[Bacteriophages in complex treatment of septic diseases of the hand]. / Ispol'zovanie lekarstvennykh preparatov bakteriofagov v kompleksnom lechenii gnoinykh zabolevanii kisti.

OBJECTIVE: To evaluate the effectiveness of bacteriophages in complex surgical treatment of septic diseases of the hand. MATERIAL AND METHODS: We analyzed treatment outcomes in 111 patients with septic diseases of the hand (septic arthritis, tendovaginitis, phlegmon). Surgical treatment was finished by primary sutures and drainage. They were divided into two groups. Bacteriophages were used in the main group. Other components of treatment were identical. «Pyobacteriophage complex¼ was injected into drainage tubes during dressings. Effectiveness of treatment was evaluated considering elimination of septic process, bacterial flora and healing of surgical wound. In addition, we performed in vitro testing of microorganisms for sensitivity to Pyobacteriophage. RESULTS: Staphylococcus and Streptococcus genus prevailed in hand infections. Pasteurella multocida has been isolated after pet bites. Growth of microflora in drainage tubes was observed in 16.7% and 21.1% of cases, respectively (p=0.02). Wound healing via primary intention was found in 83.6% and 71.4%, respectively (p=0.03). When testing in vitro, we observed lysis of cultures of Staphylococcus aureus in 83.6% of cases, Streptococcus pyogenes - in 33.3% of cases. CONCLUSION: «Pyobacteriophage complex¼ was effective for septic diseases of the hand. However, its partial lytic activity against the most common pathogens makes it advisable to combine phages and antibiotic therapy. Systematic renewal of phages is important due to widespread resistance of bacteria.

[Purulent iliopsoitis: etiology, pathogenesis, diagnosis and surgical treatment]. / Gnoinyi iliopsoit: etiopatogenez, diagnostika, khirurgicheskoe lechenie.

Purulent iliopsoitis is a quite rare and difficult disease regarding diagnosis and treatment. However, treatment outcomes are not so favorable, incidence of sepsis and mortality are still extremely high. Original up-to-date studies devoted to this issue were analyzed. The authors discuss the actual problems of etiology, pathogenesis, classification, clinical features, diagnosis and surgical treatment of iliopsoitis. Considering these data, they conclude that timely diagnosis and adequate surgical treatment are essential for favorable outcomes. Prevention of relapse is based on detection of possible cause of disease and its possible correction.

[Acute haematogenous osteomyelitis of the pelvis with multifocal pyogenic abscesses in an adult]. / Ostryi gematogennyi osteomielit taza u vzroslogo s mnozhestvennymi gnoinymi metastazami.

Acute hematogenous osteomyelitis (AHO) in adults is a rare disease complicating timely diagnosis. Even greater difficulties are observed in case of pelvic bone lesion. The authors report AHO of the pelvis an adult. Osteomyelitis was complicated by generalized infection and multiple pyogenic abscesses in subcutaneous adipose tissue of the upper and lower extremities. Detection of primary infectious focus was complicated by extreme severity of the patient's condition and low informative value of X-ray and ultrasound at the early stage of disease. Staphylococcus aureus was obtained from blood culture and infectious foci. Surgical debridement along with complex intensive care ensured a positive outcome.

[Endovascular surgery for critical ischemia of lower extremities with suppurative-necrotic lesion of the feet]. / Rentgenoéndovaskuliarnaia khirurgiia pri kriticheskoi ishemii nizhnikh konechnostei s gnoino-nekroticheskim porazheniem stop.

AIM: To improve treatment of patients with grade IV chronic ischemia of lower extremities via endovascular angioplasty combined with surgical methods for suppurative-necrotic lesions of the feet. MATERIAL AND METHODS: 51 patients with grade IV chronic ischemia of lower extremities underwent endovascular interventions (balloon angioplasty, stenting). A total of 23 stents were deployed in 16 patients including 12 stents in superficial and common femoral arteries, 5 in popliteal artery, 6 in iliac artery. There were no stents in crural arteries. The most perspective artery for wound healing was preferred in case of revascularization below popliteal segment. Necrectomy was performed along with angioplasty in patients with suppurative-necrotic lesion of the feet followed by delayed reconstructive operations if it was necessary. RESULTS: Endovascular surgery for grade IV chronic ischemia of lower extremities was associated with good immediate results in most cases due to revascularization and organ-sparing interventions for suppurative lesions of the feet. Current endovascular methods allow to perform successful re-operations to restore blood flow in previously repaired arteries and implanted stents with restenosis or thrombosis.

[Peculiarities of the course, diagnosis and surgical treatment of non-lactating mastitis]. / Osobennosti techeniya, diagnostiki i khirurgicheskogo lecheniya nelaktatsionnogo mastita.

AIM: To improve treatment of patients with non-lactating mastitis through the study of the course, diagnosis and surgical treatment. MATERIAL AND METHODS: The study included 336 women aged 18-72 years with non-lactating mastitis who were hospitalized into the clinic for the period 1999-2016. RESULTS: Main clinical variants of the disease, spectrum of pathogens and its relationship with clinical forms of mastitis were determined. Also early and long-term outcomes were evaluated followed by formulation of therapeutic and diagnostic concept of surgical care for non-lactating mastitis. Thus, good results were obtained in most cases (95.8% in early period and 92.6% in long-term period). CONCLUSION: Only differentiated approach to diagnostic and curative tactics will allow to achieve good cosmetic and functional results in these patients.

[Infectious arthritis of sternoclavicular joint: surgical approach to the issue].

AIM: To study the features of occurrence, diagnosis, clinical course of infectious arthritis of sternoclavicular joint, as well as to develop differentiated therapeutic tactics depending on the clinical form and stage of disease. MATERIAL AND METHODS: It was analyzed treatment of 18 patients with infectious arthritis of sternoclavicular joint aged 27 to 88 years who were hospitalized for the period 2008-2014. Acute or chronic forms were determined depending on clinical course and serous arthritis, para-articular phlegmon and osteoarthritis--according to nature of tissue damage. Hypothermia and blunt trauma were often preceded to onset of disease. Diabetes and drug addiction were present as comorbidities. Also disease as the variant of purulent metastasis in case of sepsis was noted. Bone scintigraphy, CT and magnetic resonance imaging are the most informative. RESULTS: Infectious arthritis of sternoclavicular joint often had hematogenous origin, and Staphylococcus aureus was the most common cause. At the stage of serous arthritis antibacterial therapy was effective. Incision and drainage were performed urgently in case of para-articular phlegmon. Sternoclavicular joint resection was performed usually in 2-3 months after subsidence of inflammation.

[Streptococcal infection in surgery].

INTRODUCTION: Despite the advances of modern medicine purulent-inflammatory diseases of soft tissues continue to occupy a leading position in surgical practice. Streptococcal surgical infection does not refer to specific category, but it has a number of significant features and its definition as separate type is necessary. MATERIAL AND METHODS: Based on the results of treatment of 312 patients with streptococcal infection of soft tissues we studied the prevalence of this disease in overall structure of surgical infection of soft tissue, main clinical courses are defined. We performed molecular genetic typing of pathogens that allows to predict the course of pathological process taking into account microorganism's characteristics. RESULTS AND DISCUSSION: On the basis of obtained data basic medical and diagnostic concept of surgical care for these patients depending on clinical course of disease was formulated. It allowed to improve significantly the results of treatment of such patients.

[Frequency of diseases caused by group A streptococci among invasive infections of soft tissues and characteristics of the causative agent].

AIM: Determine frequency of diseases caused by group A streptococci (GAS) among invasive infections of soft tissues; identify emm-types of the isolated streptococci, determine the presence of bacteriophage integrases and toxin genes in their genomes. MATERIALS AND METHODS: 4750 case histories of patients with soft tissue infections of the purulent-surgical department of the 23rd City Clinical Hospital.of Moscow "Medsantrud" in 2008 - 2011 were analyzed. 46 strains of GAS isolated from patients with invasive streptococcus infection (ISI) were studied. GAS identification was carried out by latex-agglutination method. GAS emm-type was determined by molecular-genetic methods, as well as the presence of bacteriophage integrases int2, int3, int4, int5, int6, int7, int49, bacteriophage toxins speA, speI, sla, speC/J, speL, speH, speC, ssa and speB gene present on the chromosomal DNA. RESULTS: 132 cases (2.8%) were attributed to invasive infections. In 46 cases of invasive infections (35%) GAS were isolated. 22 different emm-types of invasive GAS strains were detected. Only speB gene among all the toxin genes (as well as the expression of the gene--SpeB toxin) was detected in all the strains, whereas sla and speI genes were not detected in any of the strains. Genes of the other toxins (ssa, speL, speC, speA, speH, speC/J) occurred in a number of strains. Genes of phage integrases were detected among all the strains however in varying combinations (from 1 to 4 genes). CONCLUSION: Invasive infections caused by GAS are more frequently spread than had been previously assumed and a high degree of genetic heterogeneity of invasive GAS strains was detected.

[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.

[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.

[Pelvic ostheomyelitis: diagnostics and treatment].

Results of treatment of 223 patients with ostheomyelitis of various etiology and localization were analyzed. Such aspects as diagnostic difficulties, polifocal type of the disease, sepsis development on the background of pelvic ostheomyelitis were discussed. Ostheoscintygraphy, magnetic resonance imaging and computed tomography proved to be of highest diagnostic value by pelvic ostheomyelitis. The original method of surgical treatment of purulent sacroileitis with the use of combined (pelvic and extrapelvic) access was represented.

[Treatment tactics by frostbites].

317 patients with frostbitten limb injuries of various severity were healed. A differential treatment tactics were worked out, basing on localization, area, time of frost exposure and concurrent vascular disease. Surgical treatment of IV stage congelation stipulates early necrectomy by lower limbs affection, whereas, congelation of the upper limbs requires delayed necrectomy; both should be followed by appropriate wound healing and early reconstructive operations. Indications for primary amputations by deep congelation were formulated.

[Prognosis of long tubular bone strength changes in surgery of chronic osteomyelitis].

Mineral bone density (MBD) in osteomyelitic focus and symmetric intact tubular bone was compared in 54 patients. Changes of MBD values were also measured after surgical treatment (bone trepanation or osteonecroectomy with bone plasty). Thus, MBD, and, therefore, bone strength, was mostly higher in pathologic focus then in the healthy bone. Operative treatment showed no negative influence on MBD.

[Plastic surgery in patients with surgical wound infection].

Results of various skin plastic operations performed in 312 patients with soft-tissue infection were analyzed. The choice of the method depended on size and site of the wound, predisposing pathological process, age and general patient's condition. Differential approach to the choice of reconstruction method allowed satisfactory short-term results in 91,4% of patients. 80% of patients demonstrated good long-term results.

[Choice of surgical approach in the treatment of patients with deep frost bites]. / Vybor khirurgicheskoi taktiki pri lechenii bol'nykh s glubokimi otmorozheniiami.

Two main approaches to surgical treatment were studied in 114 patients with deep frost bites of the extremities. First - early necrectomy with subsequent local treatment of wounds and their surgical closure on the final stage. Second - long-term conservative treatment until formation of demarcation line and limitation of necrotic tissues with subsequent surgical treatment including their resection and simultaneous formation of the stump of the extremity. It is demonstrated that active surgical policy has significant advantages over expectant one as evident from reduce time of treatment and less number of postoperative pyonecrotic complications (21,7% vs 78,4%).