[Morphological justification of the effectiveness of ultrasonic cavitation with 0.2]. / Morfologicheskoe obosnovanie éffektivnosti primeneniia ul'trazvukovoi kavitatsii s 0,2 % rastvorom lavasepta pri lechenii gnoino-nekroticheskikh oslozhnenii sindroma diabeticheskoi stopy.

AIM: Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. MATERIAL AND METHODS: It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. RESULTS: Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.

[Oflomelid ointment: activity against hospital microbial strains].

Ofloxacin susceptibility was tested with the use of 100 hospital isolates by the disk diffusion method vs. the activity of Oflomelid ointment tested by the cavity method. It was shown that the hospital isolates of all the species were susceptible to the Oflomelid ointment, while susceptibility to ofloxacin was preserved in S. epidermidis, the susceptibility of Acinetobacter spp., E. coli, Proteus spp. being intermediate. Such a difference in the susceptibility of the isolates was evidently due to the properties of polyethylene glycols in the ointment composition.

[Pyo-necrotic injuries in case of the neuro-ischemic form of diabetic foot syndrome].

It was analyzed the results of examination and treatment of 217 patients with neuro-ischemic form of the diabetic foot syndrome. Diabetic macroangiopathy with critical limb ischemia (TASC II) was diagnosed in all patients. Tissue foot damage of grade 3 (Wagner) was observed in 100 (46.1%) patients, grade 4 - in 117 (53.9%) patients. The developed strategy of surgical treatment includes the revascularization of an affected limb, surgical management of a pyo-necrotic focus and the plastic reconstruction of the foot after rapid relief of ischemia symptoms. An application of such treatment strategy led to preserve a foot or a stump of the foot in 205 (94.5%) patients.

[Morphological and functional aspects of wound regeneration in the treatment by iodine-containing ointments].

The comprehensive morphological investigation indicated a high antimicrobial activity of iodine-containing ointments in the treatment of septic wounds from the first days of the ointments using. 3% ointment "Stellanin-PEG" helps to reduce the local inflammatory changes by activating neutrophils and macrophages. A management of wounds by 3% ointment "Stellanin-PEG" improves their condition by stimulating regeneration, which leads to an intensification of the proliferative and functional activity of granulation tissue. Clinical, morphological and cytological data are evidence of time reduction of relief of purulent process, which leads to an earlier (in comparison with the use of ointment "Betadine") wound epithelization.

[Dioxidin: antimicrobial activity and prospects of its clinical use at present].

In vitro activity of dioxidin against pathogens of nosocomial infections and its cytotoxicity were estimated. The study involved 300 isolates from patients with nosocomial infections. The MICs of dioxidin were determined with the method of serial dilutions in broth. The dioxidin cytotoxicity was investigated with the MTI assay to assign the cell culture viability. In concentrations of 2 to 1024 meg/mi dioxidin was active against 279/300 (93%) strains. The drug inhibited the growth of all the gramnegative isolates. The highest activitywas observed against Enterobacteriaceae vs. nonfermenting gramnegative bacteria: the median, minimum and maximum MICs of dioxidin were 12 (4-32) and 32 (16-64) mcg/ml respectively. The dioxidin activity against gramnegative bacteria and fungi was lower. The MIC of dioxidin for 7/70 (10%) staphylococcal isolates, 9/28 (32%) enterococcal isolates and all the Candida isolates was > 1024 mcg/ml. The IC50 of dioxidin was 2.4+/-0.3 mM (low cytotoxicity). The results showed that the use of dioxidin as an antimicrobial for local application was advisable in the treatment of gramnegative bacterial infections provided adequate tissue concentrations were attained.

[Rapid bioluminescent antibiotic susceptibility assay].

Rapid testing of pathogen susceptibility to antibiotics is of great practical value for rational chemotherapy of pyoinflammatory deseases and postoperative complications of microbial etiology. The standard microbiological methods, i.e., the disk diffusion method and the method of serial dilutions are labour- and time-consuming (not less than 18-36 hours). The method of the authors is based on measuring bioluminescence resulting from interaction of adenosine-5'-triphosphate (ATP) and ATP reagent, a standard reaction mixture of firefly luciferase (an enzyme) and luciferin. The bioluminescence intensity is proportional to the ATP concentration in the reaction mixture and the ATP concentration is proportional to the number of the pathogen viable cells in the sample. The bioluminescence intensity value in the pathogen suspension aliquots with and without (control) the antibiotic were compared after the incubation for 5 hours and the coefficient of the microbial cell growth inhibition was calculated. Satisfactory correlation (R2 > 88%) of the results of the bioluminescent assay and the assay with the disk diffusion method and the method of serial dilutions was observed.

[Stellanin-PEG 3% ointment: comparative antimicrobial activity against surgical infection pathogens].

Comparative antimicrobial activity of four ointments, i. e. stellanin-PEG, levomecole, dioxydin 5% ointment and betadin was studied with the use of collection microbial strains and the most frequent pathogens of pyoinflammary processes in surgical patients. Clinical strains of gram positive and gram negative organisms were used as the test cultures. Stellanin-PEG 3% ointment showed high antimicrobial activity against both the gram positive and the gram negative organisms, including methicillin resistant staphylococci, E. faecalis, E. faecium, as well as E. coli and Klebsiella spp. producing extended spectrum beta-lactamases. As a whole, stellanin-PEG 5% ointment was inferior only to 5% dioxydin ointment.

[Clinical efficacy of a novel antimicrobial drug combination containing ciprofloxacin and tinidazole in the treatment of patients with skin and soft tissue infections].

Clinical and microbiological efficacies of a combined drug, a fixed combination of ciprofloxacin and tinidazole in the form of tablets (Cifran ST, Ranbaxy, India) were studied. The drug was given to 40 patients with skin and soft tissue infections in the complex surgical treatment. The clinical effect and bacteriological efficacy were observed in 97.5 and 75% of the cases respectively. The drug tolerability was good and no adverse reactions were stated.

[Clinical importance of early diagnosis of anaerobic non-clostridial infection].

Anaerobic infection is one of the most complicated problems of pyosurgery. The algorithm of examination of patients with anaerobic infection including intraoperative diagnosis is proposed. Surgical treatment playing also diagnostic role is the basis of combined treatment of soft tissues anaerobic infection. Early diagnosis and active surgical policy is one of the main ways of problem solving.

[Nosocomial infection in a resuscitation and intensive care unit for patients with surgical infection].

The study was undertaken to define the main causes of nosocomial infection and the possible ways of its prevention in a resuscitation and intensive care unit (RICU). In 1999 to 2004, intensive therapy was performed in 408 patients (244 males and 163 females) aged 18 to 60 years (54%) and above 60 years (45%) who had severe surgical infection (severe sepsis). Most patients aged over 60 years had one concomitant disease or more. Wound biopsy specimens were bacteriologically tested for the microflora. If there were clinical indications, cavitary puncture specimens, urine and blood samples were also bacteriologically tested. Wound discharges were cultured on liquid and solid nutrient media. Microbial sensitivity to antibacterial agents was estimated by the agar diffusion method using standard paper disks. Bacteriological monitoring was made in 408 patients with surgical infection in RICU in 1999 to 2004. The task of this monitoring was to analyze changes in the microbial picture and to determine the antimicrobial activity of antibacterial agents, and to detect resistant strains of the microflora. Analysis of the results of the bacteriological monitoring makes it possible to develop effective starting and programmed antibacterial therapy and to prevent the development of nosocomial infection in patients in RICU.