Khirurgiia
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The results of treatment of 73 patients with surgical sepsis are analysed. 57% of the patients were older than 60 years. In 35.6% of the cases sepsis was caused by soft tissue infection, in 35.6%-pyo-inflammation of the blood vessels. In 81% of the cases infective agents were verified; in 45.2% they were found in associations. ⋯ Early treatment of abscesses, adequate antibacterial and detoxication therapy are major tasks in the treatment of sepsis. Intravenous injections of immunoglobulins (Endobulin., Intraglobin and Pentaglobin), extracorporeal detoxcication and polyorganic disorders correction have led to positive results in most cases. The mortality rate in this group was 14.5% compared with 38.5% in the control group.
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The changes in the system of hemostasis were studied in 36 patients with sepsis managed with sorptive detoxication. The starting status of the system of hemostasis in patients with favorable outcome of the disease can be considered as the 2d stage of the disseminated intravascular coagulation (DIC), and in patients with the unfavorable outcome--as the 3d (hypocoagulative) stage. The sorptive detoxication provides the treatment of the DIC syndrome in favorable outcome, as well as further progression of the process in unfavorable outcome of sepsis. Conservative treatment provides stabilization of the hemostatic system and gives opportunity to perform delayed hemosorption with a positive clinical result.
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The cervical vertebrae were replaced by carbon implants in 60 patients; carbon synthetic foam was used in 19 of them and composite material based on carbon (ostec) in 41. The biological and mechanical properties of the implants ensured firm stabilization of the spine and excluded the danger of postoperative kyphosis and destruction of the vertebral bodies by the implant.
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The authors work is based on experience in the study of 56 patients with acute mediastinitis of various origin who were treated in the period from 1981 to 1990. There were 33 males and 23 females whose ages ranged from 16 to 65 years, Odontogenous mediastinitis was diagnosed in 23, tonsillogenous in 2, and mediastinitis resulting from injury to the esophagus in 31 patients. Instrumental injuries prevailed. ⋯ Diffuse anterior mediastinitis was managed by tunneling and drainage of the mediastinum through the seat of the removed xiphoid process. Prophylactic treatment of the mediastinal space and intensive therapy including active detoxification were applied in the 56 patients who underwent operation died, 26 of them were admitted to the clinic 24-72 hours after the onset of the disease in a state of severe intoxication caused by violently developing mediastinitis. The remaining 27 patients recovered.