[Increase of reparative potential of fabrics in sugar diabetes]. / Povyshenie reparativnogo potentsiala tkanei pri sakharnom diabete.

AIM: The purpose of the study was to study the effectiveness of the domestic drug Remaxol in reparative processes of laparotomic wound tissues in acute surgical abdominal pathology in patients with diabetes mellitus. MATERIAL AND METHODS: Clinical and laboratory studies were performed in 86 patients with acute surgical pathology of the abdominal cavity, 56 patients with type 1 diabetes mellitus, including 26 patients who received Remaxol in the early postoperative period (daily intravenous infusions of 400.0 ml for 5 days). RESULTS: It was established that diabetes mellitus is an important aggravating factor in the reparative process of tissue structures of a laparotomic wound. Undoubtedly, a significant factor in reducing the reparative potential of tissues is a significant activation of factors leading to membrane-destabilizing phenomena - oxidative stress, activation of phospholipases, hypoxia. The inclusion of Remaxol, which has antioxidant and antihypoxic effects, allows to significantly correct these pathogenetic components, which is the basis for optimization of the reparative process against the background of diabetes mellitus. There was a significant decrease in wound complications in the early postoperative period, a significant reduction in the stay of patients in the hospital.

[Prevention of wound infection in cardiac surgery: how much is topical use of antibiotics justified?].

The authors studied efficacy of preventing wound infection of a sternotomic wound with and without conventional use of topical antibiotics, also determining predictors of the development of infectious complications after cardiosurgical interventions. Our retrospective study included a total of 1,593 patients subdivided into two groups. In Group One patients (n=951) sternal infection was prevented according to the P. Vogt technique; Group two patients (n=642) were also subjected to the same methodology, but with the exception of topical use of antibiotics. By the frequency of re-sternotomies performed, cases of superficial and deep wound infection, as well as by the average duration of operation, hospital and ICU stay there were no statistically significant differences between the groups (p<0.05). The average cost of antibacterial agents as calculated per one patient in Group One turned out substantially higher than in Group Two (amounting to 8.1±3.9 and 3.3±1.4 thousand roubles, respectively, p<0.001). Analysing possible predictors of the risk for the development of wound infection showed that the body mass index, duration of the operation, and performing re-sternotomy exerted a statistically significant influence on probability of infections complications. It was determined that using the methodology of preventing sternal infection with topical application of antibiotics led to predominance of Gram-negative flora in the wound discharge (p=0.02). Exclusion of topical use of antibiotics does not lead to an increase in the incidence rate of wound complications (p=0.78) and normalizes the ratio of Gram-negative and Gram-positive strains.