EARLY RHEOLOGICAL DRUG THERAPY AND STIMULATION OF DELIMITING PROCESSES IN PATIENTS SUFFERING FROM ACUTE PANCREATITIS

The results of surgical treatment of 470 patients with acute pancreatitis of severe severity were studied. Out of 314 patients with infected pancreatonecrosis, 224 had retroperitoneal phlegmon and 90 - parapancreal abscesses. In this group of patients, early surgical treatment was used in the first 3-5 days from the time of admission. In all cases in the process of laparotomy open necrectomy and drainage were performed. In 156 patients of the second group, a savings technology was used for 4-8 weeks, aimed at distinguishing the purulent-necrotic process. Of these, 98 had local intra-arterial rheological therapy, 46 had early video laparoscopic drainage, and 12 had decompression retroperitoneal drainage. As soon as the delimitation (formation of the fluid cluster, parapancreatic cyst, abscess) was achieved, in 4-6 weeks in this group, minimally invasive transabdominal or transgastral drainage was performed and only open operations "on demand" were carried out with the progression of the purulent-necrotic process. The results of the treatment showed high mortality in the early extended operations in the first group of patients. With retroperitoneal phlegmon it reached 55.4 %. Savings tactics aimed at limiting the process in the retroperitoneal tissue and subsequent minimally invasive drainage, was characterized by a lower mortality - 31 (19.9 %) patient. Early video laparoscopic drainage of the abdominal cavity and retroperitoneal space (mortality - 10.9 %) and local rheological drug therapy (mortality - 21.4 %) were the most effective among the minimally invasive technologies of surgical treatment of pancreonecrosis, which facilitated the accelerated formation of the delimitation of the inflammatory process in the pancreas and retroperitoneal space

Результаты коррекции почечного кровотока в лечении больных гнойным пиелонефритом

Aim. This paper aims to examine the state of the renal blood circulation in patients with purulent pyelonephritis and to improve the quality of treatment through the use of our own technique.Materials and methods. The author personally examined and operated on 30 patients with confirmed purulent pyelonephritis in the conditions of a urology department at the regional clinical hospital. The author used his own method of treatment. A retroperitoneoscopic decapsulation of the affected kidney was performed on all the patients within the first 24 hours; this was combined with continuous regional arterial infusion of alprostadil within the next 72 hours. All the patients prior to surgery had undergone the following diagnostic procedures: general clinical examination, bolus contrast-enhanced MSCT of kidneys, renal duplex ultrasound, morphology examination.Results and discussion. The postoperative period in all the cases was good with the reduced number of days needed for treatment. On the first day after operation, the patients noted a reduction in the pain intensity in the affected side. The bolus contrast-enhanced MSCT imaging of kidneys in comparison to the data obtained prior to treatment demonstrates the disappearance of the destruction foci in the kidney and a clearly visible restored blood circulation in the affected side achieved rather fast. No patient required a nephrectomy.Conclusion. Every stage of the proposed treatment technique is an inalienable part of the method as a whole. Every stage is necessary to deliver the impact on its level of circulation, on the parenchyma affected by microabscesses, and on the infected areas. The method makes it possible to restore blood flow in the kidney and open up a path for the delivery of antibiotics into the organ parenchyma.Введение. В последние годы отмечается рост заболеваемости острым пиелонефритом. Ведение больных с острым осложненным пиелонефритом требует дальнейшего изучения, направленного на оптимизацию диагностического алгоритма и методов лечения.Цель работы: изучение состояния кровообращения в почке у больных с гнойным пиелонефритом и улучшение качества лечения данных больных путем внедрения собственной разработанной методики.Материалы и методы. В Краевой клинической больнице в условиях урологического отделения обследованы и прооперированы лично автором 30 больных с гнойным пиелонефритом по собственной методике с установленным диагнозом гнойного пиелонефрита. Всем больным в первые сутки предпринята ретроперитонеоскопическая декапсуляция почки на стороне поражения в сочетании с регионарной артериальной инфузией алпростадила в течение 3 суток. Всем больным перед операцией и после проводилось общеклиническое обследование, МСКТ почек с болюсным контрастированием, дуплексное сканирование сосудов почек, морфологическое исследование материала.Результаты и обсуждение. Во всех случаях послеоперационный период протекал благоприятно с сокращением сроков лечения. В первые сутки после операции больные отмечали снижение интенсивности болевого синдрома в области пораженной почки. При сравнении данных МСКТ почек с болюсным контрастированием, полученных у больных до лечения, определяется исчезновение очагов деструкции в почке и выраженное восстановление утраченного ранее кровотока почки на стороне поражения в ранние сроки. Ни в одном наблюдении не проведена нефрэктомия.Заключение. Каждый из этапов предложенного способа лечения острого гнойного пиелонефрита является неотъемлемой частью методики в целом, каждый этап необходим для воздействия на свой уровень сосудистого русла и паренхимы в области ее микроабсцессов и зон инфицирования. Метод позволяет добиться восстановления кровообращения в почке с открытием доступа антибиотиков в паренхиму органа

Effect of blood plasma cryoprecipitate on microflora growth taking into consideration possibilities for its use

The necessity of use of cryoprecipitate (CP) in clinic as a basis of biocomposite for creation of interstitial barrier to prevent the spread of retroperitoneal abscesses in necrotizing pancreatitis. The research of the influence of CP on the growth of microorganisms with three types of cultures (E. coli, Acinetobacter, E. faeccalis) was realized. Incubation of bacteriological environment (51 series) was carried out under standard conditions in the presence of CP, antibiotics and retroperitoneal adipose tissue with a visual assessment in vitro and by the change of the densitometric density of environments on the MicroScan Turbidity Meter (Siemens) unit. As it was stated, the presence of CP in pure form in bacteriological environment as well together with an antibiotic or adipose tissue does not affect the growth of investigated microflora and in combination with the antibiotic inhibits it suppresses growth. Taking into consideration the indifference of CP to microflora, its use as a drug interstitial barrier to the migration of retroperitoneal phlegmon in necrotizing pancreatitis the activation of abdominal infection is safe

Correction of Kidney Blood Circulation in Patients with Purulent Pyelonephritis

Aim. This paper aims to examine the state of the renal blood circulation in patients with purulent pyelonephritis and to improve the quality of treatment through the use of our own technique.Materials and methods. The author personally examined and operated on 30 patients with confirmed purulent pyelonephritis in the conditions of a urology department at the regional clinical hospital. The author used his own method of treatment. A retroperitoneoscopic decapsulation of the affected kidney was performed on all the patients within the first 24 hours; this was combined with continuous regional arterial infusion of alprostadil within the next 72 hours. All the patients prior to surgery had undergone the following diagnostic procedures: general clinical examination, bolus contrast-enhanced MSCT of kidneys, renal duplex ultrasound, morphology examination.Results and discussion. The postoperative period in all the cases was good with the reduced number of days needed for treatment. On the first day after operation, the patients noted a reduction in the pain intensity in the affected side. The bolus contrast-enhanced MSCT imaging of kidneys in comparison to the data obtained prior to treatment demonstrates the disappearance of the destruction foci in the kidney and a clearly visible restored blood circulation in the affected side achieved rather fast. No patient required a nephrectomy.Conclusion. Every stage of the proposed treatment technique is an inalienable part of the method as a whole. Every stage is necessary to deliver the impact on its level of circulation, on the parenchyma affected by microabscesses, and on the infected areas. The method makes it possible to restore blood flow in the kidney and open up a path for the delivery of antibiotics into the organ parenchyma

Biosynthesis of Bacterial Cellulose by Extended Cultivation with Multiple Removal of BC Pellicles

Extended cultivation with multiple removal of BC pellicles is proposed herein as a new biosynthetic process for bacterial cellulose (BC). This method enhances the BC surface area by 5–11 times per unit volume of the growth medium, improving the economic efficiency of biosynthesis. The resultant BC gel-films were thin, transparent, and congruent. The degree of polymerization (DP) and elastic modulus (EM) depended on the number of BC pellicle removals, vessel shape, and volume. The quality of BC from removals II–III to VII was better than from removal I. The process scale-up of 1:40 by volume increased DP by 1.5 times and EM by 5 times. A fact was established that the symbiotic Medusomyces gisevii Sa-12 was adaptable to exhausted growth medium: the medium was able to biosynthesize BC for 60 days, while glucose ran low at 24 days. On extended cultivation, DP and EM were found to decline by 39–64% and 57–65%, respectively. The BC gel-films obtained upon removals I–VI were successfully trialed in experimental tension-free hernioplasty