SURGICAL INFECTION. ACUTE PURULENT INFECTION OF THE SKIN, CELLULAR SPACES

An infection in surgical procedure occupies considered one of main locations regarding lethality and determines the essence of many inflammatory illnesses and postoperative problems. Final years, a rise within the incidence of pyoinflammatory illnesses and postoperative purulent problems, which is linked each to the spreading of antibioticresistant strains of microflora and to the rise in complexity of operative interventions (operations on the center, the esophagus, the lungs, the mind, organ transplantation, and many others.), has been noticed. Infringement of the immune standing of sufferers is predetermined by many elements: allergic reactions, affect of dangerous ecological elements of the atmosphere (elevated background of radiation in reference to failures on the atomic energy stations, air pollution of water, the usage of poorquality merchandise with excessive contents of agricultural chemical compounds, pesticides, and many others.) has particular worth within the purulent an infection spreading.

Classification of Surgical An infection

Relying upon the ethiology: staphylococcal, streptococcal, pneumococcal, collibacillosis, pseudomonas aeruginosa, gonococcal, anaerobic asporous, claustrid anaerobic, blended and other forms of an infection are distinguished.

After the localization of the infectious course of: surgical an infection of the pores and skin and hypodermis, an infection of the pores and skin on the cranium and its contents (mind, membranes), purulent an infection of the thorax and organs (lungs, mediastinum), infections of the peritoneum and stomach organs, harm to the pelvic organs, an infection of the bones and joints.

In accordance with the extent of the scientific image manifestation, acute and continual varieties are distinguished. Acute surgical an infection relying upon the infectious agent and character of the scientific image is split into purulent, putrefactive, nonspecific anaerobic (fuel gangrene), particular anaerobic (tetanus, diphtheria).

Persistent surgical infections are divided into nonspecific and particular (tuberculosis, syphilis, actinomycosis). Every of the listed varieties can run with the prevalence of native indicators (native surgical an infection) or systematic phenomena with a septic course (systematic surgical an infection).

Aetiology and Pathogenesis of Surgical An infection

Now the fundamental brokers of purulent an infection are staphylococcus, E. coli. Staphylococcus takes the central place among the many brokers of purulent an infection; it’s noticed (as much as 80%) each in monoculture and in associations with E. coli, streptococcus, fungi, and many others.

Distinguished options of a staphylococcal an infection are quick incidence of antibiotic-resistant pressure, important poisonous affect on the organism because of toxins and enzymes (staphylohemolysin, staphyloleukolysis, plasmocoagulase), excessive virulence, skill emigrate and kind metastatic abscesses.

Vast-spread within the pre-antibiotic period, aerobes (streptococcus, gonococcus, and pneumococcus) seldom trigger purulent an infection in the present day; they’re excreted, principally, in affiliation with different microflora. E. coli takes the second place (47%) within the aetiology of purulent processes; it could possibly exist in cardio and anaerobic circumstances, continuously varieties associations with staphylococcus and streptococcus, particularly within the pathology of the stomach organs.

Sources of purulent an infection will be saprophytes (protei, pseudomonas aeruginosa), extensively unfold within the atmosphere, on pores and skin and mucous membranes. They’ve particular worth with the lower in immunity, in depth traumas (burns), could also be the reason for sepsis.

Final years after the introduction into the scientific apply of particular microbiological strategies and nutrient mediums, it was proved that within the aetiology of pyoinflammatory illnesses a big function is performed by aclostrium (asporous) anaerobes, which weren’t revealed by widespread strategies. They encompass Gr-positive (peptococcus, peptostreptococcus, lactobacills) and Gr-negative (bacteroids, fusobacteria, campylobacteria) sorts.

Peculiarity of anaerobic aclaustrium an infection is its quick progressiveness and spreading to the areolar tissue with the prevalence of necrolysis processes and endogenic intoxication. Aclaustrium anaerobes are excreted throughout wound an infection of the stomach cavity, peritonitis, pelvic abscesses, paraproctitis, and abscess of the lungs.

Many elements affect the pathogenesis of purulent an infection improvement. An important ones are infringement of the pores and skin or mucous membrane trophic on the entry of an infection, the situation of the organism’s protecting forces, microflorae virulence. Microbes won’t penetrate an organism by way of undamaged pores and skin or mucous membranes. Even an insignificant trauma of the pores and skin promotes microbic invasion into the organism. The circumstances of blood and lymph circulation of the given space have particular worth. Purulent processes develop much less usually on the pinnacle and face (because of dense blood vessel community) than on different areas of the physique. An necessary function is performed by “native” immunity of the tissue. For instance, the perineum space, on account of fixed motion of microbes and their toxins, has a big pores and skin resistance to microbic invasion. Injury to the pores and skin and mucous membranes promotes the penetration of microflora, however their division and development happen solely in 6 h. The rules of major surgical processing of contaminated wounds are based mostly on this reality. The presence of nutrient medium (haemorrhages, useless tissue) within the injured zone promotes to the event of an infection.

An necessary issue within the pathogenesis is microflora virulence and its resistance to antibiotics. Poisonous microbic substrata (hemolysin, leukocidin, necrotoxin, and many others.) together with enzymes (plasmocoagulase, hyaluronidase) function on the cell penetration and your entire organism. The spreading and improvement of the inflammatory course of throughout microbic invasion are decided by the interrelation between the quantity and virulence of microflora, which will get to an organism, with the immune forces of an organism.

With a giant doze of virulence of the microflora and weak protecting forces of an organism, there’s quick improvement of the irritation and even generalization of the method (sepsis). With the reverse ratio, the inflammatory course of localizes and stops.

The organism reacts to the penetration of an infection with native and systematic indicators — ache, hypostasis, infringement of perform, hyperemia, venous stasis, and enhance in temperature. Hyperergetic, normergic, hypergic and anergic types of irritation are distinguished.

Hyperergetic response is characterised by a tough course with the event of serious hypostasis, necrolysis, sharp deterioration of the final situation (intoxication, hyperthermia, hypotension). Normergic irritation is accompanied by reasonable tissue hypostasis, favorable course with non-pronounced common response of the organism. Hypergic response is expressed by obscure common and native symptomatology: native course of, subfebrile temperature. The irritation is shortly stopped; it’s noticed throughout non-pronounced immune standing, continuously doesn’t require remedy, and completes spontaneously.

Anergic response happens throughout sharp lower within the immune standing, within the case of lengthy utilization of antibiotics or hormonal preparations. An in depth uncared for purulent course of with important destruction with out hyperemia and hypostasis of the pores and skin, a so-called “sac of pus” is noticed. In addition to, the final protecting response is sharply decreased (non-pronounced leukocytosis, leukopenia, secondary immunodeficiency phenomena).

The organism’s common response to microbic invasion seems as signs of intoxication (headache, weak point, fever, tachycardia, hypotension, encephalopathy) and adjustments within the blood (leukocytosis, enhance within the ESR, left shift of leukocytes, hypoproteinemia, enhance in immunoglobulin, development within the phagocytar exercise). Within the case of an infection spreading, the intoxication phenomena progress, infringements of the cleansing organs features (acute hepatic or renal insufficiency) happen, lower within the immune standing (lower within the leukocytic exercise, phagocytosis, immunodeficiency phenomena happen).

Fashionable Strategies of Treating Pyoinflammatory Ailments

It’s cheap to mix common and native sorts of remedy. Native remedy is directed on preventing towards microflora and correcting the course of the wound course of. The motion on microflora is achieved with antibiotic remedy and antiseptics.

Antibiotic remedy needs to be carried out with due regard for microorganism’s sensitivity and the macroorganism’s response. Earlier than utilizing antibiotics it’s essential to determine the microflora within the wound and decide the antibiotic-sensitivity (pure tradition, antibioticogram). The microflora’s sensitivity is usually decided with the antibioticogram disk (if the zone of development delay is lower than 15 mm in diameter — sensitivity; from 15 as much as 25 mm — resistance; whether it is greater than 25 mm — excessive resistance ). It’s attainable to make use of an express-method to find out sensitivity with out the excretion of a pure tradition through the use of indicators (2.6-dichlorophenolindophenol, pink blood salt) with the assistance of phase-contrast microscopy. As a way to stop problems (rash, anaphylactic shock) it’s essential to conduct for all of the sufferers the pores and skin check earlier than utilizing antibiotics. Sufferers with medical allergic reactions needs to be carried out sequentially the over-skin, scarification and pores and skin checks.

Antibiotics are appointed in ample dozes (many medical doctors desire the dozes greater than therapeutic), some preparations with taking into consideration synergism and for a short while (4–5 days) with the next verify of the antibioticogram and alter of the preparation to forestall the incidence of antibiotic-resistant or antibioticdependant strains of micro organism. Antibiotic remedy is utilized parenterally. Just a few preparations are entered regionally into the wound, as a result of a majority of them inactivate within the acidic medium of irritation. Intravenous, intraarterial and endolymphatic methods of introduction prevail, which supplies efficient focus of antibiotics within the pathological focus.

Final years, antibiotics of the second technology are largely used: semisynthetic penicillin (ampicillin, carbenicillin, ampiox), cephalosporin, aminoglycoside, semisynthetic tetracycline. Antibiotics of the primary technology (benzylpenicillin, streptomycin, chloramphenicolum, tetracycline) are nearly not utilized, due to broad spreading of antibiotic dependance on account of mutagen motion on microflora. As a way to stop the problems it’s essential to comply with the foundations: antibiotics are utilized in massive doses;

they mix antibacterial preparations and antibiotics whichhave totally different mechanisms and spectrum of motion, in addition to mix the methods of introduction.

Amongst chemical antibacterial preparations, sulfanilamides, primarily of lengthy motion, are utilized (sulfapyridosin, sulfadimethoxin, sulfalen), preparations of sulfanilamides with derivatives of diaminopyrimidin (bactrim, biseptol). In addition to, the derivatives of quinoxaline are utilized (dioxydinum, chlorhexidin gluconate), which take impact on resistant antibiotic strains, microflorae. Such derivatives of nitrofuran as furacilinum, kalium furagin are utilized within the remedy of pyoinflammatory illnesses.

The motion on the course of the wound and purulent processes, to begin with, begins with surgical strategies: early elimination of the an infection foci, incision and rational drainage of the abscesses, it’s higher to make use of lively strategies of drainage. Proteolytic enzymes are utilized efficiently on the hydration section for necrolysis (trypsin, chymotrypsin, plasmin, papain, ribonuclease, desoxyribonucleasa) which have proteolytic, anticoagulant and dehydrational results. Cleaning the injuries of pus, necrotic plenty, and the incidence of granulations throughout remedy with proteolytic enzymes occurs 1.5 occasions quicker than with conventional strategies of remedy. It permits the appliance of an early secondary suture, autodermoplasty. For the final years bodily strategies of remedy of purulent surgical an infection have develop into widespread: remedy by laser, ultrasound, ultra-violet irradiation of wounds, diodynamical currents. Targeted laser rays are used (quantum mills on carbonic fuel or argon), and non-focused rays (helium-neon). The primary ones are utilized as a surgical scalpel for incision of abscesses and eradicating necrotic mass. Thus, the bactericidal motion (discount of microbes in wounds, lower within the pathogenicity of microflora) is pronounced. The nonfocused therapeutic laser (helium-neon) additionally corrects the bactericidal motion, promotes early cleaning of necrolysis from the wound and the incidence of granulations. Ultrasound is efficiently utilized too. Bactericidal property of ultrasonic waves is predetermined by bodily, chemical, and organic processes (cleaning of pus and necrotic tissue from a wound, motion on microflora and stimulation of bodily processes within the affected person’s organism).

The best impact of ultrasound is with gram-negative flora (Pseudomonas aeruginosa, E. coli). Strategies of systematic motion on purulent an infection encompass transfusion and disintoxication therapies, in addition to immunological strategies.

Disintoxication remedy is directed on absorption of poisons from the broken web site, dilution, binding and eradicating the toxins from the circulatory system. A lower in absorption of poisons from the an infection focus is achieved by surgical strategies (broad sectioning, necretomy, drainage, lively aspiration), in addition to steady irrigation with antiseptic options and antibiotic remedy. As a way to dilute and take away toxins, blood substitutes with desintoxication actions are used (haemodes, neohaemodes, rheopolyglucin), albuminous preparations (albumin, albuminous hydrolysate), colloidal options with the overall quantity of 4–5 l a day. As a way to take away toxins, intensified diuresis, peritoneal dialysis, and haemodialysis are used.

Adsorption of poisons is efficiently carried out by strategies of extracorporal cleansing (hemosorption, plasmosorption, plasmapheresis, lymphosorption, haemofiltration, xenospleen software, xenoliver). The destruction of poisons is promoted by such strategies as oxygenotherapy, hyperbaric oxygenation, ultra-violet irradiation of the blood.

Immunotherapy for purulent an infection is pathogenetically justified, as a result of to a sure extent secondary immunodeficiency develops, which might worsen the affected person’s situation through the use of antibiotic remedy. Immunotherapy consists within the software of the substitute remedy and immune correction. Haemotransfusions, hyperimmune serums (antistaphylococcal, anticollibacillary, and many others.), gamma-globulin, staphylococcal anatoxin, and bacteriophage, that are utilized for sepsis, peritonitis, i.e. within the case of a extreme purulent an infection with its generalization, are used as substitute remedy. With a continual an infection staphylococcal anatoxins, Pseudomonas aeruginosa and Proteus vaccines, which permit the creation of a neighborhood lively immunity, are used. Artificial (prodigiosan, methyluracil, decaris, levamizol) and pure immune stimulators (preparations of the thymus — tactivin, thymalin, timosin; the bone marrow — myelopeptide and so forth) are utilized as lively immune remedy, moreover of vaccines and anatoxins.

PURULENT DISEASES OF THE SKIN AND SUBCUTANEOUS FAT

Furuncule, anthrax, hydradenitis, abscess, phlegmon, and erysipelatous irritation belong to illnesses of this group. Purulent illnesses of the pores and skin and subcutaneous fats have two levels of improvement: the infiltration stage and the abscess stage. Therapy is carried out in response to the stage of the illness. Conservative strategies are utilized on the I stage: antibiotic remedy, physiotherapy (UVrays, solux, quartz, dry warmth), desintoxication remedy. On the ІІ stage with the event of an abscess operative strategies are utilized (chopping, drainage), remedy of purulent wounds. It’s supplemented with antibiotic and antiseptic remedy, desintoxication remedy and if vital — immunotherapy.

Furuncule is an acute purulent irritation of the hair follicle and surrounding tissue. The preceded elements are air pollution of the pores and skin, avitaminosis, metabolic issues (for instance, diabetes). The direct cause — a repeated trauma to the pores and skin.

Localization: the forearm, the again of the hand, the neck, the buttocks. Fundamental attributes: itching, ache, redness, hypostasis of the pores and skin, subfebrile temperature. Within the I stage (2nd–third day) — round of hair a small pustule with inflammatory infiltration like a nodule varieties. Within the ІІ stage (third–seventh day) on the highest of the infiltration necrosis (black speck) seems, purulent disintegration of the infiltration as a core happens. Pus discharge is noticed, the purulent wound after cleaning is filled with granulations. Additional, a whitish scar is shaped. Problems: thrombophlebitis, thrombosis of the venous sinus of the mind (with the localization on the higher lip), basal meningitis, sepsis.

Formation of a number of furuncules is known as furunculosis, a scientific illness. It develops in weakened sufferers with infringement of the immune standing, metabolism diseases (diabetes, and many others.). Therapy of a furuncule is decided by the stage of the illness. With the infiltration stage conservative remedy is utilized: broad-spectrum antibiotics, rubbing with spirit, good inexperienced, dry warmth (hot-water bottles, UV, quartz, solux). With the abscess stage (3–8 days) — incision of the abscess and subsequent remedy of the purulent wound. With furunculosis, remedy is supplemented with autohemotherapy, immunotherapy (staphylococcal anatoxin, vaccine, thymus preparations, decaris).

Carbuncule is acute in depth pyonecrotic irritation of a number of hair follicles and sebaceous glands with necrosis formation on the pores and skin and subcutaneous layer. The explanations are the identical as for furunculosis. The illness is promoted by: hypovitaminosis, exhaustion, metabolic illnesses (adiposity, diabetes). The localization is identical as for furunculosis. The scientific image is characterised by systematic and native semiology. On the I stage, a sharply painful infiltration with crimson pores and skin that covers the hair saccule and sebaceous glands is noticed; there are a number of apertures, by way of which pus discharges. In the course of the ІІ stage, the apertures merge, forming a defect on the pores and skin, a lot of pus discharge, necrosis reaches the subordinate fascia. Systematic phenomena: the temperature is as much as 39– 40°C , attributes of intoxication (headache, nausea, vomiting, sleeplessness, typically delirium). Problems: lymphangitis, lymphadenitis, thrombophlebitis, thrombosis of the venous sinus of the mind, meningitis (localized on the higher lip and face), sepsis. Therapy relies upon upon the section of the method. In the course of the I section — conservative remedy like for furunculosis. Antibiotic remedy needs to be carried out intravenously together with sulfanilamide. Surgical remedy begins in 3 days if conservative remedy was inefficient. Incisions on the abscess are finished x-like whereas eradicating the necrotic tissue. The next remedy is carried out by the precept of treating purulent wounds (drainage, native software of antiseptics, proteolytic enzymes, and many others.).

Hydradenitis — acute purulent irritation of the sudoriferous glands. Localization: underarm, genital and perianal areas, in girls — the nipples space. Causes and aiding elements for the illness: sweating, untidiness, eczema. In the course of the I stage — a dense painful nodule coated with unchanged pores and skin. In the course of the I stage — a purple-reddish nodule with fluctuation; milky pus discharges by way of the small aperture. The merging of a number of inflammatory infiltrations is feasible. Hydradenitis is seldom accompanied by intoxication, continuously has sub-acute and long-term course. Therapy: throughout the I stage — conservative remedy much like treating furunculosis. In the course of the ІІ stage — incision and treating the purulent wound. With a long-term course autohemotherapy in small dozes will be utilized.

Abscess is a restricted accumulation of pus in tissues and organs. Causes: injections, wounds, penetration of an infection throughout medical measures (hypodermic, intramuscular injections), and purulent hematomas. Abscesses can develop round overseas objects. Their brokers will be numerous microflora. Nonetheless, extra usually — staphylococcus, streptococci, E. coli, Protea. Abscesses happen in cavities of purulent irritation (furuncule, anthrax, hydradenitis, lymphadenitis, and many others.). With superficial abscesses, hyperemia of the pores and skin, swelling, fluctuation are noticed over them. The scientific illness is accompanied by ache (largely pulsating), attributes of intoxication, fever, tachycardia, headache, weak point, left-shift leukocytosis. The peculiar function of the abscess is a pyogenic membrane — the internal wall, coated with granulation tissue, that exactly separates the pyogenic abscess from the wholesome tissue. Abscesses needs to be distinguished from hematomas, spinal tuberculosis, aneurysms, and vascular tumours. The prognosis of deeply positioned abscesses, particularly inside organs’, is tough. Pc tomography, roentgenography assist in prognosis. Therapy is surgical. Incision, elimination of necrotic tissue, drainage (ideally — lively), subsequent remedy is carried out much like a purulent wound.

Phlegmon is an acute in depth purulent irritation of the areolar tissue (hypodermic, intermuscular, retroperitoneal). Not like to abscesses, with phlegmons the method is just not restricted however spreads to the areolar tissue. The phlegmon is an impartial illness, however is usually a complication of purulent processes (anthrax, abscess, sepsis). Purulent, pyo-hemorrhagic, and putrefactive types of phlegmons are distinguished by the character of the exudate. Relying upon the localization, phlegmons will be epifascial or subfascial (intermuscular). Particular localizations are distinguished: paranephritis, paracolitis, paraproctitis. The scientific course is characterised by inflammatory infiltration with out exact borders with the next softening, excessive fever, intoxication, chills. Problems: lymphadenitis, erysipelas, thrombophlebitis, sepsis, purulent arthritides, purulent meningitis.

In the course of the preliminary stage, conservative remedy (antibiotics, loads of liquids, cardiac substances, dry warmth, solux) is carried out. With the formation of abscesses — incision and drainage. In specialised hospitals lively surgical administration is utilized — broad incision of the useless tissue, drainage with lively aspiration. With in depth phlegmons, sophisticated by sepsis, hyperbaric oxygenation and other forms of extracorporal detoxifications (hemosorption, plasmosorption, plasmapheresis) are utilized. After incision of the in depth phlegmons, it’s attainable to use aerotherapeutic apparatuses (АТV3, АТV-5) with regulated abacterial medium.

Erysipelatous irritation is acute purulent harm to the pores and skin (sometimes mucous membranes), which are sometimes brought on by haemolytic streptococcus. Erysipelas is a model of the organism’s response to microflora with allergic reorganization: acute or latent an infection, endogenic finishing issue, allergic response, pores and skin trophic harm, transition of the an infection into the latent kind. The scientific course is progressing with the prevalence of systematic intoxication phenomena (headache, vomiting, fever, tachycardia). Native adjustments have a section course. The next scientific types of erysipelas are distinguished: erythematous, bullous, phlegmonous, necrotic. These phases flip one into one other. The erythematous kind is characterised by redness with pronounced exact border between the wholesome and broken websites (“tongues of fireplace”), pronounced itching and hypostasis of the pores and skin. The bullous kind is characterised by the incidence of blisters within the redness zone with yellowish or haemorrhagic exudate. Deeper harm with the incidence of a phlegmon (phlegmonous kind) or necrosis of the pores and skin (necrotic kind) is noticed if purulent an infection accompanies. Localization: the extremities, the scrotum, the penis, the face. Erysipelas will be crawling (with gradual spreading to the following space) or migrating (wandering) — consecutive harm to totally different components of the physique. Problems: improvement of extreme toxemia, purulent harm to mucous membranes, tendons, muscle mass, joints, thrombophlebitis.

Therapy is carried out relying upon the shape. With erythematous kind they appoint antibiotics, sulfanilamides, ultra-violet irradiation (sub-erythematous and erythematous doses). With the bullous kind, the blisters are incised open, processed with spirit, and suspensions or ointments with antibiotics are utilized. With phlegmonous or gangrenous varieties, the congestion of pus are opened; the wound is drained; the necrotic tissue is deleted. Desensitized means are additionally utilized (dimedrol, suprastin, calcium chloride, roentgenotherapy in small doses), immunotherapy will be utilized (antistreptococcal vaccine), particularly for the migrating recurrent varieties.

Erysipeloid is a crawling erythema of the pores and skin, or pig erysipelas. It’s brought on by the pig erysipelas bacillus (Erysipelothrix rhusiopathiae) throughout contact with sick animals (staff of meat-packing crops, farms endure from it), it’s attainable to catch it whereas processing uncooked meat or fish. It’s characterised by serous irritation of all layers of the pores and skin with hyperemia, hypostasis, pronounced itching. It’s accompanied by lymphostasis and lymphangitis. Localization: fingers, arms. The affected person’s common situation normally doesn’t change. Erysipeloids can relapse and migrate to different fingers.

Therapy. Antibiotic remedy, software of particular serums, ultra-violet irradiation, roentgenotherapy.

Purulent Ailments of Mobile Areas and Organs

Mediastinitis is a purulent irritation of the connective tissue of the mediastinum.

Aetiology and pathogenesis. Causative brokers are extra usually staphylococcus, enterobacteria, much less usually anaerobes. Purpose: harm to the esophagus by overseas objects or throughout endoscopy, purulent problems after operations on the esophagus, the lungs, the center. Much less usually: lymphogenic or from the oral cavity (carious enamel, tonsils).

Medical image. Prognosis of mediastinitis is advanced, as a result of the scientific course is continuously hidden behind the first course of, the supply of the illness (pneumonia, phlegmon of the neck, harm to the esophagus).

Restricted (abscesses) and in depth (phlegmons) processes are distinguished. After the kind of the agent: purulent and putrefactive. Mediastinitis has the course with out exact signs towards a background of pronounced intoxication (fever, temperature as much as 40°C, fever, tachycardia, hypotension). Ache behind the sternum is essentially the most pronounced symptom. For anterior mediastinitis, pains within the sternum and behind it, their amplification throughout sternum percussion, whereas leaning the pinnacle backward, and swelling of the neck are typical.

Throughout posterior mediastinitis, pains are typical between the scapulas, within the again, within the epigastric space. With wounds to the esophagus, pains happen throughout swallowing. In circumstances of anaerobic or putrefactive processes emphysema of the mediastinum is detected radiologically. Hypodermical emphysema is decided throughout palpation of the neck.

With the aim of decreasing the ache, sufferers take a compelled place (sitting or semi-sitting with the pinnacle leaned ahead).

Compression of the neurovascular formations (the aorta, the pulmonary artery, the vagus and diaphragm nerves, sympathetic fulcrum) is a really extreme complication. Consequently, hoarseness, hiccups, vomiting, paroxysmal coughs, dyspnea could happen. Purulent mediastinitis is important to differentiate from pneumonia, pleurisy, pericarditis, tumours of the mediastinum, tubercular spots. Pc tomography, radiography, esophagoscopy and mediastinoscopy are utilized with this function.

Therapy ought to start with antibiotic remedy (semisynthetic penicillin, aminoglycosides, cephalosporins. With the presence of attributes of abscesses and putrefactive irritation surgical remedy (mediastinotomy) is carried out. Considering excessive lethality of the illness, in the present day there are numerous indications to an operation. With anterior mediastinitis, the incision is made above the sternum and within the fossa beneath the sternum (beneath the xiphoid course of). The cervical mediastinotomy by В. І. Razumovsky (incision alongside the interior fringe of the m.sternocleidomastoideus whereas accessing the periesophageal area, the anterior mediastinum) is extensively utilized. Posterior mediastinotomy is carried out by I. І. Nasilov’s technique (incision on the again parallel to the spinal column with extra two horizontal incisions on the ends, which permits to search out the orifice and after the ribs incision to make incision of mediastinitis behind the pleura). It is rather necessary throughout surgical remedy to supply lively aspiration of the pus with flowing washing (two-opening drainage tubes, an aspirator with a dilution price of fifty–100 mmH₂O).

For laundry the cavity they use antiseptics (dioxydine, dimexide, furacilin), proteolytic enzymes (trypsin, chymotrypsin). Intra- and extracorporal cleansing, haemotransfusions, desintoxication with blood substitutes are strategies extensively used to combat towards intoxication.

Paranephritis is purulent irritation of the renal cortex.

Aetiology and pathogenesis. Causative brokers are extra usually staphylococcus, E. coli, much less usually — saprophytes and anaerobes. Purpose: direct bringing of the an infection throughout acute or continual processes within the kidneys (purulent nephritis, pyelitis, abscess), much less usually — lymphogenic means throughout purulent processes within the stomach organs.

Medical image. Within the preliminary levels of the illness, the prognosis is tough to find out, as a result of the scientific course consists largely of systematic semiology (indisposition, fever, headache) and non-pronounced native attributes (ache within the again, swelling, tissue hypostasis). Ache seldom has a exact localization. Later, the ache is extra exactly positioned, irradiates into the leg (particularly throughout crawling abscess alongside the large lumbar muscle and the psoas-abscess formation). Painful inflammatory infiltration of dense-elastic consistence within the lumbar space (typically in the fitting subcostal space by the sting of the rectal muscle mass) is decided. When mendacity on the abdomen, lateral curvature of the lumbar division of the backbone with the deviation of the road of the spinous course of in direction of the wholesome aspect, smoothed contours on the corresponding half of the again, strain of the muscle mass of the again are marked. The illness is accompanied by pronounced adjustments within the urine: leukocyturia, hematuria, cylindruria. Paranephritis needs to be distinguished from phlegmons of the retroperitoneal cavity, retroperitoneal acute appendicitis.

Therapy ought to start with antibiotic remedy (semisynthetic penicillin, aminoglycosides, cephalosporins). With the primary attributes of abscess (hectic fever, pulsating pains) lumbotomy with broad incision of the abscess is carried out. Within the postoperative interval, washing the abscess, lively aspiration are carried out. With the phenomena of generalization of the an infection and endotoxicosis, intra- and extracorporal detoxication strategies are extensively used.

Paraproctitis is a purulent irritation of the perirectal tissue.

Aetiology and pathogenesis. Illness is brought on by blended microflora (staphylococcus, enterococcus, E.coli, anaerobes). It’s noticed extra usually in males. The illness is brought on by cracks within the rectum space, irritation of haemorrhoidal nodules, harm to the rectal mucosa, pores and skin scretches.

Medical image. Two types of the course are distinguished: diffuse (phlegmon of the pararectal space) and restricted. Phlegmon of the pararectal tissue is characterised by a really extreme course (quick spreading, necrosis of tissue, pronounced intoxication), noticed throughout gunshot wounds, most cancers of the rectum, uric phlegmons.

Restricted paraproctitis will be noticed within the following varieties: hypodermic, ischiorectal, submucosal, pelviorectal, retrorectal. The hypodermic abscess, as a rule, is across the anus. Swelling, hyperemia of the pores and skin, issue and ache throughout defecation are decided. Ischiorectal paraproctitis has a way more extreme course (excessive temperature, fever, intoxication). Thus, the method spreads across the rectum to the prostate gland and pelvis. Throughout palpation of the rectum painful infiltration is decided. Submucosal abscess is normally positioned within the submucous layer of the rectum above anorectal strains. Throughout palpation painful hypostasis of the abscess within the anus space is decided. Not like to hypodermic abscess the ache is much less intensive. Pelviorectal abscesses is a uncommon type of paraproctitis; the abscess is positioned, as a rule, above the pelvic ground. In distinction to different varieties the onset of the illness has an asymptomatic course.

Retrorectal abscesses are shaped on account of the an infection bringing into the lymph nodes; it’s positioned behind the rectum; it’s also asymptomatic to start with, then the method can go down into the ischiorectal space with the event of a phlegmon. Paraproctitis typically completes with the formation of intestinal fistulae.

Therapy. Within the infiltration stage, conservative remedy is utilized (antibiotics — semisynthetic penicillin, aminoglycosides, cephalosporin, liquid food plan to delay defecation). With a phlegmon or abscess, pressing surgical remedy is indicated. A simicircular incision is made, step 2 cm again from the exterior sphincter of the rectum. At submucosal abscesses the abscess incision is constructed from the aspect of the rectal lumen. With anaerobic paraproctitis broad incisions whereas eradicating the necrotic tissue is proven. Within the postoperative interval, washing with antiseptic options (hydrogen peroxide, dioxydin), proteolytic enzymes, sedentary baths with antiseptic options are used.

Parotitis is an irritation of the parotid glands. The an infection is introduced from the oral cavity shifting by way of the excretory duct of the parotid gland or by hematogenous or lymphogenous means. It happens in weakened sufferers throughout common an infection or in depth operations with pronounced dehydration or unhealthy care of the oral cavity. Causative brokers: staphylococci and streptococci. Restricted abscesses within the glands are shaped or phlegmon of the glands happens with spreading into the exterior mobile tissue. These sufferers continuously have purulent oedemas on the neck, temporal space.

Medical image. Within the parotid space there’s swelling, acute ache throughout palpation. It’s accompanied by deterioration of the final situation (fever, rise in temperature to 39–40°C, sophisticated swallowing and chewing).

Within the space of swelling there’s redness of the pores and skin, fluctuation. Hypostasis passes to the taste bud, neck, cheeks, submaxillary space. In some sufferers, paresis of the optical nerve happens. The abscess can transfer to the surface with the formation of fistulae by way of which sequestrations of useless parenchyma depart. Grave problems will be generalization of the an infection (sepsis), inflicting excessive lethality.

Therapy. Within the preliminary levels antibiotics are used (semisynthetic penicillin, aminoglycosides, cephalosporins), thermal procedures (warming compresses, solux), cautious sanitation of the oral cavity (rinsing with antiseptic options, therapeutic massage of the oral mucosa).

With an abscess surgical remedy is indicated — eradicating the purulent cells from the gland and creating good circumstances for draining the pus. Incision of the abscess needs to be carried out on the world of best fluctuation taking into consideration the route of the fundamental branches of the optical nerve (in parallel to them). They dissect the pores and skin and gland capsule, additional with a dressing forseps or finger open the abscess within the parenchyma, with out damaging the optical nerve branches. Additional they drainage, wash the wound with antiseptics, proteolytic enzymes. Native antibiotics, water-soluble ointments (levosin, levomecol, dioxicol, and many others.) are used. Plentiful consuming, full-value food plan, vitamin remedy, protein preparations.

With parotitis grave problems are attainable: bleeding from the gland vessels or carotid artery with purulent oedemas, improvement of a phlegmon within the peripharyngeal area, deep phlegmons of the neck.

Mastitis — irritation of the mammary gland tissues. Lactational mastitis of breast-feeding girls, mastitis neonatorum and mastitis of puberty are distinguished.

Aetiology and pathogenesis. Causative brokers: staphylococcus and enterobacteria. Methods of an infection: cracks within the nipple, intracanalicular (in feeding girls), hematogenous, lymphogenous (with endogenous infections). Aiding elements: galactostasia, unhealthy care of the breast throughout feeding.

Medical image. In accordance with the course, acute and continual varieties are distinguished. Acute mastitis is especially lactational. Persistent mastitis is seldom; they’re the consequence of mistaken remedy of acute processes or particular harm (tubercular, syphilitic). In accordance with the scientific image acute mastitis has the next varieties: serous, infiltration, abscess, phlegmonous, gangrenous. Mainly, these are phases of 1 course of which might go to one another.

The serous type of mastitis is characterised by the rise within the temperature as much as 38–39°C , diffuse hypostasis and ache within the breast. Any swelling of the glands with an increase in temperature needs to be thought-about as serous kind. The next progress of the method with mistaken remedy leads to the infiltration kind. Sharp painful infiltration with vague contours, with hyperemia of the pores and skin above it seems within the mammary glands; axillary lymph nodules are elevated, painful. Ache within the glands will increase; complications, sleeplessness, weak point are marked.

Adjustments within the blood: enhance in leukocytosis (10–12·109/l), enhance within the erythrocyte sedimentation price (ESR) (30–40 mm/h). With ineffective remedy the abscess section happens. Restricted infiltration and the presence of fluctuation, incidence of pulsating pains within the glands are marked. Common phenomena enhance: fever with the rise within the temperature as much as 39–40°C, enhance in leukocytosis (15–20·109/l), enhance within the ESR (50–60 mm/h). Abscesses within the gland will be positioned elsewhere: beneath the nipple (subareolar), contained in the mammary gland (intramammary), behind the mammary gland (retromammary). Retromammary localization continuously is the consequence of different inflammatory processes (osteomyelitis of the ribs). The next deterioration of the final situation with septic phenomena (repeated fever, enhance within the ESR and enhance in left-shift leukocytosis, lymphopenia, eosinophilia) leads to the phlegmonous kind. The mammary gland is elevated and swollen, sharp ache, hyperemia of the pores and skin, nipple is pulled in, areas of a number of fluctuations within the gland, acute dilation of the hypodermic veins, lymphangitis phenomena are noticed.

The gangrenous type of mastitis develops on account of thrombosis of the mammary vessels, characterised by essentially the most extreme course with intoxication phenomena (temperature of 40°C, tachycardia as much as 120 per min, hypotension, headache). Vital adjustments within the blood: with left-shift leukocytosis as much as 25 thousand/l, enhance within the ESR as much as 60–70 mm/h. The hypochromic anemia phenomena are noticed. The gland is sharply elevated, pastose, painful. The pores and skin above it’s pale-green or darkish blue-crimson, with websites of blisters and areas of necrosis. The regional lymph nodes are elevated, painful. Problems: improvement of sepsis.

Therapy is carried out relying upon the section. With serous and infiltration varieties, conservative remedy is run: breast feeding is just not stopped and promote the liquidation of galactosaria (guide or with gadget expression of breast milk), antibiotic remedy (semisynthetic penicillin, aminoglycosides, macrolides, cephalosporins), physiotherapy (solux, ultrasound, UV-irradiation, novocain, electrophoresis). It’s attainable to use retromammary novocain blockades with antibiotics. With the abscess kind, surgical remedy is finished. It’s essential to make incisions relying upon the localization of the abscesses: with subareolar — semilunar, with intramammary — radial incisions in response to the route of the lactic ducts, with retromammary — an arch-like incision alongside the pores and skin fold beneath the gland. Sufferers with phlegmonous and gangrenous varieties require pressing surgical remedy (some radial incisions in size of 8–10 cm, eradicating the necrotic tissue, drainage, washing with antiseptics). Therapy is supplemented with infusion remedy (antibiotics, haemotransfusions and blood substitutes, immunity stimulators), in addition to disintoxication (hemosorption, hyperbaric oxygenation).