Purulent Focus Research Articles

Efficacy of Miramistin-Metronidazole Combination in the Treatment of Purulent-Inflammatory Processes of Soft Tissues

Importance of the topic. The patients with purulent-inflammatory processes of soft tissues are the most common category of surgical patients, since the effectiveness of their treatment decreases due to the development of microorganism resistance to antibiotics and antiseptics. The aim of research was to study the clinical efficacy of topical application of miramistin-metronidazole combination immobilized on sodium salt of carboxymethyl cellulose in the treatment of purulent-inflammatory processes of soft tissues.Materials and methods. The study included 60 patients with purulent-inflammatory diseases of soft tissues. They were divided into 2 groups, 30 people in each group. All patients were exposed to partial surgical treatment of the purulent focus. In the first group, the treatment consisted of local application of dioxomethyltetrahydropyrimidine ointment with the antibiotic chloramphenicol, and in the second group with miramistin-metronidazole combination immobilized on the sodium salt of carboxymethylcellulose. The course of the wound process was assessed by the dynamics of the local wound temperature, the percentage of reduction of the wound size and volume and the rate of its healing; the terms of edema and purulent discharge elimination, the onset of the appearance of mature granulations and epithelialization of wounds, the cessation of the microflora growth in wounds, the average number of inpatient days were also registered. Results. Measurements of the local wound temperature demonstrated that the inflammatory process in patients of the first group lasted for 10 days, and in patients of the second group for 5-6 days. Prior to discharge from the hospital, the wound area was 16.1% and the volume of wounds was 14% less in patients of the second group compared with similar findings in patients of the first group. The edema of the tissues surrounding the wound eliminated within 1.5 days, and the exudation from the wound stopped 2 days earlier in patients of the second group. Granulation in the wound appeared 2 days, and marginal epithelialization 1 day earlier in patients of the second group. With bacterial culturing of the wound discharge, the growth ceased 1 day earlier in patients of the second group compared to patients in the first group. Such dynamics of the course of the wound process led to a 3 bed-day decrease in the hospital stay of patients of the second group.Conclusion. Local treatment of purulent-inflammatory diseases of soft tissues with miramistin-metronidazole combination allowed optimizing the course of the wound process, reducing duration of inpatient stay.

Role of disarticulation and guillotine amputation of the shin in the lower limb ischemic gangrene surgical treatment strategy

Ischemic foot gangrene is one of the most common reasons of nontraumatic low limb amputations all over the world. Objective: to analyze the clinical effectiveness of an individual treatment strategy application for patients with absolute indications for high limb amputation, aimed to reduce amputation level, the number of postoperative complications and mortality. Materials and methods. This article presents the results of comparative clinical trial executing a lower-extremity amputation in 992 patients with ischemic gangrene. Applied in this study strategy of surgical treatment included usual below-knee, above-knee amputations and guillotine amputations in the lower third of the shin also the shin exarticulation without wound plastic. Guillotine amputations was used as an intermediate stage of treatment in cases where due to the severe general condition of patients to perform a classic myoplastic amputation with stump formation was impossible, since it is accompanied by a very high risk of postoperative complications and mortality. Results. Using guillotine amputations and shin exarticulation as the first stage of complex surgical strategy aimed to rapid elimination of the purulent focus with minimal risks and the speedy stabilization of the patients general condition, emaciated and weakened by developing gangrene, led to reduce general lethality by 17.1 % and increased the quantity of below-knee amputations by 23.0 % compared with the comparison group. Conclusion. Patients with ischemic gangrene require the development of an individual strategy for surgical treatment (taking into account the severity of the patients general condition, the prevalence of the purulent-necrotic process in the lower limb, the nature and degree of peripheral macroangiopathy), which can reliably and significantly reduce the number of amputations at the hip level (by 46.2%), as well as reduce mortality after high amputations of the lower extremities (by 17.1%) in an emergency city hospital. We consider it extremely important to reduce the number of primary amputations at the hip level!

The Effectiveness Of The Use Of Transtrachial Sanitation In The Treatment Of Patients With Lung Abscess Complicated By Bronchial Fistula

The results of the research of 44 patients with lung abscesses complicated by bronchial fistula of various etiology, who were treated in the purulent surgical department in the clinical base of the Bukhara State Institute in 2010-2019, were analyzed. All patients, depending on the method of treatment, were divided into 2 groups: I - comparison group and II - main. The controlled group I consisted of 31 (70.4%) patients who received traditional (conservative) methods of treatment. The II - main group included 13 (29.5%) patients who, in addition to conservative treatment, underwent transtrachial drainage of a purulent focus with sanitation with antibacterial and diluting drugs (trypsin, chymotrypsin). The analysis of the obtained results revealed that although transtrachial drainage of a purulent focus of the lung is a more effective method than conservative treatment, it also has its drawbacks in the form of complications such as: tracheobronchitis 23.1%, suppuration of soft tissues in the area of microtrachestomy 15.4%, bronchospasm 7.6%, self-extradition of the catheter 23.1%, from the purulent cavity and loss of microdrainage 7.6%.

Treatment of Acute Lung Abscesses Considering their Non-Respiratory Function in Patients with Diabetes

During the examination and treatment of 465 patients with acute lung abscesses on the background ofdiabetes mellitus, a preoperative preparation program was developed that takes into account the phase of theprocess (group 1 - septic course of the process, group 2 - stabilization, group 3 - remission), the severity ofendotoxemia and non-respiratory lung function. Patients of the 1st group against the background of basiclong-term intra-arterial catheter therapy used the scheme of correction of non-respiratory function of thelungs that we developed, sanitized purulent foci with an electrolyzed solution of sodium hypochlorite. In202 (79.9%) of 254 patients of the 1st group, it was effective that allowed to refuse the operation, while only52 (40.6%) were not operated on in the 2nd, and 26 in the 3rd (31.3%) patients. In parallel, a pronouncednormalizing effect was achieved in correcting the degree of violation of non-respiratory lung functionagainst the background of delimitation and stabilization of the process. This allowed in 109 (60.9%) of 179operated patients to confine themselves to lung resection with 8.7% of postoperative complications in the 1stgroup versus 18.4% in the 2nd and 24.6% in the 3rd, which emphasizes the effectiveness of our preoperativepreparation.

ARTHROSCOPIC TREATMENT OF HEMATOGENOUS PATELLA OSTEOMYELITIS IN A 12-YEAR OLD CHILD

Introduction. A rare disease in pediatric population - acute hematogenous osteomyelitis of the patella - is presented in the article by the authors. Diagnostic approaches and specificity in choosing a curative modality are described as well. A purulent focus in the patella was treated arthroscopically. Satisfactory outcomes in the shortest possible period were achieved due to the combined curative modality: antibiotic therapy, flow-lavage drainage of the joint and early rehabilitative measures. Purpose. To demonstrate potentials of modern diagnostic and endosurgical techniques for treating acute hematogenous osteomyelitis of the patella of rare location. Material and methods. In February 2017, a 12-year-old boy with acute hematogenous osteomyelitis of the right patella was examined and treated at the department of purulent surgery of the Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST). A complex of diagnostic techniques included laboratory (clinical analysis of blood and urine, biochemical blood test) and instrumental (ultrasound diagnostics of knee joints, computed tomography) examinations. Conservative treatment included antibacterial, anti-inflammatory and symptomatic therapy . Surgical debridement of the osteomyelitis focus in the knee joint was made arthroscopically. Results. Given the obtained data, the diagnosis of acute hematogenous osteomyelitis of the right patella was put. Location of the process, purulent effusion in the joint cavity and damaged articular surface of the patella urged surgeons to decide on the endosurgical treatment: arthroscopic cleansing of the purulent-necrotic focus of the patella and sanitation of the knee joint cavity. In the postoperative period, the child had medicamentous therapy, apparatus therapy, hyperbaric oxygenation therapy. The right lower limb was immobilized with a posterior plaster cast for 7 days. The joint was washed with physiological saline solution for 5 days, after which the drainage was left for passive aspiration for another two days. Standing-up position with crutches and emphasis on the low legs were achieved on the 7th postoperative day. On the 14th postoperative day, the child was discharged home in a satisfactory state. Catamnestic examination 4 months later revealed that the right knee joint was not externally changed, movements in the joint were in full range. Ultrasound examination did not reveal any pathology either. MRI examination revealed an area with reparative signs at the site of operated purulent focus which looked like a partial replacement of the bone defect. Conclusions. The arthroscopy is a minimally invasive and effective technique for surgical treatment of intra-articular purulent foci in acute hematogenous osteomyelitis of the patella.

Zakażenia zębopochodne, zapalenie tkanek przyzębia oraz profilaktyka zakażeń odległych – wskazania do antybiotykoterapii

Dental prophylaxis and early diagnosis and treatment of oral diseases can significantly affect human health in a positive way and reduce the risk of many general diseases. the basis for treatment of odontogenic infections of generally healthy patients is a local treatment consisting of purulent focus drainage and removal of the causative tooth or its endodontic treatment. only if the immediate causal treatment is not possible, it is rec- ommended to consider giving the patient an antibiotic to reduce infection, and then start the causal therapy as soon as the local condition allows it. the i line antibiotic for non-sensitized individuals is amoxicillin, followed by amocycillin with clavulanic acid, clindamycin and ampicillin with sulbactam. Periodontal tissue treatment is also a primarily mechanical treatment. the use of antibiotics is limited only to few clinical conditions. to treat periodontitis, the i line antibiotics are also amoxicycline or amoxicillin with clavulanic acid. in dentistry, antibiotics are also used as a prevention of distant infections, where, according to recommenda- tions, the i line antibiotic in the absence of sensitization is amoxicycline or amoxicycline with clavulanic acid. in dentistry, similar as in case of other diseases, it is important to adhere to the principles of antibiotic therapy and to use antibiotics only in necessary situations.

Laryngeal chondritis in two Dorper sheep

Laryngeal chondritis is an acute obstructive upper respiratory condition characterised by severe dyspnoea and laryngeal stridor, considered an uncommon disease in sheep. In this study, we describe detailed clinical evolution,...

Vacuum therapy in complex treatment of neuropathic form of diabetic foot syndrome in Ghana

Diabetic foot syndrome (DFS) is a serious public health problem in developing countries, where medical resources are limited, and the vast majority of patients turn to medical facilities too late with severe forms of the disease and often in advanced stages.Objective: to evaluate the effectiveness of negative pressure wound therapy (NPWT) in treating patients with a neuropathic form of DFS compared with traditional methods to reduce the number of high amputations and overall mortality in Ghana.Materials and research methods. A prospective, non-randomized, comparative clinical study of the results of examination and treatment of 59 patients with type 2 diabetes mellitus (DM) was performed at the Seventh-day Adventist City Hospital (Ghana, West Africa), Kumasi University Hospital and the Effiduase District Hospital (Ghana, West Africa) in the period from January 1, 2011 to December 31, 2013, there were 37 female patients (63.3 %), 22 male patients (36.7 %). The volume of foot tissue damage varied from II to IV degree according to Wagner classification (II degree was diagnosed in 55.6 % of cases). The average age of patients was 31.5 ± 7.3 (20–72) years. The average duration of DM was 7.3 ± 4.2 years. Bacteriological examination of wounds showed that Staphylococcus aureus was most often an isolated pathogen. All microorganisms identified from patients’ wounds had high resistance to commonly used antibiotics. Patients were randomly assigned to groups. NPWT is the only topical treatment in the main group; traditional dressings with antiseptic solutions (iodophors) were used in the comparison group.Study results. Comprehensive treatment of patients in both groups included surgical debridement of purulent foci, local treatment (NPWT or dressings with antiseptic solutions) and skin grafting or healing by secondary intention after the transition of the wound process to the reparative stage. None of the patients in both groups had a high amputation. Not a single fatal outcome has been recorded. In patients of the main group, the transition of the wound process to the reparative stage was carried out in a shorter time compared with those treated without NPWT.Conclusion. Treatment of the neuropathic form of DFS with the NPWT (for example, patients in Ghana) reduces the hospital stay and the number of high amputations of the lower extremities, and improves the quality of life of patients.

Improving effectiveness of microbiological diagnostics in patients with surgical infection of soft tissues.

Recently, there has been a steady tendency towards increase in the resistance of microorganisms to antibacterial drugs, which is due to the lack of development of new antibiotics, their uncontrolled administration, total use in animal husbandry, etc. leads to fatal outcomes, unsatisfactory results of treatment, rise in cost of treatment, formation of hospital pan-resistant strains. The increasing ability of microorganisms to cooperate in biofilms, production and improvement of resistance mechanisms in symbiosis are intractable issues in the treatment of patients with surgical infection of soft tissues. In patients with surgical infection of soft tissues, surgical treatment of a purulent focus and antibiotic therapy are fundamental doctrinal, determining the success of treatment.The choice of an antibacterial drug in most cases is based on the results of an antibioticogram. A study of wounds by smear technique and biopsy samples of wound tissues in 81 patients was performed. The quantitative and qualitative composition of wound microflora of patients was evaluated during the study of biopsy samples and standard culture from the wound surface. When examining the biopsy samples, 86 strains were isolated, and 110 – in the material from the wound surface. There was no growth on the wound surface in 11 cases (13.5%), against 20 (almost 25%) in biopsy samples. One species of flora was isolated from 37 wound surfaces (about 46%), biopsy samples of wounds with monoculture – in 61 samples (75%). Associations (two or more) are present in 33 (41%) wound samples, and only in 21 biopsy samples (26%). Thus, the conducted studies confirm the fact that wound surface is more contaminated by foreign microflora than biopsy samples. The data obtained allow us to recommend the method of wound biptates instead of a smear, as more specific and sensitive in patients with surgical infection of soft tissues.

КЛИНИКО-МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА ХРОНИЧЕСКОГО РЕЦИДИВИРУЮЩЕГО ГЕМАТОГЕННОГО ОСТЕОМИЕЛИТА

The studied material of scanning and transmission electron microscopy were bone fragments of 40 patients obtained during surgery from various pathologically altered sections of the affected tubular bones. Morphological studies revealed microscopic foci of necrosis, leukocyte infiltrates and microabscesses both in the main focus and in other parts of the bone marrow canal. Microabscesses detected by microscopy represent the morphological basis of chronic hematogenous osteomyelitis, can be located at a considerable distance from the main necrotic purulent focus and, under appropriate conditions, cause a relapse of the disease. Morphological studies have shown that surgical debridement of the lesion with ultrasonic cavitation of the lesion and the medullary canal contributes to a significant reduction in the degree of microbial contamination, followed by a decrease in pathological changes in bone tissue.

Experience of successful surgical treatment deep and extensive purulent-necrotic lesion of the lower limb with the neuroischemic form of the diabetic foot syndrome

The article presents the successful surgical treatment experience in a patient with deep and extensive purulent-necrotic lesion of the lower limb with a neuroischemic form of the diabetic foot syndrome. The possibilities of modern methods by revascularization, surgical treatment of purulent focus and extensive postoperative complex configuration wounds local treatment are demonstrated.

Clinical cases of meningococcal infection caused by Neisseria meningitidis serogroup W

Meningococcal infection remains a socially significant disease due to a wide range of clinical manifestations, severe course with high mortality, reaching 40-80% for certain forms. In recent years we observe a change in the serogroup picture of meningococcal infection, in particular, an increase in the proportion of meningococcal serogroup W, characterized by polymorphism of clinical manifestations. The authors present two their own clinical observations of a generalized form of meningococcal infection with a severe course in adolescents caused by Neisseria meningitidis of W serogroup with fatal outcome. They describe the peculiarities of the cases, namely, inconsistency of the clinical picture at the beginning of the disease and post-mortem changes. The article describes heart damage in the form of focal purulent septic myocarditis and purulent foci of destruction in the brain stem, hemorrhagic infarction of the choroid plexus with hemotamponade of the lateral ventricles of the brain, the predominance of septicopia over septicemia. The revealed changes are likely to reflect clinical and morphological features of meningococcal infection caused by N. meningitidis of serogroup W.

MICROBIAL COMPOSITION OF PURULENT LESIONS IN PATIENTS WITH COMPLICATED DIABETIC FOOT SYNDROME

Bacterial infection is a major pathogenetic aspects in the formation of diabetic foot complications. Joining infection is the cause of performing amputations of the lower limbs in 25-72 % of cases, especially when diabetic foot is complicated by sepsis. The aim of our study was to identify differences in the microbial background of purulent foci in patients with diabetic foot syndrome complicated by sepsis and for the further development of the algorithm of directed antibiotic therapy. Material and methods. A total of 3653 patients in the dynamics of a complicated diabetic foot syndrome were examined. There were two groups: the first - patients who were treated during 2010-2014 (a comparison group), the second – during 2015-2019 (main group), which according to the gender ratio (χ2=0.09; P=0.7698) and age (P=0.17141) did not differ. The complex bacteriological studies consisted of determining the sensitivity of microorganisms to antibiotics, the qualitative composition of microbial pathogens and the number of microbial cells per 1 g of tissues. To determine the sensitivity of purulent microorganisms to antibiotics a quick method of determination on automated systems «Vitek-2» and «BacT/ ALERT» (France) was applied. Results and discussion. All patients with complicated diabetic foot syndrome were operated under general anesthesia. As a rule, operations on the anterior foot and «high» amputations were performed. 190 people died, death rate was 5.2 %. The analyzed data indicate that in patients with diabetic foot syndrome complicated by the number of microbial cells in tissue 1g to the site of infection did not exceed 105 – 106, while in patients with sepsis, this number was more than 50% was 107 – 1012. Isolation of aerobic monoinfection of purulent foci in patients with complicated diabetic foot syndrome in the period from 2010 to 2019 decreased from 51,4 to 44,4% (P <0,05) determined by an increase in the allocation of gram-positive microorganisms from 55,2 to 60,2% (P<0,05). The dynamics of microbiological research indicates an increase in the proportion of MRSA- staphylococci from 23,4 to 43,3 %. Determined microbial pathogens are characterized by a high level of antibiotic resistance, particularly to antibiotic-I-II generation. Conclusions. These experiments enable to distinguish particularly microbial background of purulent foci of the two groups of patients and determine antibiotic algorithms.

Modified crosslinking in the treatment of purulent keratitis and corneal ulcers

To evaluate the efficacy of modified crosslinking (M-CXL) in the treatment of purulent corneal ulcers, including those of mixed etiology. The M-CXL method consists of simultaneous cross-linking and frequent instillations (FI) of anti-infective solutions. We observed 36 patients (37 eyes) with purulent corneal ulcers (PCU) of various etiologies. The test group included 24 patients (24 eyes) who received 1–2 sessions of M-CXL with active conservative therapy. In the control group (12 patients, 13 eyes), only active conservative therapy was performed. Complete reduction of the purulent process was achieved in 18 (75%) eyes in 29.6 ± 9.38 days in the test group; and in 8 eyes (61.5%) in 50.4 ± 15.9 days in the control group. The efficiency of M-CXL ranged from 100% to 66.6% depending on depth and width (square area) of the infiltration in question. In cases where infiltration affected the entire stromal thickness, the M-CXL efficacy sharply decreased to 66.6%, even with its small (<6 mm) area. In cases where infiltrations extended to the Descemet’s membrane with an overall area >7 mm, the clinical effect of M-CXL was absent or insufficient. In 75% cases, M-CXL showed complete reduction of PCU. Comparing with control groups, the duration of treatment in the test group decreased 42% (P less than 0.05). In infiltrations over a wide area affecting all the layers up to the Descemet’s membrane, resorbtion of the purulent focus was not achieved. However, it’s spread and purulent fusion were sufficiently suspended, thereby allowing therapeutic penetrating keratoplasty to be performed with a smaller graft diameter.

PECULIARITIES OF PARANEPHRAL ABSCESSES WITHOUT OBSTRUCTIVE NEPHROPATHY

Until now the appropriateness of surgical tactics for paranephral abscess has been unquestionable. However, due to the improvement of visualizing techniques and wide clinical implementation of minimally invasive technologies, new prospects in the treatment of the disease are coming to light. The article demonstrates the peculiarities of aetiology, pathogenesis, diagnosis and treatment of 73 patients with perinephric abscess, which in most cases develops without being accompanied with obstructive nephropathy. Purulent inflammatory process in the paranephral fatty tissue without obstructive nephropathy was preceded by infectious inflammatory diseases of different localization, hypothermia and trauma. More often, purulent inflammation in the paranephral fatty tissue developed in patients with diabetes mellitus. Septic complications were seen in 80.8% of all cases. At the same time, in patients with diabetes mellitus, the complication rate was significantly higher. Based on the recommendations of the EAU, for starting therapy we used antibiotics, the sensitivity of uropathogens to which, according to the results of the local monitoring of the microbial landscape in the urological department exceeded 90%. After obtaining the results of bacteriological culture test, correction of antibacterial therapy was performed. Percutaneous drainage of a purulent focus was carried out under general anaesthesia with ultrasound guidance, according the Seldinger technique. Severe septic complications occurred in 80.8% of patients without obstructive nephropathy and in 86.3% of patients with obstructive nephropathy, more often in diabetics. Ultrasound and CT with contrast enhancement allow revealing a purulent focus in the paranephral fatty tissue with high probability. Percutaneous drainage has proven to be an effective method for the treatment of paranephral abscess.

THERAPY AND PREVENTION FOR ACUTE AND CHRONIC LYMPHADENITALS OF MAXILLOFACIL AREA IN CHILDREN

The article presents the reviews of the relevant literature on the effectiveness of therapeutic and preventive measures in children with acute and chronic lymphadenitis of non-odontogenic and odontogenic origin of the maxillofacial localization. Despite the large number of technical innovations and modern pharmacological preparations, it is not always possible to achieve the desired success. Moreover, a number of factors as the peculiarities of the perinatal and posntatal development of the child, the role of the concomitant somatic pathologies, the premorbid background, the versatility of the etiological factors and the pathogenetic changes sometimes are far from being taken into account. Special attention should be paid to the further improvement of ways towards advancing antibacterial therapy of purulent foci that should be based on the techniques elaborated for administering reduced doses of the drug and can be achieved by para- and endolymphatic application of antibacterial drugs. However, the introduction of this method in clinical dentist practice requires the objectivity of the assessment of its therapeutic efficacy, as the results of the study of pharmacokinetics have shown that such mode of administering a daily dose of antibiotics provides the inhibitory concentrations of the drug for many infectious agents within 24-48 hours. Immunotherapy in the treatment of purulent surgical diseases is an essential component of the integrated treatment, and the correction should be based on the clear evidence of the deficiency of individual components in the immune defence. The investigation of the pharmacological action of antioxidants has demonstrated their marked anti-peroxide and antiphospholipase effects, however, some issues regarding their influence on the state of the oral cavity with these types of the disease are remaining unclear. Many years of the experience in applying physiotherapeutic agents for purulent wounds have been proven as effective and promising. It is necessary to emphasize that the drugs used in the first phase of the wound process possessed not only antibacterial effects, but also a significant osmotic activity and necrolytic properties. In the phase of scar remodelling and epithelisation, ointments stimulating reparative processes and promoting epithelisation are recommended to apply. Unfortunately, there are few scientific studies on the effect of therapy and prevention on acute and chronic inflammatory processes of the maxillofacial area in children. At present, this issue is in the focus of researchers’ close attention that is implemented through the elaboration of new approaches taking into account the predominant role of the main mechanisms of pathogenesis.

Evaluation of the efficacy of modern wound care dressings in the complex treatment of purulent wounds

Objective. Evaluate the efficacy of the treatment of purulent skin and soft tissue wounds using modern interactive dressings and conventional wound care dressings. Material and methods. The study included 160 patients, who were treated at the outpatient department of the Clinic of the SamGMU for the period from September 2018 to January 2019 after an autopsy, necrosectomy and drainage of purulent foci in the surgical hospital. Group I (n = 82) included patients, who applied Sorbalgon® interactive dressing (Paul Hartmann, Germany) during the first phase of the wound healing and Branolind® N atraumatic mesh dressing (Paul Hartmann, Germany) during the second phase of the wound healing for topical treatment of wounds in the postoperative period. Patients of Group II (n = 78) applied ointment dressings using Levomekol ointment during the first phase of the wound healing and Methyluracil ointment during the second phase of the wound healing. Patients in both groups received the same broad spectrum antibacterial therapy. In Group I, the dressings were applied once per 2 days, in Group II the dressings were applied on a daily basis. The researchers studied the following indicators: the nature of the wound discharge; the presence of edema and hyperemia of tissues; timing of the wound defect cleansing; temperature and leukocyte reactions of the body; crops on microflora and sensitivity to antibiotic therapy. Results. The study showed more pronounced dynamics of the temperature reaction normalization, reduction of the local inflammatory reaction and the leukocytosis level in patients of Group I. The wound cleansing from pus and fibrin, the development of granulation tissue on Day 5 were reported in 87.8% of patients of Group I and in 35.9% of patients of Group II, on Day 10 in 100% and 88.5% of patients, respectively. Conclusion. The use of Sorbalgon® and Branolind® N dressings improves the results of treatment of patients with purulent soft tissues pathology and reduces the risk for secondary infection, and improves the quality of life due to increase of interval between the dressings.

Evaluation Scale of Sepsis II severity score

Background. Actually sepsis is one of the main causes of high lethality among surgical patients.&#x0D; The purpose of this study. Is improvement of Sepsis severity evaluation Score based on available clinical and laboratory indicators.&#x0D; Materials and methods. 140 patients with surgical sepsis and purulent focuses localized in skin and subcutaneous tissue, abdominal cavity, lung, urogenital system were included to investigation.&#x0D; Results. Improved Sepsis severity evaluation Score includes clinical characteristics (estimation of consciousness, systolic blood pressure, heart rate, respiratory rate, daily diuresis, body temperature), blood system`s reaction, indicators of acute physiological disorders of kidneys and liver. Evaluation score includes localization of purulent focus, pathogen type, patient`s age, accompanied chronic pathology.&#x0D; Conclusions. Use of Improved Sepsis severity evaluation Score, based on available clinical and laboratory indicators, allows to estimate severity and unfavorable outcome risk in patients with having sepsis with reasonable accuracy.

Justification of sorption composite usage on the basis of nanodisperse silica for sepsis prevention in complex treatment of purulent-inflammatory processes

Introduction. The problem of purulentinflammatory processes treatment and the prevention of sepsis remains one of the most pressing problems of surgery.&#x0D; Purpose of the study. Is to estimate the effectiveness of sorption composition with antimicrobial properties on the basis of nanodisperse silica on the adhesive properties of microorganisms and to substantiate the expediency of its use for the purulent and inflammatory processes treatment and prevention of sepsis.&#x0D; Materials and methods. To determine the antimicrobial activity and the influence of the antiseptics of decasan, myramistin, ethonium, chlorhexidine and the sorption on the microorganisms adhesion properties composition was used the method of diffusion in agar of the museum strains of microorganisms S. Aureus ATCC 25923, E. Coli ATCC 25922, R. Vulgaris 4636, R. Aureginosa ATCC 27853, S. AIbicans 855/653, SI. Perfringens 28, Peptostreptococcus anaerobicus 22, Bacteroides fragilis 13/83, and clinical strains of S. Aureus, R. Aeuroginosa, E. Coli. Adhesive properties of microorganisms were studied according to the Brillis method et al. (1986) with the subsequent statistical processing of the data.&#x0D; Results. Studies have shown that antiseptics have high antimicrobial activity and reduce the adhesion ability of microorganisms. But the use of only antiseptics or only antibiotics for the purification of purulent foci can lead to toxins absorption and tissue decay products from purulent foci. That processes could be the trigger mechanism for sepsis development. The sorption composition is able to reduce the adhesive activity of bacteria, allows to absorb toxic substances from pathological foci, what preventing their resorption and thereby prevent the development of sepsis.&#x0D; Conclusions. The composition made from sorbents and antiseptics is not inferior to antimicrobial activity to antiseptics, which can reduce the virulence of bacteria, by reducing their adhesive activity, and absorb toxins of microorganisms and tissue decomposition products on their surface, thus prevent their absorption, which will prevent the purulent-inflammatory process progression and sepsis development.

Хірургічне лікування низхідного гнійного медіастиніту

Мета. Покращити результати лікування хворих з низхідним гнійним медіастинітом (НГМ) шляхом удосконалення хірургічних доступів до середостіння, методів місцевого хірургічного лікування та дренування середостіння.&#x0D; Матеріали і методи. Проведено обстеження та лікування 170 хворих із флегмоною шиї (ФШ) за період з 2004 по 2018 р. У 73 (42,9%) хворих ФШ ускладнилася розвитком НГМ. Чоловіків було 49 (67,1%), жінок − 24 (32,9%) віком від 21 до 72 років, середній вік хворих становив (47,3 ± 4,3) року.&#x0D; Результати. Хірургічне лікування НГМ передбачає усунення первинного джерела захворювання, вибір операційного доступу до середостіння, розкриття і санацію всіх гнійних ділянок середостіння, забезпечення постійного видалення гнійних мас із клітковини середостіння та плевральної порожнини. У разі застосування інтрамедіастинального введення антибактеріальних препаратів у 30 (90,9%) із 33 хворих гнійний процес було ліквідовано на стадії ФШ без його поширення в клітковину середостіння. НГМ розвинувся лише у 3 (9,1%) хворих. Із 137 хворих, яким даний метод не застосовували, у 70 (51,1%) ФШ ускладнилася НГМ.&#x0D; Висновки. Застосовуючи інтрамедіастинальне введення антибактеріальних препаратів у хворих з ФШ, ми знизили частоту поширення гнійного процесу в середостіння з розвитком НГМ з 51,1 до 9,1%. Перевагами використання відеоасистованої торакоскопії в порівнянні з торакотомією є менша травматичність, скорочення тривалості операції, хороша візуалізація уражених ділянок плеври та можливість мініінвазивного дренування середостіння та плевральної порожнини.&#x0D; Розроблена тактика хірургічного лікування НГМ забезпечує адекватну санацію гнійних вогнищ на шиї та в середостінні, швидке зниження рівня ендогенної інтоксикації та зменшення летальності із 27,0 до 8,3%.