[Drug monitoring of the antibacterial drug Vancomycin in patients with purulent-inflammatory diseases of the maxillofacial region]. / Lekarstvennyi monitoring antibakterial'nogo preparata vankomitsin u patsientov s gnoino-vospalitel'nymi zabolevaniyami chelyustno-litsevoi oblasti.

THE AIM OF THE STUDY: To evaluate the change in the level of concentration of the antibacterial drug Vancomycin registered in the purulent focus area (facial vein) and in the peripheral blood flow (cubital vein) in patients with phlegmon of the maxillofacial region (MFR). MATERIALS AND METHODS: The clinical material of the study was 12 patients with phlegmon of MFR who were being treated in the maxillofacial department of the N.I. Pirogov State Clinical Hospital No. 1 of the Moscow Medical Center. The drainage of phlegmons was performed on the day of admission of the patient 2-3 days after the onset of the disease. The phlegmons involved two or more spaces of the MFR. As an antimicrobial drug, 500 mg of Vancomycin in 400 ml of saline solution was used intravenously. Quantitative registration of Vancomycin was carried out 2 hours after intravenous infusion. Blood sampling was carried out from the cubital and facial veins in an amount of 7-8 ml intraoperatively at the opening of the phlegmon, under endotracheal anesthesia. The concentration of the antibiotic was determined by high-performance liquid crystal chromatography. RESULTS AND DISCUSSION: The study found that the concentration of Vancomycin in the facial vein exceeds similar indicators obtained from the cubital vein. The difference in the percentage ratio averaged 19.2±7.3%. In 10 patients with phlegmons of various localization, it was found that the penetration of the antibacterial drug into the tissues of the inflammatory focus is higher compared to the periphery. However, in a number of patients, the concentration of the drug did not exceed the minimum suppressive concentration recommended for obtaining a therapeutic effect (for Vancomycin, it is at least 2 mcg / ml). CONCLUSION: To achieve the therapeutic effect of phlegmon treatment, it is necessary to select an individual dose of the drug for each patient.

[Lethality after gastroduodenal ulcer bleeding].

The retrospective analysis (2006-2010 yy) of treatment of 895 patients with gastroduodenal ulcer bleeding was conducted. Lethal outcome was registered in 220 (24.6%) patients, of them directly of the ulcer bleeding died 45 (5%). The Rockall score was used as universal prognostic instrument. Of 164 lethal outcomes, did not directly connected to the ulcer bleeding, the etiological distribution was as follows: multiple organ failure - 36% (n=59), cardiovascular diseases - 24.4% (n=40), inveterate oncology - 15.9% (26). Of 45 deaths from bleeding, only 4 patients died of the uncontrolled bleeding, whereas 18 (45%) died after the emergency surgery. Signs of hemorrhagic shock were registered in 60% of died patients (in comparison with 18% among the survived). Bleeding reccurrence was registered in 28.6% of died patients (in comparison with 11% among the survived). The use of the Rockall score confirmed its prognostic value: the mean score was 4.3±2.12 points among the survived patients, whereas among the died patients it was 7.16±2.35 points (p=0.001). Authors conclude, that the leading reasons of death, considering the bleeding itself, were the hemorrhagic shock and recurrent bleeding. Though, about 80% of patients are dying of reasons, do not directly connected to the bleeding episode, but of concomitant diseases (multiple organ failure, cardiovascular and oncologic diseases). The least, nevertheless, leads to the wrong formulation of the final diagnosis and incorrect interpretation of the etiology of death.

[The new algorithm of diagnostics, prevention and treatment of acute erosive and ulcerative lesions of the gastrointestinal tract].

The work presents an analysis of treatment 745 patients with gastrointestinal bleeding from acute ulcers. Algorithm diagnosis and treatment of acute ulcers by different groups of patients. Treatment depends on the nature of secretory activity stomach bleeding risk of relapse and localization ulcers.

[Free radical processes in patients with the gastro-intestinal bleedings].

The role of the free radical processes (FRP) is shown and objectified in the development of the ulcer gastro-intestinal bleedings (UGIB). It is revealed on the first day of hospitalization already. The greatest imbalance of the FRP is registered in heavy patients with acute UGIB. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. Unheavy patients have FRP changes refer to the oxygen part of the oxidation process only. Intensification FRP in process of increase of weight disease consists in decrease activity oxygen and increase a lipid disbalance. FRP disbalance has long time proceeds, last till the patient's discharge. Results of the research prove as much as possible early inclusion in a complex of medical actions antoixidant therapy. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with UGIB.