Local Inflammatory Signs Research Articles

Inhaled nebulized glatiramer acetate against Gram-negative bacteria is not associated with adverse pulmonary reactions in healthy, young adult female pigs.

The developmental speed of new antimicrobials does not meet the emergence of multidrug-resistant bacteria sufficiently. A potential shortcut is assessing the antimicrobial activity of already approved drugs. Intrudingly, the antibacterial action of glatiramer acetate (GA) has recently been discovered. GA is a well-known and safe immunomodulatory drug particular effective against Gram-negative bacteria, which disrupts biological membranes by resembling the activity of antimicrobial peptides. Thus, GA can potentially be included in treatment strategies used to combat infections caused by multidrug-resistant Gram-negatives. One potential application is chronic respiratory infections caused by Pseudomonas aeruginosa, however the safety of GA inhalation has never been assessed. Here, the safety of inhaling nebulized GA is evaluated in a preclinical pig model. The potential side effects, i.e., bronchoconstriction, respiratory tract symptoms and systemic- and local inflammation were assessed by ventilator monitoring, clinical observation, biochemistry, flowcytometry, and histopathology. No signs of bronchoconstriction assessed by increased airway peak pressure, Ppeak, or decreased oxygen pressure were observed. Also, there were no signs of local inflammation in the final histopathology examination of the pulmonary tissue. As we did not observe any potential pulmonary side effects of inhaled GA, our preliminary results suggest that GA inhalation is safe and potentially can be a part of the treatment strategy targeting chronic lung infections caused by multidrug-resistant Gram-negative bacteria.

Poor prognosis for infectious complications of surgery for ankle and hindfoot fracture and dislocation. A 34-case series

IntroductionAnkle and hindfoot fractures are associated with high rates of complications, and of infection in particular, for which rates of 1% to 48% are reported. HypothesisTreatment of bone and joint infection (BJI) secondary to surgery for ankle or hindfoot fracture is at high risk of failure. We analyzed results of treatment of BJI in this context. Material and methods33 patients (34 cases) were treated for ankle or hindfoot BJI between 2010 and 2015. Cure was defined by absence of fistula and of local or general inflammatory signs and by normal C-reactive protein level, at a minimum 2 years’ follow-up. Fusion without infection was counted as success; recurrent infection and amputation were counted as failure. Mean age at trauma was 52 years (range, 16–85 years). Median time to diagnosis of BJI was 44 days (range, 2–830 days). ResultsMean follow-up was 20 months (range, 3–59 months). Twenty-two patients were cured (65%). Seven cases required joint fusion (21%). The failure rate was 15%, including 5 transtibial amputations. Skin cover flap was required for 15 patients (44%), at a median 33 days (range, 0–167 days). DiscussionDespite its retrospective design and small numbers, the present study confirmed the poor prognosis of BJI following surgery for ankle and/or hindfoot fracture. Patients need to be informed of this. Type of study and level of evidenceIV, retrospective observational.

Intra-Articular Injection of 2 Different Dosages of Autologous and Allogeneic Bone Marrow- and Umbilical Cord-Derived Mesenchymal Stem Cells Triggers a Variable Inflammatory Response of the Fetlock Joint on 12 Sound Experimental Horses.

Osteoarthritis is a significant and costly cause of pain for both humans and horses. The horse has been identified as a suitable model for human osteoarthritis. Regenerative therapy with allogeneic mesenchymal stem cells (MSCs) is a promising treatment, but the safety of this procedure continues to be debated. The aim of this study is to evaluate the safety of intra-articular injections of allogeneic MSCs on healthy joints by comparing two different dosages and two different tissue sources, namely, bone marrow and umbilical cord blood, with a placebo treatment on the same individuals. We also assessed the influence of autologous versus allogeneic cells for bone marrow-derived MSC treatment. Twelve clinically sound horses were subjected to injections in their 4 fetlock joints. Each of the three fetlocks was administered a different MSC type, and the remaining fetlock was injected with phosphate-buffered saline as a control. Six horses received 10 million cells per joint, and the 6 other horses received 20 million cells per joint. Clinical and ultrasound monitoring revealed that allogeneic bone marrow-derived MSCs induced significantly more synovial effusion compared to umbilical cord blood-derived MSCs but no significant difference was noted within the synovial fluid parameters. The administration of 10 million cells in horses triggered significantly more inflammatory signs than the administration of 20 million cells. Mesenchymal stem cell injections induced mild to moderate local inflammatory signs compared to the placebo, with individual variability in the sensitivity to the same line of MSCs. Understanding the behavior of stem cells when injected alone is a step towards the safer use of new strategies in stem cell therapy, where the use of either MSC secretome or MSCs combined with biomaterials could enhance their viability and metabolic activity.

Watchful waiting in carefully selected metachronous cystadenolymphomas of the parotid gland: a reliable option?

The aim of this study was to evaluate the potential of watchful waiting in the treatment of metachronous cystadenolymphomas, taking the experience of our department into consideration. All patients suspected of having a metachronous cystadenolymphoma, and who had a minimum follow-up time of 12 months, were studied (n = 26). Data about the growth rate, number of lesions, and symptoms of inflammation were recorded. Mean (range) follow-up was 36 (13–94) months. Metachronous tumours developed in three cases on the ipsilateral side, in 22 cases on the contralateral side, and on both sides in one case. The mean rate of growth /lesion was 15% /year (range: 22%–158%). There were no signs of local inflammation. The extreme variability in the behaviour of metachronous cystadenolymphomas points to the need for an individualised approach, accurate investigation of the sonographic characteristics, and continuous watchful waiting in affected patients.

Impact of Infection Prevention and Control Education Program on Improving Knowledge, Attitude and Practices of the Healthcare Staff in Hemodialysis Unit at Egyptian Tertiary Care Facility

Objective: Infection is a leading cause of hospitalization and the second most common cause of mortality among hemodialysis (HD) patients. The aim of this study is to assess the impact of infection prevention and control education program on improving healthcare workers knowledge, attitude and practices and reducing incidence of infection in the hemodialysis unit.
 Methodology: All patients and healthcare workers in the unit within the study period were included. This study was conducted through 3 phases; Phase I: base line survey for assessment of infection prevention and control knowledge, attitude and practices among healthcare workers, Phase II: Intervention that included infection control standardized education program followed by post education survey. Phase III: Implementation of infection control program was done associated with assessment of blood born viruses (HCV, HBV & HIV) and monitoring patients for fever and/or local signs of inflammation at catheter exit or at skin around shunt to be subjected to blood culture.
 Results: Health care workers knowledge, attitude and practices of infection prevention and control before intervention were unsatisfactory followed by significant improvement reflecting the effectiveness of such interventions. Regarding incidence of infection there were three cases of blood stream infections; two of them were multidrug resistant organisms (MDROs) and no reported cases of seroconverion for HIV, HCV or HBV during study period. 
 Conclusion: Lack of knowledge about infection prevention and control practices in hemodialysis unit could be significantly improved by standardized education program which results in reducing incidence of infections in such units.

Systemic and local inflammation in colorectal cancer.

Colorectal cancer (CRC) is the third most common cancer in the world. The cornerstone of CRC treatment is surgical resection. However, patients in the same TNM stage show different recurrence rates and survival. Of patients with a local disease without lymph node or a distant metastasis, 20-25% still develop recurrence. There is evidence that inflammatory reaction is one of the key elements in tumour development. We reviewed literature on colorectal cancer and its relationships with the immune system, with special focus on local and systemic inflammatory reaction. The Pubmed and ClinicalKey databases were searched using the key words colorectal cancer, local inflammation, systemic inflammation, markers of inflammation. The relevant literature was reviewed and included in the article. The immune system has two-sided relationships with cancer, so it not only performs anti-tumour activities, but can also promote tumour growth and spread. Research has shown that signs of local inflammation are associated with a better prognosis in CRC. Systemic inflammation has been associated with more aggressive behaviour and a worse prognosis for patients with several cancers, including CRC. Recent findings in tumour biology have improved our understanding of colorectal cancer and of the natural course of this disease. Several markers of local and systemic inflammatory reaction have been identified. The next step is to find the most accurate and applicable marker, so that this promising tool can be used in clinical practice and aid in decision making.

Liver abscesses ultrasonic semiotics and its significance for the surgery method choosing

Significant progress has now been made in diagnosing, treating, reducing complications and lethality at liver abscesses. This is due to the displacement from the arsenal of surgery of complex and traumatic abdominal or trans thoraces approach to abscesses, which themselves created the problem of the postoperative period, complicated the course of an already severe infectious pathology. Modern minimally invasive technologies have significant advantages, especially with regard to interventional sonography, that is, the combined properties of diagnosis and treatment.
 Purpose of the study. To objectify the choice of the method of surgical intervention of liver abscesses on the basis of a new self-developed ultrasound semiotics of the stage of the formation of abscesses.
 Materials and methods. A comprehensive examination of 62 patients with liver abscesses was based on the study of the clinical picture of the liver abscesses, a bacteriological study of the contents, CT scan, and especially ultrasound, on the basis of which the ultrasound semiotics of the stages of the formation of abscesses was developed and implemented.
 Results and discussion. According to the possibilities of ultrasound diagnosis of abscesses of the liver from the first signs of local inflammation in the liver to the final stage of formation of the pyogenic capsule, we identified four stages of their development: 1 stage – local inflammatory changes of the parenchyma without its destruction; Stage 2 – destructive changes of parenchyma without signs of distinct boundaries; Stage 3 – clear boundaries of destructive changes with a non-expressed capsule; Stage 4 – clear formation of a capsule with complete destruction of tissues.
 The proposed ultrasonic semiotics allows us to determine the method of operation. Thus, at stages 1 and 2, and in some cases in 3 stages, there is no alternative to puncture-drainage methods in residual postoperative cavities. At stages 3 and 4, there are more advantages in laparoscopic operations, in some cases laparotomic.
 Conclusions. the proposed classification of ultrasonic semiotics stages of the formation of liver abscesses most pathogenetically corresponds to the morphological changes of the abscess zone and, most importantly, is adapted to the choice of the method of operation.

Acute Osteomyelitis of the Posterior Column of the Acetabulum: About a Case

Introduction: Acute osteomyelitis usually occurs in the metaphysis of the long bones, the lower limb being more commonly affected than the upper limb. Pelvic localization is rare.
 Observation: An 11-year-old boy with no remarkable history of illness visited our emergency room complaining from high fever and atromatic right hip pain. The orthopedic examination objectified a limitation of the right hip joint motions especially in extension, the palpation of the groin’s crease was slightly painful without local inflammatory signs nor lymphadenopathies. Blood laboratory tests found an inflammatory syndrome. Hip X-rays did not show any abnormality, the ultrasound of the right hip showed a joint effusion of low abundance measuring 1 mm. Magnetic resonance imaging detected anhypointense signal on T1-weighted sequences and a high intensity signal on T2-weighted on the right acetabulum with contrast enhacement after gadolinium administration. It combines a fat infiltration and a collection of 13x6 mm in the internal obturator muscle. The diagnosis of acute osteomyelitis of the posterior column with soft tissue invasion and reactive arthritis was confirmed. The blood cultures did not isolate a germ and the urinalysis was negative. The child was given antibiotic therapy: amoxicillin clavulanic acid and fusidic acid intravenously for a period of 21 days and then orally for a total duration of 12 weeks. The evolution was marked by a clinical improvement and a negation of the CRP. A 3-month control MRI showed total regression of the soft tissue collections.
 Discussion: Pelvic osteomyelitis is rare, patients with pelvic osteomyelitis can present various clinical signs, which gives place to late or erroneous diagnosis. The prognosis of pelvic osteomyelitis is very favorable. The rate of recovery without sequelae is greater than 95%, but decreases with late diagnosis and treatment failure.
 Conclusion: Osteomyelitis remains an endemic pathology in Tunisia despite the development of diagnostic’ means and antibiotic therapy. Pelvic osteomyelitis is rare; it poses a diagnostic problem especially with Ewing's sarcoma. Its prognosis is favorable but decreases with a delay of antibiotic administration.

Local cytokine therapy in a comprehensive treatment of HPV-associated cervical diseases

Aim. To analyze an efficacy of monotherapy and combined therapy (an immunomodulator + radio wave ablation) in patients with low-grade squamous intraepithelial lesion (L-SIL) caused by HPV infection. Materials and methods. The study included 210 women with human papillomavirus infection which was identified using real-time polymerase chain reaction (PCR). All women underwent a comprehensive examination which included history taking, general and gynecological examinations, extended colposcopy and a bacterioscopy of Gram-stained vaginal smears. A quantitative determination of vaginal microflora composition by PCR was carried out. Conclusion on either inflammatory response is present or absent was made on the basis of an inflammation index magnitude: with a value of more than 60% indicating a presence of local inflammation signs. Based on cervical cytology data a group consisting of 79 women who had L-SIL was formed. Patients were divided into 2 subgroups: the main one (n=45) who received combined treatment with radio wave ablation + an immunomodulator and a control one (n=34) who received only local monodestruction of L-SIL foci followed etiotropic treatment. Results and discussion. An efficacy of combined treatment which included radio wave ablation + an immunomodulator was higher compared to monodestruction only - 86.7% vs 64,7% respectively. It is important that by 6th month of follow-up a relapse of human papillomavirus infection occurred in 4.5 and 23.5% of patients of main and control groups respectively. Local inflammation was assessed as positive with an inflammation index of more than 60%. So after 6 months of follow-up this indicator decreased by 83.3 and 54.2% in the 1st and 2nd groups respectively. Clinical manifestations of an inflammatory process in the cervix was observed only with CIN recurrence. In addition, combined therapy provides a higher rate of human papillomavirus elimination at 6 months and faster cervix epithelization followed treatment by ablation.

Tarsal-related cysts: Different diagnoses with similar presentations

PurposeTo study different tarsal cysts that share similar presentations and are commonly misdiagnosed clinically as a chalazion. MethodsA retrospective review of medical charts of all consecutive patients who presented eyelid tarsal-related pathology that needed surgical excision between 2010 and 2016 to a tertiary hospital was done. The data collected included preoperative, intraoperative and postoperative observations. Complete ophthalmologic examination at presentation, surgical procedures needed, complications, histopathological findings, response to treatment and follow-ups were recorded. ResultsOut of 850 patients who had an eyelid tarsal-related pathology, ten patients were found to have an eyelid cystic lesion related to the tarsus. All patients presented with an eyelid mass with no sign of local inflammation. All lesions were fixed to the tarsus with freely mobile overlying skin. Five patients had a recurrent lesion that was misdiagnosed and surgically treated as a chalazion. All patients underwent a surgical removal of these cysts, and a histopathological examination was performed. An intratarsal keratinous cyst was found in six patients and epithelial inclusion cyst was in one patient. Two patients found to have cystic structure lined by double cuboidal epithelium with numerous goblet cells consistent with benign lacrimal duct cyst (Dacryops). ConclusionCysts related to the tarsal plate could have similar presentations. Careful clinical evaluation and histopathological examination play an important role in giving the right diagnosis and in providing the appropriate management.

Effectiveness and safety of rituximab for the treatment of refractory systemic sclerosis associated calcinosis: A case series and systematic review of the literature.

To analyze the effectiveness and safety of rituximab (RTX) for the treatment of refractory systemic sclerosis (SSc)-associated calcinosis. We undertook an observational study of patients with this complication treated with 1 or more cycles of RTX (1 g × 2 weeks) and evaluated for at least 12 months after RTX treatment in a single center. The primary outcome measures of the study were the improvement of calcinosis symptoms (pain, signs of local inflammation, and new episodes of skin ulceration) and the radiologic evolution of the calcification(s). We treated 8 patients with refractory SSc-related calcinosis with RTX (off-label use). The main indications for RTX were complicated calcinosis unresponsive to previous therapies with concomitant arthritis in 2 patients and refractory arthritis or interstitial lung fibrosing disease in the remaining 6 patients. The mean number of RTX cycles administered was 3.12 ± 2.1 (range, 1-7), the median duration of RTX treatment was 9 months (interquartile range [IQR], 7.5-36 months), and the median follow-up after the first infusion of RTX dose was 19 months (IQR, http://catsalut.gencat.cat/web/.content/minisite/catsalut/proveidors_professionals/medicaments_farmacia/phf_mhda/informes_camse/esclerosi_sistemica/Dictamen-CAMS_-ES_-web.pdf (n.d.) 5-45 months). Four patients (50%) had a significant improvement in clinical symptoms (sustained improvement in the visual analog scale for pain of at least 50% and no new episodes of local inflammation or skin ulceration). Two of these patients (25%) also had a complete resolution or significant reduction in the size of the calcification(s) on X-ray, according with the radiographical scoring system for calcinosis developed by the Scleroderma Clinical Trials Consortium. In the remaining 4 patients (50%), RTX did not provide any significant clinical or radiologic benefit for calcinosis. The frequency of adverse effects was low, occurring in only 1 patient (12.5%), who developed upper respiratory tract infections not requiring hospitalization. Our preliminary data suggest that RTX may be helpful as a rescue therapy in selected cases of severe and refractory SSc-related calcinosis.

Searching for highly sensitive and specific biomarkers for sepsis: State-of-the-art in post-mortem diagnosis of sepsis through immunohistochemical analysis.

The autoptical observations commonly ascribed to sepsis deal with unspecific general and local signs of inflammation or ischemia, such as myocardial inflammation, pulmonary edema and infiltration, cerebral swallowing, and tubular necrosis in the kidney. In the two last decades, some studies have been carried out to implement immunohistochemical markers for post-mortem diagnosis. All of these target molecules are specifically up-regulated or down-regulated during systemic inflammatory responses, especially for infective causes. Among these, we found some antigens expressed on leukocyte surfaces (very late antigen-4 (VLA-4), cluster differentiation-15 (CD15)), enzyme contained in neutrophils granules (lysozyme (LZ), lactoferrin (LF)), endothelial markers and junctions (E-selectin, vascular endothelial cadherin (VE-cadherin)), and soluble factors (vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNFα), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (s-TREM-1)). All of these showed potential reliability in differentiating sepsis cases from controls. Further studies are needed to provide a concrete validation for a combination of markers on specific organ samples in order to reach a post-mortem diagnosis of sepsis also in the absence of clinical records.

МОНО- И БИСЕГМЕНТАРНЫЕ ВНЕБОЛЬНИЧНЫЕ ПНЕВМОНИИ У МУЖЧИН МОЛОДОГО ВОЗРАСТА (ТОПИЧЕСКИЕ И КЛИНИЧЕСКИЕ АСПЕКТЫ)

Localization of community-acquired pneumonia (CAP) is its independent clinical sign which has not received proper coverage in the medical literature. The aim of the study is to compare the topical and clinical characteristics of unilateral lobar and segmental CAP in young men. Materials and methods: topical and clinical features of lobar, bi- and monosegmental CAP were studied in 6332 young military men. It was found out that monosegmental CAPs (mCAP) are more variable in their clinical and laboratory manifestations than their bisegamental and lobar variants not identified at the segmental level. The frequency of occurrence of mCAP of a specific localization directly correlates with the frequency of sputum expectoration, the severity of systemic and local neutrophilic inflammation. The 5th and 10th segments of both lungs are the zones of the most frequent localization of mCAP associated with a relatively high severity of systemic neutrophil reaction, and the 6th and 8th segments are the zones of a relatively longer course of mCAP and the predominance of signs of local inflammation. In bisegmental CAP, there is a general trend of a more pronounced systemic inflammatory response to the criterion of blood neutrophils level than in mCAP. The revealed regularities can contribute to a more accurate prediction of the mCAP course in the population of young men.

Skin lesions over the pocket area that may mimic cardiac implantable electronic device infection: A case series.

The early and correct diagnosis of cardiac implantable electronic device (CIED) infections is critical given that early aggressive treatment with complete removal of the system along with antimicrobial therapy dramatically improves outcomes. Pocket infection manifested by local signs of inflammation is the most common form of CIED infections. Conditions mimicking pocket infection have been described in the literature. These include various types of malignancy and rarely allergic reactions/contact dermatitis to pacemaker compounds. We aimed to describe skin lesions and disorders over the pocket area that mimic CIED infection. We present a series of five cases with skin lesions that mimic pocket infection. We document these cases with corresponding photographs. Most of them have not been described in this setting. We report the following cases of conditions that proved not to be CIED infection: One case of superficial cellulitis, one case of herpes zoster over the pocket area, one case of spontaneous bruising over the pocket a long time after implantation in a patient taking oral anticoagulation, and two cases of contact dermatitis due to prolonged postoperative application of povidone-iodine. All cases had favorable outcome after conservative treatment and no CIED infection was developed during follow-up. Clinicians should be aware of rare conditions that mimic CIED infection. Incorrect diagnosis of these disorders may falsely lead to CIED extraction.

Evaluation of Systemic and Local Inflammatory Parameters and Manifestations of Pain in an Equine Experimental Wound Model

In the last decades, a well-established equine wound model has been used to study fibroproliferative wound healing disorders. The aim of this study was to characterize the degree of discomfort of wounding and sampling in an equine excisional wound model by evaluating systemic and local inflammatory responses and signs of pain. A total of 12 cutaneous wounds, three on each shoulder and each metatarsus, were created in a standing surgical procedure. Wounds were biopsied on days 2, 4, 7, 14, 21, and 28 after surgery. Clinical parameters (rectal temperature, heart rate, respiratory frequency) and blood levels of white blood cell, serum amyloid A, fibrinogen, and iron were monitored to evaluate the systemic inflammatory response. Local signs of inflammation (swelling, heat, pain) were subjectively assessed, the limb circumference recorded, and temperature of the wound measured by thermometry. Pain was evaluated by a composite measure pain scale (CMPS). The results demonstrated that the wounding procedure elicits an inflammatory response. Day 1 after surgery, two horses scored 2 and 7 units (of 27 units), respectively, on the CMPS, and day 8 after surgery, one horse scored 3 units. The biopsy procedure did not elicit local or systemic signs of inflammation. Based on these findings, it appears that the equine experimental wound model causes mild discomfort and pain manifestations. This information is important for researchers, who consider using the model. To justify the use of an animal model, it should be demonstrated that the expected benefits of the research outweigh the discomfort imposed to the animal.

Surgical management of sternoclavicular joint septic arthritis

IntroductionInfections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections. Patients and methodsWe retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). ResultsNine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 × 109 L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7. ConclusionCT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis.

Development of clinical sign-based scoring system for assessment of omphalitis in neonatal calves

Omphalitis contributes significantly to morbidity and mortality in neonatal calves. Diagnosis of omphalitis is based on the local signs of inflammation—pain, swelling, local heat and purulent discharge. An abattoir trial...

Recurrent central catheter complications in a newborn: can we blame neonatal lupus?

We present the case of a preterm newborn, whose mother had medical history of systemic lupus erythematosus and antiphospholipid syndrome treated in pregnancy with enoxaparin, prednisolone, azathioprine and hidroxicloroquine. Routine...

The treatment of the patients suffering from acute bacterial external otitis with the use of intravenous blood illumination by low-intensity laser radiation at a wavelength of 445 nm

The prevalence of allergic reactions to the pharmaceutical products and the development of antibiotic resistance limit the provision of the high-quality medical care to the patients presenting with acute bacterial external otitis media (ABEO). The objective of the present study was to evaluate the effectiveness of the treatment of the patients suffering from ABEO with the application of the new technique based on intravenous blood illumination by low-intensity laser radiation at a wavelength of 445 nm (ILBI-445). This open comparative clinical study was carried out from April 2017 till June 2017 and included the patients with ABEO who were divided into two groups. The patients of the main group underwent the standard treatment in the combination with low-intensity laser radiation at a wavelength of 445 nm. Those comprising the control group were given the conventional treatment alone. The end point of the study was the complete disappearance of local inflammatory signs in the region of the external auditory canal (EAC) and auricle, the restoration of the volume of the EAC, the absence of complaints estimated based on the visual analogue scale (VAS), and the complete disappearance of symptoms of intoxication. The local signs of inflammation in the region of the EAC and auricle were assessed from the otoscopic picture. The measurement of the volume of the external auditory canal were carried out by filling it with a furacilin solution at a temperature of 360C using a 2 ml syringe. The character of the inflammatory changes in the external auditory canal, the intensity of pain and itching, as well as the degree of hearing loss were estimated at 10 points based on the 10-point visual analogue scale (with 0 points standing for the absence of complaints and 10 points denoting the maximum severity of the complaints). The symptoms of intoxication were determined from the measurements of body temperature. The combined treatment of the patients with ABEO using ILBI-445 resulted in their earlier recovery in comparison with that achieved by means of the standard therapy. The differences were especially pronounced on the 5th day of treatment. Complaints of pain and the loss of hearing were documented only in the patients of the control group. Itching was a significantly less serious trouble in the patients of the main group than it was in those comprising the control group. The volume of the external auditory canal in the patients of the main group on the 5th day after the onset of the treatment was more than 16.7% greater than in the control one. The high therapeutic effectiveness and simplicity of the approach employed in the present study taken together with a minimum of contraindications for its application give reason to recommend intravenous blood illumination by low-intensity laser radiation at a wavelength of 445 nm for the treatment of the patients suffering from acute bacterial external otitis.

Особенности хирургического лечения анаэробных инфекций глубоких пространств шеи, осложнённых медиастинитом

The article analyzes the surgical treatment of 78 patients with deep neck total necrotic phlegmon. It was revealed that in 95 % of cases in the early period are complicated by descending mediastinitis. The pre-examination stage included: X-ray of the neck by Zemtsov and chest X-ray, ultrasound examination of pleural cavities, thoracic and mediastinal MSCT The surgical stage included opening and draining of the abscess, revision of the deep cellular spaces of the neck and upper mediastinum. In 65 (83.3 %) case thoracomediastinoscopy and decompressive mediastinotomy were performed. In 58 patients, "programmed" bilateral thoracoscopic sanations were performed, with drainage of the mediastinum. Anaerobic microflora made 84.6 % of the infection. The total necrotic phlegmon of the deep cell spaces of the neck in 95 % is complicated by descending necrotizing mediastinitis. Local signs of inflammation, with necrotic phlegmons of the neck, do not allow to determine involvement in the inflammatory-destructive process of mediastinum. The absence of early findings from radiological exam does not exclude the presence of descending necrotizing mediastinitis. Autopsy and revision of the deep cellular spaces of the neck in 87.8 % does not eliminate the spread of the necrotic process along the mediastinal fiber. Active surgical tactics in the total phlegmon of the deep cellular spaces of the neck is justified and allows us to recommend one-stage drainage on the neck and thoracic-mediastinal sanation.