ACUTE PURULENT INFECTION OF THE SEROUS CAVITIES, VESSELS, BONES, JOINTS. PUTREFACTIVE INFECTION

PURULENT INFLAMMATION OF THE SEROUS CAVITIES

Purulent meningitis — irritation of the mind membranes brought on by purulent microflora (staphylococcus, streptococcus, E.coli, pneumococcus). Purulent meningitis, as a rule, is a secondary course of brought on by penetration of microflora into the subarachnoidal house throughout traumas to the cranium (fracture to the calvarium or foundation) or throughout purulent illnesses of the ear, nostril and paranasal sinus, mind abscess burst. Hematogenous or lymphogenous bringing of the an infection is much less typically noticed.

Medical image. In accordance with the course meningitis is split into traumatic, otitic, hematogenous, lymphogenous. The illness signs are insupportable complications, excessive temperature, rigidity of the occipital muscle groups, optimistic Kernig’s symptom, nausea, vomiting. Impairment of consciousness (inhibition) all the way down to full loss is noticed. The attribute pose of the affected person — lies on his aspect with legs pressed towards the stomach and the pinnacle leaned again. Hypertension of the pores and skin sensitivity and enhance in tendon reflexes are marked. Together with the modifications within the blood (leukocytosis — left shift, enhance in ESR) an enormous diagnostic worth has the information from the spinal puncture: liquid flows out underneath excessive stress (400–500 mmH₂O) and incorporates a major quantity of protein, leukocytes, micro organism. The illness course is characterised by quick deterioration of the affected person’s situation, progress of intoxication. Lethality is from 50 to 70%.

Remedy. The sooner remedy the extra profitable outcomes. Within the early stage, conservative remedy is indicated: repeated lumbar punctures, endolumbar antibiotic remedy. Together with antibiotics, antiseptics, sulfanilamides (preparations of metronidazole, dioxydine, etazol, sulfalen) are entered intravenously, intra-arterially. Surgical remedy supplies an early publicity of the main target of the inflammatory course of and removes purulent exudate (incision of the paranasal sinus, purulent mastoiditis, mind abscesses, and contaminated wounds of the cranium).

Purulent pleurisy. Purulent pleurisy or pleural empyema — irritation of the pleura brought on by pyogenic an infection (staphylococcus, streptococcus, pneumococcus, enterobacteria). As a rule, it’s a secondary course of. It develops throughout burst of the abscess of the lungs, pneumonia difficult by the abscess, traumas to the thorax, costal osteomyelitis. Much less typically the an infection is introduced by the hematogenous (sepsis, deep phlegmons, hematogenous osteomyelitis) or the lymphogenous means (appendicitis, cholecystitis, pancreatitis). There are completely different classifications of acute pleural empyema:

after the causative agent (staphylococcus, streptococcus, diplococcus, and many others.);

after the situation of pus (free — whole, average, gentle; sacculated — multichamber, one-chamber);

after the pathoanatomical attribute (purulent, putrefactive);

after the medical course (septic, extreme, average, gentle).

Medical image. Shows of purulent pleurisy accumulate on the attributes of the essential illness (pneumonia, abscess of the lungs, and many others.). The medical image is characterised by the incidence of sturdy stabbing ache within the thorax, which amplifies throughout cough and respiration. Enhance within the physique temperature as much as 39–40°C, incidence of dry cough, dyspnea, cyanosis of the pores and skin. The affected person takes a bent place; the broken aspect is delayed throughout respiration; intercostal areas are smoothed; vocal tremor is weakened. Within the preliminary levels, pleural friction rubbing, diminished breath sounds are decided. With the buildup of pus within the pleural cavity, the medical image turns into exact. With the assistance of percussion and auscultation, attributes, which specify the buildup of liquid within the pleural cavity, the peak of its degree, and the shift of the mediastinum seem. The road of dullness within the again is often larger, in entrance — decrease (Damoiseau’s line). Greater than the dullness within the paravertebral zone, a transparent pulmonary sound is set (Garland’s triangle), which corresponds to the contour of the lung. With vital accumulation of liquid, the mediastinum shifts to the wholesome aspect, which is set as a blunt triangular kind from beneath the vertebrae (Grocco—Rauchfuss’s triangle).

Throughout radiological examination, homogeneous shadow of the pleural cavity, the extent of liquid, and the shift of the mediastinum are decided, and with the presence of a putrefactive course of — an air bubble above the liquid. The pleural puncture permits to find out the character of the exudate and conduct bacteriological analysis. Throughout sacculated processes, thoracoscopy with following drainage of the gathered pus is carried out for prognosis generally.

Remedy is begun with remedy of the first course of (pneumonia, abscess of the lungs, and many others.). All strategies of treating empyema have the aim of offering evacuation of the exudate, spreading the lungs and decreasing intoxication. The strategies of remedy are divided into closed and open. Closed: repeated punctures of the pleural cavity, getting into drainage by means of a small puncture (lower) with fixed aspiration of exudate. After eradicating the pus, washing with antibiotics the pleural cavity has adverse stress, which promotes the decomposition of the lungs. Fixed aspiration of exudate might be carried out with the assistance of the Subbotin—Peters’s triampullary programs by or a water-jet vacuum pump. The pleural cavity is washed out with antiseptics (furacilin, dioxydine, chlorhexidin) with the next introduction of proteolytic enzymes (for the lysis of fibrin, dense pus) and antibiotics bearing in mind the sensitivity of microflora.

With the event of huge accretions (sacculated processes) and the presence of fibrin lots, the effectivity of the closed strategies of remedy is just not excessive. They resort to the open technique — thoracotomy with extensive opening of the pleural cavity, evacuation of pus and fibrin clots, liberation of the lungs from accretions (decortication), resections of the broken segments or part of the lung (with gangrene) with following pleural drainage. Together with surgical strategies, detoxication of an organism (intra- and extracorporal strategies), immune and antibiotic remedy (intravenous, endolymphatic introduction) are broadly used.

Purulent pericarditis is a purulent irritation of the pericardium, very seldom major (tubercular, gonococcal), extra typically secondary. It develops as complication of the center wound or as the results of lymphogenous bringing of an infection throughout completely different illnesses (purulent pleurisy, pulmonary abscess, rheumatism, scarlet fever, phlegmon, osteomyelitis). Causative brokers: staphylococcus, streptococcus, tubercular bacillus, and many others.

Medical image. Attributes of basic intoxication and phenomena linked with the tough work of the center as the results of the buildup of inflammatory secretion within the cardiac sac. Excessive temperature, facial cyanosis, swelling of cervical veins are marked. The affected person is disturbed with ache of compressing character behind the sternum, dyspnea, and assaults of palpitation. The affected person takes a compelled place (semi-sitting). With percussion the center borderlines are dilated. With auscultation within the early levels — pericardial friction rub, and with the presence of exudate — acute dullness of the cardiac tones. Radiological examination reveals an intensive triangular enlargement of the cardiac shadow with the disappearance of the weist of the center. An auxiliary technique of prognosis is the exploratory puncture of the pericardium. The intoxication phenomena, modifications within the blood (left shift leukocytosis, enhance in ESR) be a part of early. Lethality is excessive due to issues (cardiac weak point as the results of adhesions between the myocardium and pericardium, sepsis).

Remedy. With the assistance of a practical mattress, the affected person is put in a semi-sitting place; cardiac substances, antibiotics, antiseptics are given. There are two strategies of native remedy: conservativesurgical (repeated punctures of the pericardium to take away the pus) and surgical (pericardiotomy). For conducting the puncture of the pericardium, immediately the most secure is the Marfan’s technique (a needle is injected close to the premise of the xiphoid course of to the left on the place of junction with the cartilage of the VII rib). The pus is aspirated from the pericardium and antibiotics are entered (semisynthetic penicillins, cephalosporins). With the absence of impact after finishing up 3–4 punctures and the deterioration within the affected person’s situation they resort to pericardiotomy — openning of the cardiac sac and creation of a relentless drainage of the pus. With adhesive pericarditis and the event of the stone coronary heart phenomena, pericardectomy (resection of the pericardium) is indicated.

Purulent peritonitis — irritation of the serous covers of the belly cavity, brought on by numerous microflora (E. coli, staphylococci, streptococci, pneumococci, blended an infection). Peritonitis, as a rule, is a secondary course of, which develops as a complication of illnesses of the belly organs (pyesis, gangrene, perforation) or their wounds, in addition to the results of an infection of the belly cavity throughout surgical procedure. Much less typically the an infection penetrates the belly cavity hematogenously or lymphogenously.

Peritonitis is split:

after the aetiology: E.coli, staphylococcus, streptococcus, blended,and in addition nonspecific and particular (tubercular);

after the mechanism of incidence: perforational, traumatic,postoperative, hematogenous, cryptogenic;

after the kind of exudate: serous, serous-fibrinous, purulent, putrefactive;

after the prevalence of the method: native (restricted), diffuse(unfold), basic;

after the part of the method: reactive part (1st day), toxicphase (2nd–fifth day), terminal part (after the fifth day); 6) after the medical shows: acute and persistent.

Native peritonitis is injury to a sure space of the peritoneum with restriction from free belly cavity by adhesions, accretions, inner organs. Diffuse (unfold) peritonitis is characterised by the spreading of the method into the belly cavity with out exact borders, affecting completely different elements of the belly cavity. Common peritonitis is an inflammatory technique of the complete belly cowl.

Medical image. Considering secondary peritonitis, attributes of the illness, as a rule, accumulate on the clinic of the first course of. The very first attribute is ache within the abdomen, depth of which might be completely different: boring, regularly growing, and through perforation of a hole organ — acute, knife-like. Localization of the ache might be completely different and relies upon upon the prevalence of the method (appendicitis, cholecystitis). Throughout diffuse or basic peritonitis, the ache spreads onto the anterior belly wall and turns into fixed. These attributes of peritoneal irritation seem early: nausea, vomiting, swelling of the abdomen, stress of belly muscle groups, Shchotkin—Bluberg’s symptom. The given signs are characterised by ache enhance throughout palpation of the abdomen, in the meanwhile of sharp lifting the palms from the belly wall. Pressure of the abdomen muscle groups is a really typical symptom that seems already on the preliminary part of peritonitis. With native processes, it’s decided above the middle of harm, throughout diffuse and poured peritonitis — on the entire anterior belly wall. Expressiveness is completely different, together with “disk-shaped stomach” with perforation of hole organs.

Unfold types of peritonitis are characterised by paresis of the GIT that seems as a lower or full absence of peristalsis, meteorism, swelling of the stomach, retention of gases and urination. Vomiting within the preliminary part is characterised by stagnant contents, and within the terminal — faecal. Effusion seems within the belly cavity, particularly with unfold varieties, which seems throughout percussion (boring sound within the sloping areas) and palpation (fluctuation with vital quantity of free liquid). Within the aged sufferers, indicators of peritonitis are incessantly imprecise. For specification of the prognosis, extra strategies of inspection are utilized: radiological, ultrasonic, “looking” catheter technique throughout laparocentesy, laparoscopy, endoscopy. With peritonitis, endotoxicosis is noticed too early, the essential pathogenetic second of which is adsorption of a major quantity of metabolism poisonous merchandise, microbic toxins into the blood from the belly cavity. Endotoxicosis grows progressively in time, ranging from the 2nd day of the illness, and is the primary explanation for excessive lethality (within the terminal stage — as much as 60%). Endotoxicosis causes vital infringement of the operate of significant organs: the center (pronounced tachycardia of 100–140 per minute, hypotension, lower within the shade index, acrocyanosis), the lungs (dyspnea, stagnant pneumonia, hypostasis of the lungs), the liver (hepatopathy, parenchymatous jaundice phenomena), the kidneys (nephropathy, oliguria, anuria, uraemia), the mind (encephalopathy, complications, sopor, intoxication delirium). As a result of vomiting within the terminal stage, vital infringement of the acid-base situation (metabolic acidosis), desiccation are noticed.

The affected person’s look within the terminal stage, described by Hyppocrates, may be very attribute. The affected person takes a compelled place, bent on the knee and hip joints. Options of the face are sharp, hole eyes, gray pores and skin, dry mucous, dry tongue with fur. The stomach doesn’t take part in respiration. Peritonitis might be difficult by the event of sepsis, the formation of abscesses of the belly cavity (subphrenic, subhepatic, interintestinal), eventration of the intestines, intestinal fistula, which significantly affect the result of the illness. However, the principal trigger for top lethality (with unfold types of peritonitis) is endotoxicosis with the event of a number of organ failure syndrome (MOFS).

Remedy. If prognosis of peritonitis is confirmed, the affected person is topic to emergency surgical remedy (inside 2–3 h). Contraindications to the operation: pre-agonal situation with acute haemodynamic infringements. The peritonitis remedy needs to be complicated and embrace the next actions: liquidation of the supply of peritonitis and motion on the microflora; endotoxicosis remedy.

In non-pronounced diagnostic circumstances earlier than the operation it’s not beneficial to use medication, antiemetic substances, siphon and cleaning clysters, which may worsen the affected person’s situation. Operative assist largely consists of median laparotomy, which permits inspecting the belly organs for revealing and liquidating the supply of peritonitis (suturing the perforating ulcers, appendectomy, eradicating the biliary bladder, and many others.). After liquidating the supply of widespread types of peritonitis, they take away the exudate and wash the belly cavity with antiseptic options. The operation is accomplished with introducing by means of sure counterapertures into the belly wall polyvinylchloride (rubber) drainages to the areas of doable exudate accumulation (subphrenic or subhepatic house, proper and left iliac websites, pelvic cavity). The wound median is sutured tightly. In pronounced circumstances of peritonitis, they apply open administration of the median wound with liquid sutures (laparostomy), which supplies a chance for dynamic management over the method situation within the belly cavity.

With restricted peritonitis after eradicating the exudate, peritoneal lavage is just not carried out so as to not entail spreading the an infection into the belly cavity. Thus the mobile irritation is drained. With basic peritonitis within the postoperative interval for discount of intoxication and infecting the belly cavity, many surgeons apply fixed or fractional washing of the stomach with antiseptic options (peritoneal dialysis). The getting into of antiseptics is carried out by means of prime drainages, and the eradicating — by means of decrease ones (5–10 l of resolution).

Liquidating the intestinal paresis has nice worth when combating endotoxicosis. With the aim of liquidating the paresis they apply medicamentous (neostigmine methylsulfate, eserin, kalymin, pituitrin, and many others.) and intestinal electrical stimulation, warming the stomach (solux), hypertonic clysters. With the intention to scale back the paresis and intoxications they take away the contents of the GIT (intestinal decompression). Intestinal decompression is carried out by introducing perforating one- and two-opened tubes (2–3 m in size) by means of the mouth to the extent of the empty intestines. It’s often carried out throughout the operation. With progressive peritonitis, operative methods of intestinal decompression are used (enterostomy, appendicostomy, colostomy).

With the intention to affect the belly microflora, they apply antiseptics (dioxydine, chlorhexidine, dimexide, biseptol) and antibiotics with bearing in mind the microflora sensitivity (polysynthetic penicillin, aminoglycosides, cephalosporin). The way in which of introduction is intraperitoneal, intravenous, intraarterial, endolymphatic. For endotoxicosis correction and with the aim to normalize homeostasis, in addition to of peritoneal irrigation and dialysis, they apply intracorporal detoxing: compelled diuresis (lazex, manitol), haemoinfusion and endolymphatic detoxing (haemodes, polymisin formation, albumine), enterosorption (sorbents, carbovit), and intravascular laser irradiation of the blood. With deep types of endotoxicosis with hepatic and renal insufficiency, extracorporal strategies of detoxing are indicated: ultra-violet irradiation of the blood, lymphosorption, haemosorption, plasmosorption, plasmapheresis, emodialysis, haemofiltration, hyperbaric oxygenation. With widespread varieties bearing in mind infringements to the immune standing and the event of secondary immunodeficiency, they apply replaceable immunotherapy (fresh-citrate donor blood, gamma-globulin, hyperimmune plasma, leukomass) and immunity stimulators (decaris, daucifon, thymalin, T-activinum, timogen, myelopeptide).

Phlebitis, thrombophlebitis. Phlebitis is an irritation of the venous wall, throughout the phenomena thrombogenesis is known as thrombophlebitis.

Aetiology and pathogenesis. It’s brought on by numerous microorganisms, extra typically staphylococci. Injury to the venous wall can happen throughout the presence of neighboring inflammatory processes (erysipelas, phlegmon) or the an infection is introduced by means of the blood or lymph by the unleashed cells. Change within the vascular wall, chemical compound of the blood, delay in blood circulation and infringement of the coagulation system have essential significance.

Extra typically the veins of the decrease extremities are affected. Thrombophlebitis is noticed twice as typically in girls. First inflammatory infiltration of the vascular wall, which ends up in vascular spasms, happens. It, in flip, promotes the delay of blood circulation, and the formation of a blood clot. The spasm, thrombosis of the veins leads to the rise in stress within the veins and capillaries that causes a rise in vascular permeability and hypostasis of the extremities.

Medical image. Thrombophlebitis of the deep and hypodermic veins is distinguished. By the medical course: acute, subacute and persistent levels of thrombophlebitis.

Acute thrombophlebitis of the deep veins of the hip is characterised by sturdy ache alongside the way in which of the vascular bunch, enhance in temperature (39–40°C ), and the event of hypostasis of the extremity. The pores and skin on the sick extremity is shiny with a cyanochroic marble shade, chilly to the contact as in comparison with the wholesome one. On account of spasm in the primary arteries, the heartbeat on the broken extremity is absent or lower than on the wholesome one. Throughout acute thrombophlebitis of the hypodermic veins, pronounced morbidity alongside the veins, hyperemia of the pores and skin as a wire or separate inflammatory infiltrations are marked. Acute thrombophlebitis can remodel into purulent one with the incidence of quite a few abscesses and phlegmons by the injury course, deterioration within the basic situation (fever, intoxication), in case of an abscess burst into the blood system septicopyemia arises. Extra typically acute thrombophlebitis transforms into subacute or persistent varieties. Thus, the overall situation suffers a bit, infiltration is set alongside the veins, with loading — morbidity and hypostasis of the legs.

After thrombophlebitis course, persistent venous insufficiency develops (hypostasis of the shin and ft, and many others.), joined by trophic failure (dryness and pealing of the pores and skin, varicose ulcers). It’s particularly essential to allocate migrating thrombophlebitis (Buerger’s illness) throughout which primarily the superficial veins of the higher and decrease extremities are concerned. The method is incessantly accompanied by endarteritis. Primarily younger males are affected. The overall situation suffers a bit. Alongside the superficial veins, less-painful nodules seem with hyperemia of the pores and skin and swelling. The method can final for years, periodically recurring.

Remedy for thrombophlebitis, principally, is conservative. Remedy needs to be directed on lowering the hypercoagulation phenomena, performing on blood clots and enhancing microcirculation of tissue. With this objective they apply anticoagulants of direct and oblique actions (heparin, dicumarin, phenilin, syncumar), thrombolytic means (streptokinase, fibrinolysin, trypsin, chymotrypsin, thrombolytin), preparations which enhance microcirculation and scale back aggregation of erythrocytes, thrombocytes (rheopolyglucin, haemodes, haemplasmin, trental).

With the acute course of, the affected person is appointed strict mattress routine with raised legs, heat and physiotherapy (solux, UV irradiation), ointment bandages on the broken legs throughout the formation of a blood clot. With unsuccessful conservative remedy (ascending septic thrombophlebitis in varicose veins), they resort to surgical remedy. Legation, incision of veins alongside the veins  with eradicating the broken space (venectomy), eradicating a blood clot (thrombectomy), transplantation and plastic operations on the veins belong to surgical remedy. With restricted purulent thrombophlebitis, incisions with opening the vein are utilized and treating by the kind of purulent wound or eradicating the broken vein.

Lymphangitis is a secondary irritation of the lymphatic vessels, which happens as a complication of pyoinflammatory illnesses (furuncule, anthrax, abscess, phlegmon, panaritium, contaminated wound). Causative brokers: staphylococci, streptococci, E. coli, proteus. Microorganisms from the irritation focus penetrate into the lymphatic capillaries and farther with the lymph movement — into bigger lymphatic vessels and lymph nodes.

Medical image seems domestically (ache, native rise in temperature, swelling, reddening) and customarily (fever, headache, sweating, basic weak point, elevated leukocytosis). Native shows rely upon the kind of the vessel. With reticular lymphangitis, pronounced hyperemia of the pores and skin, just like erysipelatous however with out exact borders is marked. With stem lymphangitis — hyperemia as separate strips from the irritation focus to the regional lymph node zone. The lymph nodes are affected early within the course of — regional lymphangitis happens. Issues: phlegmon, abscess, thrombophlebitis, sepsis.

Remedy needs to be directed on the liquidation of the first focus (lancing of abscesses, drainage). A broken leg is in a raised place, generally immobilized. Antibiotic remedy is appointed with bearing in mind the sort of microflora and its sensitivity.

Lymphadenitis — irritation of the lymph nodes occurring as a complication of various purulent illnesses and particular infections (tuberculosis, actinomycosis, plague, and many others.).

Acute and persistent, particular and nonspecific lymphadenitis are distinguished. The an infection will get from purulent or particular cells by means of the lymphatic or blood vessels to the lymph nodes. The first course of is seldom noticed throughout wounds or contaminated lymph node. Relying upon the exudate character, it may be serous, haemorrhagic, fibrinous, or purulent. Purulent processes consequence within the destruction of node’s tissue and transition of the irritation to the encompassing tissue with the event of adenophlegmon.

Medical image for nonspecific lymphadenitis is characterised by painfulness and enhance within the lymph nodes, complications, weak point, indisposition, and rise within the physique temperature. Within the preliminary levels, ache within the regional lymph nodes, that are dense, painful, not adhered with the encompassing tissue, is marked; and the pores and skin above them is just not modified.

With harmful processes (purulent kind) the ache has an acute character; the pores and skin above the lymph nodes is hyperemic; the nodes merge collectively and with the encompassing tissue. With an adenophlegmon, dense infiltrations with softening cells are decided. Intoxication phenomena be a part of: fever, tachycardia, headache, weak point. With putrefactive adenophlegmon, within the injury zone crepitation is set throughout palpation.

Issues: thrombophlebitis, spreading of pus onto the areolar tissue with the event of phlegmons (retroperitoneal, mediastinitis, and many others.), purulent fistulae, sepsis.

Remedy relies upon upon the part of the method. Within the preliminary levels (infiltration) remedy is conservative: relaxation, antibiotic remedy bearing in mind the microflora, remedy of the essential focus of an infection (slicing abscesses, phlegmons, drainage), dry warmth (extremely excessive waves, solux, warming compresses). With abscess lymphadenitis — surgical remedy (slicing the abscess or adenophlegmon with following drainage and remedy like for purulent wounds). The remedy for particular lymphadenitis is set by particular remedy of the essential illness (tuberculosis, actinomycosis).

Bursitis is irritation of the mucous sacs. Mucous sacs are restricted connective tissue sacs, lined with endothelium, which produces sinovial liquid. Bursas kind in lots of locations, however principally on areas of steady stress and pores and skin friction, fascia, muscle groups, and bone protrusions. Causative brokers of purulent bursitis are extra typically staphylococci and streptococci, much less typically particular bursitis (gonococcal, tubercular, pneumococcal). The an infection penetrates by the lymphogenous or hematogenous means. Extra typically purulent inflammations of the mucous sacs of the ulnar, humeral and knee joints are noticed. Usually, it’s defined by the affected person’s career (miners, engravers, carriers, and many others.) and fixed trauma of the mucous sacs.

Medical image consists of systematic and native signs. The incidence of painful swelling in accordance with the situation of the mucous sacs, swelling and native enhance in temperature is proof of bursitis. Together with the native indicators of purulent bursitis, an increase in temperature and leukocytosis, weak point happen. The prognosis of bursitis is just not complicated with superficial localization of mucous sacs. It’s vital to tell apart bursitis from arthritis: with bursitis actions within the joints are stored. With persistent bursitis, the bursa is full of serous contents; the partitions of the bursa are sharply thickened.

Remedy. Within the preliminary levels of the illness for exudate resorption they apply dry warmth, extremely excessive waves, bandages with Vishnevsky ointment, immobilize the leg. With pyesis, a puncture with sucking out the pus and antibiotics introduction are carried out. With unsuccessful remedy, the sacs are lower open; they delete the pus and additional deal with as a purulent wound. With persistent bursitis, take away the mucous sacs with out incision its opening.

Tendovaginitis is irritation of the tendinous sheath. Causative brokers (staphylococci, blended flora) penetrate throughout wounds or as the results of irritation spreading from the encompassing tissue.

Medical image. Tendovaginitis is characterised by the incidence of ache, inflammatory infiltration by the course of the tendinous sheath. To scale back ache, the affected person fixes the extremity (finger) in a half-bent place. Hyperemia of the pores and skin above the broken space, rise in temperature are noticed. If the method progresses because of vascular constrictions which nourish the tendon, necrosis of the tendons can develop; purulent fistulae kind.

Remedy. Within the preliminary levels relaxation, immobilization, utility of antibiotics and physiotherapy (extremely excessive waves, solux, magnetotherapy) are indicated. With the event of pyesis, the suppurative focus is opened with following washing and drainage.

Arthritis is irritation of the joint.

Aetiology. Arthritis may end up from completely different causes. Such sorts of arthritis are distinguished: traumatic, infectious, dystrophic, endocrine, anaphylactic. Extra typically purulent arthritis, the causative brokers of which (staphylococci, pneumococci, enterobacteria) penetrate into the joint throughout a trauma or from different cells (osteomyelitis, phlegmon), much less typically with the hematogenous means with sepsis, thrombophlebitis.

Medical image relies upon upon the morphological modifications within the joint. First serous or fibrinous synovitis, which may additional flip into panarthritis and phlegmon of the articulate capsule, develops. The method can unfold to the following bones with the incidence of osteoarthritis (purulent fistula, sequestrations). Native signs: ache, swelling. The compelled place of the extremity relies upon upon the reflex muscular contraction. The extremity is fastened in such place (half-bent, retracted, pronation, and many others.), throughout which the capability of the joint is maximal. On account of a rise in exudate, the contours of the joint are smoothed, there may be fluctuation. With injury to the knee joint, balloting patellar is set. Reddening, swelling of the pores and skin, native rise in temperature on the broken joint are noticed. With dry varieties (fibrinous), deforming arthrosis, ankylosis of the joints can develop. With purulent osteoarthritis, the articulate ligaments and cartilages are broken, subsequently incomplete dislocations and full dislocations can happen. The systematic intoxication phenomena seem (fever, encephalopathy, delirium). Often hematosepsis or septicopyemia develops.

Remedy relies upon upon the method part, sort of exudate. Within the preliminary levels, they apply extremity immobilization, physiotherapy (extremely excessive waves, solux, ionophoresis, magnetotherapy), punctures of the joint with the introduction of antibiotics into the cavity. With the event of purulent arthritis, incision the joint (arthrotomy) and washings with antiseptics are administered. Additional, washing the joint with antibiotics and antiseptics (dioxydine, chlorhexidine, dimexide) are indicated. Antibiotic remedy, haemotransfusion and protein blood substitutes, desintoxication with remedy throughout the growth of endotoxicosis and sepsis (hyperbaric oxygenation, haemosorption, plasmapheresis, and many others.) add to it.

With the destruction of the bones’ articulate ends and with the absence of impact from the utilized remedy they perform a resection of the joint with the creation of ankylosis. With risk to the affected person’s life in case of sepsis, panarthritis with in depth destructions within the joint, amputation of the extremity is carried out.

Osteomyelitis is irritation of the bone tissue that covers all of the bone components (bone marrow, compact layer, periosteum). Relying upon the causative brokers of osteomyelitis are divided into nonspecific (brought on by pyogenic microflora) and particular (syphilitic, tubercular, brucellosis). The an infection can penetrate hematogenously or exogenously. Relying upon the methods of penetration osteomyelitis is distinguished as hematogenous and non-hematogenous.

Non-hematogenous osteomyelitis is subdivided into: traumatic; gunshot; osteomyelitis, which happens throughout the unfold of purulent irritation to the bone from adjoining tissues or organs.

In accordance with the medical course: acute, persistent, primary-chronic, atypical types of osteomyelitis are distinguished.

Every type of osteomyelitis has outstanding options of the medical course.

Pathological anatomy — modifications within the bone throughout osteomyelitis can start within the bone marrow, much less typically — inner layers of the periosteum. Hyperemia, hypostasis of the bone marrow, growth of phlegmon causes the penetration of an an infection into the compact layer of the bone and periosteum. With the event of purulent infiltration of the periosteum and sub-periosteum abscesses, the diet of the bone is sharply damaged, leading to necrosis and rejection of bone areas (sequestration). Bone sequestration is positioned within the sequestral cavities the place there are merchandise of autolysis, pus. Pus from the sequestral cavities, sub-periosteum abscesses, destroying the periosteum, can go between muscle groups, forming phlegmons, comfortable tissue abscesses, spreading to the following joint. With pus breaking out the fistula such ducts kind by means of which items of useless bone, purulent secretion discharge. Intensive necrosis of the bone tissue may end up in pathological fractures. With the event of sequestration and fistula, the method turns into the persistent kind; its period relies upon upon the scale of the bone space rejected.

Parallel to the destruction processes, bone regeneration as osteoblastic processes (thickening of the periosteum, bone tissue, obliteration of the bone marrow cavity) happens.

Acute haematogenous osteomyelitis is noticed extra typically in youngsters and youngsters. It’s brought on by pyogenic microbes. The injury covers primarily lengthy tubular bones (hip, humeral, tibia). The an infection from the first cell (furuncule, anthrax, carious enamel, tonsillitis, phlegmon, panaritium, and many others.) is carried by the blood present to the bone marrow the place it causes irritation.

The next components play a task within the growth of osteomyelitis:

Peculiarities of blood provide to bones in youngsters.

Organic and immune options of the organism.

For the diaphysis the primary sort of blood provide is attribute, metaphysis and epiphysis have impartial arterial programs like intertwined community of effective vessels and capillaries.

Quite a few theories of the pathogenesis of hematogenous osteomyelitis exist.

The Lexer’s concept (1894), bearing in mind the options of blood provide of tubular bones in youngsters, explains the event of osteomyelitis as the results of embolism from the branches of the metaphysic arteries with bacterial emboli from the first cell. However, the worth of the organism’s reactance is totally ignored.

S. M. Derezhanov (1940) proved that osteomyelitis develops solely in sensibilized organisms and has the course of hyperergic irritation. Merchandise of protein disintegration, infectious illnesses, and many others. may cause organism’s sensitization. Favorable components for the event of osteomyelitis might be avitaminosis, exhaustion, earlier infections, trauma to the bone.

Medical image. Relying upon the pace of growth of the pathological course of, medical shows and prevalence of native purulent foci, in accordance with the Krasnobayev’s classification, three types of hematogenous osteomyelitis are distinguished: poisonous; septicopyemic; native.

With the poisonous kind, the phenomena of septic intoxication prevail. The method has a lightning course, causes the affected person’s loss of life incessantly earlier than any modifications. The consciousness is confused, delirium, signs of irritation of the mind membranes, fever (39°C and better), headache, vomiting. The individual is pale; eyes are sunken; lips and mucous are cyanotic; the pores and skin is dry with an icteric shade. Hypotension, tachycardia, dyspnea, bronchopneumonia phenomena are noticed.

With septicopyemic kind, native purulent-destructive modifications shortly happen; there are completely different foci in numerous bones on the similar time; pyemic cells can seem in different organs and tissues (the lungs, the liver). With the native kind, throughout the first days of the illness, intoxication signs (fever, weak point, headache, nausea, vomiting, elevated leukocytosis) are accompanied by ache within the legs, that are insignificant within the onset of the illness. The localization is tough to seek out, solely with the event (1–2 days) of hypostasis of native tissue, infiltration of the pores and skin the positioning of the best painfulness by palpation might be decided. Heel or elbow palpation causes sturdy ache on the broken website. The extremity is in a compelled half-bent place. On the finish of the primary week within the heart of the painful swelling the pores and skin turns into crimson, there may be fluctuation; a sub-periosteal abscess, an intermuscular phlegmon kind. The intermuscular phlegmon can independently break by means of with the formation of fistula. With the grave course, a phlegmon leads to purulent arthritis, periarticulary phlegmon and sepsis.

An early radiological symptom of osteomyelitis is the symptom of the pealing periosteum — a skinny linear shadow, above the shadow of the cortical layer of the bone. Modifications within the metaphysis seem radiologically as a darkening of the bone construction; osteoporosis phenomena (completely different websites of thinning and condensing). The standard radiological image (presence of sequestral cavities, sequestrations, fistula) seems on the second month of the illness. With the intention to decide the prognosis, bone puncture, osteomedulography, fistulography are utilized.

Remedy relies upon upon the stage of the method. Within the infiltration stage (as much as 2 months) principally, conservative remedy is utilized: immobilization, antibiotics (semisynthetic penicillin, aminoglycosides, cephalosporins), sulfanilamides, antiseptics (nitrofurane, metronidazole). Antibiotics are entered intramuscularly, intraarterially (regional perfusion), intraosseously, subperiostally. Subperiostal or intrabone introduction of antibiotics is carried out by micropunching the bone with the assistance of particular needles and microirrigators, which allow the creation of excessive concentrations of antibiotics within the heart of the injury, in addition to on the similar time, delete the pus and wash out the wound. With grave circumstances, they apply trepanation of the bone with the next washing out. In progressive circumstances with the presence of phlegmons, they’re opened with the next steady washing out with antibiotics and antiseptics.

Radical operations (sequestrotomy) are carried out within the persistent interval with exact restriction of the sequestration. A tough process for the surgeon after sequestrotomy (removing of useless tissue, incision of the sinus tracts) is the liquidation of the residual cavity within the bone. There are about 60 strategies of liquidation of sequestral cavities within the bones (sealing with paraffin, plastic, preserved cartilaginous tissue, bone alo- and autotransplantation, and many others.). Nonetheless, the vast majority of them are ineffective.

Strategies with the appliance of transplants with blood vessel are efficient. Current years autotransplantation of bone-muscle-skin orifice has develop into very efficient with the assistance of microvascular approach.

Non-hematogenous osteomyelitis. They embrace traumatic, gunshot, post-operative osteosynthesis, throughout the irritation unfold to the bone from the encompassing tissue (for instance, with phlegmon). The an infection is introduced by the exogenous means from the atmosphere. Many components play a task within the incidence of traumatic osteomyelitis: diploma of air pollution of sentimental tissue and bone fragments, late major surgical processing, organism’s reactance, microflora’s virulence, character of fracture (detrital).

Medical image. The event of osteomyelitis is often preceded by the trauma (fracture) with the phenomena of sentimental tissue and contaminated wounds with pyesis throughout the subsequent few days (rise in temperature, deterioration within the basic situation). Incidence of ache repeatedly on the fracture website or on the entire extremity testifies to the event of osteomyelitis. Thus, hyperemia of the pores and skin, hypostasis of sentimental tissue, and vital purulent secretion from the wound are noticed. The formation of purulent fistulae on the fracture website offers foundation to suspect the event of osteomyelitis. Radiological modifications come up some time after the trauma: osteoporosis, small cavities with comfortable sequestrations, usuration of the ends of the bone fragments. With gunshot osteomyelitis overseas objects are discovered (bullets, fraction, splinters from shells). Restriction of the harmful modifications of bones solely within the zone of the bone fracture is attribute. The peculiarity of traumatic osteomyelitis in distinction to hematogenous is much less pronounced systematic phenomena because of the nonunion of fragments; a synthetic joint incessantly varieties. The acute interval turns into the persistent with the formation of a purulent fistula with little secretion.

Remedy of non-hematogenous osteomyelitis is carried out by the identical rules as for hematogenous. Surgical remedy is indicated to take away sequestrations, necrotic bone fragments, overseas objects, opening purulent fistulae. With the presence of a fracture which hasn’t not healed and osteomyelitis a cheap freshening of the bone fragments with their repositioning is carried out. The tactic of immobilization of fragments is extrafocal compression osteosynthesis. With the inefficiency of remedy of the essential joint after the liquidation of osteomyelitis, resection of the bone is carried out throughout the limits of wholesome tissue with simultaneous autotransplantation of the bone.

Main-chronic osteomyelitis. These are uncommon types of hematogenous osteomyelitis throughout which the illness from the very onset has an atypical course and seems within the persistent kind. Atypical varieties are Brodie’s abscess, Garre′’s sclerosing osteomyelitis, Ollier’s albuminous osteomyelitis.

Brodie’s abscess is a model of subacute hematogenous osteomyelitis. It’s characterised by boring whining pains within the legs, particularly at night time. Radiologically within the spongy layer of a bone close to the joint a spherical cavity seems. When incision an abscess full of pus with little virulent microbes is discovered. Remedy is surgical: bone trepanation, eradicating the pus with the next sealing of the cavity within the bone.

Garre′’s sclerosing osteomyelitis begins subacute, with typical night time pains within the legs, average rise in temperature and leukocytosis. The peculiar characteristic of the method is a sharply pronounced progressing sclerosis of the broken bone and small websites of colliquation of the bone tissue. On account of sclerosis, the diaphysis thickens spindle-shaped, the bone marrow cannel is totally sclerous. Remedy principally is conservative: antibiotics (lincomycine, semisynthetic penicillin), physiotherapy (electrophoresis with trypsin, extremely excessive waves, mud functions, and baths).

Ollier’s albuminous osteomyelitis is brought on by little virulent microflora (streptococcus, staphylococcus). The illness has a subacute course with minor alterations (small infiltration of sentimental tissue with non-pronounced hyperemia of the pores and skin). The peculiarity of this type is the next: serous liquid wealthy in mucin accumulates within the osteomyelitis focus as a substitute of pus. The languid course generally is difficult with destruction of the pores and skin with the formation of sequestrations or secondary an infection.

Remedy is surgical (slicing the main target, currettage of the granulations).

Panaritium is purulent irritation of the tissue on the fingers. The causative brokers: staphylococcus and blended flora, which penetrate into the tissue by means of effective traumas (injections), overseas objects (prickle, splinters of glass), after manicures. In accordance with the anatomic precept the next classification of panaritium is distinguished: cutaneous panaritium, subcutaneous panaritium, tendovaginitis (tendon), articular panaritium, subungual panaritium, paraungual panaritium, nail-wall panaritium, bony panaritium, pandactylitis.

Cutaneous panaritium is the results of microtraumas, positioned underneath the dermis each on the palmar and again floor of the fingers, throughout the limits of 1 phalanx. Attribute: formation of purulent blisters with pealing of the dermis and native hyperemia of the pores and skin. Pains usually are not sturdy, the medical course is favorable, with out pronounced basic phenomena. Remedy: surgical. Exfoliated dermis is incised, and panaritium is handled as a purulent wound. Within the preliminary stage, they apply spirit compresses, sizzling baths.

Subcutaneous panaritium is probably the most typically type of panaritium with overwhelming injury to the palmar floor of the fingers. Due to the options of construction of the hypodermic tissue of the palm (cavernous) it tends to shortly transit into the bony kind. Clinically it seems as two phases: infiltration and abscess. Infiltration seems throughout the limits of 1 phalanx. Ache is pulsating, pulling, hyperemia of the pores and skin is non-pronounced; the sufferers shield the finger. Within the abscess part, fluctuation is tough to seek out as a result of the connective tissue membranes within the hypodermic tissue restrict the spreading of the method on the periphery. The character of ache helps to seek out it (fixed, pulsating which deprives the affected person of relaxation and sleep). With compression of the vessels, purulent exudate disrupts blood circulation; subsequently dry necrosis of the hypodermic tissue is feasible.

Remedy. Within the infiltration part remedy is conservative: antibiotics, sulfanilamides, physiotherapy (sizzling baths, spirit compresses). Within the abscess part, the abscesses are opened with Klapp’s linear-lateral incisions, that are carried out on the sting of the lateral and palm surfaces of the finger throughout the limits of the phalanx. The incisions are linked amongst themselves with the assistance of a hypodermic tunnel by incision the tendinous membranes. It allows the opening of all abscesses. The incisions are drained with a rubber strip (however not gauze drainage) for enough outflow of the pus and prevention of the sticking of pores and skin wounds and formation of one other abscess. On the nail, incision of an abscess is carried out with a sticklike lower.

The incision used earlier as “fish jaws” is just not fascinating, as a result of it damages the nerve endings, and tactile sensitivity is misplaced. The incision of abscesses might be carried out underneath narcosis or underneath native anaesthesia in accordance with Oberst—Lukashevich. Within the postoperative interval — remedy is like for purulent wound (native antibiotics, antiseptics, proteolytic enzymes, extremely excessive waves, UV irradiation).

Paronychia — irritation of the nail wall, which happens with microtraumas (agnails, injury throughout a manicure). Reddening, swelling, and painfulness of the nail wall are typical. When urgent on the nail, pus discharges from underneath the sting of the nail wall. Often the method proceeds lengthy with no pronounced response.

Remedy is conservative within the preliminary stage: baths, spirit compresses. With the buildup of pus, underneath block anaesthesia, wedge-shaped, P-like pair of lateral incisions on the again floor of the nail (relying upon the localization) are carried out.

Subungual panaritium — develops when overseas objects (thorns) get within the nail mattress, because of punctured wounds or pyesis of hyponychial hematomas. The event of purulent irritation underneath the nail is attribute. It’s accompanied by pulsating ache, seen accumulation of pus underneath the nail plate. With the rupture of pus to the skin it will possibly kind purulent fistula. Remedy: surgical. With positioned types of subungual panaritium it’s essential to restrict the resection of the nail plate. With full exfoliating of the nail plate, the latter is eliminated with the aim of draining the suppurative focus and treating the purulent wound.

Tendinous panaritium (tendovaginitis) often arises secondary as a complication of subungual panaritium with unsuccessful remedy. It’s characterised by a deterioration within the basic situation, incidence of pulsating ache on the entire finger, uniform hypostasis of the tissue on the finger from easy interphalanx sulcus. The finger seems to be like sausage, in a half-bent place. An try and unbend the finger causes sharp ache, throughout bending the ache abates. It is without doubt one of the attribute signs. Harmful tendovaginitis are on the first and fifth fingers, due to the doable drift of the an infection onto the forearm, incidence of V-like phlegmons. Remedy within the preliminary stage consists in puncturing the tendinous vaginas for draining the exudate and introduction of antibiotics. If inefficient, it’s essential to resort to an pressing operation. A delay in regards to the operation is harmful, as a result of the tendon, disadvantaged of blood because of compression of the vessels with exudate, shortly perishes. Thus the flexing operate of the finger can be misplaced, although it’s doable to cease the inflammatory course of. Incision of the inflammatory cell is carried out with Klapp’s incisions on the anterior-lateral floor of the finger with the next drainage with rubber drainages and remedy with native antiseptics.

Bony panaritium is osteomyelitis of the phalanxes happens as the results of improper or late remedy of subcutaneous panaritium. With small incisions of subcutaneous panaritium, preconditions for deep an infection spreading to the finger bone are created. The ache is boring, fixed; the pus discharge from the wound doesn’t cease, generally with effective bone sequestrations. The phalanx thickens clubshaped, sharply painful throughout palpation; the operate of the hand is diminished. On the roentgenogram osteoporosis, destruction and sequestration of the phalanxes are discovered.

Remedy: a mixture of antibiotic remedy (native and systematic) and surgical. Broad lateral incisions in accordance with Klapp and the removing of necrotic hypodermic tissue with the rubber drainage are carried out. In grave circumstances, they take away the massive sequestrations.

Articular panaritium happens as a complication of subcutaneous or bony panaritium. Generally, it’s the consequence of the an infection bringing from wounds to the joints. Sturdy pains which amplify throughout bending the finger are typical. The joint is spindle-shaped, hypostasis and hyperemia of tissue are most of all pronounced on the posterior floor of the finger. Joint puncture reveales a muddy liquid. Throughout grave circumstances destruction of the capsule and pathological dislocation are doable. Purulent fistulae kind. There may be destruction of the articular surfaces on roentgenograms. Remedy within the preliminary stage: joint puncture, liquidation of exudate and introduction of antibiotics. Immobilization of the finger is indicated. With the presence of pus within the joint, arthrotomy with two parallel incisions with the next draining and washing are finished. Generally amputation of the finger with destruction of the joint and vital destruction of the bones is carried out.

Pandactylitis is a purulent irritation of all tissues of the finger. Often, it’s the results of the improper remedy of bony, articular and tendinous panaritium. The illness develops regularly. The medical image consists of mixture of all types of purulent injury to the finger. It has a extreme course; it’s accompanied by pronounced intoxication (headache, fever and leukocytosis), regional lymphadenitis. Ache within the finger is insupportable. The finger is sharply thickened, deformed, darkish blue-crimson. The irritation happens with dry or damp necrosis. There are a number of purulent fistulae with gray granulations. With the presence of virulent infections, the irritation incessantly spreads to the hand.

Remedy is surgical (extensive lateral incisions in accordance with Klapp). It’s essential to attempt to save the fingers although, as a rule, with panaritium the finger contracture develops. For the prevention of the generalization of the an infection, they resort to exarticulation of the finger.

PUTREFACTIVE (PUTRID) WOUND INFECTION

Aetiology. The putrefactive an infection develops solely within the wound the place there may be useless tissues, that are topic to putrifactive disintegration because of very important exercise the putrefactive micro organism. Issues can happen from in depth extreme wounds of the comfortable tissue, open fractures, gunshot wounds, and mattress sores. The putrefactive an infection seldom happens independently; often it joins Claustrid anaerobic or cardio an infection. Non-Claustrid anaerobic putrefactive an infection is brought on by: bacteroid, peptococcus, fusobacteria that typically saprofited on the mucous membrane of the GIT, respiratory methods, and feminine genitals.

In the present day the thought is established that 90% of surgical infections have an endogenous origin. As probably the most a part of regular microflora are anaerobes, the anaerobic and blended (anaerobic-aerobic) infections make up one of the crucial vital classes of pyoinflammatory illnesses. An particularly huge function they play in surgical procedure of illnesses and issues in stomatologic, thoracic, belly, gynaecologic clinics and with sure infections of sentimental tissues. Expertise testifies that almost all of infections which occur with the participation of anaerobes usually are not monomicrobic. Extra typically they’re brought on by the affiliation of anaerobes or the mix of anaerobes with aerobes (Staphylococci, E.coli).

Medical image. Putrefactive an infection is independently noticed slightly seldom, often it joins an already superior anaerobic or purulent (cardio) an infection. Therefore, the medical image of the wound issues is just not incessantly clear and merges with the medical image of anaerobic or purulent an infection. Among the many basic signs, it’s vital to tell apart the next: oppression of mentality, drowsiness, lower in urge for food, growth of anemia. The incidence of sudden repeated fever is an early basic signal of putrefactive disintegration within the wound. The most important and fixed attribute is the presence of sharp disagreeable odour of exudate. A nasty odour is predetermined by flying sulphurous compounds (hydrogen sulphide, methyl mercaptan, methyl thiomethane) — merchandise for the very important exercise of putrefactive micro organism. The second attribute of anaerobic injury is putrefactive character of the wound. The middle of harm incorporates useless tissues as unstructured detritis with a gray or grey-green shade, generally with black or brown websites. These cells seldom have a cavity kind, restricted to right contours, extra typically they’ve a chimerical kind or fill intertissue cracks.

The colour of the exudate additionally has peculiarities. It’s often graygreen, very often brown. The coloring is just not homogeneous; it incorporates small droplets of fats. With huge accumulation of pus within the tissue, the exudate, as a rule, is liquid, however with injury to the muscle groups it’s scanty, which diffusely impregnates tissues. With cardio suppuration the pus has dense consistency, extra typically yellow or white shade, homogeneous, with out an odour. A attribute attribute of anaerobic infections is gasoline formation.

The explanation for gasoline formation is that in anaerobic metabolism, hydrogen, nitrogen, methane, which dissolve badly in water launch. Fuel formation causes crepitation throughout palpation of the broken website, the presence of gasoline blisters within the exudate.

In differential prognosis, radiological strategies of analysis have nice worth. With putrefactive an infection, the extent of gasoline formation is low. In distinction to it with gasoline (claustridial) gangrene, gasoline spreads shortly, immense past the bounds of the wound and into the muscular layer. Soiled-green spots seem at a major distance from the wound on the pores and skin because of haemolysis. Within the preliminary stage when the putrefactive an infection joins, throughout examination of the wound incessantly it’s not possible to seek out the presence of hypostasis, crepitation, gasoline formation, purulent swelling. Exterior attributes of harm to tissue incessantly don’t correspond to in depth deep damages — hyperemia of the pores and skin could also be absent, which doesn’t induce the surgeon to well-timed and in depth surgery of the main target of harm. Dry and useless tissue, the incidence of a dirty-green or brown movie, discharge of muddy exudate with a small quantity of gasoline blisters, the presence of an terrible (ichorous) odour from the wound — attribute attributes of the including putrefactive an infection. The putrefactive an infection spreads onto the hypodermic tissue, then onto the interfascial areas, inflicting necrosis of the fascia, muscle groups, and tendons. The event of a putrefactive an infection within the wound can have three medical varieties (P. M. Napalkov):

1) with the prevalence of shock phenomena; 2) with a tough progressing course; З) with a imprecise course.

The primary two varieties run have the phenomena of serious basic intoxication (fever, chills, lower in arterial stress, encephalopathy, and the event of renal and hepatic insufficiency).

The prognosis of putrefactive an infection needs to be based mostly upon the options of medical and microbiological prognosis of the exudate. The causative brokers usually are not incessantly decided by routine strategies of bacteriological investigation. Bacteroids shortly perish with the presence of oxygen, the fabric for examination is to be taken with warning and urgently delivered to the laboratory. It’s not allowed to contact the fabric with oxygen. The expansion of the bacteroids on nutrient mediums is sluggish; the reply is available in 72 h and extra. Microscopy of native materials (exudate smears, stained by Gram) and gasoline chromatography belong to the straightforward and quick methods of figuring out anaerobes. The tactic of gasoline chromatography relies upon the chromatographic definition of particular chemical substances of anaerobes very important exercise merchandise (unstable fatty acids: propionic, valerian, capron and others).

The remedy for putrefactive infections ought to consists of the next:

а) creation of grave circumstances for the event of microflora (removing of useless tissues, extensive drainage of the abscesses, antibacterial remedy);

detoxing remedy (strategies of intra- and extracorporal detoxication);

correction of homeostasis and immune standing of the organism(correction of systematic and organ infringements, immune remedy and immune correction).

With the presence of a putrefactive an infection within the wound, they take away the broken tissues. On account of the anatomic localization, prevalence and different options of an an infection, the achievement of radical outcomes (eradicating the broken tissue) is just not at all times doable. In such circumstances, the operation has a palliative character and consists of a large incision of the suppurative focus, removing of the necrotic tissues, draining the wound with the aim of eradicating the exudate and native performing upon the microflora with completely different antiseptic substances. For prophylaxis of spreading putrefactive course of onto the wholesome tissue limiting incisions are carried out.

The irrigation or fixed perfusion of wounds with options of hydrogen peroxide, potassium permanganate, and sodium hypochlorite is expedient within the remedy of anaerobic infections. Sodium hypochlorite is ready earlier than use by electrolysis with a 0.9% resolution of sodium chloride. Hydrophilic ointments on polyethylene oxide foundation (levosin, levomacol, dihydroxycol, maphenid, sulfamilon) are very efficient. Ointments on a hydrophylic base present good adsorption of exudate and quick clearing of the wound. They apply hyperbaric oxygenation, however in some circumstances (with the presence of aerotolerance) a lower within the impact of this technique is noticed.

Nearly all of bacteroids are immune to antibiotics, subsequently antibiotic remedy is important to hold out underneath compulsory management of the antibioticogram. Chemotherapy of putrefactive an infection consists of efficient antibiotics (thienam, lincomycin, rifampicin), preparations of metroimidazole (metronidazole, metragil, tinidasol).

The complicated of measures on correcting homeostasis and detoxing needs to be decided individually for every affected person in accordance with the medical course (tough septic course or languid, imprecise).

With a tough septic course, they start with intracorporal strategies of detoxication: haemoinfusion and endolymphatic therapies (introduction of haemodes, neoheamodes, albumin with disaggregants towards a background of compelled diuresis). They apply UV-irradiation, applicational sorption (inserting carbon fibrous sorbents, immobilized enzymes together with antibiotics on the wound). With the event of the phenomena of hepatic insufficiency they use haemosorption, lymphosorption, plasmapheresis, plasmosorption.

In case of renal insufficiency, the strategy of selection is haemodialysis, haemodiafiltration.

Correction of immune standing infringements with a putrefactive an infection (particularly with the event of septicopyemia) consists of transfusion of fresh-stabilized blood and the appliance of synthetic (decaris) or pure immune correctors (thactivin, thymalin, thymogen).