POINT-OF-CARE ULTRASOUND IN THE EARLY DIAGNOSIS OF NECROTIZING FASCIITIS.

OBJECTIVE: The aim: To detect the ultrasonographic signs of necrotizing fasciitis (NF) suitable for its early diagnosis. PATIENTS AND METHODS: Materials and methods: Eigty two patients with soft tissue infection, including 14 with necrotizing faciitis, were examined by ultrasonography at the admission. Ultrasonografic features were compared to intraoperative findings by the same surgeon. RESULTS: Results: The thickening of subcutaneous tissue had high sensitivity (100%), but low specificity (5.8%). The hypoechoic and hyperechoic zones had the shape of "cobblestone" with sensitivity - 78.5%, specificity - 33.8%. Higher specificity (69.1%) had sign of "cobblestone separation" on two layers. The presence of fluid above the fascia (sensitivity - 71.4%; specificity - 69.1%), thickening of the fascia (sensitivity - 85.7%; specificity - 58.8%), indistinctness of the fascia edges (sensitivity - 85.7%; specificity - 66.1%) and loss of fascial homogeneity (sensitivity - 71.4%, specificity - 66.1%) were noted in early stages of NF. Advanced cases of NF were accompanied by the dissection of thick¬ened fascia with a strip of fluid (sensitivity - 57.1%, specificity - 92.6%) and accumulation of a fluid under the fascia (sensitivity - 28.5%, specificity - 95.5%). The muscles thickening (sensitivity - 28.5%; specificity - 67.6%), skin thickening (sensitivity - 57.1%; specificity - 58.8%), and loss of the skin's lower edge clarity (sensitivity - 57.1%; specificity - 63.2%) don't have diagnostic value without other signs of NF. CONCLUSION: Conclusions: Point-of-care ultrasonography allows visualization of soft tissue changes that may be hidden in the initial stages of necrotizing fasciitis and should be recommended for implementation as mandatory method of examination in patients with suspected surgical soft tissue infection.

Complex program of diagnostics and treatment of polytraumatized patients with II-III degrees obesity.

OBJECTIVE: The aim: Elaboration of the complex program of diagnostics and treatment of the polytraumatized overweight patients. PATIENTS AND METHODS: Materials and methods: Clinical material was composed of 64 patients with the combined body trauma who suffered from II-III grade obesity. RESULTS: Results: Main principles of rendering the aid to the polytraumatized overweight patients included the pathophysiological and topographic features of the group. The obtainedstudy results confirmed the credible difference of the traumatic disease progress in the patients with the normal weight and overweight patients which was the basis of our differential complex treatment program. The treatment tactics also had certain characteristics connected with the obesity. The development of RDS syndrome is a typical stage of the traumatic disease during the blunt thoracal trauma in case of obesity. The programmed and urgent relaparotomy, as a method of the stage treatment in the present group of patients, is the integral component of the blunt abdominal injury in case of obesity. CONCLUSION: Conclusions: The study results proved that our complex program of diagnostics and treatment of the polytraumatized patients shall be basic for the patients with II-III grade obesity.

Role of the family physician in the treatment of patients with polytrauma on the obesity background on an ambulatory stage.

OBJECTIVE: Introduction: Obesity rates have continued to increase recently, what is connected to the reduction of physical activity of population. The aim: To determine the peculiarities of treatment of patients with obesity, who sustained a severe concomitant body trauma on an outpatient basis by family physicians. PATIENTS AND METHODS: Materials and methods: Clinical material composed of 67 patients who sustained severe concomitant body trauma. RESULTS: Results: On the grounds of the long-term outcomes assessment cards developed by us, treatment of the severe concomitant trauma in persons with obesity, we found typical complications of the traumatic disease, which family physicians faced on an ambulatory stage. These cards contained by system analysis of consequences of the sustained polytrauma on the systems and organs respectively to the body mass index meaning. In general, treatment of such patients was complex and included applying of the diet therapy (a low-calorie diet with enough protein, vitamins and low levels of animal fats and carbohydrates, especially easily digestible), pharmacological therapy (antibiotics, mucolytics, solvents) as well as therapeutic exercise, which played almost dominant role. In particular, therapeutic massage was prescribed for improvement of general body tone, activation of peripheral circulation and lymph flow, oxidation-reduction and metabolic processes, retroaction to the impaired motor-evacuation function of the large intestine, eliminating fatigue and increasing muscle tone and functioning. CONCLUSION: Conclusions: Role of the family physician in the process of traumatic disease treatment is especially important and lies in the organization of medical treatment of patients on an ambulatory stage.