Uso de productos barrera para prevenir complicaciones en la piel periestomal / Use of barrier products in order to prevent complications in the peristomal skin

OBJETIVO: evaluar la eficacia del uso de un aerosol protector barrera para la prevención de la maceración e irritación de la piel periestomal, en el paciente quirúrgico, antes de la colocación de los discos, y valorar la eficacia de la aplicación de dicho aerosol previo a la retirada de los adhesivos. MÉTODO: se llevó a cabo un ensayo clínico aleatorizado con dos grupos de comparación: grupo control (cura habitual) y grupo experimental (cura habitual + aplicación de aerosol como método barrera antes de la colocación del disco y spray quita-adhesivo para su retirada). Se incluyeron a los pacientes ostomizados en el Hospital Universitario Infanta Cristina (Parla, Madrid) en 2019, atendidos en la Consulta de Cirugía General. Se aleatorizaron a dos grupos, 15 por grupo. Se recogieron variables descriptivas el día de la captación y de resultado a los 10 días del seguimiento. Se llevaron a cabo análisis univariante y bivariante. La relación entre las distintas variables se evaluó mediante pruebas estadísticas. RESULTADOS: se aleatorizaron 30 pacientes, 15 en grupo control y 15 en grupo experimental. Se observaron diferencias clínicas en los grupos de comparación al inicio del estudio. Al comparar las variables de resultado a los 10 días de la cirugía en los dos grupos del estudio, se observaron diferencias estadísticamente significativas en la presencia de complicaciones en la piel periestomal (p< 0,001) con un 80% (n= 12) en el grupo control frente al 6,7% (n= 1) en el grupo experimental, y en el tipo de complicaciones entre ambos grupos (0,002), destacando las lesiones de tipo L2 Erosivas. CONCLUSIONES: la utilización tanto de un aerosol protector barrera sobre la piel del paciente antes de la colocación del disco de ostomías como la aplicación para su retirada de un spray quita-adhesivo, parece reducir el riesgo de complicaciones en la piel periestomal en el paciente quirúrgico

OBJECTIVES: to assess the efficacy of using a protective barrier spray for preventing peristomal skin maceration and irritation in surgical patients before disc placement, and to assess the efficacy of the application of said spray before removing the adhesive discs. METHOD: a randomized clinical trial was conducted with two comparison arms: the control group (standard cure) and the experimental arm (standard cure + application of spray as barrier method before disc placement and adhesive remover spray for removing them). The study included ostomized patients from the Hospital Universitario Infanta Cristina (Parla, Madrid) in 2019, seen at the General Surgery Unit. Patients were randomly assigned to two 15-patient arms. Descriptive variables were collected on recruitment day, and for outcomes at 10 days follow-up. Univariate and bivariate analyses were conducted. The relationship between different variables was evaluated through statistical tests. RESULTS: thirty (30) patients were randomized, 15 patients to the control arm and 15 patients to the experimental arm. Clinical differences were observed in the comparison arms at study initiation. When comparing the outcome variables at 10 days after surgery in the two study arms, statistically significant differences were observed regarding the presence of complications in the peristomal skin (p< 0.001) with 80% (n= 12) in the control arm vs. 6.7% (n= 1) in the experimental arm, and in terms of type of complications between both arms (0,002), particularly L2-type erosive lesions. CONCLUSIONS: the use of a protective barrier spray on the skin of the patient before placing the ostomy disc as well as the application of an adhesive remover spray for removal seems to reduce the risk of complications in the peristomal skin of surgical patients

[Evaluation of local treatment of donor sites wounds in patients with deep burns]. / Otsenka mestnogo lecheniia ran donorskikh mest u patsientov s glubokimi ozhogami.

AIM: To assess the impact of local treatment of donor sites wounds in patients with deep burns on the frequency of complications and to identify the main risk factors of complications of donor sites wounds. MATERIAL AND METHODS: There were 486 patients with deep burns who underwent split-thickness skin grafting. Treatment of donor sites wounds was carried by using of moisture-controlled dressings DDB-M in the main group (n=56). Conventional approach including once imposed wet-to-dry gauze bandages was applied in the control group. RESULTS: We identified the structure of complications of the donor sites wounds and the main risk factors of suppuration.

[EXPERIENCE OF TOTALLY TRANSCUTANEOUS ENDOPROSTHESIS OF THE INFRARENAL AORTA АNEURYSM].

Endovascular endoprosthesis infrarenal aorta constitutes a miniinvasive highly technological method of treatment of a life-thretening pathology. Experience of transcutaneous endoprosthesis of infrarenal aorta in 6 patients was presented. Possibility of a common femoral artery (CFA) suturing, using Prostar XL apparatus, was estimated on a stage of the endoprosthesis dimensions calculation in accordance to a CT and duplex US scanning data and recommendations of manufacturer. In transcutaneous CFA suturing the complications were absent. Absence of a sectional access to CFA have permitted to avoid such complications, as neuralgia, paresthesia, seroma, suppuration of operative wound. In bilateral suturing of CFA a duration of the patients stationary state have reduced.

[Peculiarities of surgical care in case of open injuries of limbs in emergency situations in peacetime].

It was done the comparative analysis of treatment results of casualties with open injuries of limbs in emergency situations in peacetime. It was determined that traditional approach of field surgery is unacceptable for this group of casualties. It is connected with limitations of evacuation and high frequency of complications. The developed modified surgical protocol permits not only to provide specialized care to casualties with soft tissue trauma and open fracture of limbs but also to reduce frequency of deep suppuration in 1.9 times. Also it allows to decrease number of dressings for one patient and period of the wound defect preparation to reconstructive plastic surgeries in 2.6 and 1.5 times respectively.

Pregnancy coexisting with uterus didelphys with a blind hemivagina complicated by pyocolpos due to Pediococcus infection: a case report and review of the published reports.

A woman in early pregnancy was referred due to severe pelvic pain. Vaginal examination showed a severely protruding left vaginal wall with severe tenderness. A transvaginal ultrasound showed a double uterus and a mixed echogenic mass next to the cervix of the left uterus. After creating an opening in the left vaginal wall and inserting a Foley catheter through the opening into the vaginal wall for drainage with antibiotic therapy, the patient's condition rapidly improved. A culture of the pus drained from the vaginal wall showed Pediococcus species. The patient delivered a healthy infant by cesarean section at term gestation without recurrence of pyocolpos. Ten months after delivery, resection of the vaginal septum was performed and the left cervix was exposed. Ultrasound revealed normal kidneys.

Odontogenous sinus tract to the chin--case report.

This report describes the diagnosis, treatment and follow-up of a rare case of an odontogenic sinus tract to the chin. Despite the absence of caries, fillings, or crown damage, both lower central incisors were involved in a bony lesion. No history of any traumatic facial or dental injury was reported, and no orthodontic treatment with fixed appliances was performed. The findings on panoramic radiograph were incidental--the patient applied to the dental clinic due to a toothache in a lower first molar. The patient's history comprised seven-year-long unsuccessful dermatologic therapy. This included intraoral antibiotic and antihistamine intake, as well as topical antibiotic and steroid application. Endodontic treatment was proceeded, followed by recovery of the skin lesion. In the case of a single chronic suppurative or nodulocystic facial lesion, a dental clinical examination as well as a radiological assessment of the maxillary and mandibular dentition should be performed to exclude any odontogenic cause.

Intracranial suppurations in the African child: a severe but preventable complication.

INTRODUCTION: Intracranial suppurations (ICS) are collections of pus of infectious origin in the skull. The authors present their experience. PATIENTS AND METHOD: All children operated for ICS at the Central Hospital of Yaoundé from January 2000 to December 2008 were retrospectively included. RESULTS: Thirty-five patients were recruited: 26 (74.29 %) males and 9 (25.71 %) females. These represent 82.9 % of all ICS operated in our institution. ICS represented 14.3 % of intracranial space-occupying lesions. The mean age was 8.34 years. They presented with headaches (80.77 %), altered consciousness (20 %), convulsions (76 %), vomiting (20 %), unilateral motor deficit (69.23 %), speech disorders (12 %), and fever (89.29 %). Bergman's triad (51.86 %) was frequent. The primary infection was: meningitis, eight cases (22.85 %); sinusitis, six cases (17.14 %); head trauma, five cases (14.28 %); otitis media, one case (2.85 %); suppurations of the face, three cases (8.56 %); cardiopathy, one case (2.85 %); and craniotomy, one case (2.85 %). In seven cases (20 %), the origin was unknown. The lesions were empyema in 23 cases (65.71 %), cerebral abscess in 8 cases (22.85 %) and pyoventriculitis in 2 cases (5.72 %). The surgical procedures were burr holes (88.89 % of empyemas) and trepano-puncture-aspiration (75 % of abscesses). The mortality (21.42 %) and morbidity (42.85 %) were recorded. CONCLUSION: ICS are frequent but preventable (early treatment of the primary infection) pathologies of childhood in developing countries. Burr hole drainage (empyemas) and puncture-aspiration (abscesses) are simple, safe, and effective techniques.

[Antibiotic therapy by suppurative diseases of the abdominal cavity and soft tissues].

Microbial background of the departments of abdominal and septic surgery was monitored and analyzed. More the 950 samples from each department was worked out. Therefore, it was determined, that gram-negative bacteria were more typical for the abdominal pathology, whereas, soft tissue infection was represented by gram-positive strains. Compliant antibioticogramms were performed and analyzed. For achieving effective prophylactic and empiric antibiotic therapy, data-based formular lists of antibacterial drugs were performed.

[Factors responsible for the development of purulent complications of acute pancreatitis in the active phase].

An analysis of treatment of 260 patients with acute destructive pancreatitis (ADP) has shown that the main factors responsible for the development of purulent complications in the reactive phase of ADP are the following: pronounced and prolonged paresis of the gastro-intestinal tract, reduced function of the liver and open operations at the early stage of ADP. Prophylactic antibacterial therapy is indicated in patients having these signs as early as in the fermentative phase. If these signs are absent, prophylactic antibacterial therapy fulfilled in the fermentative phase has no effects on the frequency of the development of purulent complications in the reactive phase.

Do subcutaneous sutures increase risk of laparotomy wound suppuration?

REASONS FOR PERFORMING STUDY: Incisional drainage and suppuration occurs commonly following exploratory laparotomy; any technique with the potential to reduce the incidence of this complication warrants investigation. OBJECTIVES: To determine if abandoning the use of subcutaneous sutures in laparotomy wound closure is safe and whether it reduces the risk of suppuration. METHODS: A randomised controlled study was carried out at 2 referral hospitals in the UK, involving 309 horses undergoing exploratory laparotomy; 150 horses underwent '2-layer' closure without a subcutaneous suture, while 159 underwent conventional '3-layer' closure. Information regarding degree of oedema and gross types of discharge was recorded daily; suppuration was defined as discharge of pus. Telephone follow-up was carried out 30 days after hospital discharge to identify those complications occurring after that date and, thereafter, every 3 months. The influence of closure method on risk of wound suppuration was assessed by Chi-squared analysis and by logistic regression. Time to suppuration was modelled using a Cox proportional hazards model. RESULTS: No catastrophic failures of 2-layer closures were recorded. Prevalence of suppuration was not significantly different, being 18.7% and 23.9% for 2- and 3-layer closures, respectively (OR = 1.37, 0.79-2.37, P = 0.263). CONCLUSIONS AND POTENTIAL RELEVANCE: This study found no significant difference in prevalence or rate of wound suppuration in 2-layer closures compared to conventional 3-layer closure. Two-layer closure is recommended as a safe alternative means of achieving ventral midline abdominal closure in horses.

[The role of ozone therapy in prevention of pyoinflammatory complications after transurethral resection of prostatic adenoma].

The study of efficacy of ozone therapy (OT) in preparation of patients with prostatic adenoma (PA) and cystostoma for transurethral resection (TUR) of PA included 20 PA patients with cystostomic drainage who had undergone PA TUR and preoperative preparation with OT sessions. The control group consisted of similar patients but without ozone pretreatment. OT efficacy was assessed by the rate of pyoinflammatory complications (PIC), results of immunological examination, positive changes in prostatic secretion, urine analysis, total blood count, degree ofbacteriuria. In the study group PIC (acute urethritis) developed in 1 patient, in the control--in 6 patients (3 cases of acute urethritis, 2 cases of acute prostatitis and 1 case of acute epididymitis). OT led to lowering of mean values of leukocyturia from 18.1 +/- 0.6 to 14.3 +/- 0.7 on the day of operation, to 10.9 +/- 0.7 after 4 days and to 8.7 +/- 0.6 on postoperative day 8 versus from 18.8 +/- 0.8 to 15.4 +/- 0.7, to 15.8 +/- 0.6 and 13.5 +/- 0.6, respectively. Mean control count of leukocytes in prostatic secretion fell in both groups. OT reduced bacteriuria. Number of bacteria to the day of operation decreased in both groups, but complete elimination of the agent from urine on day 8 was not achieved in the controls. The study group exhibited a rise in the absolute count of blood leukocytes, lymphocytes and ESR diminishing. OT raised significantly the phagocytic count and activity, concentration of mature T-lymphocytes (CD3), T-helpers (CD4), cytotoxic T-lymphocytes (CD8), B-lymphocytes (CD20), T-NK-cells (CD16), T-lymphocyte activation markers (CD3+, CD16+, CD56+, CD3+, CD25+, HLADR+, CD3+. The concentration of IgG, IgM, IgA remained high. Thus, the results of ozone application before PA TUR appeared promising in prevention of postoperative PIC.

Sepsis neonatal / Neonatal sepsis

La sepsis neonatal se refiere a la sospecha clínica de infección asociada al Síndrome de Respuesta Inflamatoria Sistémica (SRIS) en el recién nacido (RN) 1,2. La literatura, en general, hace énfasis en la definición sobre el SRIS como base para el diagnóstico inicial de sepsis y en el aislamiento del microorganismo causal en los cultivos correspondientes para la confirmación de esta patología.

Antibiotic prophylaxis in clean and clean-contaminated ear surgery.

BACKGROUND: Ear surgery may be performed in the treatment of chronic otitis media, ossicular chain disorders, tympanic membrane perforations and otitis media with effusion. Postoperative infection in ear surgery may result in: Wound infections Infection of the middle ear or mastoid resulting in discharge from the ear canal Failure of the tympanic membrane to close Labyrinthitis due to infection in, or adjacent to, the inner ear These complications may be associated with discomfort and inconvenience for the patient, an increase in morbidity and an increase in the costs of medical care. OBJECTIVES: The objective of this review was to assess the effects of local and/or systemic antibiotics for preventing complications such as postoperative discharge, graft failure and labyrinthitis in patients undergoing clean or clean-contaminated ear surgery. SEARCH STRATEGY: We searched MEDLINE (searched January 1966 to December 2002), EMBASE (searched January 1980 to December 2002), the Science Citation Index, The Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 4 2002); the Cochrane Acute Respiratory Infections Group and Cochrane Ear, Nose and Throat Group Specialised Registers and proceedings of scientific meetings. The date of the last search was December 2002. We also contacted investigators in the field (Govaerts, Antwerp). Bibliographies of identified articles were screened for further relevant trials. No language restriction was applied. SELECTION CRITERIA: Randomised or quasi-randomised trials involving: PARTICIPANTS: patients undergoing clean or clean-contaminated types of ear surgery. Skull base surgery was excluded. INTERVENTION: any regimen of local and/or systemic antibiotic prophylaxis administered at or around the time of surgery compared to placebo, no antibiotic, or an alternative intervention group. OUTCOME MEASURES: infection, discharge, graft failure, labyrinthitis, adverse effects of prophylaxis. DATA COLLECTION AND ANALYSIS: When possible, investigators were contacted for additional information on data and methodological issues. At least two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Eleven studies were included in the review. The methodological quality of the trials was fair to good. However, most studies presented insufficient detail on methodological data. Although definitions of outcome measures were heterogeneous, pooling of results was possible. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of postoperative infections, graft failures, draining outer ear canals and adverse drug effects. REVIEWERS' CONCLUSIONS: There is no strong evidence that the large scale use of prophylactic of antibiotics in clean and clean-contaminated ear surgery is helpful in reducing postoperative complications such as wound infection, discharge from the outer ear canal, labyrinthitis and graft failure.

[Choice of surgical method in rectal cancer]. / Opyt khirurgicheskogo lecheniia raka priamoi kishki.

Based on randomized study of 589 patients radically operated for rectal cancer, rational surgical policy was developed. Efficacy of rectal resection depending on the approach, scope of mesorectumectomy and anal demucosation was studied, comparison of purulent complications number, sphincter function and early recurrence in 315 patients was carried out. It is demonstrated that methods of rectal resections with lowest per cent of purulent complications lead to the worst functional results and increase number of local recurrences. Differential approach to choice of resection or extirpation method is proposed, clear indications are formulated.

[Prophylaxis of pyogenic complications in total replacement of large joints]. / Profilaktyka nahniinykh uskladnen' pry total'nomu endoprotezuvanni velykykh suhlobiv.

Results are studied of management of 378 patients having undergone total knee and hip arthroplasty over the period 1995-2001. Surgical interventions were undertaken in those patients presenting with osteoarthrosis deformans, rheumatoid arthritis, for complicated posttraumatic fractures, pathological fractures secondary to an oncological process. Pyo-inflammatory complications which necessitated removal of endoprothesis developed in nine (2.32%) patients. A strict keeping to the system of the purulent complications prophylaxis in total arthroplasty is an important component of a successful management of those patients presenting with grave forms of affections of the great joints.

[Effectiveness of sporobacterin in the prevention and treatment (of postoperative wound infections)]. / Otsenka éffektivnosti ispol'zovaniia sporobakterina v profilaktike i lechenii.

Peculiarities of penetration of living bacterial cultures of Bacillus strain into the structures of the abdominal wall, their positive influence upon the reparative regeneration of surgical wounds were studied in experiments in 240 rats. It was found the living bacterial preparation to be expedient to use as an antagonist of pyogenic infection for purulent postoperative wounds and in order to prevent its development. The clinical antiinflammatory and stimulating the reparative process effects of sporobacterin were studied in 50 patients with infectious wound complications after urgent and scheduled operations. A prophylactic effect was noted in 145 patients operated on for complications of cholelithiasis and commissural ileus. Sporobacterin was proved to give better results of treatment as compared with traditional methods of antiinflammatory therapy with antibiotics.

[Prevention of purulent complications after reconstructive vascular operations in elderly and aged patients]. / Profilaktika gnoinylh oslozhnenii posle rekonstruktivnykh operatsii na sosudakh u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of surgical treatment of 382 patients with III-IV stages critical limb ischemia and concomitant diseases were analyzed. The mean age of the patients was 67.7 years. All the patients underwent reconstructive operations on lower limbarteries. Three variants of antibiotic therapy were compared: 1) antibiotics were administered parenterally; 2) they were injected endolymphatically; and 3) they were used parenterally and endolymphatically. Combined antibiotic, i.e. a combination of parenteral and endolymphatic routes of administration was most effective.

[Reliability of the sterilization of surgical instruments is a key point in prevention of surgical infection]. / Nadezhnost' sterilizatsii izdelii meditsinskogo naznacheniia.

Occurrence of postoperative purulent-inflammative complications (PPIC), their structure and dynamics after improvement of sterilization are studied. For epidemiological analysis 65,246 medical histories of operated patients were studied, in 404 of them PPIC were revealed. The PPIC rate reduced from 3.05% in 1981 to 0.49 in 2000 though surgical activity increased 12 times after this period. Thus developed measures for improvement of sterilization promoted reduction of the PPIC rate.