Possibilities of prophylaxis of purulent complications in patients with acute intestinal obstruction

Academia Medicală de Studii Postuniversitare, Harkov, Ucraina, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Mortalitatea postoperatorie prin complicaţii septice acute ce survin la 50-85% dintre pacienţii cu ocluzii intestinale acute (OIA) ajunge pînă la 17-21%. Injectarea intraluminală a antibioticelor, terapia parenterală empirică cu antibiotice, cît şi intubarea intestinului urmată de lavaj nu îmbunătăţesc parametrii indicaţi mai sus. Scopul studiului: Definirea rolului antibioticilor, care reprezintă cel mai răspîndit grup, în profilaxia complicaţiilor purulente septice în OIA. Material şi metode: Au fost analizate rezultatele tratamentului a 176 pacienţi, inclusiv a 62 cazuri diagnosticate cu OIA; obturaţie – în 82 cazuri, iar în 32 cazuri cauza a fost hernia strangulată. Primul grup a inclus 81 pacienţi, 41 dintre care au beneficiat de tratament parenteral cu preparate din grupul aminoglicozidelor şi 40 – preparate din seria penicilinelor. Al doilea grup a inclus 95 pacienţi, la 48 dintre care li s-au administrat preparate din grupul fluorochinolonelor şi 47 – preparate din seria cefalosporinelor. Alegerea preparatelor antibacteriene s-a bazat pe rezultatele studiului experimental de acumulare a antibioticelor în peretele intestinal inflamat. Rezultate: Eficacitatea terapiei antibacteriene a fost estimată prin frecvenţa ritmului cardiac, temperatura corpului, timpul de restabilire a peristalticii, normalizarea indicilor clinici ai sîngelui şi urinei, caracterul şi calitatea complicaţiilor purulente. În ambele grupuri nu au fost stabilite diferenţe semnificative referitoare la temperatura corpului şi timpul de restabilire a peristalticii. Au fost atestate deosebiri semnificative între grupuri în ceea ce priveşte timpul de normalizare a frecvenţei ritmului cardiac, formula sîngelui şi rata complicaţiilor purulente. În grupul al doilea de pacienţi numărul complicaţiilor inflamatorii purulente a fost de 21%, iar în primul grup, în care pacienţilor li s-au administrat preparate aminoglicozide – 33,3%. Concluzii: Utilizarea parenterală a fluorochinolonelor şi cefalosporinelor a influenţat rezultatele experimentului, diminuînd esenţial complicaţiile purulente septice asociate cu OIA.Introduction: Post-operative mortality with acute-septic complications in patients with acute intestinal obstruction (AIO) as its reason in 50-85% cases comprises 17-21%. Intraluminal introduction of antibiotics, empirical parenteral antibiotic therapy as well as intestinal intubation with further lavage did not improve the parameters mentioned above. The aim of study: Definition of antibiotics role, the most widespread groups, in septic complications prophylaxis in AIO. Material and methods: There were analyzed the results of treatment of 176 patients, including 62 cases with diagnosed AIO of adhesive genesis, obstructive – in 82 cases and 32 cases with strangulated hernia. The first group included 81 patients, 41 – have incurred preparations with parenteral aminoglycosides and 40 – preparations with penicillin series. The second group included 95 patients, 48 of them followed preparations with fluoroquinolones and 47 – with cephalosporin. The choice of antibacterial preparations was based on the data of experimental trial on antibiotics cumulation in the wall of inflamed intestine. Results: Efficacy of antibacterial therapy was estimated considering heart rate frequency, body temperature, and terms of peristaltic restoration, normalization of blood and urine tests, character and quality of purulent complications. In the second group of patients (fluoroquinolones and cephalosporins preparations) the number of purulent inflammatory complications was 21%, but in the first group (aminoglycosides) – 33.3%. Conclusion: Parenteral indication of fluoroquinolones and cephalosporines in patients with acute intestinal obstruction influence on the results essentially decreases the number of purulent complications correlated with AIO

Dynamics of cumulating of metronidazole in the gut wall on a model of mechanical ileus.

The frequency of acute intestinal obstruction in relation to urgent surgical diseases in Ukraine remains high and reaches 3.8-6%. In the postoperative period, such patients develop a high number of severe purulent-septic complications. For the prevention and treatment of purulent-septic complications, various combinations of antibiotics with metronidazole are used. On the model of experimental mechanical ileus, the ability of the modified bowel wall to retain metronidazole was determined. The experiment was performed on 20 lines of the "Vistar" line in which the mechanical model of the ileus was formed. The results of the study showed that the accumulation of metronidazole in the phlegmonous-altered gut wall at therapeutic concentrations occurs within the first 24 hours and is of a short-term nature. The lack of the possibility of cumulating of antibacterial drugs by the wall of the inflamed gut after 24 hours contributes to the development of purulent complications

Dynamics of cumulating of metronidazole in the gut wall on a model of mechanical ileus.

The frequency of acute intestinal obstruction in relation to urgent surgical diseases in Ukraine remains high and reaches 3.8-6%. In the postoperative period, such patients develop a high number of severe purulent-septic complications. For the prevention and treatment of purulent-septic complications, various combinations of antibiotics with metronidazole are used. On the model of experimental mechanical ileus, the ability of the modified bowel wall to retain metronidazole was determined. The experiment was performed on 20 lines of the "Vistar" line in which the mechanical model of the ileus was formed. The results of the study showed that the accumulation of metronidazole in the phlegmonous-altered gut wall at therapeutic concentrations occurs within the first 24 hours and is of a short-term nature. The lack of the possibility of cumulating of antibacterial drugs by the wall of the inflamed gut after 24 hours contributes to the development of purulent complications

Факторы риска развития и проявления острого холангита у больных с доброкачественной обструкцией внепеченочных желчных путей

Цель. Определение факторов, способствующих развитию острого холангита (ОХ) или являющихся его признаками при доброкачественной обструкции внепеченочных желчных путей (ДОВЖП). Материалы и методы. Ретроспективно проанализированы 144 наблюдения ДОВЖП, ОХ отмечен в 17 наблюдениях. Проведено сравнение встречаемости различных факторов и признаков у больных с ОХ и без ОХ. Результаты. Различия выявлены (p 0,05) между следующими показателями: пол, возраст, индекс массы тела, наличие абдоминального болевого синдрома, холецистэктомия в анамнезе, объем ЖП, причина обструкции, расширение гепатикохоледоха, эндоскопическая папиллосфинктеротомия в анамнезе, наличие околососочкового дивертикула и острого билиарного панкреатита. Выводы. Факторы риска развития ОХ: уровень общего билирубина 70 мкмоль/л и выше, утолщение стенки ЖП до 4 мм и более, отключенный ЖП, фиксированный камень БСДПК, размер БСДПК 15 мм и более. Проявления ОХ: гипертермия, наличие триады Шарко, лейкоцитоз 9 × 109 в 1 л и выше, увеличение содержания палочкоядерных нейтрофилов до 7% и выше, гиперамилаземия

The risk factors for development of an acute biliary pancreatitis and its signs in obstruction of extrahepaic bilairy ducts

Objective. A search for factors, promoting development of an acute biliary pancreatitis, and peculiarities of its signs in patients, suffering obstruction of extrahepatic biliary ducts. Materials and methods. Retrospective analysis of treatment in 283 patients, suffering obstruction of extrahepaic biliary ducts, was conducted, together with various indices analysis in patients, suffering an acute biliary pancreatitis and without acute biliary pancreatitis. Results. An acute biliary pancreatitis was diagnosed in 30 (10.6%) patients. Trustworthy differences (p < 0.05) were revealed, concerning pronounced pain syndrome, hyperthermia, leukocytosis, young neutrophils, general bilirubin, amylase in the blood, the gallbladder volume, choledocholithiasis, the fixed calculus and stenosis of duodenal papilla magna, cholangitis. Big calculi of hepaticocholedochus did not associated with development of an acute biliary pancreatitis, and a sludge in common biliary duct and stenosis of duodenal papilla magna were characteristic for an acute biliary pancreatitis (p < 0.001). Conclusion. Sludge of common biliary duct, stenosis and fixed calculus of duodenal papilla magna, bilirubinemia 70 mcmol/l and higher constitute the risk factors for development of an acute biliary pancreatitis, and the pronounced abdominal pain syndrome, hyperthermia, hyperamylasemia, leucocytosis, increase of the young neutrophils content up to 7% and higher, the volume of  a gallbladder 50 cm3 and more - served as the signs of an acute biliary pancreatitis in obstruction of extrahepatic biliary ducts. In obstruction of extrahepatic biliary ducts with an acute biliary pancreatitis, comparing with obstruction of extrahepatic biliary ducts without an acute biliary pancreatitis, cholangitis is revealed trustworthily: 16.7 and 5.1% accordingly (p < 0.05)