Purulent Surgery Research Articles

Improving the results of treatment of patients with purulent diseases of fingers and hands using laser irradiation and photodynamic therapy

Despite the evolution in modern surgery and in pharmaceutical industry, purulent pathology of the hand is occupying a leading position for many years among all diseases with which patients are admitted to hospitals. Over the years, medical care for such patients has been improving. A high social and economic significance of this problem makes surgeons to continue searches of new directions not only in surgical techniques, but also in postoperative wound management to improve outcomes in patients with purulent diseases of the hand.The purpose of this work is to assess results of care of patients with purulent finger and hand diseases treated with laser light necrectomy and photodynamic therapy. A comparative analysis of wound process dynamics and treatment outcomes in 198 patients with hand purulent diseases who had been admitted to Moscow City Hospital No. 4 was made by the authors. All patients were divided into four groups depending on the curative modality. In Group 1 (n = 53), a wound was sutured after surgery, and a drainage-lavage system (DLS) was installed; in Group 2 (n = 50), a wound was not sutured because of contraindications to suturing; in Group 3 (n = 46), patients had laser necrectomy after which a wound was sutured and DLS was installed; in Group 4 (n = 49), a wound was not sutured because of contraindications like in Group 2, but it was treated with antiseptic dressings and photodynamic therapy at an early postoperative period. Various aspects of the effectiveness of laser techniques have been analyzed: dynamics of wound healing, changes in wound defect size, level of pain syndrome assessed by VAS, changes in clinical blood tests, changes in wound exudate cytological picture as well as changes in wound microflora. Acceleration of wound healing was noted in all patients who were treated with laser light what, consequently, shortened their inpatient stay. Laser light also changed cytological and microbiological patterns of wound exudate, as evidenced by the decrease of wound detritus and by the decrease of microbial content in the wound. In patients, who were treated with laser light, less pain syndrome was registered immediately after laser technique application.The obtained findings demonstrate a positive effect of laser necrectomy with DLS at wound process as well. Photodynamic therapy significantly improved results in patients with open wound management on the hand and fingers. Laser techniques have good perspectives in purulent surgery of the hand.

Diagnostic significance of blebbing formation of cytoplasmic membranes in lymphocytes and neutrophils in assessing the clinical condition in diabetic foot syndrome

The OBJECTIVE was to study the nature of blebbing formation of peripheral blood leukocytes in patients with diabetic foot syndrome, the effect of treatment on this process.METHODS AND MATERIALS. The data of treatment of patients of the Department of Purulent Surgery of the City Clinical Hospital No 6, Izhevsk, 2019–2020 (clinic of the Department of General Surgery of Izhevsk State Medical Academy) were analyzed. 2 groups of patients with diabetic foot syndrome n1 (Meggit – Wagner 1–2) and n2 (Meggit – Wagner 0) were formed. The blebbing formation of neutrophils and lymphocytes, parameters of integral leukocyte indices, data of the scale of the general assessment of neuropathy and the Michigan screening test, indices of planimetry of ulcerative defects were studied.RESULTS. It was revealed that the blebbing formation of neutrophils and lymphocytes in the studied groups was different, which was reflected in a decrease in these indices in the n1 group and an increase in the n2 group. Integral indices revealed a decrease in immunoreactivity and nonspecific reactivity. In the dynamics of treatment, there was an improvement in the data of the scale of general neuropathy and the Michigan screening test.CONCLUSION. The studied indices of blebbing formation correspond to the indices of the leukocyte integral indices, the diagnostic scales for neuropathy, reflect the severity of the wound process. The study of blebbing provides objective data on the dynamics of the immune status of patients with diabetic foot syndrome, which allows improving treatment results.

Prospects for the use of nanostructured silver preparations for the control of infections diseases, including COVID-19

The ongoing COVID-19 pandemic has highlighted significant gaps in human protection from infection. There is a real and fairly high probability of new infections that pose a danger to humans. To combat (prevention and treatment) this kind of infections, new types of drugs are needed, which differ in their mechanism of action from existing antimicrobial agents and vaccines, and thus complement them. These drugs should have complex universal activity against pathogens, regardless of their type (bacteria, viruses, fungi, protozoa) and, in general, increase the resistance of the macroorganism to infection by pathogenic agents, stimulate nonspecific immunity, both general and local. In this regard, preparations of nanostructured silver are promising. The properties of silver nanoparticles depend on their structure, shape, size, morphology, ligand environment and preparation method. Argovit represents nanosilver formulation with optimized biochemical and toxicological characteristics. Argovit effectiveness for combating infectious pathogens in various fields of medicine was shown for: intestinal infections of various etiologies; acute respiratory viral infections and associated bacterial complications; purulent surgery, diabetic foot; drug resistant forms of tuberculosis; viral infections caused by both DNA and RNA viruses. In the clinic, argovit effectiveness in protection from coronavirus infection and for treatment of the early stages of COVID-19 disease on volunteers was shown.

Physico-Chemical Properties of Antiseptics in Surgery: What is not Taken into Account in Treating Long-Term Non-Healing Wounds

The treatment of long-term non-healing wounds in the conditions of purulent surgery departments, widely uses solutions of chemotherapeutic and antiseptic agents. The most common are the solutions of 3–6 % hydrogen peroxide and solutions of 2–10 % sodium chloride. As a rule, solutions of these drugs are used to treat non-healing, particularly, purulent wounds, bedsores and trophic ulcers. Therefore, solutions are injected into the wound area repeatedly in the form of course therapy. The findings show that the mechanism of action of these drugs and the effect of treating long-term non-healing wounds is largely determined by such physical and chemical factors of their local interaction as concentration of the main ingredients, osmotic, alkaline activity and local temperature. The findings point out the leading role of the local temperature and the dependence of the local effect on the concentration. They describe the essence of the innovative method of treatment.

Spinal anesthesia during foot surgery

Purpose of the study. To improve the results of treatment of patients with diabetic foot syndrome by substantiating the optimal type of spinal anesthesia during foot surgery.
 Materials and methods. 70 patients undergoing treatment in the department of purulent surgery were examined. Patient groups: Group 1 – patients operated on under conditions of unilateral spinal anesthesia; Group 2 – patients operated on under traditional spinal anesthesia.
 Research methods. Assessment of the level and intensity of pain, concentration of catecholamines in urine in the first postoperative day, monitoring of blood pressure (BP), heart rate (HR), peripheral blood oxygen saturation (SpO2), Doppler scanning of peripheral blood flow in the foot, skin temperature integument of the foot during anesthesia and statistical.
 Results. In group 1, pain sensitivity during movement of the lower limb after anesthesia was 21% less pronounced than in group 2. In group 2, the heart rate decreased by 4,8% during anesthesia. The SpO2 level 20 minutes after the onset of anesthesia decreased in group 2 by 5,1% compared to group 1. The mean arterial pressure in group 2 decreased during anesthesia by 9,9%, in contrast to patients in group 1. After performing anesthesia, systolic blood pressure in the toe increased by 18,3%, and the temperature of the skin on the lateral surface of the leg increased by 3,7%. The concentration of adrenaline in the daily portion of urine in the next postoperative day in group 2 is 35,1% higher than in group 1.
 Conclusions. During anesthesia, the blood pressure, heart rate and SpO2 in group 1 did not change in comparison with the initial values (on the operating table before anesthesia). After anesthesia, an improvement in peripheral blood flow in the operated limb was noted. Unilateral spinal anesthesia, in comparison with traditional spinal anesthesia, has a positive effect on the stress response of the patient's body to surgery.

Features of the course of Fournier’s gangrene in patients with diabetes mellitus

Fournier’s gangrene (FG) is a septic process accompanied by tissue necrosis of the scrotum, penis and perineum, as well as systemic inflammatory syndrome and endotoxicosis. FG is associated with long hospital stay and high mortality. In recent decades, there has been an increase in the incidence of this pathology, as evidenced by the indicators of the “database of the treated case” in Kyrgyzstan. This fact is associated with the growth of immunocompromised patients and, first of all, patients with diabetes mellitus. The result of treatment depends on the correct tactics, time and volume of emergency surgery. This article presents a 5-year experience of treating patients with FG against the background of diabetes mellitus in the department of purulent surgery of the National Hospital in Bishkek.

The legacy of Saint Luke (Valentin Felixovich Voyno-Yasenetsky) to medical sciences

Saint Luke, Archbishop of Simferopol and Crimea (1877‒1961), was born Valentin Felixovich Voyno-Yasenetsky in Kerch, Crimea. He served as an outstanding physician and Academic Professor of Topographic Anatomy and Operative Surgery at Medical School of Tashkent University. He worked extensively on the fields of surgery, regional anesthesia, pyogenic infections, ophthalmology, neurosurgery, oncology, orthopedics, otorhinolaryngology, gynecology, urology, and dentistry, often under difficult circumstances. He performed a wide variety of operations, from minor outpatient procedures to extremely complicated ones, followed by extensive inpatient management and treatment of ailing individuals. He published numerous research articles and books. His most acclaimed monograph entitled “Essays on the surgery of pyogenic infections” (“Sketches of purulent surgery”), focused on the broad field of surgery with special reference to the pyogenic infections and served as a reference tool and guide book for the next generations of physicians. The Stalin Prize was the highest professional honor awarded to Valentin Felixovich Voyno-Yasenetsky by the Soviet state in recognition of his contribution to science. Voyno-Yasenetsky was a blessed physician who had a major influence on both patients and colleagues, due to his fundamental ethical principles and values based on Christian beliefs. His life and scientific work have been an example of the practical unity of scientific truth and religious faith. He was ordained to the diaconate and priesthood, until he elevated to the ranks of Bishop and Archbishop. He was arrested and subsequently exiled for his religious beliefs and his glorification by the Orthodox Church as Saint Luke was held in Russia in 2000, as a recognition of God’s holiness manifesting in his life. Saint Luke received an honorable place in the history of Medicine and the Eastern Orthodox Church. The present study aims to highlight key elements of his life and his scientific contributions.

Rational antimicrobial therapy and wound healing stimulation in patients with surgical infection

The objective of the study was to develop the problem of complex treatment of surgical infections of the skin and soft tissues (SISST).The studies were carried out in 201 patients with SISST who were treated at the Department of Purulent Surgery of the Hospital Surgery Clinic of the EE “Vitebsk State Medical University” in 2017–2020. As a result, it was developed: a protocol for a rational use of antibiotics in the patients with SISST, an effective regimen for use of antiseptic drugs, a method for treating purulent wounds with autologous bone marrow aspirates.For 13 years, there have been significant changes in the etiological structure of gram-negative problematic pathogens in patients with purulent wounds. The share of K.pneumoniae increased approximately 8 times (by 12.25 %; p < 0.05), and A.baumannii ‒ 9 times (by 14.69 %; p < 0.05). The share of MRSA remained virtually unchanged. The resistance of problem microorganisms to almost all antibacterial drugs significantly increased. For MRSA-induced SISST, glycopeptides (vancomycin) should be recommended as a drug of choice, and oxazolidinones (linezolid) and glycylcyclines (tigecycline) should be recommended as a reserve; K. pneumoniae ‒ colistat and tigecycline; P. aeruginosа ‒ carbapenems (doripenem) and colistat; A. baumannii ‒ penicillins or cephalosporins with sulbactam (ampicillin + sulbactam) and colistat.It was found that septomyrin and 0.02 % chlorhexidine bigluconate have the greatest activity against the leading representatives of the microflora of purulent wounds. With a combined use of septomirin and chlorhexidine, the bacterial contamination of wounds decreased below the critical level already on the 2nd day after surgical treatment (p < 0.01).To stimulate wound healing, sternocentesis is performed and automyeloaspirate is taken. The curettage of the wound and the aspirate introduction into the wound edges and the application to the wound surface are performed. It has been established that, along with the pelvic bones, the sternum can be an alternative source of red bone marrow. The myeloaspirate volume obtained by sternal puncture varied from 10 to 140 ml. The developed method allows us to reliably reduce the duration of the 2 phase of the wound process by 7 days (р < 0.01).

In Memory of Sergey P. Sergeechev (13.10.1962–07.01.2021)

This paper provides information about the sudden death from COVID-19 of Sergey P. Sergeechev, the head of the Department of Purulent Surgery of Tver Childrens Regional Clinical Hospital.

Prosthetic repair of the aorta with a cadaveric homograft for infection of bifurcated synthetic vascular prosthesis

Infection of arterial vascular grafts is a rare but utterly severe complication in vascular surgery. Therapeutic policy in patients with graft infection has not been standardized, to be determined individually. One of the variants of surgical treatment is considered to be repeat aortic repair using a cadaveric graft. Presented in the article is a clinical case report concerning a 60-year-old male patient previously subjected to aortofemoral bifurcation bypass grafting with stage IV ischaemia of lower limbs according to the Pokrovsky-Fontaine classification. In the early postoperative period the events of critical ischaemia were not arrested. Due to the presence of a block of the femoropopliteal segment, as the second stage 3 days after the primary operation, the patient underwent autovenous femoropopliteal bypass grafting with a reversed autovein above the knee-joint fissure. The clinical course of critical ischaemia of the limb was relieved. During subsequent 8 months of follow up his state remained stable. Eight months after the primary operation he developed purulent discharge from the postoperative scar on the left femur. In the setting of the Purulent Surgery Department, the patient was emergently subjected to opening and drainage of the abscess of the postoperative scar. On the bottom of the wound there was a freely lying branch of a synthetic vascular prosthesis. Computed tomography revealed infection of the entire synthetic prosthesis and aneurysms of distal anastomoses. Given extremely high risk for the development of arrosive haemorrhage, a decision was made on operative treatment - repeat prosthetic repair of the abdominal aorta with a cadaveric allograft. At the Vascular Department of the Clinic of Faculty Surgery, laparotomy was performed, with removal of the infected graft, followed by debridement of the retroperitoneal space and repeat aortofemoral bifurcation prosthetic repair of the abdominal aorta with a cadaveric allograft. The wound healed with first intention. There was no evidence of infectious process relapse. The patient was discharged on postoperative day 15 in a satisfactory condition. The duration of follow up amounted to 6 months. The control examination showed that the pain-free walking distance was 500 m. Doppler ultrasonography demonstrated that the graft was functioning, with no signs of either anastomotic aneurysms or suppuration of the retroperitoneal space.

Patient care after surgery: suture care and wound care process

Background. A wound is a defect of skin and underlying tissues that can be caused by many factors. Wound care is more than just changing dressings. Different wounds require different approaches and care. Optimal wound care supports the natural healing process in an effective but gentle way. Wounds are classified into acute and chronic, as well as cut, scalped, chopped, stabbed, bruised, torn, bitten, gunshot, and surgical. Surgical wounds are distinguished by the fact that they are applied specifically, for medical or diagnostic purposes, in special aseptic conditions, with minimal tissue trauma, in conditions of anesthesia, with thorough hemostasis and joining of separated anatomical structures with sutures.
 Objective. To describe the modern approach to wound care.
 Materials and methods. Analysis of literature data on this topic.
 Results and discussion. Types of wound healing include primary tension healing, delayed primary tension healing, secondary tension healing, and scab healing. When caring for surgical wounds, primary protection against microorganisms is important. In this case, sterile dressings play an important role, for example, a medical surgical patch with an absorbent pad (Yu-Fix, “Yuria-Pharm”). The pad is characterized by high hygroscopicity, does not stick to the wound and does not leave fibers in the wound. The frequency of dressings changing depends on the healing process and the amount of exudate released from the wound. For festering wounds, the dressing should be changed daily and sometimes more often. Hands and gloves should be worn before bandaging. After removing the gloves, the hands are also treated with an antiseptic (Gorosten, “Yuria-Pharm”, a decamethoxine-based antiseptic). The use of Gorosten in medical institutions for prophylactic purposes is indicated for disinfection of staff hands in order to prevent the spread of transient microflora. Sutures from the surgical wound are removed after the onset of epithelialization, when the wound is covered with a thin protective film. However, in this period there are still wound channels from the threads, so after that it is necessary to treat the wound several times with antiseptic (Dekasan, “Yuria-Pharm”). Signs of local infection of the wound are redness, excess exudate, sometimes – with the addition of pus, odor, pain in the area of injury, fever, edema. Sometimes postsurgical wound suppuration occurs even with proper care due to weak immunity or rejection of surgical suture material. If there is suppuration, it is advisable to switch to dressings with Dekasan and hyperosmolar antibacterial ointments. Unlike 2 % povidone-iodine, which causes severe inhibition of granulation in an open wound, Dekasan does not damage granulation tissue. Surgical treatment, lavage, drainage, antibiotics, laser or ultrasound may also be required. After removing the signs of local inflammation, secondary sutures are applied to the wound or the edges of the wound are connected with the help of adhesive plaster. Before starting the wound care procedure, it is necessary to assess the condition of the wound bed, the nature of the exudate, the condition of the tissues around the wound, pain, wound size. Wound management should involve a multidisciplinary approach. For example, an endocrinologist, a diabetic foot specialist, a purulent surgery surgeon, a vascular surgeon, and a nurse are involved in the treatment of ulcerative defects in patients with diabetes. In the treatment of wounds it is necessary to maintain a humid environment in the wound, maintain a constant temperature without hypothermia, provide adequate drainage and not too tight tamponade, use additional means of healing (eg, unloading the foot in the treatment of foot ulcers in patients with diabetes).
 Conclusions. 1. Optimal wound care supports the natural healing process in an effective but gentle way. 2. When caring for surgical wounds, primary protection against the effects of microorganisms is important. 3. Sutures from the surgical wound are removed after the onset of epithelialization, when the wound is covered with a thin protective film. 4. If there is suppuration, it is advisable to switch to dressings with Dekasan and hyperosmolar antibacterial ointments. 5. Wound management should involve a multidisciplinary approach.

Modern approach to the treatment of stage IV decubitus ulcers

Objective a retrospective assessment of the bedsores' features, the optimization of treatment tactics, evaluation of long-term treatment results.
 Material and methods.The study group included 38 patients with stage IV decubitus ulcers according to the classification of AHCPR localized in the sacral region, the area of the ischial tuberosity and the greater trochanter.
 Results.We determined the critical time intervals for the decubitus ulcers occurrence. It has been found that in most patients bedsores are remaining for a long period of time. The modern complex methods for the IV stage decubitus ulcers treatment with the plastics of the soft tissue defects revealed their reliably higher effectiveness.
 Conclusion.The formation of bedsores most often occurs during the first month after the injury and three years after the injury. The treatment of patients with this pathology should be comprehensive and carried out in the well-equipped purulent surgery department by the specialists experienced in treating such patients. The plastic surgery by displaced blood-supplying flaps contributes to success in the treatment of stage IV bedsores.

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.

High amputation of the lower extremities

Objective: to develop technology for high amputations of the lower extremities.Materials and methods.We analyzed the materials of the Nizhny Novgorod branch of the Federal State Unitary Enterprise “Moscow Orthopedic and Orthopedic Enterprise” Ministry of Labor of Russia for the period 2004–2018, the operation logs of the purulent surgery department of PIMU (1971–2018), and the electronic medical history “Program 1C” (2006–2012) and “Medialogue” (2013–2018) in all departments of PIMU, where high amputations of the lower extremities are possible performed.Results.Between 2006 and 2018, 391 lower limbs were cut off in 289 patients (above the knee – 128, below the knee – 263). With diabetic foot syndrome, 135 (34.5 %) amputations were performed, due to burns and frostbite, 73 (18.7 %) operations were made, while arterial atherosclerosis – 57 (14.6 %) operations, and the rest – about the consequences of injuries, tumors, malformations and vicious stumps. The number of amputations on the shin is 2 times more than on the hip. A technology has been developed for the formation of a new support and movement organ, including amputation of the lower leg, anesthesia, intensive care, and rehabilitation treatment.Conclusion. An analysis of the initial applications for prosthetics showed that the most frequent high amputations of the lower extremities are performed due to gangrene in arterial atherosclerosis (53.9 %) and diabetes mellitus (24.9 %). High amputations of the lower extremities at the hip level are performed in 60.4 % of patients and only in 30.1 % of patients – at the shin level. Malformations and diseases of the stumps of the thigh and lower leg are detected in 15.4 % of patients. The gold standard should be recognized as myoplastic amputation at the border of the upper and middle third of the shin with excision of the soleus muscle. Preservation of the knee joint creates the conditions for optimal prosthetics and timely social adaptation of patients.

Academician Sergey Ivanovich Spasokukotskiy (1870–1943) (on the 150<sup>th</sup> anniversary of the birthday)

Professor Sergey Ivanovich Spasokukotskiy was born on June 10 (May 29 according to the old style) 1870 in Kostroma. In 1879 Sergey Spasokukotskiy began his study at the Yaroslav Provincial Gymnasium, after which he applied to the Faculty of Medicine of Moscow University in August 1888. After graduating from the Faculty of Medicine and receiving a diploma of doctor with honors in 1893, Sergey Ivanovich was left a supernumerary resident at the hospital surgical clinic. S. I. Spasokukotskiy is rightly considered one of the founders of surgical gastroenterology in Russia. In 1907 in St. Petersburg, he made a report «The breadth of indications for gastric resection in cancer and ulcer of it from the experience of 250 gastric operations and 29 resections». Problems of purulent surgery in the broadest sense have always been the focus of attention of Sergei Ivanovich, so there was a large purulent department in the clinic. In 1926, he was elected the Head of the Department and Clinic of Faculty Surgery of the II Moscow University. The works of Sergei Ivanovich and his students on hepatobiliary surgery, urology, neurosurgery were of great importance. Being since 1926 the head of the surgical sector of the Institute of Blood Transfusion, S. I. Spasokokotski has made a huge contribution to the development of domestic transfusiology. Under his guidance, the Faculty Surgery Clinic and the Blood Transfusion Institute Clinic developed blood transfusion indications for many pathological conditions. Spasokukotskiy had a high pedagogical skill, for which he earned great respect from students and young doctors, who always admired the Teacher ‘s personal example as a doctor, surgeon and scientist. Academician Sergei Spasokokotskiy died on November 17, 1943 and was buried in Moscow at the New Maiden Cemetery. For the best works in the field of surgery by the decision of the Government, there is a prize of his name.

Comparative antibiotic resistance of S. aureus strains isolated in surgical and therapeutic departments of hospitals

Objectives - to identify the characteristics of resistance of clinical isolates of S. aureus, obtained in hospitals of various specialization, to beta-lactam antibiotics, and to improve recommendations for empirical etiotropic therapy prescribed to patients with staphylococcal infections. Materials and methods. The subject of the study is the clinical isolates of S. aureus received from patients hospitalized to Vitebsk Regional Clinical Infectious Diseases Hospital "therapeutic" isolates, n=117) and purulent surgery departments and intensive care units of Vitebsk Regional Clinical Hospital ("surgical" isolates, n=111) in 2016-2017 years. Methods for the study of antibiotic resistance of clinical isolates of S. aureus: disk diffusion method, method for determining the beta-lactamase activity of bacterial suspension using the "BioLactam" test system. Results. It was found, that 80.6% of the therapeutic isolates and 73.2% of the surgical isolates were resistant to the 1st generation penicillins. 5.4% of therapeutic isolates and 34% of surgical isolates were resistant to inhibitor-protected beta-lactams. 36.8% of surgical isolates and no therapeutic isolates were resistant to cephalosporins of the 3rd generation. No MRSA were detected among the therapeutic isolates, and among the surgical isolates the prevalence of MRSA was 30.5%. 93.3% of therapeutic isolates of S. aureus did not show any beta-lactamase activity. Among surgical isolates there were only 34.4% of such isolates. Direct Spearman's correlations of moderate strength were revealed between the levels of beta-lactamase activity of S. aureus isolates, the duration of hospitalization and febrile period, as well as between the isolation of MRSA and the duration of hospitalization, fever and diarrheal syndrome. Conclusion. The use of inhibitor-protected penicillins and 3rd generation cephalosporins is recommended for empirical antibiotic therapy of "therapeutic" infections caused by S. aureus. Reserve antibiotics with selective antistaphylococcal activity (such as glycopeptides or oxazolidinones) are required for empirical antibacterial therapy of staphylococcal infections in surgical departments and resuscitation units

Application of photodynamic therapy in complex treatment of purulent diseases of the hand

For many years, the treatment of purulent diseases of the hand has stayed relevant. Despite the progress in modern medicine, this pathology retains its prevalence and, most importantly, is often found in patients of the working age, which determines the socio-economic importance of the search for new approaches to the treatment of purulent diseases of this localization. In the purulent surgery department of State Clinical hospital № 4, a study and treatment of two groups of patients were carried out: patients with phlegmons and felons of the hand with open management of postoperative wounds using traditional treatment methods (antibiotic therapy, immobilization, dressings with antiseptic solutions and ointments, the use of wound enzymes) and with the use of photodynamic therapy (PDT) in the postoperative period. PDT was performed on the second or third day after opening the phlegmon or felon using an ATKUS-2 semiconductor laser (AO “Poluprovodnikovye pribory”, Russia) with an output power of 1 to 2 W, an operating wavelength of 660 ± 0.03 nm and an energy density between 20 and 25 J/cm² after application of the photosensitizer based on chlorin e 6 to the treated wound area. The article describes the technique of PDT in patients with purulent diseases of the hand. It was found that it is optimal to perform PDT as early as possible after the operation period, but not earlier than on the second day after the operation, because earlier dressing is especially painful in the absence of sutures and can lead to bleeding from a postoperative wound when the dressing is removed. The effectiveness of treatment in the studied groups was evaluated: the terms of inpatient healing in the groups were compared; the dynamics of the course of the wound process was analyzed. When comparing the results of the two groups, a significant acceleration in the healing of the postoperative wounds was noted in patients for whom PDT was used – 5 days (1.4 times) faster compared to treatment according to the generally accepted technique. The early appearance of granulations and the antibacterial effect of this procedure are noted, which significantly improves the treatment outcome for this pathology. This makes the use of PDT relevant and appropriate in the complex treatment of purulent diseases of the hand

Therapeutic drug monitoring of vancomycin in patients with infectious complications in traumatology and orthopedics

Objective. The purpose of this study was to study the frequency of achievement of target values of vancomycin residual concentration (RC) and to identify the factors influencing this indicator. Materials and Methods. A retrospective observational study of vancomycin RC was performed in 471 patients who received vancomycin infusions in the department of purulent surgery of the RSRI of TO named after R.R. Vreden about capillary instillation after major orthopedic operations over the period from 01.01.2014 to 05.31.2016. Results. The target RC values on the third day of vancomycin administration reached 12.1% of patients (76.2% below target RC), after correction of the dosing regimen, the target RC was achieved in 20.3% of patients (56.9% below target RC). Multivariate analysis revealed a connection between RC and age (an increase in RC in age patients) and sex (a higher RC in women). In most cases, the prescribed doses of vancomycin corresponded to the recommended, however, the target RC levels of vancomycin were achieved only in a small proportion of patients. Conclusions. At the same time, the lowest frequency of reaching target concentrations was observed in young patients. The study proposed a multifactor model of vancomycin RC, on the basis of which it is possible to carry out the best correction of dosing taking into account the factors of age and sex.

Nitric oxide role in development of the endothelial dysfunction in diabetic foot syndrome

Introduction. Diabetes mellitus causes many acute and chronic complications, including diabetic foot syndrome (DFS) – a serious complication that can be a test for patients and directly affect their quality of life.
 One of the most effective treatments for DFS is the use of nitric oxide (NO). The main advantage of using NO-therapy is the effect of polyfunctional nitrogen monoxide on all phases of purulent-inflammatory process.
 Purpose of the study. The nitric oxide effect features on the development of endothelial dysfunctions in patients with diabetic foot syndrome are explored.
 Materials and methods. In the department of purulent surgery at Kyiv City Clinical Hospital No. 6 in 2019 from January to June, 76 patients with DFS in stages II–V were treated by F. Wagner. In 47 (61.8%) patients the neuropathic form of DFS was observed, and 29 (38,2%) were neuroichemic form. According to the DFS rates of F. Wagner patients were distributed: II – 24 (31,7%) patient, III – 29 (38,1%) patient, IV – 15 (19,7%) and V stages – 8 (10,5%). All patients were studied in the capillary zone of necrotic lesions of the content of NO, the activity of superoxide dismutase (SOD).
 Results and discussion. The signaling role of NO in cells is highly dependent on the level of superoxide. The balance between systems that synthesize NO and superoxide determines the regulatory orientation of the signals, and its disruption contributes significantly to inflammation in diabetes.
 Conclusions. The use of NO-therapy helps to optimize the processes of regulation of the induction of nitric oxide and to improve the clinical results in the treatment of diabetic foot syndrome.

A HISTOLOGICAL PICTURE OF BONE TISSUE IN CHILDREN WITH HEMATOGENOUS OSTEOMYELITIS

Introduction. Currently, there is a limited number of works devoted to the comprehensive study of specific features of surgical treatment of patients with acute hematogenous osteomyelitis (AHO) which includes histological and immune histochemical (IHC) tests of the bone marrow at different periods of the disease. In this regard, the purpose of our work was to make the morphological analyses of bone tissue and bone marrow fragments in children with hematogenous osteomyelitis. Material and methods. In 2013- 2016, in the department of purulent surgery of the city hospital in Stavropol, there were 64 children with AHO of long tubular bones aged from 3 to 17. 47 boys (73.4%), 17 girls (26.6%). The lesion was located in : femur - 25 (39.1%) children; tibia - 24 (37.5%); fibula - 6 (9.4%); humerus - 5 (7.8%); ulna - 3 (4.7%); radius - 1 (1.5%). All children had urgent osteoperforation of the affected bone. Bone slices were taken for histological examination and bone marrow fragments for IHC examination. Tissue sections were stained with hematoxylin and eosin, pikrofuksin by Van Gieson, aniline blue by Mallory, trichrome by Masson. IHC examination was done using a standard protocol with anti-CD3, CD4, CD8 monoclonal antibodies. Results. In AHO, the histological examination has revealed fragments of spongy bone tissue, elements of yellow and red bone marrow with diffuse abundant leukocyte infiltration, hemorrhages in bone marrow spaces, microcore fractures and necrotic foci in the trabeculae, vast areas of pronounced autolytic resorption of the bone tissue. Accumulation of CD3+cells (2-4) is seen in the inflammation infiltrate areas located along the fistula passage. The expression of T-lymphocyte-helper markers, or CD4 +, is moderate in chronic osteomyelitis (2 points). The expression of T-lymphocyte suppressor marker, or CD8 +, is moderate in chronic osteomyelitis (2 points). Immunoreactive material - coarse granular, cytoplasmic, disseminated (3 points). CD8 + lymphocytes are seen in clusters of cells in the amount from 4-6 to 20-30. In addition, to our mind, the picture of structural location of lymphocytes, is not completed, since cells are moving to the zone of interaction of CD8 + lymphocytes. Conclusions. Thus, minor subpopulations of lymphocytes, in particular double-positive T cells, or CD3 + / CD4 + / CD8 + lymphocytes, or highly differentiated memory cells are registered in the red bone marrow of patients with AHO. It characterizes the immunoregulatory index of the organism and may indicate the presence of autoimmune component in the immune response. If even separate CD8 + lymphocytes are revealed in the bone marrow of children with hematogenous osteomyelitis at IHC, it may indicate a risk of complications.