Purulent-septic Complications Research Articles

Complicated infectious endocarditis in a patient with human immunodeficiency virus: A case report

INTRODUCTION: Infectious endocarditis (IE) in injecting drug patients with human immunodeficiency virus (HIV) is manifested predominantly by damage to the tricuspid valve (TV). The pathogen of the disease is Staphylococcus aureus. The IE peculiarities of the TV in this category of patients are multiple septic emboli in the small circulation, which may result from flotation vegetations, and predominance of pulmonary symptomatology over cardiac phenomena.
 CASE PRESENTATION: A 30-year-old female HIV-infected injecting drug user was dynamically monitored for the laboratory-confirmed IE development by transthoracic echocardiography during a year. The patient was twice admitted to the intensive care unit in a serious condition with purulent-septic complications in the lungs in the form of bilateral polysegmental destructive (septic) pneumonia confirmed by X-ray and multispiral computed tomography. After intensive therapy, the patient refused further ARV treatment and consultations with a cardiac surgeon. A clinical follow-up demonstrated IE of the TV and right-sided lower lobe pneumonia in an HIV-infected drug-dependent patient after a cesarean section. Immunodeficiency without appropriate ARV therapy had a negative impact on the course of the disease. According to transthoracic echocardiography, an increase in TV vegetations from 7 mm to 16 mm and regurgitation were observed, whereas left ventricular ejection fraction decreased from 60% to 47% during the follow-up. Complications of cesarean section, immunodeficiency, and absence of ARV therapy could be the trigger factors of the IE development. Injection drug use with possible violations of asepsis and circulation of microorganisms of the causative agents in the blood contributed to the rapid development of the disease and was a determining factor of the infectious process in the TV.
 CONCLUSIONS: Echocardiography remains the primary radiological diagnostic method for examining HIV-infected drug-dependent patients with fever and/or after medical manipulations. However, this group of patients more frequently clinically manifests the disease with bright pulmonary pathology. Therefore, radiological methods should necessarily be a priority during the diagnostic search. The sources of septic embolism in the small circulation in IE may be loose and floating TV vegetations.

BACTERIAL TRANSMISSION AND ANTIBIOTIC SENSITIVITY OF CAUSATIVE AGENTS IN PURULENT-SEPTIC COMPLICATIONS IN PATIENTS WITH A SEVERE COURSE OF ACUTE PANCREATITIS

Introduction: Acute pancreatitis has emerged as a leading urgent abdominal condition, with a high mortality rate of up to 70% in cases of purulent-septic complications. The identification of specific causative agents during the infection stage of acute severe pancreatitis is challenging due to the various mechanisms by which pathogens can infiltrate parapancreatic fluid collections. However, early antibiotic prophylaxis is essential in the management of this patient population, considering the potential need for prolonged treatment involving multiple antibiotic rotations. This study aims at analyzing the changes in the microbial species spectrum responsible for purulent-septic complications in acute severe pancreatitis during the course of treatment.
 Methods: We investigated 174 bacterial cultures obtained from patients diagnosed with acute severe pancreatitis who were treated at the Surgical Department of M.V. Sklifosovsky Poltava Regional Hospital between 2015 and 2018. Among these cultures, 87 were obtained during the initial surgical intervention (39 after initial ultrasound-guided drainage and 38 during the initial open surgical intervention), and 87 were obtained during the course of treatment.
 Results: Among patients who underwent primary drainage of parapancreatic fluid collections, no aerobic flora was detected in 71.4% of cases, but subsequent bacterial cultures revealed microbial growth in 77.6% of patients. In patients who underwent open surgical intervention, pathological flora was detected in nearly all cases, both during the primary bacterial passage and in subsequent cultures. The species spectrum differed significantly between the primary and repeated bacterial passages. The initial cultures showed a predominance of gram-positive flora (S. epidermidis, Streptococcus spp., Enterococcus spp.), while repeated cultures demonstrated a notable increase in hospital-acquired strains and gram-negative flora (E. coli, Proteus spp., Acinetobacter spp.), along with a nearly three-fold increase in S. aureus. These findings have significant implications for selecting appropriate antibacterial agents throughout the treatment course. Notably, a substantial decrease in the sensitivity of multidrug-resistant strains to reserve antibiotics such as meropenem and trigecycline, by approximately 20%, was observed in subsequent bacterial studies.
 Conclusion: The microbial spectrum and antibiotic sensitivity of pathogens causing purulent-septic complications in acute severe pancreatitis undergo dynamic changes during the course of treatment. These findings underscore the importance of conducting repeated bacterial cultures and adjusting antibiotic therapy accordingly to optimize treatment outcomes.

Features of the endothelial status in patients with gastric cancer and its impact on surgical treatment outcomes

BACKGROUND: The incidence of gastric cancer is still high and holds the leading place in the structure of oncological pathology in the world. Prognostic aspects in the treatment of generalized forms of gastric cancer are currently under revision.
 AIM: To study functional status of vascular endothelium in patients with gastric cancer in perioperative period and evaluate its influence on the outcomes of surgical treatment.
 MATERIALS AND METHODS: A prospective, randomized study was conducted from 2009 to 2019. Two populations were studied: healthy individuals (control group, n=40); patients diagnosed with gastric cancer (general group, n=122). Patients with gastric cancer underwent gastrectomy with lymphodissection.
 The functional state of the vascular endothelium was studied: the volume of circulating endotheliocytes (CCE); the level of von Willebrand factor (VF) and the degree of endothelium-dependent vasodilation (EDV). To study their prognostic significance we calculated a conventional cut-off point.
 RESULTS: The general group patients were divided into 2 subgroups: the main group the laparoscopic access (n=54) and the comparison group the laparotomy access (n=68).
 Endothelial dysfunction (EDF) correction with Glutargin 1.0 g per day in combination with Enalapril 2.5 mg per day was additionally used in the main subgroup.
 In the main group, the values of CCE and VF were lower (8.33.0 and 84.621.3, respectively) and the values of EDV were higher (13.73.9) in contrast to the comparison group (p 0.0001).
 Use of the EDF correction method in the main group resulted in a 4.4-fold and 5.1-fold decrease in CCE and VF concentrations, respectively, and a 4.3-fold normalization of EDV (p 0.0001). Increase of CCE concentration more than 7.0 per 103 platelets; PV more than 120 g/ml, as well as decrease of EDV below 14% in the study stages increased the risk of postoperative complications by 2.9; 1.7 and 1.8 times, respectively (p 0.0001).
 The incidence of surgical complications was 19.7% and non-surgical complications 31.1%. Hospital mortality was 3.3% and out-of-hospital mortality with up to three years follow-up was 13.1%.
 The number of purulent-septic complications in the main group was 2.9 times lower, and the rate of thrombotic complications was 4 times lower than in the comparison group (p 0.05).
 CONCLUSION: Combined use of laparoscopic technique by EDF medication correction reduces manifestations of stress reaction and decreases the potential risk of complications development in the postoperative period. Elevation of CCE, as well as EDV decrease beyond the relevant excision points in patients with gastric cancer in the perioperative period are prognostic predictors of the risk of purulent-septic and thrombotic complications development.

Vacuum therapy for the prevention of suppurations in sutured soft tissue wounds. First experience

Infectious and inflammatory processes in sutured soft tissue wounds are met in 3–22% of cases despite the strict following of aseptic and antiseptic rules, application of new antiseptic agents with high bactericidal effect as well as improved techniques for prevention and management of wound infection.Objective. To perform a comparative analysis on healing processes in sutured soft tissue wounds after surgical interventions in which purulent-necrotic processes have developed.Materials and methods. All patients were divided into two groups – main and control. Patients from the main group (n = 58) had vacuum drainage of subcutaneous tissues in sutured wounds after surgery from June 2019 till November 2021. Case-histories of 80 patients from the control group were analyzed retrospectively; the researchers assessed outcomes after surgical management. In these patients, drainage of subcutaneous tissues in sutured wounds after surgery for purulent-necrotic processes in soft tissues was done using the traditional flow-washing technique. Both studied groups were comparable in sex, age and co-morbidity.Results. In the control group, complications in the form of suppurated lesions were noted in 17 (17.5 %) patients. In 10 (12.5 %) patients with marginal skin necrosis, there was suture dehiscence. None of 58 patients from the main group in whom surgical wounds were treated with the technique of vacuum drainage developed by us had any purulent-septic complications. In all cases, wounds healed with the primary intention.Conclusion. The technique of vacuum drainage developed by us allowed to achieve better outcomes at the early postoperative period.

Clinical evaluation of the effectiveness of procalcitonin in diagnosing purulent septic complications of acute necrotizing pancreatitis

Purulent septic complications seriously worsen the prognosis for patients with acute necrotizing pancreatitis. Early diagnosis is an important issue in establishing the effectiveness of their conservative and interventional treatment. Recently, procalcitonin (PCT) has been suggested as a diagnostic criterion for bacterial contamination of pancreatic necrotic tissue.
 The aim of study is to estimate PCT efficacy for early diagnosis of purulent septic complications of acute necrotizing pancreatitis and to investigate its use for disease prognosis.
 Materials and methods. A prospective cohort study of 151 patients with severe acute necrotizing pancreatitis was conducted. Clinical, laboratory, and bacteriological studies were carried out. Serum levels of PCT were determined during hospitalization, before intervening treatment, and in the postoperative period.
 Results and discussion. Infected acute necrotizing pancreatitis was diagnosed in 89 (55.6%) patients. Local purulent complications were revealed in 27 patients, sepsis in 33, and septic shock in 29. PCT concentration was higher in 62 patients with sterile pancreatic necrosis than in healthy individuals, reaching 1.34±0.19 ng/ml (p=0.045). The development of infected acute necrotizing pancreatitis was accompanied by increased PCT levels in patients with sepsis (up to 5.03±1.38 ng/ml; p=0.001), septic shock (up to 7.21±1.91 ng/ml; p=0.001), and local purulent septic complications (up to 2.03±0.48 ng/ml; p=0.072). The PCT levels above 4.0 ng/ml were prognostically unfavorable for patient survival.
 Conclusion. PCT levels in the blood serum are an effective criterion for diagnosing generalized purulent septic complications of acute necrotizing pancreatitis. Its levels above 4.0 ng/ml indicate an unfavorable prognosis for patient survival.

Septic complications of surgical pathology of the mediastinum

Relevance. Surgical interventions used in cardiovascular surgery often lead to the development of many different etiology and manifestations of purulent-septic complications. The development of this pathology worsens the course of the postoperative period and increases the duration of the patient's stay in the hospital. The range of these complications varies quite widely, which is explained by the different initial state of the patient's body, as well as the peculiarities of operations, care and treatment in the postoperative period.The purpose of this study is to study the frequency of occurrence of purulent-septic complications of mediastinal organs in surgery and to analyze the characteristics of this pathology.Materials and methods. In the course of this work, the analysis of foreign and domestic literature on the problem of the occurrence of purulent-septic complications of mediastinal organs in surgery was carried out.Results. The development of purulent-septic complications in cardiovascular surgery is due to a number of factors, among which it is necessary to note the presence of concomitant diseases, the peculiarities of some surgical interventions, inadequate antibacterial therapy. Due to the severity of the above factors, the development of many formidable purulent-septic diseases is possible. And unfortunately, even with timely treatment of the patient, the percentage of mortality from them remains quite high.Conclusion. Purulent-septic complications in cardiac surgery practice are a frequent phenomenon associated with a variety of risk factors. Such complications include mediastinitis, sepsis, pneumonia, urinary tract infections, local inflammatory reactions and much more. However, thanks to the knowledge of the causes of their occurrence and the features of the clinical course, it is possible to choose appropriate methods for correcting a particular condition at various stages of the patient's treatment.

The role and place of transanal endoscopic resections in rectal cancer

The aim of the work is to improve the algorithm of intraoperative diagnosis of rectal cancer metastasis in order to optimize surgical intervention and reduce the number of intraoperative and postoperative complications. Materials and methods. 184 operated patients with rectal cancer (RC) were divided into 2 groups: group 1 – patients with stage I RC (T1–2N0M0), and group 2 – stage II RC (T3N0M0), who underwent intraoperative detection and examination of sentinel lymph nodes. The volume and surgical approach depended on the stage and the presence of metastases (MTS). The average period of postoperative observation was 12–60 months, taking into account early (purulent-septic complications, bleeding, intestinal perforation) and late (recurrent rectal cancer) complications. Results. The patients of group 1 had no MTS lesions of the sentinel lymph nodes, the surgical intervention was limited to transanal microsurgery due to this fact. Among the complications were the following: bleeding – 2.2 %; intraoperative perforation of the intestinal wall – 5.6 %. No purulent-septic cases, no recurrences of rectal cancer were detected. In group 2, 36 (38.3 %) out of 94 patients had MTS detected intraoperatively in the sentinel lymph nodes which required a low anterior rectal resection with total mesorectumectomy. Among the complications was bleeding – 6.3 %. No intraoperative perforations of the intestinal wall and no purulent-septic complications were detected. Recurrence of rectal cancer was detected in 12 (12.8 %) patients. Conclusions. Performing transanal endoscopic resections in patients with stage I RC and especially stage II RC is possible only under the conditions of mandatory intraoperative staining and urgent histological examination of the sentinel lymph nodes. The extent of the surgical intervention is determined on the operating table based on urgent histological examination results. When MTS lesions of the mesorectal sentinel lymph nodes are detected, the operation should be continued with mandatory mesorectumectomy.

Features management of very early preterm birth

The objective: to determine features of tactics of very early preterm birth depending on the gestational age with the assessment of perinatal consequences. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation (the main criterion of inclusion). The patients were divided into two groups depending on the criteria of live birth: group 1 – 79 women, whose labor was regarded as late miscarriage (retrospective study); group 2 – 87 women, whose labor occurred as a very early premature (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups had serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. All women have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. The main complications of gestation in pregnant women of both groups in the second trimester were the threat of abortion and insufficiency of the fetoplacental (IFP), which caused fetal growth retardation syndrome (FGRS) in both groups – 66% and 63% of children, respectively. IFP in VEPB was confirmed histologically in 68% and 72% of cases in each group of mothers. Vaginal delivery occurred with 55 patients of group 1 and 26 women of group 2 (69,6% and 29,9%), among them in the period of 22–24 weeks – 100% and 57,1%, 25 weeks – 83,3% and 26,7%, 26–27 weeks – 57,7% and 24,1%, respectively, in each group. Indications for cesarean section (CS) in group 1 were mainly from the mother (75%), in group 2 – 27,8% from the mother, from the fetus – 4,9% (IFP), according to the combined indications – 65,6% (deep prematurity). Expansion of indications for CS in VEPB by 41% led to a decrease in perinatal mortality by 1,5 times (p<0,05). In the postpartum period, patients in both groups showed a decrease in purulent-septic complications on the background of preventive treatment from 13,9% (group 1) to 4,6% (group 2) (p<0,05). In the analysis of perinatal mortality, the highest rates were observed at 22–24 weeks of gestation, while they are 1,5 times lower at 25 weeks and 3,5 times lower at 26–27 weeks. The study found that the method of delivery did not affect perinatal outcomes at 22–25 weeks, but at 26–27 weeks, the survival of children born by CS surgery is higher than in spontaneous births, by 10% (p<0,05). Expansion of indications for the prevention of respiratory distress syndrome (RDS) of the fetus from 22 weeks in group 2 (in group 1 was not performed) by 10,7% led to an increase in survival of children with extremely low body weight (ELBW) by 11% (p<0,05). Conclusions. Under threat of VEPB the choice of delivery tactics is determined by the gestation period, the state of health of the mother and fetus, the degree of readiness of the birth canal for delivery. Premature pregnancy is not an indication for CS, except the specific obstetric indications, but abdominal delivery is possible for children in early pregnancy (22–25 weeks). The questions concerning the usage of instrumental care at birth, determination of gestational dates for the beginning of RDS prophylaxis with glucocorticoids, the necessity of using tocolysis remains ambiguous. Proper definition of management of women who give birth prematurely will allow timely implementation of measures aimed at improving the results for mother and newborn, and can be prognostic.

Роль генетических факторов в развитии гнойно-септических осложнений в акушерстве

The purpose to study the role of polymorphisms of endothelial nitric oxide synthase (eNOS3 G894T), transforming growth factor beta TGF-β (CA rs1800470) and plasminogen activator inhibitor (SERPINE-1 5G (-675)4G) in full-term pregnant women in the development of purulent-septic complications after cesarean section in the lower uterine segment. Material and methods. The authors analyzed obstetric complications after cesarean section in the lower uterine segment. Prospectively, 81 maternity patients after single-fetus delivery by caesarean section in the lower uterine segment were monitored and treated for emergency indications in order to diagnose purulent-septic complications and perform genetic analysis. The Statistica 10.0 and Eviews 12.0 software packages were used for statistical processing of the obtained results. Results. A direct correlation was established between the presence of a homozygous mutation of the transforming growth factor-β1 gene (TGF-β (CA rs1800470)), as well as the presence of a homozygous mutation of the endothelial nitric oxide synthase eNOS3 (G894T) gene, with significant risk factors for purulent-septic complications after cesarean section in full-term pregnancy: obesity 3-grade II (rs = 0.467, p < 0.001; rs = 0.461, p = 0.005) and pathological overall weight gain during pregnancy (rs = 0.660, p < 0.001; rs = 0.385, p = 0.024). Conclusion. The genetic study data allow concluding that homozygous polymorphisms of the studied genes of transforming growth factor-β1 (TGF-β (CA rs1800470)) and endothelial nitric oxide synthase eNOS3 (G894T) are associated both with the presence of purulent-septic diseases in the postpartum period after cesarean section in the lower uterine segment, and with metabolic disorders such as obesity of the 3rd degree and pathological overall weight gain during pregnancy. It is the combination of these factors that significantly increases the risks of obstetric purulent-septic complications in women with this genotype.

Influence of early surgery and endoscopic interventions on the risk of infection in patients with pancreatic necrosis

To prevent purulent-septic complications in patients with destructive pancreatitis. A cohort study included 488 patients with pancreatic necrosis: group 1 (n=331) - active surgical strategy, group 2 (n=157) - follow-up and therapy. We used binary logistic regression to predict purulent-septic complications. Original model of independent variables significantly (p<0.001) revealed 5.3 times higher risk of infectious complications after laparotomy within the first week after hospitalization. Incidence of these events increased by 2.8 times in patients biliary pancreatitis compared to alcohol-alimentary pancreatitis. Complication rate was higher in older patients (by 2.1% for each year). Risk of purulent-septic complications decreased by 57.4% in women compared to men. There was no significant correlation between risk of infectious complications and endoscopic procedures. Specificity and sensitivity of the model was 74.2 and 72.6%, respectively. Original model significantly predicts the risk of purulent-septic complications within the first week after hospitalization. Refusal of early active surgical strategy in these patients will significantly reduce the likelihood of purulent-septic complications.

EFFECTIVENESS OF LYMPHOTROPIC THERAPY IN THE PATIENTS WITH ACUTE APPENDICITIS AND ITS COMPLICATED FORMS

Introduction. Despite using the latest generations of antibiotics and modern methods of their introduction in the surgical treatment of acute appendicitis, purulent-septic complications keep occurring, accounting for 45% of fatal outcomes in the patients operated on for this disease. Materials and methods. Patients were divided into two groups. The main group included patients who were administered antibiotics and pathogenetic drugs locally to the ileocecal zone by means of lymphotropic administration. The comparison group included patients who received standard antibiotic therapy. Results. On the 5th day of the postoperative period, the level of IgA in the main group was 1.16 ± 0.7 mg/ml, and in the comparison group – 1.54 ± 0.8 mg/ml. The level of elastase in the operated patients of the main group decreased to 111.797 ± 21.39 nmol/min × ml, i.e., by 2.4 times (p &lt;0.001), and in patients of the comparison group – to 179.605 ± 26.79 nmol/min × ml, i.e., by 1.5 times (p &lt;0.05). Under the influence of lymphotropic administration of the antibiotic, the volume of the spleen decreased by the 5-th day to 281.22 ± 18.8 cm³, i.e., 145.44 cm³, and with standard administration of antibiotics, the spleen decreased within the period to 344.71 ± 21.13 cm³, i.e., by 79.54 cm³, which is less by 66 cm³, or 1.8 times (p &lt;0.05) vs. main group. Conclusions. The proposed method of antibiotic therapy is a preventive measure against purulent-septic complications, especially in its destructive forms, improves the results of treatment of patients with acute appendicitis, and shortens their term of staying in the hospital, which has a positive impact on financial status.

Current Problems of the Diagnostics and Treatment of Sepsis and Burn Injuries: The Modified Pathogenetic Concept

Background: The deep understanding of pathogenesis is a key moment in the formation of the modern strategy of modern medicine. We conducted the thorough analysis of the microscopic processes occurring in the bodies of patients with purulent-septic complications. The modified pathogenetic concept of the diagnostic and treatment model of diseases with septic complications is presented. The obtained information about the mechanisms of origin and development of these diseases is fundamentally important for finding the modern effective methods of treating patients. The aim of the research is to modify treatment tactics for patients with sepsis and burn injuries based on the modified pathogenetic concept using modern diagnostics, i.e. the method of fluorescence spectroscopy (MFS) and biomarkers. Materials and Methods: The proposed modified pathogenetic concept of the diagnostic and treatment model of diseases with purulent-septic complications along with standard methods was used successfully for effective treatment of 15 patients with sepsis and 25 with burn injuries. Results: 3 main scenarios of behaviour of spectral-fluorescence characteristics of patients with sepsis are illustrated. Spectral-fluorescence markers of sepsis were studied, which are informative 24 to 48 hours before the appearance of obvious clinical and laboratory signs of significant changes in the general somatic status of patients. Conclusions: The proposed diagnostic and therapeutic approach is new and fundamentally important for diagnostics and monitoring of the process of treatment of patients with purulent-septic diseases and burn injuries. An in-depth understanding of the dynamics of septic complications and the corresponding changes of the main markers of these diseases during treatment is especially relevant. The use of infusion therapy with solutions of donor albumin as an effective pathogenetic treatment is scientifically justified.

Роль бактеріального чинника у розвитку гострого панкреатиту та його гнійно-септичних ускладнень

Introduction. A feature of acute pancreatitis is the high risk of developing complications (occurring in 50% of patients), the total mortality of which reaches 15%, and in severe cases it varies within 40-70%. The aim of the study was to determine the role of Helicobacter pylori as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications. Materials and methods. The results of treatment of 280 patients with acute pancreatitis were analyzed, which were divided into two groups: the main group (n=187) – patients with severe acute pancreatitis and the comparison group (n=93) – patients with a mild and moderate course of the disease. In addition, in order to determine prognostic criteria for the development of purulent-septic complications, the patients of the main group were divided into two subgroups. The first subgroup included patients with a severe course and the development of purulentseptic complications (n=59), the second (n=128) – with a severe course without the development of purulent-septic complications of acute pancreatitis. Results. When screening patients for Helicobacter pylori, the results of the express test were positive in 232 patients (82.9%), while in the main group 165 (88.2%) patients, in the comparison group – 75 (80.6%) patients (χ2= 2.9, 95% CI -1.1-17.6, p=0.08). An increase in the content of immunoglobulin M to Helicobacter pylori was also determined in patients with a severe course of acute pancreatitis after 7 and 14 days from the moment of hospitalization, which indicates the acute phase of the disease. The correlation between immunoglobulin M and procalcitonin was strong (r=0.87; p=0.0001), but the relationship between these indicators was not linear, but closer to exponential (y=1.1543-2.7292*x +2.1604*x^2). Conclusions. The results of a screening study of Helicobacter pylori in patients with acute pancreatitis allow us to consider this microorganism as one of the factors in the pathogenesis of this disease (82.9% of cases). For patients with severe acute pancreatitis, the content of immunoglobulin M to Helicobacter pylori in blood serum ≥1.24 IU/ml can be considered as a likely predictor of the development of purulent-septic complications (sensitivity 86.4%, specificity 100.0%).

Prevention of the development of additional purulent-septic complications in peritonitis of various etiologies, taking into account reduced reactivity

To evaluate the effectiveness of the drug aminodihydrophthalazinedione sodium (Galavit) for the prevention of the development of additional purulent-septic complications associated with a reduced reactivity in patients with peritonitis. Patients diagnosed with peritonitis were included in a prospective, non-randomized, single-centre study. Two groups of patients were formed, the main and control, 30 people each. In the main group, patients received aminodihydrophthalazinedione sodium at a dose of 100 mg/day for 10 days, in the control group they did not receive the drug. During 30 days of observation, the development of purulent-septic complications and the number of days of hospitalization were recorded. Biochemical and immunological blood parameters were recorded at the time of inclusion in the study and for 10 days of therapy. Information about adverse events were collected. Each study group included 30 patients (60 in total). The additional complications developed in 3 (10%) patients who received the drug and in 7 (23.3%) in the group that did not receive the drug (p=0.166). The risk ratio is up to 0.556 and the risk ratio is 0.365. The average number of bed-days in the group that received the drug was 5, and in the group that did not receive the drug - 7 days (p=0.108). No statistically significant differences between groups in biochemical parameters were identified. However, there were estimated statistical differences in immunological parameters. Thus, CD3+, CD4+, CD19+, CD16+/CD56+, CD3+/HLA-DR+, IgG were higher in the group taking the drug, and the CIC level was lower than in patients of the group that did not receive the drug. There were no adverse events. Aminodihydrophthalazinedione sodium (Galavit) is effective and safe for preventing the development of additional purulent-septic complications associated with a reduced reactivity in patients with peritonitis, decreases the incidence of purulent-septic complications.

Evaluation of the possibility of diagnosing purulent-septic rhinogenic complications of the orbit and eyelids in children based on the analysis of clinical and laboratory data

To study the features of clinical and laboratory parameters of rhinogenic complications of the orbit (RCO) and eyelids depending on the blood leukocyte shift index (LSI) to create a predictive model in pediatric patients. The study included 50 patients who were treated at the Regional Clinical Hospital No. 2 of Tyumen with inflammatory pathology of the paranasal sinuses. Group I with RCO - reactive edema of the eyelids and orbital tissue included 29 (58.0%) patients (of which 16 (32.0%) were boys, 13 (26.0%) were girls). In group 2 with ROC, purulent-septic complications of the eyelids and orbit included 21 (42.0%) patients (of which 10 (20.0%) were boys, 11 (22.0%) were girls). LSI values in the general age group (n=50) from 1 to 17 years old were: 1.61 [1.40; 1.82] in patients of group 1; 3.45 [2.96; 3.94] in patients of group 2 (p≤0.05). With an index of LSI from 1.36 to 1.96, the development of reactive edema of the eyelids and orbital tissue is predicted, from 3.14 to 4.72 - the development of purulent-septic complications of the eyelids and orbit in patients of preschool and primary school age. The marker of clinical and laboratory parameters of the severity of the disease is the LSI indicator, taking into account the age of the child, which can be used in the early diagnosis of purulent-septic rhinogenic complications of the orbit and eyelids in children.

REASONS FOR THE DEVELOPMENT OF INFLAMMATORY COMPLICATIONS IN INTRAUTERINE DEVICE CARRIERS

Introduction. In the context of the deteriorating demographic situation in the country, the decline in the living standards of the majority of the population, the deterioration of their reproductive health, and family planning issues deserve special attention [1, 2, 9]. One of the methods of contraception, which is widely used by women of reproductive age, is intrauterine contraception [7, 8]. Worldwide, millions of women have been using the IUCD for over three decades as a highly effective, safe, and convenient form of contraception [4, 5]. However, in recent years, there has been a sharp increase in the number of complications associated with this method of contraception, the most dangerous of which, both at the time of administration and due to long-term consequences for the reproductive system of women, are inflammatory diseases [6, 10]. The aim of our study was to identify the risk factors for inflammatory complications in IUCD carriers. Methods. The study was conducted on the basis of the Municipal Non-Profit Institution "Clinical Perinatal Center of the Blessed Virgin Mary" in 2015–2021 years. In order to analyze the causes of the inflammatory complications in IUCD carriers, we examined 101 patients hospitalized at a specialized gynecological hospital for acute inflammatory processes of the uterus and appendages. Results. The control group consisted of 20 women who were carriers of the IUCD, registered in the dispensary in the city antenatal clinic. The average age of women was 22.2 years: from 19 to 45 years. The duration of IUCD usage ranged from 8 months to 6 years. The reason for hospitalization was pain in 98% of cases, fever in 92%, violation of the ovarian-menstrual cycle in 45%, a combination of symptoms and complaints in 96% of cases. In the hospital, the standard clinical, laboratory, immunological, and ultrasound examinations were repeatedly carried out. The causative agents of inflammatory diseases of the genitals were determined using bacteriological and PCR research methods. We revealed the association between the incidence of purulent-septic complications and the frequency of examinations performed before the introduction of the IUCD. Consequently, only 48 (59.4%) patients underwent a full clinical and laboratory examination; in the future, only 26 (25.7%) of the admitted patients were constantly observed in the antenatal clinic. Moreover, an analysis was made of the dependence between IUCD type, the duration of carriage, and the prevalence of inflammatory diseases of the female genital organs. Conclusions. Thus, there is reason to assume that the use of IUCDs, especially Copper Y Cu 380 for more than three years, in women of childbearing age is a risk factor for the occurrence of purulent-septic complications.

Перспективы микроволновой радиотермометрии в ранней диагностике эндометрита и несостоятельности шва на матке после абдоминального родоразрешения

Aim: To assess the capabilities of microwave radiothermometry (MRTM) in early diagnosis of Postpartum endometritis and uterine suture failure after caesarean section. Design: Prospective non-randomized clinical trial. Materials and methods. A comparative analysis of the sensitivity of ultrasound (ultrasound) with dopplerometry and MRTM in the diagnosis of endometritis and suture failure on the uterus after cesarean section was carried out. The study included puerperal women after abdominal delivery (n = 90): 24 patients with a puerperia complication in the form of endometritis (group I), 16 — with suture failure on the uterus (group II), 50 — with a physiologically occurring postoperative period (control group). Assessment of the condition of the uterus and the postoperative suture on it was carried out on the 3–4th day after the operation. Results. Despite the fact that ultrasound with dopplerometry assessment of blood flow in the branches of the uterine arteries makes it possible to assess the structure of the myometrium and with a fairly high degree of probability to identify its inflammatory changes and defects in the suture, the sensitivity of this method in the early (3–4th day of the postoperative period) diagnosis of endometritis after abdominal delivery reaches an average of 54.2 ± 23.5%, and in the insolvency of the suture on the uterus — 31.25 ± 14.65%. At the same time, the MRTM study revealed indirect signs of endometritis in 66.7 ± 7.9% (if the conclusion is based on only one parameter — the thermoassymetry index, ITA) and 87.5 ± 8.3% (taking into account the combination of three signs), and for the insolvency of the suture on the uterus, the sensitivity of the method is 81.25 ± 4.75% for both ITA and three thermogram parameters, which is 2.6 times higher, than with ultrasound. Conclusion. Despite the rather high diagnostic effectiveness of the ultrasound method for assessing the condition of the scar on the uterus after cesarean section, the MRTM method has advantages in the form of higher sensitivity, ease of implementation, no need for expensive equipment and specialized medical qualifications. The greatest effectiveness of the diagnosis of postpartum purulent-septic complications can be achieved only with an integrated approach with clinical and laboratory tests and functional diagnostics, and timely prevention and an integrated approach to the treatment of purulent-inflammatory diseases of postoperative puerperia contribute to a significant reduction in the frequency of severe forms of postpartum infection. Keywords: caesarean section, endometritis, uterine suture failure, ultrasound, microwave radiothermometry, hysteroscopy.

Анализ результатов лечения ранений малого таза с повреждением органов репродуктивной системы у женщин в условиях локального вооруженного конфликта

Summary. The aim of the study was to analyze the results of treatment of pelvic gunshot wounds with damage to the reproductive system organs in women in a local armed conflict. Materials and research methods. A retrospective analysis of the results of treatment of 86 patients with pelvic gunshot wounds with genital damages was performed. All the patients were members of the general population. Treatment was carried out at Grozny City Clinical Hospital in 1997-2005. The mean age of patients was (25±7) years. Female patients of fertile age with gunshot wounds in the pelvic area with damages of reproductive organs were included in the study. The following patients were excluded: patients younger than 18 and older than 45 years; patients with concomitant injuries of the chest, head, limbs, and patients in agonal state. Study results and their analysis. The results of the study showed that most of the women had severe injuries, which resulted in bleeding, pain syndrome and shock as a consequence. Severe injuries were often combined with pelvic injuries and required wide laparotomy and revision of the abdominal cavity organs. The signs of peritonitis due to concomitant injuries at the moment of admission limited the choice of tactics. In the nearest postoperative period the complications were related mainly to the purulent-inflammatory processes in 24.4% of cases. Nineteen patients died (22.1%). The main causes of lethal outcome were: shock in 15.1% of cases; purulent-septic complications in 6.9% of cases. It has been concluded that severe gunshot wounds of the pelvic organs in women, accompanied by the reproductive system injuries, are characterized by a severe postoperative course, a great number of lethal outcomes and require urgent hospitalization in a multidisciplinary hospital.

ADVANTAGES OF VAC POSTOPERATIVE ABDOMINAL WALL WOUND COMPLICATIONS TREATMENT IN CANCER PATIENTS

Summary. Introduction. Postoperative abdominal wall wound infevtions became significant problem om modern surgery impacting approximatly 110,800 patients in 2015.&#x0D; Aim of study. Comparison of postoperative abdominal wall wound complications treatment methods in cancer patients.&#x0D; Materials and method. 24 cases of patients with purulent-septic complications of postoperative wounds were analised. 10 (41,6 %) — men and 14 (58,4 %) — women. The average age of patients was 63,8±17,1 years. Patients were divided into two groups: a comparative group — 12 patients (routine treatment), and an experimental group — 12 patients, which was treated using the VAC system. Both groups received infusion and antibacterial therapy.&#x0D; Research results. In cultures of wound contents, the following were found: (1) Staphylococcus aureus — 38,9 %, (2) Staphylococcus epidermidis — 19,5 %, (3) Enterococcus faecalis — 19,1 %, (4) Escherichia coli — 15,4 %, (5) Pseudomonas aeruginosa — 5,8 %, (6) Proteus vulgaris — 0,9 %, as well as (7) gram-positive aerobic and facultatively anaerobic pathogens — 0,4 %.&#x0D; According to the results of bacteriological examination of the wound contents in the patients of the experimental group, the microbial count decreased statistically significantly (to 105-106, p&gt;0,05) starting from the third day of treatment. In the comparative group — all indicators remained at the previous levels (108-109).&#x0D; Conclusions. VAC-therapy appeared superior in postoperative abdominal wall wound complications treatment in cancer patients. VAC significantly reduces both duration of hospital stay and mortality.

POSSIBILITIES OF ALTERNATIVE ANTIBIOTIC THERAPY FOR ABDOMINAL INJURIES

Summary. Aim. The purpose of the work was to study the possibility of alternative antibacterial therapy by the type of lymphotropic targeted accumulative antibiotic therapy for injuries of the abdominal cavity.&#x0D; Materials and methods. To implement it, we studied in an experiment the accumulation of the antibiotic in the tissues of various organs of rabbits after its lymphotropic administration.&#x0D; Results of the research. The experiment proved, that lymphotropic antibiotic therapy, depending on the place of regional administration of the drug, contributes to the targeted accumulation of the antibiotic in the corresponding organ in an amount sufficient for a persistent antibacterial effect.&#x0D; Conclusions. The proposed method of administration of antibacterial drugs may be the most appropriate for injuries of the abdominal cavity and retroperitoneal space, as it significantly reduces the likelihood of purulent-septic complications and makes it possible to significantly reduce the length of stay of patients in the hospital, reduce the amount of financial costs and early return to socially useful work.