[Antibiotic therapy by suppurative diseases of the abdominal cavity and soft tissues].

Microbial background of the departments of abdominal and septic surgery was monitored and analyzed. More the 950 samples from each department was worked out. Therefore, it was determined, that gram-negative bacteria were more typical for the abdominal pathology, whereas, soft tissue infection was represented by gram-positive strains. Compliant antibioticogramms were performed and analyzed. For achieving effective prophylactic and empiric antibiotic therapy, data-based formular lists of antibacterial drugs were performed.

[Comparative results of endoscopic operations on account of soft tissues purulent diseases].

The results of open and endoscopic operations in 430 patients with purulent soft tissue diseases are comparatively studied. Hospital stay after the endoscopic treatment averaged 11,6+/-1,1 days. 90,8% of those, who were treated endoscopically, has completely recovered during the hospital stay and didn't require further treatment. 31,6% of patients experienced a suppuration of the postoperative wound, which called forth the conversion to the open operative technique. These patients had an average hospital stay of 15,6+/-2,1 days. The hospital stay of the patients treated traditionally with wide opening of the wound and secondary sutures, averaged 19,3+/-1,8 days. The hospital stay of patients with a complicated disease course was 26,4+/-3,4 days.

[Ultrasound evaluation of traumatic process course after endoscopic operations for pyoinflammatory diseases of soft tissues].

Soft tissues dynamic ultrasound investigation was applied for diagnostics of pyoinflammatory diseases. Ultrasound image correlated with intermuscular liquid formations (abscess, phlegmon) of soft tissues was revealed in 65 observations (100%). On the basis of findings 21 (32.3%) patients underwent surgical treatment of leg and gluteal region phlegmons and abscesses with application of traditional methods. Endoscopic operations on account of pyoinflammatory diseases of soft tissues were carried out in 44 (67.7%) patients. Ultrasound monitoring of traumatic process course was conducted. It is ascertained that total regress of purulent process occurs by the 14th day of postoperative period. Traumatic process regresses more rapid after endoscopic operations in comparison with traditional open methods.

[Early diagnosis of hospital infection based on monitoring of wound microflora at purulent surgery unit].

Microflora of purulent surgical wounds of patients of purulent surgery unit was studied, multiresistant strains were analyzed particularly. Data of 1994 and 1999 were compared with ones of 2004 bearing in mind the administration of new antibiotics (cefalosporins and phthorquinolones) since 2000. Etiology and causes of nasocomial infections, principles of early diagnosis are analyzed in detail.

[Current trends in surgical treatment of peritonitis].

Results of treatment using laparoscopic operations, traditional laparotomy with passive abdominal drainage and laparostomy at 1835 patients with peritonitis are analyzed. It is demonstrated that choice of surgical policy depends on ethiology, generalization of peritonitis, abdominal microphlora, degree of endogenous intoxication and organs failure, prognosis of disease. Lethality after laparoscopic operations was 1.8%, after traditional laparotomy--3.4%, after laparostomy--47.7%. Lethality at local peritonitis was 1.3%, at generalized--13.8%, at postoperative--22%. General lethality was 7.4%. Experimental studies on 55 mongrel dogs demonstrated the advantage of mechanical suture at peritonitis that prevents insufficiency of anastomoses.

[Videoendosurgical treatment of postinjection abscesses and phlegmons].

Method of treatment of postinjection abscesses and phlegmons was developed. This method includes endovideoscopy of purulent focus with creation of permanent liquid medium, visual revision of purulent cavity with evacuation of pus, controlled radical surgical treatment and introduction of perforated drainages for flowing drainage. Hand endoscopic instruments or special shaver were used for surgical necrectomy. Flowing-aspiration drainage of formed cavity was performed after surgery. This technique was used in 12 patients. It permitted to improve significantly results of treatment, reduce period of temporary disability and achieve good cosmetic effect.

[Principles of differentiated treatment of acute pancreatitis]. / Printsipy differentsirovannogo lecheniia ostrogo pankreatita.

Results of treatment of 3372 patients with acute pancreatitis for the period from 1990 to 2002 are analyzed. The authors have developed a medico-diagnostic algorithm for acute pancreatitis. The introduction of it into clinics allowed the general lethality from acute pancreatitis to be reduced to 2.9% for 11 years.

[Laparoscopic diagnosis and treatment of acute pancreatitis]. / Laparoskopicheskaia diagnostika i lechenie ostrogo pankreatita.

Laparoscopy and pancreatoscopy were performed in 2091 (62% of all hospitalized) patients with acute pancreatitis. High informative value of laparoscopy and pancreatoscopy in diagnosis of different morphologic forms of acute pancreatitis is demonstrated. Original fistula for pancreatoscopy was developed. It permits one to evaluate visually the dynamics of repair in the pancreas and surrounding tissues and to correct treatment policy.

[Possibilities in diagnostic laparoscopy of acute appendicitis]. / Vozmozhnosti diagnosticheskoi laparoskopii pri ostrom appenditsite.

Results of diagnostic laparoscopy in acute appendicitis suspects are presented. Laparoscopy allowed examination of the appendix in 96.5% cases, to make final diagnosis in 92.5% and to avoid surgery in 31.2% cases. Larger application of diagnostic laparoscopy in patients suspected of acute appendicitis will reduce significantly rate of diagnostic mistakes, complications and unwarranted appendectomies.

[Prophylaxis of complications in injuries of pancreas]. / Profilaktika oslozhnenii pri travme podzheludochnoi zhelezy.

One-stage operations in pancreatic injuries are characterized by high rate of complications (acute traumatic pancreatitis, peritonitis, sepsis, bleeding, etc.) and high mortality rate. The method of repeated sanations of omental bursa and sequestre-necrectomy of the pancreas through the fistulas used in 61 patients provided a considerable decrease of the rate of complications and mortality in injuries of the pancreas and acute traumatic pancreatitis.

[The surgical procedure in neck wounds]. / Khirurgicheskaia taktika pri raneniiakh shei.

The results of 44 patients treatment with neck wounds are analysed. Isolated wounds of the neck were shown to be in 77.3%, combined trauma was determined in 22.7% of examination. Cervical organ's injury had been revealed in 51 patients (84.1%). Postsurgical complications have developed in 6. The main reasons for complications occurred to be primary surgical wound treatment from little operative approach and noncomplete revision of the wound canal.

[Surgical treatment of acute destructive pancreatitis]. / Khirurgicheskoe lechenie ostrogo destruktivnogo pankreatita.

The possibilities of the accepted surgical tactics in the treatment of acute destructive pancreatitis based on a single operative intervention with drainage of the omental bursa and retroperitoneal space are very limited. It is not always possible to remove the necrotic tissues fully, arrest the inflammatory process, and completely cleanse the abdominal cavity, omental bursa, and parapancreatic fat during the operation. Reasoning from this, the authors suggest a method for treating acute destructive pancreatitis. It consists in the creation of an omentobursopancreatostoma followed by stage endoscopic necrectomy of pancreatic areas and endoscopic control over the course of regeneration in the omental bursa and retroperitoneal space till a chronic pancreatic fistula forms, which usually spontaneously closes later. With the use of this method in 46 patients with pancreonecrosis, postoperative complications and mortality reduced.