[Chemiluminescent and enzyme activity of neutrophils in patients with widespread purulent peritonitis depending on the outcome of disease].

BACKGROUND: Aim was to study the chemiluminescent activity and the activity of NAD- and NADP-dependent dehydrogenases of neutrophils depending on the outcome of the widespread purulent peritonitis (WPP). PATIENTS AND METHODS: 51 patients with a mean age of RSE 54.2 ± 19.2 years were observed. As a control 75 healthy people of similar age range were examined. Lucigenin- and luminol-dependent chemiluminescence activity and activity of NAD(P)-dependent dehydrogenases peripheral blood neutrophils were studied. RESULTS: In patients with a favorable outcome of WPP the maximum intensity increased and the magnitude of the activation index of lucigenine-dependent spontaneous chemiluminescence reduced. Regardless to the outcome of WPP in patients with increased activation index and maxima of the luminol-dependent spontaneous and zymosan-induced chemiluminescence. At the unfavorable outcome of the disease in neutrophils NAD- dependent isositrate dehydrogenase and anaerobic lactate dehydrogenase reaction activity increased. Regardless to the outcome WPP in patients neutrophils aerobic reaction of lactate dehydrogenase, glucose-6-phosphate dehydrogenase and NADP-dependent glutamate dehydrogenase activity reduced but levels of NADH-dependent reaction of malate dehydrogenase, NADH-dependent glutamate dehydrogenase and NADP-dependent isocitrate dehydrogenase activity increased. CONCLUSION: With the reduction of the intensity ofplastic processes and imbalances enzymatic activity in nitrogen metabolism in patients with WPP at unfavorable outcome of the disease increases the activity of enzymes that characterize the level of anaerobic and aerobic respiration. In the absence of marked changes in the activity of enzymes that characterize the level of energy processes in cells of patients with favorable outcome of the WPP, increases the intensity of spontaneous lucigenin-dependent chemiluminescence and reduced neutrophil activation index.

[Problems of prevalance and resistance of nosocomial Klebsiella pneumonia in hospitals of Russia].

Prevalence of Klebsiella pneumoniae among gramnegative pathogens of nosocomial infections in intensive care units of 33 hospitals of 22 towns in Russia was investigated. Antibiotic susceptibility and extended-spectrum beta-lactamase production were tested in 420 nosocomial K. pneumoniae isolates. Carbapenems (imipenem, meropenem and ertapenem) showed the highest activity. Extended-spectrum beta-lactamase production based on the phenotyping methods was revealed in 342 (81.4%) isolates. The maximum activity against the K. pneumoniae isolates producing extended-spectrum beta-lactamase was observed in imipenem and meropenem (no unsusceptible strains were isolated). 3.2% of the isolates was not susceptible to ertapenem. Differences in the activity of cefoperazone/sulbactam, amikacin, ciprofloxacin and levofloxacin against the extended-spectrum beta-lactamase producing isolates in various hospitals were recorded.

[Treatment of generalized peritonitis with fenestration of the abdominal cavity]. / Lechenie rasprostranennogo peritonita metodom fenestratsii briushnoi polosti.

The authors suggest a new method for the treatment of generalized peritonitis. It is based on the use of a device of the authors' construction which allows the condition of the abdominal cavity to be visualized continuously and the cavity to be cleansed regularly with the aid of laparoscope. The method is called fenestration of the abdominal cavity. The authors had 395 patients with purulent peritonitis, 171 (43.3%) of them were treated by the semiopen method, 41 of these patients (10.4%) were subjected to fenestration of the abdominal cavity. The authors consider fenestration indicated in generalized peritonitis with signs of polyorganic insufficiency in the presence of a large amount of exudate and concurrent interintestinal, subdiaphragmatic, and pelvic abscesses or when there is a tendency towards their development. With the use of the device for fenestration the number of cleansing relaparotomies was reduced to minimum. Relaparotomy was conducted once in 35, twice in 4, and three times in 2 patients. In all patients the abdominal cavity was examined daily with a laparoscope, the exudate was aspired, and antibiotics were introduced. Phlegmon of the anterior abdominal wall was in early postoperative complication in 2 patients. Five (12.2%) patients died.