[Immunocorrection in the treatment of diffuse peritonitis in aged patients].

The results of treatment of 161 patients with diffuse forms of peritonitis with, using of the immunostimulators are analyzed. The algorithm of staged complex immunocorrection for patients with acute pancreatitis, including aged patients, is worked out. The use of it improves the results of treatment and allows decrease the morbidity.

[Prediction of surgical infections severity at elderly and old patients].

Clinical and immunological characteristics of generalized peritonitis in different age group at complicated and non-complicated postoperative period were analyzed at 246 patients with abdominal purulent infection. Prognostic criteria of complicated postoperative period at elderly and old patients have been determined. It is concluded that interpretation of immune characteristics permits to determine the prognostic criteria of disease course and outcome at various age group, and to use the rational immunocorrection.

[Surgical interventions in HIV-infected and patients with AIDS]. / Khirurgicheskaia pomoshch' VICh-infitsirovannym bol'nym i bol'nym SPIDom.

176 patients with HIV-infection and AIDS were examined. 77 of them underwent various surgical interventions the most frequent of which were: opening of abscess and phlegmons--14 (23%), biopsy of lymphatic nodes--10 (13.1%), appendectomy--5 (6.2%), condyloma excision--21 (27.2%), removal of uterus adnexa--2 (2.5%), pleural puncture--4 (5.9%), cholecyst- and splenectomy--5 (8.2%). Operations for stomach cancer (creation of gastroenteroanastomosis), extrauterine pregnancy, brain tumor (drainage of IV ventricle of the brain), penetrating wound of cornea were performed less often. 43 patients underwent emergency operations without preoperative preparation, 34 patients underwent elective operations. The causes of 6 deaths were secondary diseases (Kaposi's sarcoma, purulent processes, metastases, pulmonary edema). There were no complications and blood changes in postoperative period in infected patients. These patients were discharged in the same terms as non-infected patients. In patients with AIDS, especially in combination with other infections, fever persisted long after the operation. The wound healed by first intention in all the patients, but the sutures were removed on day 10-30. Immunologically, a high ratio T-suppressors/T-helpers existed. An increase in fibrinolytic activity without high tissues hemorrhage was observed.

[A trial of using augmentin (amoxicillin/clavulanate) in surgical practice]. / Opyt primeneniia augmentina (amoksitsillin/klavulanata) v khirurgicheskoi klinike.

The experience with the use of augmentin (amoxycillin/clavulane) in abdominal surgery for prophylaxis of postoperative purulent complications was analyzed. The drug was used in 44 patients after relatively pure operations, 37 of them having various risk factors. In 2 patients (4.5 per cent) of that group postoperative pyoinflammatory complications were recorded. For comparison the results of the prophylactic use of cefoperazone, cefamandole or ceftazidime in the group of 78 patients after relatively pure operations on the abdominal cavity organs were analyzed. Postoperative complications in the latter group amounted to 7.4 per cent (4 patients). The results of the treatment of patients in two groups after contaminated operations were also compared. The patients of one group (41 patients) were treated prophylactically with augmentin in a dose of 1200 mg intraoperatively followed by the drug use in a dose of 600 mg thrice daily for 1 to 2 days after the operation. Postoperative pyoinflammatory complications were recorded in 4 patients of that group (9.7 per cent). 78 patients of the other group were treated prophylactically with ceftazidime or cefoperazone in a dose of 2 g and metronidazole intraoperatively or cefoperazone in a dose of 2 g twice daily and metronidazole in a dose of 500 mg twice daily for 1 to 2 days after the operation. Postoperative infectious complications were recorded in 8 patients of that group (10 per cent). In the group of patients with acute cholecystitis treated with ciprofloxacin in a dose of 400 mg in combination, with metronidazole before the operation and for 1 to 2 days after the operation postoperative complications were recorded in 4 patients (17 per cent).

[The immunological aspects of predicting antibiotic therapy efficacy in peritonitis patients]. / Immunologicheskie aspekty prognozirovaniia éffektivnosti antibiotikoterapii u bol'nykh peritonitom.

The analysis of the impact of various group antibiotics on the mechanisms of development and correction of pathogenetically heterogeneous immune deficiency in 235 patients at age of 17 to 85 years with local (80 patients) and general (155 patients) peritonitis is presented. Cephalosporins and fluoroquinolones promoted restoration of the immune and interleukin (IL-1 and IL-2 of donors, IL-1r and IL-2r of patients) status and lowered the immunodepressive effect of glucocorticoids (GC) at the organism (cortisol, ACTH and cortisol-binding globulin) and cellular (GC receptors III) levels. Aminoglycosides and penicillins had no significant action on the immune and interleukin status but lowered the EG effect at the organism (aminoglycosides) and cellular (penicillins) levels. It is recommended that the antibiotics be used with an account of their involvement in the systemic reactions of the host.