Vol 19, No 7-2 (2017)
Articles
Complicated skin and soft tissue infections: the modern features of antibiotic therapy
Abstract
Complicated skin and soft tissue infections (cSSTIs) are the more extreme end of clinical spectrum SSTI’s, encompassing a range of clinical presentations such as deep-seated infection, a requirement for surgical intervention, the presence of systemic signs of sepsis. Staphylococcus aureus is the commonest cause of SSTI across all continents, although its epidemiology in terms of causative strains and antibiotic susceptibility can no longer be predicted with accuracy. The epidemiology of community-acquired and healthcare-acquired strains is constantly shifting and this presents challenges in the choice of empirical antibiotic therapy. Toxin production (Panton-Valentine leucocidin) may complicate the presentation still further. Polymicrobial infection with Gram-positive and Gram-negative organisms and anaerobes may occur in diabetic foot infections and burns. Successful management of cSSTI involves prompt recognition, timely surgical drainage and debridement, intensive care if required and appropriate antibiotic therapy. The mainstays of treatment are the penicillins, cephalosporins, clindamycin, co-trimoxazole and b-lactam/b-lactamase inhibitor combinations are indicated for polymicrobial infection. A range of new agents for the treatment of methicillin-resistant Staphylococcus aureus infections have compared favourably with the glycopeptides and some have distinct pharmacokinetic advantages. These include linezolid, daptomycin, tigecycline, telavancin, ceftaroline and tedizolid.
Consilium Medicum. 2017;19(7-2):7-1
7-1
Anaerobic non-clostridial infection of soft tissue and musculoskeletal system
Abstract
The article presents a review of the literature deals with the diagnosis and treatment of anaerobic non-clostridial infection of soft tissues and bones, presents our own data which illustrating the current state of this problem and approaches to its complex surgical treatment and intensive care.
Consilium Medicum. 2017;19(7-2):13-18
13-18
Prevention of wound infections and skin damage
Abstract
Progressive development of microorganisms’ resistance to antibiotics limits their widespread systematic application of prophylactic for local skin damage in favor of more severe injuries. Local application of preparations on the basis of a combination of antibiotics and silver has a significant advantage in the prevention of infectious process in the wound area compared with the individual drugs also possess antifungal and antiviral effect. These combinations are mutually potentiate the antimicrobial effect and allow the use of lower doses.
Consilium Medicum. 2017;19(7-2):19-22
19-22
Gangrenous pyoderma: modern state of problem
Abstract
The article presents literature data devoted to modern problems of etiology, pathogenesis, diagnosis and treatment of gangrenous pyoderma. The authors also give their own observations and experience in the use of mycophenolate mofetil with gangrenous pyoderma.
Consilium Medicum. 2017;19(7-2):23-27
23-27
NSAIDs: safety from the point of evidence-based medicine
Abstract
Prescribing of NSAIDs in modern clinical practice is a routine procedure. However, all aspects of NSAIDs safety are often not assessed. The article highlights the main aspects of safe prescription of NSAIDs, which every doctor should be guided in his practice.
Consilium Medicum. 2017;19(7-2):28-32
28-32
Experience of surgical treatment of hypertrophy of the nasopharyngeal tonsil
Abstract
For a long time the presence of adenoids in the nasopharynx was associated only with childhood, as it was believed that by 14-15 years of a child's life age involution of nasopharyngeal tonsil and all complaints associated with this area of the nasopharynx are. This opinion was supported by a majority of the limited methods of diagnosis region of the nasopharynx. Mostly used methods are the front and rear rhinoscopy, not always allowing to assess the condition of the deep parts of the cavity of the nose and throat, and finger examination of the nasopharynx, uninformative, given the structure of the nasopharynx of an adult. As the most informative method, performed radiography of head in lateral projection, where it was possible to evaluate the lumen of the nasopharynx. Modern methods of diagnostics allow to diagnose pathological conditions of the nasopharynx, and identify a benign process from malignant, properly prescribe the necessary treatment.
Consilium Medicum. 2017;19(7-2):33-35
33-35
Modern possibilities of correcting iron deficiency anemia in patients with pathology of the digestive system
Abstract
Iron deficiency anemia (IDA) is associated with several pathologic conditions of the gastrointestinal tract. In addition to inflammatory bowel disease, IDA is often associated with chronic liver disease. Different factors such as chronic blood loss, malabsorption, inflammation, may contribute to the development of IDA. Although patients with symptoms of anemia often initially turn to gastroenterologists approach to diagnosis and treatment, as well as measures for subsequent monitoring of the patient are not standardized and optimal. Iron deficiency, even without the development of symptoms of anemia, can significantly affect the physical health and cognitive function, reduce quality of life. So important is regular assessment of iron concentration and understanding of the clinical consequences of reducing the concentration of serum iron by specialists of different profile: surgeons, internists, cardiologists. Currently, the range of treatment options awaiting increases due to the introduction into clinical practice of effective and well-tolerated iron preparations for parenteral administration. Available in scientific periodicals there is a lack of systematic reviews for the treatment of IDA and, in particular, its treatment for patients with diseases of the gastrointestinal tract. In the presented review summarizes the current understanding of the period of awaiting for specific gastrointestinal and hepatic disorders and discusses a unified approach to the treatment of anemia and iron deficiency in daily clinical practice.
Consilium Medicum. 2017;19(7-2):36-41
36-41
To problem early intraabdominal complications in gastric surgery
Abstract
The organized analysis of the treatment 122 patients, handled on belly. All sick were executed operation on belly: gastrectomy, sabtotal resection of the belly, classical and economical resection of the belly, SPV, suturing perforative of the canker on Opel-Polikarpov. The primary emergency operations on belly are executed beside 55 (45.1%) sick. The evidences of the form were complicated to emergency operation to peptic ulcer of the belly and duodenum: bleedings, perforation, but in the same way disintegrating tumours of the belly, peritonitis. The planned operations on belly are executed beside 67 (54.9%) patient. The evidences to this operation were sub- and decompensate stenosis ulcerous and cancerous pathology, as well as the other pathology of the belly. At early postoperative period beside 18 (14.8%) patient developed the complications, required repeated operative interference. The diagnostics early postoperative intraabdominal complications carried the complex nature. The main method of the treatment of the postoperative peritonitis was shown relaporotomy. The repeated operations are executed in current two hours since moment of the diagnostics of the complication. The evidence to execution relaporotomy is quiping pathology to abdominal cavity, developed after operation on belly. The reason intraabdominal complications in most cases are a tactical mistakes and technical inaccuracy, допущенные in step of primary operative interference. The preventive maintenance of the development intraabdominal complications must be realized in step of primary interference and conduct execution of the early postoperative period, including optimum choice of the way and volume to operations; the careful auditing, sanation and drainage abdominal cavity.
Consilium Medicum. 2017;19(7-2):42-44
42-44
Ten years of experience of the using intestine sutures on different level gastro-intestine tract
Abstract
The designed and introduced into the clinic methods of the intestine seam on different level of the gastrointestinal tract, in base which lies the principles precisional technology, allowing ideal to adapt the layer sutured fabric belly and intestine. The experiments were run for 85 rabbits. It is studied mechanical other-ность precisional sutures when shaping gastrointestinal anastamosis (20 experiences), small intestine anastamosis - (25 experiences) and is made someone large intestine anastamosis (25 experiences). In checking series experience (15 rabbits) small intestine anastamosis were formed sutures Aliberta-SHmidena. The clinical study are organized beside 53 sick with different surgical diseases and high degree to probability of the origin postoperative complications. Designed by us methodses aplying under extraabdominal liquidation of kolostoms (7 sick) and cecostoms (4 sick). Inwardly abdominal operations (the resections of the belly, fine and large intestine, suturing wounds of the belly and small intestine) are made beside 42 sick. In the course of work use morphological, histological, bacteriological and physical methods of the study. The analysis given about mechanical toughness anastamosis has revealled the trace. At imposition gastroentero- and is made someone look large intestine anastamosis, formed precisional sutures during 1 day from begin experiments, mechanical toughness varies between 144±4.1 and 152±4.2 mm Hg. In checking group anastamosis sutures Alibert-Shmidens toughness was 168±4.3 mm Hg. However in all experience toughness anastamosis, regardless of methodses of the intestine seam is saved it is enough high, vastly exceeds the possible pressure in bright spot of the alimentary canal. At microscopically, anastamosis formed precisionally sutures, regardless of that, are assessed they on belly, fine or thick bowels, the general to show good their passability, nearly full absence infiltrates and inflammatory process over anastamosis at early periods after operation. Histologically, inflammatory reaction on suturing material was noted minimum. Threads polypropylene through 1-3 months after operation encircled fine connecting capsule. It is realized that offered methods of the intestine seam allow to obtain optimum healing an anastamosis, providing here with sufficient mechanical toughness and biological hermeticity of anastamosis. Postoperative period beside all sick run smoothly. The lethal upshot is not noted.
Consilium Medicum. 2017;19(7-2):45-50
45-50
Thromboprophylaxis in patients undergoing hemodialysis
Abstract
The review presents an analysis of the results of the use of different anticoagulants for the prevention of thrombosis in patients with terminal stage of chronic kidney disease on regular hemodialysis (HD). A better safety profile for hypersensitivity and risk of bleeding noted in low-molecular-weight heparin compared with unfractionated heparin. The indications and methods of blood anticoagulation using unfractionated and low-molecular heparin, as well as sodium citrate, possible complications in their use and methods of correction of possible complications are described. The article contains recommendations on the use of low molecular weight heparinoids and prostacyclin to prevent blood clots in patients undergoing HD with a high risk of bleeding and intolerance to heparin and trisodium citrate. The article is intended for nephrologists, specialists in extracorporeal methods of treatment (hemodialysis, haemofiltration, hemodiafiltration).
Consilium Medicum. 2017;19(7-2):51-54
51-54
The effectiveness of topical therapy in the complex treatment of hemorrhoids combined with anal fissures
Abstract
Nowadays a practicing coloproctologist is increasingly faced with a very common combination of diseases, such as anal fissures and chronic hemorrhoids. The aim of the study was to evaluate the effectiveness of complex therapy for combined pathology of the anal canal, by using the combination drug “Relief PRO” in the main group of patients. Reducing the intensity of the pain syndrome on day 15 (D15) of the treatment was noted by 33 (89.2%) of the patients in the main group and 26 (78.8%) - in the control group. Analysis of the results showed that after 60 days (D60), the study group showed a significant reducing of the pain syndrome, which does not require further correction. Epithelization was noted in 31 (83.8%) of the patient in the main group, and a persistent decrease of itching and burning sensation was also noted. These results prove the multifactorial therapeutic effect of the drug “Relief PRO”, which is achieved due to the combined composition (including, glucocorticosteroid - fluocortolone and lidocaine).
Consilium Medicum. 2017;19(7-2):55-58
55-58