Suppurating lesions following surgical treatment of lower limb ischemia due to atherosclerosis]

Patients with suppurative lesions complicating surgical reconstruction of the arteries have been analysed. Such complications have been noted in 110 (102 men and 8 women) out of 311 operated patients. Considering the difference in the number of male and female patients, the risk of suppurative lesions complicating vascular surgery is proportional in both sexes. Thousand three hundred sixty six surgeries included: 361 recanalizations, 944 transplantations, and 61 arterial plasties. Percentage of suppurative complications ranged from 8.8% after transplantations to 9.8% after arterial plasties. More than one surgery has been performed in some patients. The risk of infectious complications has been higher in these patients. Despite antibiotic treatment suppurative infections have been noted in 108 (101 men and 7 women) out of 1244 operated patients, i.e. in 8.6%. Intravenous administration of antibiotics during surgery has proven the most effective prophylaxis. An infection of postoperative wound is the most severe local complication in vascular surgery. It has also been most frequent in the analysed group of patients, being 31.3% of all local complications.     

Hospital infections: the problems and ways to resolve them]

The authors present the critical analysis of the existing situation in the spread of purulent septic infections in surgical hospitals of the USSR and the state of epidemiological surveillance. Considering this situation to be highly unfavorable, the authors propose a number of urgent organizational measures (the inclusion of hospital epidemiologists into the medical staff of large clinics, the system of training in this problem). The article deals with the specific features of the epidemiological process in purulent septic infections and the main principles of the organization of the epidemiological surveillance system for this group of infections.     

Anaerobic bacteria in upper respiratory tract and head and neck infections: microbiology and treatment

Anaerobes are the predominant components of oropharyngeal mucous membranes bacterial flora, and are therefore a common cause of bacterial infections of endogenous origin of upper respiratory tract and head and neck. This review summarizes the aerobic and anaerobic microbiology and antimicrobials therapy of these infections. These include acute and chronic otitis media, mastoiditis and sinusitis, pharyngo-tonsillitis, peritonsillar, retropharyngeal and parapharyngeal abscesses, suppurative thyroiditis, cervical lymphadenitis, parotitis, siliadenitis, and deep neck infections including Lemierre Syndrome. The recovery from these infections depends on prompt and proper medical and when indicated also surgical management.     

The effect of using T-activin in the therapy of the newborn with suppurative surgical infection

A total of 156 newborn infants with suppurative surgical infection (SSI) were observed; 73 of them had sepsis and 83 a severe localized process. In 47 patients with sepsis and 34 with localized infection, T-activin was included in complex therapy while the other infants formed the control group. It has been established that T-activin leads to an increase in the quantity of the active population of T-lymphocytes in the peripheral blood and to enhanced functional activity of T-lymphocytes in the newborn with SSI independent of generalization of the process. Bactericidal activity of circulating phagocytes is improved. The clinical course of SSI is less severe with more pronounced positive changes in the symptoms, hospital stay of the children is shortened, lethality is reduced. The effect of T-activin on the dynamic of the indices of the immune state is more marked in a septic process.     

IgGs containing λ- and κ-type light chains and of all subclasses (IgG1-IgG4) from the sera of patients with autoimmune diseases and viral and bacterial infections hydrolyze DNA

We present the first evidence demonstrating that small fractions of IgGs of all four subclasses (IgG1–IgG4) from patients with viral (tick‐borne encephalitis), bacterial infections (streptococcal infection or erysipelas), and suppurative surgical infections caused by epidermal staphylococci as well as from patients with autoimmune diseases (systemic lupus erythematosus and multiple sclerosis) are catalytically active in the hydrolysis of supercoiled DNA. The hydrolysis of DNA was analyzed by agarose gel electrophoresis. The catalytic activities of nonfractionated IgGs increased in the following order: tick‐borne encephalitis < suppurative surgical infection < streptococcal infection < multiple sclerosis < systemic lupus erythematosus, whereas IgGs of healthy donors were inactive. However, the pools of antibodies corresponding to any particular disease were characterized by a specific ratio of IgGs of all four subclasses (IgG1–IgG4) and IgGs containing λ‐ and κ‐type light chains, and each of these subfractions of immunoglobulins demonstrated characteristic relative DNase activity. The relative activities of IgGs containing λ‐type light chains may on average be higher, lower, or comparable with those for IgGs with κ‐type light chains. The relative contributions of IgGs of different subclasses to the total activity of IgGs also varied widely in the case of various diseases: IgG1 (7%–45%), IgG2 (0.4%–73%), IgG3 (0%–12%), and IgG4 (9%–66%). Thus, immune systems of patients with different diseases can generate a variety of anti‐DNA abzymes of different types and with different catalytic properties, which can play an important role in the pathogenesis or protection from the development of these diseases. Copyright © 2012 John Wiley & Sons, Ltd.     

急诊内镜下EST并ENBD治疗急性梗阻性化脓性胆管炎

目的:探讨急诊内镜下乳头肌切开(endoscopic sphincterotomy,EST)并鼻胆管引流术(endoscopic nasobiliary draingage,ENBD)治疗急性梗阻性化脓性胆管炎的有效性.方法:对我院132例急性梗阻性化脓性胆管炎患者在急诊内镜下行EST并ENBD,并回顾分析其治疗效果.结果:ENBD全部成功,腹痛发热迅速缓解,无并发症发生.结论:急诊应用EST并ENBD治疗急性梗阻性化脓性胆管炎安全有效,为后续手术治疗创造了有利条件.     

Characteristics of sources and means of spread of Pseudomonas aeruginosa infections in urology wards

Patients with purulent septic infections form the main source of infection in urological departments. The spread of infection from these patients occurs mainly by contact in dressing and cystoscopy rooms. The complex of measures, planned in accordance with the results of diagnosis, makes it possible to decrease morbidity rate in the purulent septic infections of the urinary tract.     

Biofilms in device-related infections

The use of various medical devices including indwelling vascular catheters, cardiac pacemakers, prosthetic heart valves, chronic ambulatory peritoneal dialysis catheters and prosthetic joints has greatly facilitated the management of serious medical and surgical illness. However, the successful development of synthetic materials and introduction of these artificial devices into various body systems has been accompanied by the ability of microorganisms to adhere to these devices in the environment of biofilms that protect them from the activity of antimicrobial agents and from host defense mechanisms. A number of host, biomaterial and microbial factors are unique to the initiation, persistence and treatment failures of device-related infections. Intravascular catheters are the most common devices used in clinical practice and interactions associated with these devices are the leading cause of nosocomial bacteremias. The infections associated with these devices include insertion site infection, septic thrombophlebitis, septicemia, endocarditis and metastatic abscesses. Other important device-related infections include infections of vascular prostheses, intracardiac prostheses, total artificial hearts, indwelling urinary catheters, orthopedic prostheses, endotracheal tubes and extended wear lenses. The diagnosis and management of biofilm-associated infections remain difficult but critical issues. Appropriate antimicrobial therapy is often not effective in eradicating these infections and the removal of the device becomes necessary. Several improved diagnostic and therapeutic modalities have been reported in recent experimental studies. The clinical usefulness of these strategies remains to be determined.     

Campylobacter fetus septic arthritis: report of a case.

We report a case of septic arthritis caused by the fastidious gram-negative rod Campylobacter fetus. We suggest that the organism may be part of the endogenous flora and that the clinical infections tend to occur in compromised hosts. Our patient is the first to be described with multiple myeloma and C. fetus septic arthritis. The documented cases of culture-proven C. fetus septic arthritis reported to date have occurred in three men and one woman, all in the seventh and eighth decades of life, with a mono-articular large joint distribution. The septic arthritis always occurred in previously injured joints and curiously enough need not be associated with a toxic-appearing patient. C. fetus infections are also associated with the signs and symptoms of clinical thrombophlebitis. We stress caution in establishing this diagnosis of phlebitis on clinical evaluation only and urge differentiation of true deep vein thrombophlebitis from pseudothrombophlebitis or dissected popliteal synovial cyst. This latter diagnosis may be made non-invasively by ultrasound techniques.     

Corneal microsporidioses: characterization and identification.

Two ocular infectious disorders attributed to Microsporidia have been observed. They differ in that one infection involves the corneal stroma leading to corneal ulceration and suppurative keratitis whereas the other infection involves the conjunctival and corneal epithelium. The corneal stromal infection is caused by a binucleated oval spore that is Nosema-like in character. The conjunctival and corneal epithelial infection occurs in HIV-sero-positive individuals and is caused by a spore containing a single nucleus that is a member of the genus Encephalitozoon. Characteristics of these genera and the above-mentioned infections are presented.     

Epidemiologic features of an intracranial abscessation/suppurative meningoencephalitis complex in white-tailed deer

Case records of 683 white-tailed deer (Odocoileus virginianus) submitted to the Southeastern Cooperative Wildlife Disease Study (Georgia, USA) for diagnostic purposes from 1971 to 1989 were reviewed for the occurrence of pyogenic infections of the central nervous system, specifically intracranial abscessation or suppurative meningoencephalitis. These conditions, either alone or in combination, were diagnosed in 24 of 683 (4%) deer. Thirteen genera of bacteria were isolated; the most frequent species was Actinomyces pyogenes. The disease was strongly sex biased (P less than 0.01); 88% of the cases occurred in males. Cases were more prevalent (P less than 0.05) in older bucks; the median age of infected bucks was 3.2 yr, and 71% of these were greater than or equal to 2.5-yr-old. Intracranial abscessation/suppurative meningoencephalitis cases accounted for 20% of the diagnoses among 56 bucks greater than or equal to 3-yr-old. Cases were seasonal, occurring only from October to April. Characteristic necrosis, erosion, and pitting of skull bones were common, and this bone damage may be useful in determining cause of death when only skeletal remains are found. Males, especially older bucks, apparently are predisposed to intracranial abscessation/suppurative meningoencephalitis because of the cycle of antler development and behavioral traits associated with reproduction. The strong bias toward prime age bucks suggests that these infections could specifically hinder management strategies designed to produce populations with older buck age structures.     

高毒力肺炎克雷伯菌致病及耐药分子机制研究进展

近年来,肺炎克雷伯菌已成为医院内感染及社区获得性感染的常见致病菌,临床标本分离率仅次于大肠埃希菌.根据毒力特征差异,肺炎克雷伯菌可分为经典肺炎克雷伯菌和高毒力肺炎克雷伯菌2种类型.高毒力肺炎克雷伯菌是引起化脓性肝脓肿的主要病原菌,其感染可出现内源性转移,包括眼、肺和中枢神经系统;此外还与原发性肝外感染有关,包括菌血症、...     

Clinical spectrum of invasive candidiasis in critically ill non-neutropenic patients

Invasive Candida spp. infections in non-neutropenic critically ill patients admitted to intensive care units can be classified as focal and systemic. Both types of infection usually occur after episodes of candidemia, although some focal infections may be of exogenous development, like those occurring after trauma or be device-related.The clinical spectrum of invasive Candida spp. infections includes focal urinary tract, abdominal, ocular, respiratory tract, renal and hepato-biliary infections, as well as systemic infections like candidemia and acute systemic candidiasis with multiorgan involvement after hematogenous seeding. Candida spp. isolates in "significant" samples, like synovial fluid, cerebrospinal fluid and blood cultures, represent true infection. However, the diagnosis of invasive infection based on "non-significant" samples, like surgical drains and digestive tract exudates, requires additional criteria. The total number of isolates from different sites, the presence of risk factors, the clinical host response, as well as severity of illness need to be taken into account for the diagnosis of invasive candidiasis. The clinical signs of systemic infection due to Candida spp. are completely non-specific and cannot be differentiated from bacterial peritonitis, urinary tract infection or bacteremia. These infections may be associated with signs of sepsis,severe sepsis, septic shock or multiorgan dysfunction. In the future clinical multicentre observational and interventional studies are necessary to reach agreement on clinical definitions and classification of invasive Candida spp. infections in critically ill non-immunocompromised patients.     

Chronic Hemodialysis for Terminal Renal Failure

Ten terminal uremic patients seen over the period of one and one-half years have been kept alive by repeated hemodialysis using a modification of the Seattle system, carried out for the most part by nurses and technicians. All the patients had creatinine clearance values below 5 ml./min., and blood urea nitrogen values which ranged between 156 and 453 mg. % before beginning the first dialysis.Selection was based on their ability to co-operate with and to tolerate the regimen. Nine patients were fully rehabilitated.The major complications were those related to shunt-site infections, including septicemia, bacterial endocarditis, septic arthritis, septic pulmonary embolism and mycotic aneurysm.Nevertheless, all patients except one were rehabilitated and resumed their full-time occupations and have continued to lead happy and useful lives.     

Obliteration of decompressed frontal sinus by means of a deepithelialized island forehead flap

A new surgical procedure for the treatment of chronic unilateral suppurative frontal sinusitis was described. A vascularized composite tissue--forehead island flap--was used for obliteration of the decompressed left frontal sinus. In the author's opinion (in selected cases) it is more physiologically sound than the use of abdominal fat or bone graft as an alternative for obliteration. It will withstand the test of time, since myocutaneous flaps have been used reliably as vascularized tissues for anatomic regions troubled by infection and radiation.     

Children with Chronic Suppurative Lung Disease Have a Reduced Capacity to Synthesize Interferon-Gamma In Vitro in Response to Non-Typeable Haemophilus influenzae

Chronic suppurative lung disease (CSLD) is characterized by the presence of a chronic wet or productive cough and recurrent lower respiratory infections. The aim of this study was to identify features of innate, cell-mediated and humoral immunity that may increase susceptibility to respiratory infections in children with CSLD. Because non-typeable Haemophilus influenzae (NTHi) is commonly isolated from the airways in CSLD, we examined immune responses to this organism in 80 age-stratified children with CSLD and compared their responses with 51 healthy control children. Cytokines involved in the generation and control of inflammation (IFN-γ, IL-13, IL-5, IL-10 at 72 hours and TNFα, IL-6, IL-10 at 24 hours) were measured in peripheral blood mononuclear cells challenged in vitro with live NTHi. We also measured circulating IgG subclass antibodies (IgG₁ and IgG₄) to two H. influenzae outer membrane proteins, P4 and P6. The most notable finding was that PBMC from children with CSLD produced significantly less IFN-γ in response to NTHi than healthy control children whereas mitogen-induced IFN-γ production was similar in both groups. Overall there were minor differences in innate and humoral immune responses between CSLD and control children. This study demonstrates that children with chronic suppurative lung disease have an altered systemic cell-mediated immune response to NTHi in vitro. This deficient IFN-γ response may contribute to increased susceptibility to NTHi infections and the pathogenesis of CSLD in children.     

State of the nonspecific humoral factors of the body's natural resistance in patients with suppurative and septic infections having various ABO system blood groups]

The results of surveying 140 patients with severe purulent and septic infections of staphylococcal etiology, when compared with the distribution of the blood groups (as classified according to the ABO system) in 180 healthy donors, revealed that generalized purulent infections occurred most frequently in patients with blood groups A (II) and AB (IV), and more seldom in patients with blood groups O (I) and B (III). The average content of lysozyme, complement and normal antibodies to E. coli, as well as the average level of general bactericidal activity in the blood sera of the patients were considerably lower than in the blood sera of healthy donors; at the same time content of lysozyme, complement and normal antibodies in the blood sera of patients having different groups of blood did not reflect the degree of their predisposition or resistance to staphylococcal infections. The general bactericidal activity of the blood serum was found to correlate with the degree of predisposition or resistance to purulent septic infections of staphylococcal etiology to a greater extent than other characteristics.     

Hearing loss in suppurative meningitis and encephalitis in our cases

Seventeen cases of the suppurative meningitis complicated by hearing loss have been analysed clinically. Emphasis is on the possibility of such a complication in any case of the suppurative infection of CNS. The authors have shown the necessity of otolaryngological examinations in each patient, basing on their own experience and available literature. An early diagnosis and appropriate treatment produces complete recover or decreases the degree of hearing loss being a complication of the suppurative neuroinfections.