EUROMEDICA  Hanover 29-30  Mai 2006	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Among late complications of diabetes mellitus the most serious are lesions of heart, kidneys, eyes and feet, however pathological process in the feet takes leading positions in this list. Development of expressed and not always convertible pathological changes, high frequency of amputations of the feet results in significant decrease of «qualities of life » and a high degree invalidization of such patients. Pathogenesis of infringements in a blood vessels at a diabetic foot syndrome is described in the modern literature in details, at the same time there are no data on features of diabetic changes in lymphatic system of lower extremities. The estimation of a functional condition of a lymphatic vessels at a diabetic foot syndrome is important for complex diagnostics of pathological process. Search of ways of influence on lymphatic system is actual with the purpose of correction of infringements of haemolymphocirculation at patients with a diabetic foot syndrome.

The purpose of the present research became studying of features of haemolymphocirculation at an initial stage of a diabetic foot syndrome and a substantiation of application of electrostimulation and low-frequency ultrasonic therapy for correction of infringements of haemolymphocirculation. 116 patients with diabetes mellitus (2nd type) with the neuro-ischemic form of a diabetic foot syndrome without ulcerous damages (Wagner stage 0) were included in trail. Frustration of sensitivity of feet of a different degree of expressiveness, hypo- and areflection were revealed during clinical inspection at all patients. Reduction of peripheral blood flow, infringement of nervous-muscular conductivity were revealed at 88% of patients. The analysis of parameters of lymphatic outflow in legs revealed expressed increase of resistance of lymphatic outflow.

Complex therapy included blood glucose control, antiagregants, low-molecular heparine, α–lipoic acid, antioxidants, and also original techniques of lymphotropic therapies. For stimulation of processes of haemolymphocirculation we applied electrostimulative therapy on device “Lympavision” and low-frequency ultrasonic therapy on device ”Prolong”.

In group of the patients who received only drug therapy, stimulation of the magistral blood flow without adequate amplification of lymphatic outflow was observed, that promoted progressing of the phenomena of stagnation of microcirculation in feet. Inclusion in the program of electrostimulative therapy allowed to improve an arterial blood flow. Also significant improvement of a condition of venous and lymphatic parts of microcirculation was achieved. Inclusion in the medical program of a low-frequency ultrasonic therapy allowed to reduce expressiveness of pathological arteriovenous shuntings at a level of feet due to restoration of blood flow in microcapillars. We revealed positive dynamics of parameters of venous and lymphatic outflow too.

Combined application of physiotherapeutic procedures resulted in improvement of a condition of all parts of haemolymphocirculation in legs. Efficiency of therapy due to mutual potentiation of methods was increased. The combination of electrostimulative and low-frequency ultrasonic therapies improves all kinds of sensitivity, reduces painful sensations in the feets, increases skin temperature of the feet, reducing a difference of temperature between shin and foot.