Surgical Sanitation Research Articles

Basic principles of treatment and follow-up of children with acute odontogenic infection and insulin-dependent diabetes mellitus

The purpose of the study is to substantiate the basic principles of treatment and clinical dental observation of children with acute odontogenic inflammatory disease and insulin-dependent diabetes mellitus as an accompanying disease. Material and methods. A medical examination was conducted for 213 children who were treated at the St. Petersburg city children’s hospital of K.A. Raukhus of. The dental status of children with insulin-dependent diabetes mellitus and children of the control group without concomitant diseases was assessed using the Fedorov-Volodkina index, the KPU index and analysis of the caries intensity according to the T.F. Vinogradova table, periodontal conditions according to the PMA index (papillary-marginal-alveolar). The state of microhemocirculation of periodontal tissues was also assessed using Doppler ultrasound and the use of a reflex cold test. In children diagnosed with “Acute odontogenic osteomyelitis of the jaws,” laboratory blood parameters, the composition of the microbial flora of wound discharge, and the length of hospitalization were studied. Results. Based on the data obtained, an algorithm for treatment and dispensary dental observation of children with diabetes was presented. The detection of diabetes mellitus in children of any age should be accompanied by increased attention to the dental health of these patients. If teeth affected by caries are identified during a preventive examination, immediate treatment is required. It is necessary to ensure constant follow-up of the child by an endocrinologist. Doppler examination of the microhemocirculatory bed vessels of the mucosa of the alveolar process of the jaw revealed that an adequate response to a reflex cold test was detected only in the control group patients, those who do not have insulin-dependent diabetes mellitus. With the development of acute odontogenic osteomyelitis of the jaw in children suffering from insulin-dependent diabetes mellitus, hospitalization is necessary when the first clinical symptoms of the inflammatory process appear. Immediately after hospitalization and immediate surgical sanitation of a purulent focus of infection in the oral cavity, drug therapy should be started: antibacterial, infusion, symptomatic, as well as insulin therapy. The results of this study are especially relevant in the treatment of children with a duration of insulin-dependent diabetes mellitus of more than 5 years and a decompensated course of endocrine disease. Conclusions. The results of the study allowed us to expand our understanding of the impact of diabetes on the oral health of children, to establish risk factors for the development of acute odontogenic osteomyelitis of the jaws in children of different age categories with insulin-dependent diabetes mellitus, as well as the characteristics of the course of odontogenic osteomyelitis of the jaws in each of the cases. Based on the identified features, the principles of diagnosis and treatment of acute odontogenic osteomyelitis of the jaws in children with insulin-dependent diabetes mellitus have been formulated.

Changes in the oral microbioty with losing teeth

BACKGROUND: The influence of the presence/absence of teeth and periodontium preserved at their existence as a balance factor in the oral cavity including the local immunity of the mucous membranes is practically not reported in the literature.
 AIM: The study aimed to examine the microbial community of the oral cavity at the loss of natural teeth.
 MATERIAL AND METHODS: Forty-five individuals aged 6174 years were under observation and divided into three study groups. The control group had partial loss of natural teeth. Group 2 had partial loss of teeth on both jaws and suffered from severe chronic generalized periodontitis. Group 3 had partial tooth loss on both jaws and suffered from chronic periapical inflammatory processes (chronic granulomatous periodontitis) in the absence of acute, chronic, or exacerbation of the chronic inflammatory process in periodontal tissues. In this study group, all upper and lower jaw teeth were extracted for oral sanitation before orthodontic treatment. The microbiota was assessed before surgical sanitation of the oral cavity (before tooth extraction) and 3035 days after the last tooth extraction, i.e., at complete tooth loss on the upper and lower jaws.
 RESULTS: On initial examination, the detection frequency of five red complex periodontopathogens (Prevotella intermedia, Bacteroides forsythus, Treponema denticola, Actinobacillus actinomycetemcomitans, and Porphyromonas gingivalis) ranged from 27% to 53%, which was significantly higher than that of the control group (13%27%). In 1 month after complete tooth extraction, the detection of these microorganisms in the experimental groups (with periodontitis and periodontitis) reliably decreased (P. intermedia, 20%; B. forsythus, 20%; T. denticola, 20%; A. actinomycetemcomitans, 20%; P. gingivalis, 33%), which was not significantly different from that of the control group.
 CONCLUSION: Complete extraction of teeth did not affect the presence of Staphylococcus spp. and Streptococcus spp. in the saliva of patients with periodontal diseases but led to a significant reduction in the presence of periodontopathogens and Candida sp. in the saliva of older people.

Changes in mucosal immunity of oral cavity upon tooth loss in patients with periodontal diseases

Partial or complete loss of teeth occurs in elderly and senile people, caused, mainly, by chronic generalized periodontitis. At the same time, the impact of presence or absence of persisting teeth and periodontium, is practically not covered in the literature as a factor of balance in the oral cavity, including local immunity of the mucous membranes. Our work concerned the changes in local immunity of the oral cavity occuring with the loss of natural teeth. We have observed 45 elderly people who were divided into 3 study groups, i.e., without inflammatory periodontal pathology (1), with periodontitis (2) and with chronic periapical inflammatory processes in the absence of periodontal inflammation (3). In order to sanitize oral cavity before the upcoming dental prosthetics, the patients of study groups 2 and 3 underwent extraction of all teeth in the upper and lower jaws. Indices of local immunity of the oral cavity in the salivary fluid of patients were assessed before surgical sanitation of the oral cavity (before the teeth extraction) and 30-35 days after removal of the last tooth. We have measured the salivary levels of secretory immunoglobulin A (sIgA) as well as pro-inflammatory cytokines, i.e., interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor- (TNF), and anti-inflammatory cytokines, e.g., receptor antagonist of interleukin-1 (RAIL), interleukin-4 (IL-4), interleukin-10 (IL-10)), as well as contents of antimicrobial peptides in saliva (catelicidin LL-37 and alphadefensins 1-3 (HNP1-3). We have found that the development of inflammation in severe inflammatory periodontal diseases, in particular, chronic generalized periodontitis requiring tooth extraction for oral cavity sanitation is characterized by functional insufficiency of secretory immunity of the oral mucosa associated with decreased secretion of secretory immunoglobulin A and antimicrobial peptides of neutrophilic origin, as well as a shift in the salivary cytokine balance towards increased production of pro-inflammatory cytokines. Removal of teeth, as the main source of inflammation and the basis for maintenance of dysbiotic microbiome biofilm leads to elimination of inflammation and the restoration of immune balance in the oral cavity.

Вплив основних положень Міжнародного керівництва з інтенсивної терапії тяжкого сепсису та септичного шоку — 2012 із додатковою ентеропротекцією на перебіг септичного процесу і вираженість енцефалопатії в структурі поліорганної недостатності

У статті проведено аналіз результатів впливу ключових положень Міжнародного керівництва з інтенсивної терапії тяжкого сепсису та септичного шоку — 2012, доповнених ентеропротекцією, на перебіг септичного процесу і вираженість енцефалопатії в структурі поліорганної недостатності. Заключення аналізу базувалося на підставі динаміки кількісних характеристик фізіологічного патерну CI-DO2-VO2; рН інтрамукозного, шкал GCS, APACHE II, SOFA; показників синдрому системної запальної відповіді; концентрації цитокінів (TNF-α, IL-1, IL-4, IFN-α); імуноглобулінів (IgA, IgM, IgG). Незважаючи на відновлення загальної оксигенації в умовах супранормальних значень DO2-VO2, на 3-тю — 5-ту добу відмічали чотири критерії SIRS, що розцінювалося як імовірність ризику уповільненої регресії синдрому запальної відповіді в подальшому. Сказане вище знайшло своє підтвердження в клінічному показнику лейкоцитів на 7-му добу — 15,18 • 109/л і незрілих форм — 11,88 %. Бали за шкалами APACHE II і SOFA, знизившись порівняно з такими на 5-ту добу, «застигли» на цьому рівні на 7-му добу. Неврологічна симптоматика на 7-му добу оцінювалася як сопор — 10,88 бала. Максимально високі концентрації прозапальних цитокінів на 5-ту — 7-му добу можна пояснити їх реперфузійним походженням після відновлення спланхнічного кровообігу. При цьому позитивним було перевищення IL-4 на 7-му добу свого рівня на 5-ту добу на 77,42 %. Використання сорбентів виявилося неефективним за наявності гострих ерозій і виразок шлунково-кишкового тракту для регенерації ентероцитів і запобігання шлунково-кишковим кровотечам навіть у поєднанні з інгібіторами протонної помпи. Початково передбачувана летальність за сумою балів шкали APACHE II становила 51 %, справжня летальність — 35,5 %, тобто застосування ентеросорбенту призвело до зниження летальності на 15,5 %.

Duration of antibiotic treatment and risk of recurrence after surgical management of orthopaedic device infections: a multicenter case-control study

BackgroundDevice-related infections in orthopaedic and trauma surgery are a devastating complication with substantial impact on morbidity and mortality. Systemic suppressive antibiotic treatment is regarded an integral part of any surgical protocol intended to eradicate the infection. The optimal duration of antimicrobial treatment, however, remains unclear. In a multicenter case-control study, we aimed at analyzing the influence of the duration of antibiotic exposure on reinfection rates 1 year after curative surgery.MethodsThis investigation was part of a federally funded multidisciplinary network project aiming at reducing the spread of multi-resistant bacteria in the German Baltic region of Pomerania. We herein used hospital chart data from patients treated for infections of total joint arthroplasties or internal fracture fixation devices at three academic referral institutions. Subjects with recurrence of an implant-related infection within 1 year after the last surgical procedure were defined as case group, and patients without recurrence of an implant-related infection as control group. We placed a distinct focus on infection of open reduction and internal fixation (ORIF) constructs. Uni- and multivariate logistic regression analyses were employed for data modelling.ResultsOf 1279 potentially eligible patients, 269 were included in the overall analysis group, and 84 contributed to an extramedullary fracture-fixation-device sample. By multivariate analysis, male sex (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.08 to 3.94, p = 0.029) and facture fixation device infections (OR 2.05, 95% CI 1.05 to 4.02, p = 0.036) remained independent predictors of reinfection. In the subgroup of infected ORIF constructs, univariate point estimates suggested a nearly 60% reduced odds of reinfection with systemic fluoroquinolones (OR 0.42, 95% CI 0.04 to 2.46) or rifampicin treatment (OR 0.41, 95% CI 0.08 to 2.12) for up to 31 days, although the width of confidence intervals prohibited robust statistical and clinical inferences.ConclusionThe optimal duration of systemic antibiotic treatment with surgical concepts of curing wound and device-related orthopaedic infections is still unclear. The risk of reinfection in case of infected extramedullary fracture-fxation devices may be reduced with up to 31 days of systemic fluoroquinolones and rifampicin, although scientific proof needs a randomized trial with about 1400 subjects per group. Concerted efforts are needed to determine which antibiotics must be applied for how long after radical surgical sanitation to guarantee sustainable treatment success.

The differential diagnostics and sepsis surgical treatment and induced metabolically diseases in diabetic foot lesions patients

Purpose of the study. The sepsis differentiation criteria and metabolically induced diabetic foot lesions must be established.
 Material and methods. The 115 patients were observed.
 Results and discussion. Sepsis by the qSOFA criteria was diagnosed in 3, heart failure of 3–4 class by NYHA classification estimated in 39 cases. High limb amputation had been performed to 18 patients, surgery on the foot to 97. Foot lesion relapse accompanied by unstable glycaemia had been observed in 25 cases. For the surgical correction of the diabetes ileoduodenoplasty had been performed in 7 cases, which resulted in uncomplicated wound healing in all patients.
 Conclusion. Sepsis progression in patient with diabetic foot case proof indicates the necessity high lower limb amputation. Foot lesion relapse after the effective surgical sanitation indicate on metabolic disorder, not on sepsis. Surgical correction of the diabetes by mean of ileoduodenoplasty performing seems to be the reliable method of foot lesion relapse preventing.

INEFFECTIVE ONE-STAGE SURGICAL TREATMENT OF DISSEMINATED TUBERCULOUS SPONDYLITIS: A CLINICAL CASE AND LITERATURE REVIEW

The paper presents a clinical case of ineffective one-stage surgical treatment of disseminated tuberculous spondylitis. Female patient with extensive destruction of the vertebrae was treated by simultaneously performed posterior decompression and drainage of the abscess and short posterior fixation using dynamic titanium nickelide implant. After 4 months, inadequate primary surgical sanitation of the inflammation focus through posterior approach resulted in the progression of tuberculosis lesions of the spine. After repeated staged surgical treatment, the patient achieved favorable outcome of the disease. A review of the literature on disseminated forms of tuberculosis spondylitis has shown that at present there are staged and singlestep approaches to the treatment of this disease. Most modern researchers of tuberculosis spondylitis tend to single-step combined operations.

The method of cochlea-sparing surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone

Surgical treatment of patients with infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone involves the radical excision of the formation, often together with the cochlea, which results in the development of the degree 4 of chronic sensorineural hearing loss in the postoperative period. This article presents a method of cochlea-sparing surgical sanitation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone. This method is applicable to the patients with the preserved function of the auditory analyzer without the extension of cholesteatoma to the labyrinth and high position of the bulb of the jugular vein. The method includes skeletonization of the fallopian canal, expansion of the hypothympanum by removal the bone shelf of the lower wall of the external auditory canal together with the tympanic ring up to the jugular vein bulb, as well as by removal the bone shelf of the anterior wall of the external auditory canal up to temporo-mandibular joint, and thinning of the cochlear capsule up to its membranous region. After that, the sinuses of hypothympanum, infralabyrinthine cellular tract, pericarotid and precaratid cells are removed up to the internal carotid artery, going deeper to the top of the temporal bone pyramid. In this case, before the fallopian canal skeletonization, the access through retroaural approach with extended anthro-mastoidotomy, the excision of malleus, incus, all cells of the cellular tract of the temporal bone. Simultaneously with the phallopian canal skeletonization, intra-operative monitoring of the facial nerve is performed using needle electromyography by means of a drill until the occurrence of threshold events at the current of 0.8 to 0.5 mA; the formed trepanation cavity is sanitized, after that the external auditory canal is plastically expanded, and type 3 or 4 tympanoplasty with ossiculoplasty is performed, depending on the degree of damage of the sound-conducting system of the middle ear; in the post-surgical period the trepanation cavity is managed open. The method provides the reduction of cholesteatoma recurrence development risk and saves the hearing of the patients. The results of the treatment were evaluated using otomicroscopy, temporal bone MSCT, MRI of the middle ear in DWI-mode in the follow-up period of 6 months through 3 years.

Impact of standardizing the surgical sanitation of paranasal sinuses on treatment results in patients with chronic rhinosinusitis concurrent with conductive hearing loss

Impact of standardizing the surgical sanitation of paranasal sinuses on treatment results in patients with chronic rhinosinusitis concurrent with conductive hearing loss

Evolution of complex treatment of patients with non-specific pleural empyema

To analyze long-term own experience of NPE treatment in view of evolution of surgical sanitation of pleural cavity. The analysis included 5115 patients with NPE for the last 39 years (1977-2015). Morbidity, features of microflora of purulent exudate, changes in the structure of surgical methods were assessed. The role of computed tomography in the diagnostic algorithm and treatment of NPE was studied. The evolution of NPE surgical management includes introduction of video technologies, thermal surgical instruments and widespread use of computed tomography in the diagnosis of pleural empyema. So, significant reduction of patients who were discharged with residual cavities was observed. Postoperative mortality was 19.5% for the period 1977-1996 when traumatic open surgery was used. At the same time there were no deaths within 1997-2015 due to introduction of VATS pleural drainage. Overall mortality decreased from 4.9% to 3.2% for the same period due to reduced postoperative complications. The introduction of minimally invasive technologies, new thermal surgical instruments changed management of NPE patients, reduced the number of traumatic open procedures. So, improved outcomes were achieved.

The method of surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone

The relevance of the study is determined by the location of cholesteatoma in the petrous part of the temporal bone and its close contact with the vital structures of the temporal bone, which makes impossible the complete excision of cholesteatoma matrix without its damaging. The work presents a method of surgical sanitation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone in the patients with stage 4 of chronic sensorineural hearing loss and subject to the spread of cholesteatoma to the cochlea. The method includes postauricular approach, the extended radical operation with the removal of cells of the cellular path of the temporal bone down the formation, skeletonization of the facial nerve canal, removing the cochlea, hypotympanum sinuses and infralabyrinthine cellular path to the top of the petrous part of the temporal bone, sanitation of the trepanation cavity and closing of the tympanic part of auditory tube by the auto-cartilage and fascial flap. Intraoperative monitoring of the facial nerve is performed simultaneously with the facial nerve canal skeletonization, using needle electromyography with the drill until the occurrence of the threshold events at the current of 0.8 mA to 0.5 mA, and after the sanitation of the generated trepanation cavity plastic extension of the external ear canal is performed, while in the postoperative period trepanation cavity is managed open. The method reduces the risk of relapse. The results of the treatment were evaluated by means of otomicroscope examination, temporal bone MLSCT, the middle ear MRI. The article provides assessment of the results of treatment of 3 patients at the period of 6 months through 2 years.

The Use of Laser Technology and Aquacomplex Titanium Glitserosolvat in the Treatment of Chronic Osteomyelitis

Хронический остеомиелит остается одной из наиболее сложных проблем гнойной хирургии, что связано, в том числе, с вы-сокой частотой встречаемости, составляющей до 6% в структуре патологии опорно-двигательной системы и 6,8–12% вструктуре гнойно-септических заболеваний, высоким риском развития септических осложнений и рецидивов, инвалидиза-ции, достигающей 55% случаев.Целью исследования явилось улучшение результатов лечения хронического остеомиелита путем применения лазерныхтехнологий и аквакомплекса глицеросольвата титана.Материалы и методы. Экспериментальные исследования проведены в 5 группахна 175 белых крысах с хроническим остео-миелитом: 2-х контрольных и 3-х опытных. 1-ю контрольную группу составили животные без лечения. Во 2-й контрольнойи опытных группах проводилась хирургическая санация гнойного очага. В 1-й опытной группе санация костной полостибыла дополнена применением низкоинтенсивного лазерного облучения. Во 2-й опытной группе выполнялось введение в кост-ную полость аквакомплекса глицеросольвата титана. В 3-й опытной группе – обработка костной полости низкоинтен-сивным лазерным излучением с последующим введением в нее аквакомплекса глицеросольвата титана. В ходе выполненияработы применяли клинические,гематологические, микробиологические и рентгенологические методы исследования.Результаты и их обсуждение. Моделирование хронического остеомиелита по разработанной методике позволяло к 31-мсуткам сформировать патологический процесс со свищами с гнойным отделяемым, что подтверждалось данными клини-ческих, микробиологических и рентгенологических исследований.Выводы Разработанный метод комплексного лечения хронического остеомиелита, основанный на сочетанном примене-нии лазерных технологий и аквакомплекса глицеросольвата титана способствовал сокращению сроков закрытия раневогодефекта, нормализации общего состояния и двигательной активности; нормализации окружности бедра поврежденнойконечности, показателей свободнорадикального окисления.

Purulent and inflammatory diseases of the neck: modern view of patient management

The problem of treatment of purulent-inflammatory diseases of the neck continues to be relevant. The number of patients with inflammatory diseases of the neck has no tendency to reduction. The number of patients with phlegmons of the neck, common in several cellular spaces, most often accompanied by the development of severe complications such as sepsis, mediastinitis, thrombosis of the cavernous sinus of the dura mater and others is increasing. Standards for the treatment of patients with purulent-inflammatory diseases of the neck, which include conducting an adequate surgical sanitation and drainage of the purulent focus, antibacterial, detoxification, anti-inflammatory therapy, correction of system homeostasis, were currently developed and put into practice. Each year new methods of purulent wounds management appear but none of them meets requirements of the modern surgeons fully. More and more authors are inclined to believe that routine methods of treatment of purulent processes become ineffective. This is due to increased antibiotic resistance, virulence and variability of microorganisms. Reduction of the morbidity of surgical treatment of a purulent focus is of great importance in the treatment of purulent wounds. In the treatment of patients with purulent-inflammatory diseases of the neck improvement of cosmetic results of treatment, lack of rough and deforming scarring, which directly affects the quality of life of patients, is very important.

Peculiarities of intensive care at destructive pneumonias in children

In spite of success in treatment and diagnostics attained last years the problem of an acute pneumonia remains actual, this fact is caused by the growing rate of prolonged clinical course and unfavorable clinical outcomes. The growth of antibiotic resistance of microflora is a substantial problem. In addition even the most vigorous modern antibacterial preparations are not effective without an adequate surgical sanitation of the nidus of infection. The aim of the work is to improve the therapy of destructive pneumonia in children that need an intensive care. Methods. 12 patients 9 month – 12 years old who underwent the treatment of heavy community-acquired pneumonia were under observation. There was carried out an X-ray examination at admission and in dynamics, microbiological examination of lavages from the respiratory tract, pleural exudate and blood, determination of laboratory indexes of intoxication (by Kalf-Kalif, Dashtayants, Lubimova) and the level of the middle molecules. The statistical analysis was done using the program package Microsoft Excel and StatSoft 6. Results. In the course of microbiological examination it was demonstrated the prevalence of gram-negative flora and its associations with gram-positive one, the purely gram-positive flora was detected only in 25 % of children. So there was proved an inefficiency of antibiotics that effect mainly on the gram-positive microorganisms. In addition the cephalosporins of the third generation were found insufficiently effective. Such preparations as carbapenems or protected penicillins were chosen in vitro and according to its clinical efficiency. Plasmapheresis and bronchoscopy are useful in the complex therapy. Thoracoscopy must be carried out if the conservative treatment is not effective Conclusions. At present the gram-negative flora and its associations with gram-positive one prevails in etiological structure of the heavy community-acquired pneumonias that must be taken into account choosing the start preparations for empirical therapy. In the cases of insufficient efficiency of conservative therapy an active surgical tactics must be used.

Castleman Disease: Retrospective Single-Center Study of Therapeutic Results in 10 Patients

Castleman disease is a non-clonal lymphoproliferative disorder with 2 clinical (unicentric, multicentric) and 4 histomorphological (hyaline vascular, plasma cell, mixed, plasmablastic) forms which combine creating a pleomorphic picture of this rare entity. In our work, the largest documented cohort in the Czech Republic was analyzed focusing on diagnostics and particularly on therapy. The retrospective study (1998-2013) included 10 patients, 6 males, 4 females. Patients with unicentric form (3) underwent surgical sanitation. Patients with multicentric form (7) were followed-up only (2) or extirpation of the largest mass was carried out (1) or a systemic therapy was administered (4) which comprised the following regimens: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), CTD/CAD/CVD (cyclophosphamide, thalidomide/adriamycin/bortezomib, dexamethasone), further including monotherapies with tocilizumab, thalidomide and lenalidomide and in one case (associated POEMS syndrome, i.e. polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) autologous stem cell transplantation after melphalan conditioning was performed. During treatment response monitoring, all patients underwent PET/CT examination (fluorodeoxyglucose positron emission tomography/computed tomography). The remission rate was 50% (3 unicentric forms with remission lasting 51, 8 and 9 months, resp.; 2 multicentric forms with remission lasting 3 months during thalidomide therapy and 12 months after lenalidomide therapy), stable disease was observed in 40% of cases (multicentric forms, 2 without any treatment followed-up for 171 and 24 months, resp.; 1 after systemic therapy followed-up for 23 months; 1 after two extirpations with stable lymphadenopathy for 15 years, where the first operation was 27 years ago). In one patient (10%), the associated POEMS syndrome progressed rapidly with fatal consequences (4 months follow-up). Unlike unicentric forms completely curable by excision, multicentric forms are often treatment-refractory. Concerning high cost-effectiveness, good tolerability and documented efficacy also in rituximab-resistant cases, we prefer immunomodulatory drugs (particularly thalidomide) for managing multicentric Castleman disease in our center.

Two-Step Total Hip Arthroplasty in Deep Periprosthetic Infection

Modern notions about surgical techniques for the treatment of deep purulent processes in the zone of hip implant are presented. In 13 cases surgical sanitation without implant removal was performed. In case of implant loosening treatment tactics was determined by the possibility of total revision arthroplasty. In 76 patients with periprosthetic infection surgical sanitation was aimed at inflammation arrest and restoration of extremity weight bearing after compelled implant removal. In 44 patients resection arthroplasty with formation of neoarthrosis by Girdlestone was performed. In 17 cases a two-step surgical intervention with implantation of antibiotic impregnated cement spacer followed by revision arthroplasty was used. Clinical, microbiologic and immunologic criteria of favourable treatment outcome with minimum risk of inflammatory process relapse were determined.

Surgical sanitation in complex therapy of acute inflammatory diseases of appendages of uterus in young women: the analysis of typical clinical practice

Among recommendations of leading Russian experts on conducting patients with acute inflammatory diseases of appendages of a uterus (AIDAU) the indication to laparoscopic sanitations at young women occurs at availability of suspicion on purulent character of inflammation. Objective: to study of typical clinical practice among gynecologists in definition of readings to surgical sanitation at AIDAU in young women. Methods: the retrospective analysis of 62 cases of repeated hospitalization of 29 patients in the age of from 19 till 37 years. The automated technology of examination of quality of medical aid (QMA) is used. The group of defects QMA «it’s not applied, but it’s shown» in cases of refusal from lapariscopic sanitations are carried out. Results: operative treatment is undertaken at 24.1 % of patients at primary hospitalization and 9,1 % at repeated. In all cases surgical sanitations were undertaken at availability of complications AIDAU. It is established, that at repeated hospitalization the risk organremoving operations reliably increases (р = 0.033). QMA «it’s not applied, but it’s shown» it is revealed in 10,1 % of cases of primary hospitalization and 3,3 % at repeated. Conclusions: Contrary to existing recommendations gynecologists do not undertake a laparoscopy in noncomplicated purulent AIDAU in young not given birth women. Refusal of a surgical component of treatment at 10,1 % of patients with clinical signs of purulent adexitis can be the factor of insufficient efficiency of treatment at primary hospitalization and the reason of recurrent disease in the further

Modern approaches to local treatment of pyo-necrotic complications of the diabetic foot syndrome

The analysis of publications devoted to modern methods of treatment of pyo-necrotic complications of diabetic foot syndrome has been presented. Identified were the most important principles of therapeutic tactics for this type of pathology. In order to create optimal conditions for wound healing after surgical sanitation local drug treatment is carried out - a thorough wound detersion with application of the isotonic sodium chloride solution or a neutral bathing solution, periodic (as needed) necrectomies, application of bandages, in accordance with the phase of wound healing process. The choice of medication for local treatment depends on the one hand on the type of lesion of the lower limbs, on the other - on the diabetes related morbidity and phase of wound healing. In the first phase of wound healing antiseptics are used: iodophors, polyhexanide (lavasept), hydroxymethyl quinoxaline dioxide (dioxidine), and in the absence of ischemia - compositions based on gelevine, water-soluble base ointments. In the second phase used were various wound covers based on collagen, as well as oil and hydrogel dressings. Ready-to-use bandages are also used, which are multi-layered system, comprised of a cellulose substrate, collagen, fibroblasts, growth factor, coated with plates of silicon to control humidity. The disadvantage of the ready-to-use dressings is the impossibility of controlling the wound on a daily basis. One of the trends in the treatment of chronic diabetic wounds is the use of living skin cells that serve as a source of growth factors, cytokines and other proteins that stimulate the healing process. The use of local immunomodulators is seen as promising. Treatment should be individualized and systemic antibiotic therapy is required. The main principle of local treatment is the creation of optimal conditions for accelerating the healing process.