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Inflammatory process is at the heart of artificial (artificial) purulent-inflammatory diseases of soft tissues (APDST), which may lead to the development of phlegmon and abscesses at the site of invasion within a three-day period. The study of the cytokine status of rats with APDST allows us to evaluate the dynamics of inflammation markers and assess the peculiarities of the pathological course in artificial model of inflammation. The experiment was carried out on 126 white Wistar rats divided into 3 groups: (1) the main group (n = 57), where the laboratory model of APDST was used; (2) a comparison group (n = 58), in which the rats were injected with a mixture of opportunistic bacterial strains isolated from pure cultures of human oral fluid, i.e., S. epidermidis, S. mitis, S. salivarius at the titer of 9lg (CFU) per 1 ml injected together with a mixture of 2.5% hydrocortisone acetate emulsion (20 mg per 100 g of animal body weight), and dexamethasone solution at the dose of 0.5 mg; (3) control group (n = 11), where the animals were injected with 0.9% sodium chloride solution in a volume of 0.3 ml, together with a mixture of 2.5% hydrocortisone acetate emulsion at the rate of 20 mg per 100 g of body weight, and dexamethasone solution at the dose of 0.5 mg. Blood cells were studied using the Mindray DC-2800 Vet Auto Hematology Analyzer automated rat blood test system. The dynamics of pro-inflammatory cytokines: tumor necrosis factor (TNF), interleukin-1β (IL-1β), interleukin-6 (IL-6), antiinflammatory cytokines: interleukin-4 (IL-4), interleukin-10 (IL-10) was assessed by enzyme immunoassay. To predict the course of inflammation towards complications, or resolution of the inflammatory process, the ratio of pro-inflammatory to anti-inflammatory cytokines was used, with normal ratio considered an estimated average of the cytokine ratio for the control group. When analyzing results of this experimental study, the nature of cellular inflammatory response was assessed in dynamics, and its relationship with inflammation markers was determined. All animals of the main group developed soft tissue phlegmon within 3 to 7 days from the beginning of the experiment, and their mortality rate was 100%. In comparison group, the abscesses developed in 82.8% of cases on the day 12 to 15 from the start of the experiment, without any deaths observed. The ratio of pro- and anti-inflammatory cytokines in the main group increased 8-fold already by the end of the 1st day, the comparison group was characterized by the absence of significant differences from the control group. The highest levels of pro-inflammatory cytokines were recorded in the main experimental group on the days 12 to 15.

Despite the progress in modern surgery, the number of patients with purulent finger and hand diseases keeps growing these days in the clinical practice of surgeons. In recent years, there has been a tendency to develop more severe forms of panaritium and phlegmon in an increasingly young contingent of patients. Increasingly, doctors refuse to use the classical method of managing a postoperative wound of the hand involving the installation of drainage tubes. This phenomenon is polygenic and calls for special attention due to the frequent deplorable consequences of a treatment failure. The high urgency of this issue in Moscow Hospital No. 4 has become a rationale to study the effect of photodynamic therapy (PDT) on the course of the wound process in patients with this pathology.The purpose of this work is to develop a technique to advance the treatment outcomes for patients with purulent finger and hand diseases in case of open postoperative wound treatment.This study includes a comparative analysis of the wound process dynamics in 49 (49.5%) patients who underwent a photodynamic therapy session in the postoperative period and in 50 (50.5%) patients who received an open wound treatment after the operation. Photodynamic therapy was performed on the second postsurgical day by a laser apparatus “Atkus-2” (wave length 661 nm) with a gel form of the chlorinseries photosensitizer photoditazin in the form of an application at the rate of 1 g ml per 3–5 cm2 of the wound surface. The power density was chosen in the range of 0.1–1 W / cm2, and the time of exposure to the wound varied from 30 to 400 seconds, depending on the area of the wound.To assess the dynamics of the wound process in the postoperative period, we took measurements of all the patients’ wound areas on the 1st and 5th days, monitored the gross impression daily. In the patients who received PDT, we observed an earlier wound cleansing and remitting of the inflammatory process, acceleration of the edge epithelization, and earlier appearance of the granulation tissue by an average of 2 days. In the group of patients who were treated with PDT in the postoperative period, on the 5th day, the wound defect decreased by an average of 1 cm2, which amounted to 22.4%, in the control group – by 18%. The analysis of cytological and morphological patterns also revealed an accelerated switch from the inflammatory stage of the wound process to the reparative one - the reparative processes in the PDT group began earlier by 2 days. The microbiological analysis of wound exudate showed a downregulation of microflora after a PDT session - only in 6 cases pathogens were identified in the repeated seeding, which amounted to 12.24% of the group compared to 38% of the control group. After a session of photodynamic therapy, patients noted a significant reduction in pain, including during dressings. The pain syndrome immediately after the session decreased by 2–3 points. By the 5th day it became moderate – 4–5 points. In the control group, this indicator on the 2nd day was 8 points, decreasing by the 5th day to 6 points. For all analyzed indicators, the groups had statistically significant differences (p

For many years, the treatment of purulent diseases of the hand has stayed relevant. Despite the progress in modern medicine, this pathology retains its prevalence and, most importantly, is often found in patients of the working age, which determines the socio-economic importance of the search for new approaches to the treatment of purulent diseases of this localization. In the purulent surgery department of State Clinical hospital № 4, a study and treatment of two groups of patients were carried out: patients with phlegmons and felons of the hand with open management of postoperative wounds using traditional treatment methods (antibiotic therapy, immobilization, dressings with antiseptic solutions and ointments, the use of wound enzymes) and with the use of photodynamic therapy (PDT) in the postoperative period. PDT was performed on the second or third day after opening the phlegmon or felon using an ATKUS-2 semiconductor laser (AO “Poluprovodnikovye pribory”, Russia) with an output power of 1 to 2 W, an operating wavelength of 660 ± 0.03 nm and an energy density between 20 and 25 J/cm² after application of the photosensitizer based on chlorin e6 to the treated wound area. The article describes the technique of PDT in patients with purulent diseases of the hand. It was found that it is optimal to perform PDT as early as possible after the operation period, but not earlier than on the second day after the operation, because earlier dressing is especially painful in the absence of sutures and can lead to bleeding from a postoperative wound when the dressing is removed. The effectiveness of treatment in the studied groups was evaluated: the terms of inpatient healing in the groups were compared; the dynamics of the course of the wound process was analyzed. When comparing the results of the two groups, a significant acceleration in the healing of the postoperative wounds was noted in patients for whom PDT was used – 5 days (1.4 times) faster compared to treatment according to the generally accepted technique. The early appearance of granulations and the antibacterial effect of this procedure are noted, which significantly improves the treatment outcome for this pathology. This makes the use of PDT relevant and appropriate in the complex treatment of purulent diseases of the hand

Cardiac involvement in sarcoidosis is considered quite rare, but it can cause the first significant disease manifestations and patient’s death. Timely disease detection improves the effectiveness of treatment and prognosis. The article presents modern approaches to the diagnosis and management of patients with cardiac sarcoidosisusing clinical case of a patient hospitalized by ambulance with a first revealed symptomatic third-degree atrioventricular block. We described methods of examining this patient, as well as difficulties in differential diagnosis.