[Optimization of surgical treatment of suppurative-necrotic lesions of the foot in patients with diabetes mellitus]. / Optimizatsiia khirurgicheskikh vmeshatel'stv pri gnoino-nekroticheskikh porazheniiakh stopy u bol'nykh sakharnym diabetom.

The analysis of treatment results in 559 patients with diabetes mellitus complicated by foot pyonecrotic lesions was carried out. Surgical treatment was performed in 448 patients considering route of infection spread (basic group), conventional methods of treatment were used in 111 patients (control group). It is shown that one of the causes of unsuccessful treatment results was the infection spread from foot to leg by toes tendons and synovial sheaths. The study of microbial contamination in wound exudate, distal and proximal sites of tendons revealed a significant difference in proximal-distal gradient for aerobes (2.8 +/- 0.19 lg/g) and anaerobes (1.71 +/- 0.16 lg/g, p < 0.01). Methods of surgical treatment of foot pyonecrotic lesions allowing for route of infection in patients with diabetes mellitus were developed. Use of these methods allowed to decrease more than 2 times the number of femoral amputations, and to increase the rate of surgical interventions with salvage of limb's support function from 71.2 to 87.7%.

[Differentiated treatment of generalized peritonitis]. / Differentsirovannaia terapiia pri rasprostranennom peritonite.

The article discusses the results of treatment of 327 patients with generalized peritonitis in the toxic and terminal stages. The patients were divided conditionally into three groups. In the first group (42 patients) treatment consisted in routine cleansing of the abdominal cavity with drainage and introduction of antibiotics into it in the postoperative period. Mortality was 45.7%, complications occurred in 52.6% of patients who had survived. In the second group (145 patients) peritoneal dialysis in the flow-drip regimen was applied 3 or 4 times per 24 hours in a volume of 3-4 liters. In this group mortality was 37.9%, the number of complications among the survivals was 41.1%. In the third group (140 patients) a complex of differentiated peritoneal therapy was employed, including the following developed methods: thorough intraoperative cleansing of the abdominal cavity with 10-15 liters of antiseptic solutions containing antibiotics chosen according to the results of express-bacterioscopy, "active" peritoneal dialysis in the flow-fraction regimen, as well as developed methods of laparostomy--controlled laparostomy, prolonged open administration with local cleansing and use of antibacterial ointments. With use of this complex, mortality reduced to 27.1% and the incidence of complications to 20.6%.

[Changes in the microflora of the suppurative cavities resulting from the treatment of acute bacterial destruction of the lungs]. / Izmeneniia mikroflory gnoinykh polostei v rezul'tate lecheniia ostroi bakterial'noi destruktsii legkikh.

The results of complex bacteriologic examination of 62 patients with acute bacterial destruction of the lungs during the process of treatment were analysed. The complex of investigations included the express methods (bacterioscopy, studies in the ultraviolet light, chromatography-mass spectrometry), inoculation under aerobic and anaerobic conditions. A role of anaerobic non-clostridial infection in the development of acute pulmonary destruction, polymicrobial character of microflora are shown. It was established that complex conservative therapy with inclusion of the methods for drainage of the cavities of destruction, prolonged intraarterial infusion, aimed antibacterial therapy permitted to achieve rapid suppression of microflora, its anaerobic component in particular. In chronization of the disease, the gram-negative aerobic flora is playing the leading part in its pathogenesis.