X-ray diagnosis of complications of purulent processes in the wrist

To reveal the spreading of a purulent process to the antebrachial fatty spaces a study was made of an x-ray picture of soft tissues of the radiocarpal articulation and the forearm distal half in 126 patients with hand paronychia and phlegmon. In 24 of 95 patients with an unclear clinical picture of purulent discharge, typical x-ray symptoms of changes in soft tissues of the distal third of the forearm were found: typical deformity of fatty spaces with its distinct dynamics with relation to a stage of development of a pathological process. X-ray investigation permits the recognition of complications in hand purulent processes in order to take necessary therapeutic measures.     

Etiological diagnosis of suppurative bacterial meningitis today

As the result of laboratory examination of 2165 patients with virulent bacterial meningitides, including cases of meningococcal infection, the etiological diagnosis was confirmed in 1407 patients (65.0%), the number of cases confirmed by the laboratory examination being significantly greater among adults than among children: 67.5 +/- 1.37% and 63.1 +/- 1.53%, respectively, (t = 2.1). Meningococcal infection was confirmed in 1111 (70.6%) out of 1572 patients under examination. Of the patients with purulent meningitides, pneumococcal etiology was determined in 27.4%, type b of Haemophilus influenzae in 13.5%, other infective agents in 10.0%. The comparison of the results obtained in the examination, carried out by different methods, of 946 children and 770 adults with meningococcal infection revealed a considerable difference in the number of positive results yielded by the bacteriological method and countercurrent immunoelectrophoresis (CIE). Among adults meningococci were isolated twice as frequently (41.1 +/- 2.5% - 19.4 +/- 1.6%), and the results yielded by CIE were predominantly positive (55.1 +/- 2.5% and 40.1 +/- 2.5%). CIE and the immunoenzyme assay were shown to have advantages in the diagnosis of the disease. Under the conditions of intensive antibiotic therapy the methods based on the detection of specific antigens in body fluids can greatly assist in diagnosis.     

Antibiotic anaphylaxis

Pulmonary cancer when localized to the lung, is curable by operation. Tumors found by routine x-ray examination before they cause symptoms are much more often confined to the lung and as such are curable. Unlike other internal growths which are more hidden, lung tumors can often be seen early on x-ray films of the chest.X-ray films of the chest were made routinely on all patients entering a hospital, regardless of the nature of their illness. In all, some 40,000 films were made. Sixty patients were found to have unsuspected solitary lesions in the lung. Twenty-four of the lesions were diagnosed and treated by operation and removal. Twelve were diagnosed by other methods. Of the 36, eight were cancer of the lung, an incidence of 22 per cent. There were also 14 localized tuberculous nodules which are best treated by removal. Since early cancer is surgically curable, it is felt that everyone over the age of 40 should have a routine x-ray examination of the chest every six months. Solitary lesions of the lung found should be excised for diagnosis.     

X-ray study in the examination of patients with perineal fistulas

The paper discusses whether X-ray study of patients with perineal fistulas is required and justified. The main reason is that there is a diversity of diseases which display the same signs as paraproctitis. Of 426 examinees, perineal fistulas were mainly caused by chronic paraproctitis in 85% and by other various diseases showing the similar symptoms in 15%. The basic studies of these patients included fistulography made in 300 patients with external fistulas and proctofistulography performed in 126 patients with incomplete internal fistulas. Comparing the data of X-ray study with those of clinical and morphological ones showed the sensitivity of the former to be 94.5%. Based on the results of their own observations, the authors defined indications for fistulography or proctofistulography. In addition to the analysis of the findings, they present the main points of differential X-ray diagnosis of different diseases manifested by perineal fistulas.     

Characteristics of the agents of acute suppurative destruction of the lungs in children]

The authors carried out bacteriological studies of the blood, the pleural cavity puncture material, the discharge from the bronchi in bronchoscopy, and also of smears from the nasopharynx of 40 children with acute purulent destruction of the lungs. Staphylococci, often in association with various Gram-negative bacilli, chiefly of the Pseudomonas genus, and Enterobacteriaceae family, prevailed in the cultures of the pathological material. Pathogenic staphylococcus was found in the nasopharynx of patients in 65% of cases. Along with staphylococci in over half of the patients there were revealed Gram-negative bacteria, and yeast-like Candida fungi. In the majority of patients the microbes isolated from the pharynx and the lungs were identical. In these cases bacteriological examination of pharyngeal smears can serve as an auxiliary method of laboratory diagnosis. The isolated straphylococcus strains possessed the majority of the pathogenicity signs; in the great majority of cases they were resistant to the antibiotics the most widely used in the therapeutic practice; among them strains of phage types 80, 54, 75, 77, and 81 prevailed. Thus, at different periods of the disease various types of the microbes prevailed in the materials obtained from the patients. In acute purulent destruction of the lungs bacteriological examination should be carried in dynamics.     

The value of the x-ray study method in the diagnosis of celiac-sprue]

The authors describe some features of x-ray symptoms of Gee-Herter disease with relation to severity and a period of disease. Altogether 106 adult patients with this disease were followed up, of them 78 patients with diagnosis of Gee-Herter disease, confirmed by histology of intestinal biopsy specimens, were selected for analysis. Three groups of patients with different x-ray symptoms were singled out. Some distinctive features of differential diagnosis and complications of Gee-Herter disease in adults were noted.     

Antibacterial therapy in disseminated purulent peritonitis

Analysis of 156 records relating to patients at the age of 15 to 85 years with extended purulent peritonitis of the surgical and gynecological genesis (the toxic phase, VI category ASA) showed that combination of programmed sanitation laparotomy and intensive antibacterial therapy performed as short-term courses before, during and after the operation with an account of the information on the nature of the microbial associations and antibioticograms was an efficient procedure in treatment of severe peritonitis. It was indicated in treatment of patients with polyorgan deficiency. When the surgical treatment was adequate early antibiotic therapy allowed to decrease the number and intensity of postoperative complications: the frequency of abscessing in the abdominal cavity and formation of intestinal fistulas lowered 2 and 1.5 times respectively. Such a decrease was also observed in asthenic patients with lowered protective reactions to development of new infectious foci in the abdominal cavity complicating the peritonitis process. It was also possible to prevent with that procedure the infection generalization and development of peritoneal sepsis. With application of the procedure to such patients (20 per cent) lethality lowered 2-fold.     

Clinico-roentgenologic manifestations of intestinal lesions in pseudotuberculosis

The authors presented the results of clinical and x-ray investigation of 102 patients with epidemic pseudotuberculosis (EP). The diagnosis was established on the basis of epidemiological evidence and the results of clinical and serological investigation. The affection of the digestive organs was observed not only in the abdominal type of EP but also in its other types. X-ray examination of the digestive organs revealed terminal ileitis in 56.8% of the patients alongside with functional disorders. X-ray examination plays a certain role in the differential diagnosis of EP from other diseases of the ileocecal region, in particular from acute appendicitis.     

PULMONARY SEGMENTAL RESECTION OF SOLITARY LESIONS OF DOUBTFUL CHARACTER

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness.Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

Pulmonary segmental resection for solitary lesions of doubtful character

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness. Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

Radiation diagnosis of aortic aneurysmal ruptures with formation of anastomoses with the inferior cava and various organs

The results of radiation diagnostic techniques were analyzed in 29 patients with aortic aneurysmal ruptures with formation of aortic anastomoses. The examination and treatment of 362 patients with abdominal aortic aneurysmal ruptures revealed that 23 (6.35%) patients had anastomoses (aortocaval (n = 15), aortoduodenal (n = 6), aortogastric (n = 1), and aortoureteral (n = 1)). Six patients were observed to have secondary aortointestinal anastomoses occurring after reconstructive vascular surgery. In one patient, abdominal aortic aneurysmal rupture first led to the formation of a primary aortoduodenal anastomosis and some time after surgery a secondary aortointestinal fistula emerged. One out of 113 patients with aortic dissecting aortic aneurysms had an aortopulmonary fistula. Ultrasonography, computed tomography, and angiography were performed in 27, 19, and 14 patients, respectively. Radiation diagnostic techniques revealed fistulas in 9 (31%) out of the 29 patients. The diagnosis of aortic anastomoses presents challenges.     

Ciprofloxacin in the treatment of infections in oncology patients

Treatment of infectious complications with ciprofloxacin in 65 patients provided good and satisfactory results in 67.7 and 20.0 per cent of the cases, respectively. The drug was efficient in sepsis, urogenital infections, respiratory infections and postoperative purulent complications. Ciprofloxacin showed a broad antibacterial spectrum. 96.3 per cent of the isolates belonging to aerobic organisms causing purulent inflammatory processes, including those with high antibiotic resistance levels, such as Pseudomonas spp., Proteus spp., Klebsiella tribe and Staphylococcus aureus were sensitive to the drug. In its antibacterial spectrum ciprofloxacin was similar to ofloxacin. The advantage of ciprofloxacin is its possible use not only orally but also intravenously. Adverse reactions to ciprofloxacin were observed in 5 (7.7 per cent) out of the 65 patients. In two cases discontinuation of the drug use was required. The use of ciprofloxacin in treatment of infectious complications in oncological patients is promising.     

Intraoperative bacteriological examination of patients operated on under extracorporeal circulation

Results of bacteriological examination of 41 patients during surgical operations on the heart under conditions of artificial blood circulation are presented. The frequency of contamination of intraoperative++ samples and species composition of the isolated microflora were analyzed. It was shown that representatives of nonfermenting gram-negative++ bacteria isolated during the operations and characterized by high antibiotic resistance could be the agents causing purulent septic complications in the patients during the postoperative period. It is concluded that intraoperative++ bacteriological examination of cardiosurgical patients with successive investigation of several samples from the pericardium before and after perfusion, as well as specimens of perfusion blood at various stages and resected heart valves is advisable.     

Pleural Effusion with Pancreaticopleural Fistula

Three patients with pleural effusion were found to have pancreaticopleural fistulas passing through an opening in the diaphragm are reported. In one case the effusion was purulent and originated from an abscess of the pancreas. Retrograde pancreatography during operation defined the course of the fistula. In two other cases the fistula was demonstrated by radiography after intrapleural injection of contrast medium. The diagnostic importance of injecting contrast medium early into the pleural cavity in cases of effusion rich in amylase, before lung expansion obscures the fistula, is emphasized. Cases of pancreaticopleural fistula may be commoner than supposed.     

Clinical and radiologic manifestations of pleural and pulmonary complications in sepsis]

Proceeding from the investigation and therapy of 106 patients with pleuropulmonary complications of sepsis the authors described clinical and x-ray features of different types of their course, complications and outcomes. In 58% of cases pulmonary lesions were detected at the stage of pyodestruction and pleural empyema; interstitial-focal and infiltrative pneumonias of considerable spreading with the development of a respiratory type of septic shock were observed less frequently. Pulmonary lesions in 24% were the only sign of septicopyemia, in 58% they prevailed in the clinical picture of polyorganic lesions; pleural complications developed in 32% of the patients. Convalescence was observed in 88 (83%) patients; they had residual bullous-sclerotic pulmonary changes. The lethality rate was 17%.     

Computed tomography in the comprehensive diagnosis of acute diseases and injuries

The author presents the results of a CT use during combined investigation on 2500 patients and the wounded who were admitted to hospital on emergency as well as patients who developed serious complications during treatment, especially in the postoperative period. CT findings were verified during operation, at autopsy or during a follow-up. They were indicative of a high effectiveness of emergency CT of different organs and systems in the diagnosis of lesions, acute diseases and their complications. The use of CT permitted considerable reduction of a diagnostic (preoperative) period, a decrease in use of routine invasive x-ray and surgical methods, and the improvement of therapeutic results.     

X-ray and computed tomographic diagnosis of aneurysm of the thoracic aorta

The paper is concerned with the results of x-ray and CT investigations conducted in 62 patients with suspected aneurysm of the thoracic aorta. The diagnosis was confirmed in 56. Of them 38 patients were operated on, 2 died without surgical intervention. X-ray investigations permitted differential diagnosis of mediastinal formations in 91.5% of cases. However in 2 cases when the combined method of intravenous administration of a contrast medium by means of a syringe was not used, aneurysmal aortic dilatation was not detected by CT. This method was found to be effective for diagnosis of complications of aneurysms of the thoracic aorta (calcinosis, aortic wall stratification and thrombosis of aneurysmal cavity).     

Critical oropharyngocutaneous fistulas after microsurgical head and neck reconstruction: indications for management using the "tissue-plug" technique

Despite advances in head and neck reconstruction with free-tissue transfer techniques, oropharyngocutaneous fistulas continue to present challenging and potentially lethal complications. The authors present a system for prioritizing these fistulas and the surgical management of nine patients in whom critical fistulas developed after microsurgical head and neck reconstruction. The indications for aggressive management of these fistulas were primarily dependent on their location. Three peristomal and six midneck fistulas were considered critical because of the risk of aspiration pneumonia and carotid artery blowout, respectively. Fistulas located in the submental and/or submandibular region were considered noncritical and were managed conservatively. Using the concept of a "tissue plug" for fistula repair, a dermal component (i.e., a deltopectoral or pectoralis major pedicled flap) is guided through the fistula, and with external traction the tissue "plugs" the tract. No sutures are placed directly in the surrounding friable tissue. There were no partial or total flap losses. There were two fistula recurrences in patients who had received postoperative radiation therapy. One of these recurrences was due to tumor recurrence within the previous fistula and was managed with palliative measures. The other fistula recurrence was closed with a local-flap procedure on an outpatient basis. All patients resumed oral feeding, except for the patient in whom tumor recurrence was suspected. This tissue-plug technique can be used in the management of critical peristomal and/or midneck oropharyngocutaneous fistulas not only to obliterate the tract but also to augment volume and vascularity in already damaged, ischemic, and deficient tissue.     

Abdominal Aortic Aneurysms—Unusual Clinical Manifestations

Misleading symptoms were responsible for failure to make the diagnosis of symptomatic abdominal aortic aneurysm in 15 patients. The presenting complaints appeared to be specific for other diseases, such as genitourinary disease, diverticulitis, intra-abdominal neoplasm and functional large intestinal disorders. A correct diagnosis was ultimately made in 12 patients and aneurysmectomy was performed. In three patients, who died of ruptured aneurysm, the diagnosis was not made until postmortem examination.An awareness of the atypical symptoms of aneurysms, careful physical examination and appropriate x-ray studies will lead to the diagnosis of symptomatic aortic aneurysms. Early resection will result in a lower mortality rate.     

X-ray characteristics of acute intestinal obstruction in middle-aged and elderly patients

The authors presented clinical and x-ray findings of 188 patients with mechanical intestinal obstruction (92 of them were middle-aged and advanced in years and 96 were under 60). A combined program of x-ray examination included 3 stages: panoramic polypositional roentgenography of the chest and abdominal cavity, dynamic x-ray control over the state of the abdominal cavity, and contrast study of the G.I. tract. A distinctive feature of the x-ray symptomatology of intestinal obstruction in middle-aged and old patients was the absence of classical x-ray symptoms in some cases during panoramic roentgenography of the abdominal cavity. In patients over 60, x-ray symptomatology was characterized by marked colon distension and intestinal distension of various degree in 77.1%