой заживления более 80% не могут быть достигнуты никаким другим методом. Эндоскопическую субфасциальную диссекцию перфорантных вен (SEPS) при наличии эпителизированной или открытой трофической язвы применяют при недоступности эндовазальных и мини-инвазивных методов облитерации. Фасциотомия голени применяется для снижения повышенного субфасциального давления при диагностировании хронического венозного компартмент-синдрома. Фасциэктомия голени в настоящее время выполняется по особым показаниям для лечения глубокого трансфасциального некроза, рецидивов трофических язв после shave therapy, выраженной кальцификации тканей голени и коррекции хронического венозного компартмент-синдрома. Помимо оптимального выбора хирургического способа лечения, долгосрочные показатели заживления венозных трофических язв зависят от стандартизированного стационарного лечения и ухода за раной в послеоперационном периоде с последующей амбулаторной медицинской реабилитацией.Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standards are proposed. The main aim of surgical therapy is the elimination of the lower extremity venous reflux so that the solution of this problem significantly reduces the incidence rate of recurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation (MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplasty with free split perforated cutaneous flap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery (SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous reflux in the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation

Building the Egyptian Canon in Early 20th-century Germany: The Case Study of Georg Steindorff’s Excavations

This thesis is a historiographic study of Germany Egyptology in the late 19th and early 20th centuries, with particular focus on how the different stakeholders involved in that academic environment – scholars, curators, donors and financiers, the German museum-going public, as well as Egyptian people who worked on archaeological excavations – influenced the development of the scholarly canon of ancient Egyptian art. The “canon” is an art historical concept from designating certain objects, styles, and forms as representative of a culture, time period, or artistic movement. Consequently, the canon establishes an artistic hierarchy according to European aesthetic standards that excludes types falling outside of its criteria. The major case study of this thesis involves the career of German Egyptologist Georg Steindorff, who worked as a museum curator at the Ägyptisches Museum in Leipzig as well as a field archaeologist in Egypt from the years 1903-1931. Three ancient Egyptian objects in the collection of the Ägyptisches Museum in Leipzig will be analyzed in depth: a miniature wooden boat model, a diadem, and a block statue. All of these objects were excavated or curated by Steindorff at different pivotal moments of his career; thus, they reflect the shifting priorities of this prominent Egyptologist as he responded to broader trends and pressures in assessing the types of objects considered most important in the canon of ancient Egyptian art. This thesis builds on existing scholarship by providing a new and enriching perspective to Steindorff’s life and legacy. Each object case study reveals Steindorff’s major contributions to his field and the importance of challenging Eurocentric readings of objects while also accurately documenting and addressing the perspectives present within modern Europe during Steindorff’s era. The primary argument of this thesis is that scholars like Steindorff were conducting excavations and making key curatorial and display decisions in response to a growing scholarly understanding of what constituted the core importance of ancient Egyptian artifacts. Amidst German Egyptologists shaping the canon of Egyptian art, Steindorff indecisively judged rare ancient objects that both aligned with and defied canonical standards. His uncertainty reflected his internal conflicts as a developing excavator and the underlying problems of the canon when applied to ancient Egyptian art. The decisions that Steindorff eventually made regarding the found objects reflected the complexities of the canon and ultimately helped dictate how ancient Egypt was portrayed to the modern museum-going public in Germany. Museums with Egyptian collections that are founded on such decisions must now reflect on what messages and agendas they project onto museum goers and require new solutions to address the longstanding issue of the canon. Germany similarly wanted to not only gain further knowledge of Persia through excavations but also remain politically competitive with the other major Western powers

Excavating Imperial Fantasies: The German Oriental Society, 1898-1914

Though established near the end of the age of exploration and empire, after its formation in 1898, the Deutsche Orient-Gesellschaft (the German Oriental Society or DOG) quickly became a leading international archaeological society. This thesis explores this period of growth during the DOG's founding years in the 1890s until the First World War. It examines the motives that led to the DOG's inception, the structure and composition of this organization, and the ways in which the DOG used its publications to present itself to the public. Though members of the society held diverse professions, religions, and perspectives, they shared two aims: to extend Germany's international influence using archaeology and to solidify a respected place within the male elite of the German Empire. Unlike the rich literature on French and British Orientalism, studies on German Orientalism have only recently emerged. This thesis hopes to contribute to this developing scholarship.Master of Art

GERMAN BIBLICAL ARCHAEOLOGY: RETROSPECTIVE OF A NEGLECTED LEGACY; A Study of the German contribution to the Archaeology of Palestine in its longue durée, from 1871 to 1945

The history of biblical archaeology and of the archaeology of the Near East has been the subject of many publications until now. Those histories usually offer the reader a detailed account of progressive facts on a long and linear chronology, in which England stares as the main character, later losing its role to the United States. Besides those totalising explanations, there are other ways to interpret the history of Western archaeological interest in the Near East. In this thesis, the emphasis lays upon Germany, which is traditionally attributed a secondary role. German’s peculiar relation to the Orient, as the only western country to settle in Palestine even in the 19th century, or as the only western country to adopt a friendly position towards the Ottoman rulers, allowed German scientific exploration to develop under unique conditions. While studying the development of German archeological interest in Palestine from 1871 to 1945, I intend to present a different perspective on this scenario of western competition for the Holy Land

Der klassische Archäologe Hermann Thiersch (1874-1939) und der Erwerb der Basler Papyrussammlung im Jahr 1899/1900

The Classical Archaeologist Hermann Thiersch (1874-1939) and the Acquisition of the Basel Papyrus Collection in 1899/1900. During the winter of 1899/1900, the young archaeologist Hermann Thiersch traveled to Cairo to purchase papyri for the universities in Basel, Strasbourg, and Munich. By this point, European and North American collectors and researchers were racing to discover the finest material either for their own archaeological excavations or by purchasing papyri from local antiquities dealers who were generally supplied with material by looters. This article examines the acquisition of the Basel papyrus collection in the context of the great 'papyrus rush' that was in full swing. It also offers an insight into the collaboration of European archaeologists and classicists working in Egypt at the turn of the twentieth century