[Invasive streptococcal (group A) infection of soft tissues in a Moscow surgical hospital].

AIM: To study features and risk factors of soft tissue's invasive streptococcal infection in surgical unit's patients: a) emm-types of the most often recovered streptococcus; b) human immune response for streptococcal antigens (streptolysin-O and the group A carbohydrate antigen); c) main patient's conditions that complicate the course of soft tissue's streptococcal infection. PATIENTS AND METHODS: 101 surgical unit's patients with soft tissue's infection, which group A streptococcal (GAS) nature, were examined. Emm-types were determined by comparison ofemm gene sequenced part with data of CDC Streptococcus Laboratory. ASO and specific anti-group-carbohydrate IgM were measured with photometry and ELISA4 accordingly. Patient's personal data were analyzed by standard statistical programs. RESULTS: Among 34 emm-types of all streptococcal isolates emm28 and emm64 were registered only in invasive infection. Emm-types 1, 49, 60, 66, 77, 84, 88 were most often. Among 23 sera from invasive GAS-infection's patients, 15(65%) were ASO-negative, 6 (26%) were ASO-low-positive, and 2 (8%) were positive, but negative for the anti-group-A-carbohydrate IgM. CONCLUSION: Lower levels of the humoral immune response as well as risk factors such as trauma, alcoholism, diabetes, chronic venous insufficiency contributed to development of severe forms of GAS-infection. The main streptococcal emm-types for soft tissue's invasive GAS infection in one of Moscow surgical unit's patients in 2008-2011 were registered.

[Predicting the risk of septic and necrotic complications in femoral amputation stump].

Treatment results of 430 patients with ischemic gangrene of lower limbs were analyzed and major risk factors of postoperative complications considering the femoral amputation stump were outlighted. These are: the high level of artery occlusion, ligature muscle compression in the stump, absence of active drainage and elderly age (more than 80 years), anemia. The intraoperative use of laser Doppler flowmetry gives the possibility to assess the potential viability of muscles at the amputation level. Predicting the risk of local postoperative complications allowed the differential approach to the stump formation and improved the treatment results.