Prevention and treatment of postoperative pyoinflammatory complications and cefuroxime]

Antibacterial activity and efficacy of cefuroxime (ketocef, Pliva, Zagreb) in the treatment and prophylaxis of surgical infections in a general hospital and particularly in the unit of vessel and aorta surgery, the unit of lung surgery and the unit of microsurgery were estimated. The study included 57 patients (43 males and 14 females) at the age of 21 to 70 years. Cefuroxime was administered intravenously in a dose of 1.5 g followed by its intramuscular administration in a dose of 750 mg with an interval of 8 hours. The results showed that cefuroxime was effective in the treatment (80 per cent) and prophylaxis (93.6 per cent) of the pyo-inflammatory complications and was active against the majority of the surgical infection pathogens.     

Use of antibiotics for the prevention of postoperative suppurative complications in planned surgery

Two methods for antibiotic prophylaxis in scheduled surgical treatment were studied comparatively. In the main group antibiotic prophylaxis with respect to 621 operations was started simultaneously with premedication, the duration of the course being defined by the operation type. With respect to 252 pure operations antibiotics were not used in 69.8 per cent of the cases or used for 2-3 days in 27.8 per cent of the cases. With respect to 253 conditionally pure operations shorter courses of antibiotic prophylaxis, i.e. for 2-3 days were used in 50.2 per cent of the cases. In the control group the antibiotics were used after operations in mean therapeutic doses, the duration of the course being defined by the clinical findings. The number of purulent complications in the main group decreased, while the amounts of the antibiotics used were much lower.     

Antibiotic prophylaxis of postoperative suppurative complications in surgical urology

Preoperative sanation of the urinary tracts is an obligatory condition for lowering the risk of severe infectious complications. When there is no bacteriuria it is recommended in the cases subject to short-term surgical interventions without subsequent drainage of the urinary tracts to perform single or one-day prophylaxis with cephalosporins or semi-synthetic penicillins in the routine doses. The same principle is applicable to transurethral operations, endourological manipulations and lithotripsy. When there are urinary fistulas preventing complete sanation of the urinary tracts before operations it is advisable to use combinations of aminoglycosides with carbenicillin. The treatment terms in such cases amount to 7 to 10 days. Antibiotics of the reserve group, i.e. amikacin, sisomicin and ureidopenicillins should not be used prophylactically in such cases.     

Role of Pseudomonas aeruginosa in the etiology of postoperative suppurative inflammatory complications in patients with chronic suppurative lung diseases

The study of P. aeruginosa strains isolated from patients and various objects of the environment in one of the clinics of Yerevan, carried out by the methods of serotyping, pyocin typing and phage typing, has allowed the authors to establish the circulation of hospital strains and their role in the appearance of post-operative suppurative inflammatory complications in patients with chronic suppurative diseases. The study has also allowed them to reveal the sources of infection which is spread by patients serving either as its reservoirs or as intermediate hosts.     

Cataract surgery and postoperative complications in diabetic patients

Diabetes mellitus influences the function and morphology of the eye lens. The cataract is the second most common complication of diabetes mellitus on the eye. A hundred patients with cataract were examined in the prospective study. The patients were divided into two groups. The first group consisted of 50 patients with cataract who had not suffered from a system or local disease. The second group consisted of 50 patients with cataract and diabetes mellitus that had lasted for at least five years. In both groups the patients underwent identical cataract extra capsular extraction with intraocular PMMA (polymethylmethacrylate) lens implantation in camera posterior. The objective of this study was to compare the two groups of patients in order to find out the most common intraoperative or postoperative complications in diabetics. The most common postoperative complications in patients suffering from diabetes were inflammatory reactions and bleeding: postoperative keratopathy, uveitis anterior serous and uveitis anterior fibrinous with posterior sinechia and opacity of the posterior lens capsule as results. Postoperative visual acuity was worse in the patients in group II on the seventh day and six months after operation. It was diabetic retinopathy and its progression that caused deterioration of visual acuity. Diabetic retinopathy and its progression, as well as maculopathy were found only in patients who were not treated with photocoagulation before the operation.     

Problems of prophylaxis and treatment of infectious complications in reconstructive surgery]

Infectious complications due to polyresistant staphylococci as well as strepto- and enterococci are of serious problem in reconstructive surgery, since the number of such strains isolated within 1999-2004 has amounted to 58.4-59.7% of all the isolates. Susceptibility testing of 195 isolates showed that 100% of them was susceptible to linezolid that was used in the postoperative treatment of 28 patients after reconstructive surgical operations including those with artificial circulation under conditions of a multiprofile surgical hospital. Linezolid proved to be a highly effective agent in the prophylaxis and treatment of infectious complications due to polyresistant grampositive pathogens. Step-by-step therapy with linezolid was shown possible. In the treatment of pediatric cases no side effects of linezolid were recorded.     

An epidemiological analysis of postoperative suppurative pathology in surgical hospitals]

Approaches to the epidemiological analysis of postoperative wound complications in surgical hospitals are summarized. The indices for the evaluation of the epidemic situation in surgical departments (the ratio of severe and mild forms of complications, severe and posthospital complications) are proposed. To determine the site of infection, the method of graphic analysis, involving the fixation of dates of the operation and the appearance of the complication and taking into account regularities in the development of the outbreak, the depth and severity of the lesion, is proposed. Epidemiological surveillance at medical institutions permits the prognostication of the epidemiological situation. The realization of epidemiological surveillance at the level of individual medical institutions is the prerequisite of effective functioning of the program of epidemiological surveillance at a given territory.     

Microbiological monitoring in prophylaxis and treatment of pyoinflammatory complications during early postoperative period in patients with cicatricial tracheostenosis]

The species composition and antibiotic susceptibility of microflora isolated from patients with cicatricial tracheostenosis (CTS) and infectious processes were investigated. Schemes for the treatment of CTS with an account of the pathogen species and multidrug resistant staphylococcal infection are described. Comparative efficacy of the combined schemes (antibiotic + bacteriophage) for the therapy of pyoinflammatory processes in the patients with CTS and the efficacy of the treatment of the patients with CTS according to the traditional antibacterial schemes were studied.     

Prevention of complications of smallpox vaccination]

In observance of the rules of vaccination and unfavourable anamnesis in the vaccinated serve as the main causes of postvaccinal complications (30 and 22%, respectively). The great majority of complications occurs at the age of 1 to 3 years (76%). In 94% of cases complications are recorded in primarily vaccinated individuals. Solution of such problems as introduction into wide practice of sparing methods of immunization and special scheme of preliminary preparation to the vaccination of weak children and those with conditioned contraindications is necessary for the purpose of prevention of complications; a possibility of using, along with gamma-globulin, of synthetic preparations, and of subjecting older children to primary vaccination for prevention of complications is discussed.     

Intralymphatic administration of antibiotics in the complex treatment of suppurative complications in patients with neurosurgical pathology

The efficacy of endolymphatic route of gentamicin and ceporin administration was studied in 89 patients with neurosurgical pathological processes complicated by acute pneumonia (80 patients) and meningoencephalitis (9 patients) usually after ineffective antibiotic therapy according to the routine methods. The antibiotics were used in accordance with the antibiograms of the causative agents isolated from the bronchial tree or CSF. The endolymphatic use of gentamicin or ceporin once a day in doses of 80 mg or 1 g respectively provided rapid sanation and arresting of the inflammatory foci, lowering of the intoxication level, more rapid promotion of the positive time course of the clinico-roentgenological and laboratory indices and decreasing of the recovery periods by 1.5-2 times in 86 per cent of the patients with pneumonia. The endolymphatic administration of gentamicin in a dose of 80 mg twice a day or ceporin in a dose of 1 g twice a day allowed one to maintain the antibiotic therapeutic levels in the cerebrospinal fluid and to obtain satisfactory clinical results in the combined treatment of meningoencephalitis. The endolymphatic administration of the drugs was well tolerated by the patients and no adverse reactions were observed. This route of administration of antibiotics and in particular broad spectrum antibiotics may be recommended for urgent antibacterial therapy of especially severe neurosurgical patients with pyo-inflammatory complications and patients who did not respond to the routine antibiotic therapy.     

Prevention of infectious complications in patients with acute bone marrow depression]

Clinical efficacy of intravenous gentamicin in combination with oral use of gentamicin, ristomycin and nystatin was studied in 1977. In 1980-1984 two antiinfectious regimens were tested: intravenous administration of gentamicin in combination with total decontamination (oral use of gentamicin and nystatin) and selective decontamination (biseptol with nystatin of amphoglucamine). It was shown that the incidence of severe infections in the patients under the observation dropped against the controls. The incidence and spectrum of infectious complications in cases with acute myelodepressions were proved to depend on the intestinal autoflora inhibition.     

Use of ceftriaxone in the prevention of postoperative purulent complications after surgery on the stomach and small intestine]

Ceftriaxone was administered intravenously in a single dose of 1.0 g 15 minutes prior to surgical intervention for peptic ulcer and gastric or duodenum tumor in 31 patients at the age of 33 to 74 years. In all the patients primary adhesion of the surgical wound was recorded. No signs of local or general infection were observed. The indices of the total blood count, urinalysis and blood biochemical analysis came to normal by the 5th or the 7th day of the postoperative period. The levels of ceftriaxone in the blood, urine, stomach wall, small intestine tissues and subcutaneous fat were evaluated. The indices of the cellular and humoral immunity in the pre- and postoperative periods in the patients prophylactically treated with ceftriaxone were analyzed.     

Use of cefoperazone in clinical practice]

The bacteriological and clinical efficacy and side effects of cefoperazone were studied in 45 patients with severe and moderate purulent inflammatory diseases. The study showed that its bacteriological and clinical efficacy was high in cases with peritonitis, cholecystitis, respiratory and urinary infections, as well as those of the eye and soft tissues. The general clinical efficacy amounted to 95.6 per cent. The number of the side effects was insignificant. This made it possible to recommend the use of cefoperazone in the therapy of many purulent inflammatory diseases, as well as in empirical therapy.     

Pre- and postoperative erythrocyte volume distribution curves in children with cyanotic heart defects]

The behaviour of the volume distribution curves (VVK) of red blood cells in children with cyanosed organic heart defect is reported by taking preoperative and postoperative observations as a basis. MCV determined from the volume distribution curve amounts to 80.3 micron3. If the volume distribution curves of the preoperative patient group are compared with the postoperative patient group (4 months) by means of the criteria DSmax, DS, inclination and dispersion, no significant changes can be identified. Therefore, shifting maturity divisions cannot be assumed in children with cyanosed organic heart defects, even in those with a preoperative hypoxia of a high degree.