ABSTRACT
Acute purulent mediastinitis (APM) is one of the most difficult forms of surgical infection with severe clinical course and lethality from 17 to 80%. Overall 80 patients with APM were treated; plasmapheresis in postoperative period was used at 66 of them. The main criteria of negative prognosis at the patients with APM were elderly age, high score on APACHE-2, SAPS-2 and SOFA scales, higher level of creatinine and urea serum concentration, hyperglycemia, leucopenia. Early application of plasmapheresis was associated with lower lethality (12.5% at the group with early beginning of plasmapheresis, 35.3% at the group with late beginning, 36.2% at the control group). Plasmapheresis promotes normalization of hemostasis, microcirculation and immune parameters, reduction of intoxication and systemic inflammation syndrome.
Subject(s)
Bacterial Infections/complications , Mediastinitis/microbiology , Mediastinitis/therapy , Plasmapheresis/methods , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Mediastinitis/mortality , Middle Aged , Preoperative Care , Survival RateABSTRACT
The aim of the study was to define the sensitivity, specificity, and diagnostic accuracy of lung perfusion scanning (LPS) in pulmonary thromboembolism (PTE). PTE diagnostic techniques are comparatively assessed. The data on 108 patients with suspected PTE and lung perfusion defects revealed at pulmonary scintigraphy were analyzed. The diagnostic techniques included electrocardiography (ECG), 150 echocardiography, venous ultrasonography, chest X-ray, and LPS. The significant signs of PTE were singled out of 150 ones (history data, complaints, clinical symptoms, instrumental findings, autopsy data); LPS data were analyzed in detail. The sensitivity, specificity, and accuracy of LPS were 95.2, 20, and 77.7%, respectively. It is shown that lung scans should be interpreted, by taking into account X-ray data, and LPS should follow ECG, venous ultrasonography, and chest X-ray.
Subject(s)
Lung , Pulmonary Embolism , Contrast Media , Diagnosis, Differential , Female , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Humans , Lung/blood supply , Lung/diagnostic imaging , Male , Middle Aged , Pulmonary Embolism/diagnosis , Pulmonary Embolism/epidemiology , Pulmonary Embolism/mortality , Radionuclide Imaging , Sensitivity and Specificity , Tomography, X-Ray ComputedSubject(s)
Cardiovascular Surgical Procedures , Heart Injuries/surgery , Multiple Trauma/surgery , Postoperative Care/methods , Postoperative Hemorrhage/etiology , Wounds, Gunshot/surgery , Adult , Heart Atria/injuries , Heart Atria/surgery , Heart Ventricles/injuries , Heart Ventricles/surgery , Humans , Male , Postoperative Period , Thoracotomy , Treatment OutcomeABSTRACT
A total of 528 patients with nosocomial pneumonias were examined by bacteriological methods during 4 years. The data on the patients and on 2468 bacterial strains isolated from them were computer processed using original software "Hospital Infection". Special attention was paid to hospital strains of pneumonia agents of the same taxonomic position with identical markers of antibacterial resistance. Tendencies and seasonal fluctuations in the prevalence of hospital serovars were detected. Special bacteriological studies helped detect differences in the translocation capacity of different biological variants of the agents. Routine bacteriological studies and their adequate statistical computer processing yield information needed for epidemiological analysis of the development of nosocomial pneumonias in patients of clinical wards of different profile.
Subject(s)
Bacteria/isolation & purification , Cross Infection/epidemiology , Cross Infection/microbiology , Pneumonia, Bacterial/epidemiology , Pneumonia, Bacterial/microbiology , Bacteria/classification , Bacterial Typing Techniques , Hospitals , Humans , Russia/epidemiologyABSTRACT
Cranio-thoracic trauma is characterized by severity of the pathologic process, peculiarities of the diagnosis, and a high mortality rate. However, problems concerning the correlation of hemodynamic and gas exchange disorders in patients with cranio-thoracic trauma, according to the principal factor of the damage, have been insufficiently studied. The purpose of the research was to study the condition of gas exchange and hemodynamics in this category of patients. Fifty-three patients with cranio-thoracic trauma (32 with main pathology of the cranium and 21 with trauma of the chest) were studied. The changes of gas exchange and hemodynamics in the early posttraumatic period in patients with principal trauma of the skull were unstable in character and responded easily to adequate therapy. Coarse disorders of gas exchange and low values of the cardiac debit were characteristic of cranio-thoracic trauma in which damage to the chest was the leading factor. Stabilization of gas exchange disorders was postponed in time, the hemodynamic parameters were stabilized by the end of the second day.
