Method for preventing endometritis after caesarean operation
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: uterine cavity should be drained in the course of operation, moreover, irrigator's distal end should be withdrawn through operation wound at anterior abdominal wall, and 2 h after the end of operation uterine cavity should be washed through irrigator with 400 ml of cooled 0.06%-sodium hypochlorite solution at perfusion rate being 200 ml/h, 6 times every 12 h up to 3-4 d; after each perfusion one should introduce 1 g kanamycin directly into uterine cavity, moreover, in case of availability of bacterioid and/or anaerobic flora in uterine cavity according to the results obtained due to pre-operational antibioticogram one should add 100 ml 3%-hydrogen peroxide solution into perfusion solution. The present innovation enables to efficiently sanitize uterine cavity due to intrauterine injection of antibiotics by taking into account antibioticogram performed at all stages of operative treatment.
EFFECT: higher efficiency of prophylaxis.
1 cl, 2 ex
The invention relates to medicine, namely to obstetrics.
The known method of prevention of inflammatory complications in obstetrics after birth and caesarean section, which consists in draining the uterus through the vagina in the postpartum period durovernum catheter for washing the cooled solution furacin and the introduction of antibacterial drugs (Worlds IM "Caesarean section"/ tutorial for students, interns and doctors// Ryazan. 1991. Pp.92. p.72-74. Worlds IM, Avdeev J.V., Solomatina L.M. "Intrauterine lavage in the treatment and prevention of postpartum endometritis" Obstetrics and gynecology No. 5, 1993, p.21-23). The authors offer at 2-3 days post-partum/post-operative period to expose the cervix in the mirror, taking a bullet forceps, hold the sensing cavity of the uterus, enter the mounted system of two (inlet and outlet) plastic tubing, and perform the lavage 2-3 liters of chilled solution of furacin, at the end of perfusion to enter 10-20 ml of 1% solution dioksidina. This method is used for the prototype.
The disadvantage of this method is deferred after birth the beginning lavage of the uterus, additional inconvenience for postpartum women and adolescent girls and the additional risk of introducing pathogenic flora from the vagina when draining the uterus, the use of ineffective against pain the merits of pathogenic bacteria and mixed infection solutions furacin and dioksidina. According to literature data (Summary A.N. et al. Akush. and gin. No. 5. - 1991. - P.37-42, Karimov SD et al. Akush. and gin. No. 7. - 1991. - P.51-53, Nikonov, A.P. et al. Akush. and gin. No. 1. - 1991. - P.31-33, V. Krasnopolsky et al. "Caesarean section", Kyiv. - 1993. - P.140-146, and others) it is known that for 3-4 days already happening, manifestirovanne endometritis (clinical, objective, ultrasonic and other signs). For a broad introduction into our clinic known way to prevent endometritis its efficiency was low, most of the known method included in the complex therapy of complications of the postpartum period.
The task of the invention is to improve the prevention of endometritis after cesarean section.
This object is achieved:
- drainage of the uterine cavity with the catheter, with removal of the distal end through the operating wound on the anterior abdominal wall;
- early, within 2 hours after the operation start of the drainage washing and injection of antibiotics directly into the uterine cavity;
- application for lavage chloractive cooled to 4-6° 0.06% of sodium hypochlorite;
- multiple (2-4 times) per day conduct of perfusion and the introduction of antibiotics without additional inconvenience;
- the presence of the irrigator in the uterine cavity allows for more manipulation to hold the fence contents of the uterine cavity for the bacteria is of bacteriological methods of research.
The method is as follows.
During caesarean section after removal of the placenta and the taking of smears for bacteriological examination in the uterine cavity is entered PVC sterile irrigator length 25-30 cm, the cross-sectional diameter of 1.5-2 mm with a simple reliable plug at the distal end, which is displayed through the anterior abdominal wall and is fixed during the suturing of the wound in the uterus and skin sutures on the anterior abdominal wall (for this we use disposable sterile umbilical catheter). In the postoperative period to the distal end of the irrigator is attached sterile system for in/infusions and is intrauterine perfusion cooled to 4-6° 0,06% sodium hypochlorite (400-800 ml) 2-3 times a day for 3-4 days of the postoperative period. For 3-4 days before the next session lavage we fence the contents of the uterine cavity (otsosov through irrigator sterile syringe) for bacteriological examination. At higher risk for the development of inflammatory diseases (duration of childbirth more than 12 hours, the dry period of more than 6 hours, the number of vaginal studies in childbirth more than 3 and others) at the end of perfusion entered antibiotics depending on the results of preoperative antibiogram or drugs with a broad spectrum actually is (we prefer 1 g of kanamycin, dissolved in 20 ml of solution). If the uterine cavity Bacteroides and/or anaerobic flora (according to the results of bacteriological examination) in the perfusion solution is added 100 ml of 3% hydrogen peroxide solution.
Examples of specific applications.
Example 1. Pregnant K. 29 years old was admitted into the hospital with complaints on a regular contractions for 6 hours, the fluid is poured out upon receipt. The opening of the cervix was 4 see diagnosed 1st period 1st term labor latent phase. Pure breech presentation of the fetus. Early rupture of amniotic fluid. After 4 hours of birth was complicated by discoordinating labor. Given breech presentation of the fetus and complications during childbirth combined readings conducted a delivery by cesarean section. During the operation conducted by the drainage of the uterine cavity by microirrigation (umbilical catheter) with removal of the distal end through the wound on the anterior abdominal wall. Antibacterial drugs in the postpartum period was not appointed. After 3 hours after the operation started drainage irrigation of the uterine cavity 400 ml of 0.06% of sodium hypochlorite with an infusion rate of 200 ml/hour. Over the next 3 days postpartum were lavage of the uterus 2 times daily at the same dose. At 4 days after a caesarean section drainage of the uterine cavity BPM is flax. Bacteriological examination of intraoperative smear of the uterine cavity revealed the growth of opportunistic epidermal Staphylococcus 103CFU/ml, the aspirate from the uterine cavity, taken through the irrigator in 3 days - flora is not selected. The hemogram, biochemical indices in the postpartum period were without pathological changes. Control ULTRASONIC examination of the uterus for 4 days - without a pathology. Sutures were removed on the 6th day and 7th day after caesarean section the travaileth with child was discharged home.
Example 2. Pregnant M,30, perforada again pregnant (in history 3 pregnancy came to a standstill in the early period) entered into the second obstetric Department regarding rupture of membranes 10 hours ago, immature cervix during pregnancy 36-37 weeks. The woman is married, pregnancy is extremely desirable. The body temperature of 37.6°With, in the hemogram leukocytosis 11,5×109, neutrophilic left shift formula (7 band). Diagnosis: pregnancy 36-37 weeks. Age perforada. The OAS. Premature rupture of the waters, when unripe cervix, the critical dry period. The chorioamnionitis. In an emergency order of rodorazresheniye by extraperitoneal caesarean section. Born alive girl with a body mass 2630 g and growth 49 see Bacteriological examination intraoper the operating strokes of the cavity of the uterus revealed the growth of epidermal Staphylococcus and Escherichia coli 10 6CFU/ml during the operation was conducted in the/in infusion of 2 g of Cefazolin and performed the drainage of the uterine cavity by the irrigator with removal of the distal end through the wound on the anterior abdominal wall. 2 hours after the operation started drainage irrigation of the uterine cavity 400 ml of 0.06% of sodium hypochlorite with the introduction at the end of the perfusion of 1 g of kanamycin, dissolved in 20 ml of physiological solution. Lavage of the uterus with the introduction of the antibiotic was carried out in 12 hours to 3 days. In the postoperative period twice in 8 and 16 hours spent in/drip infusion of 2 g of Cefazolin (as perioperative antibiotic prophylaxis). Second day normalized leukocytosis and leucoformula. Bacteriological control of aspirate from the uterus on the 4th day - flora is not selected. Drainage from the uterus removed on the 4th day. Ultrasound of the uterus on the 5th day of pathological changes it is not revealed. Skin sutures were removed on the 6th day. On the 9th day a woman with a child in a satisfactory condition and was discharged home.
Thus, drainage of the uterus during caesarean section with removal of the distal end through the operating wound allows for early and multiple effective reorganization of the uterine cavity disinfectant solutions; at elevated risk factors to conduct a rational antibiotic, injecting drugs directly into the spine of the uterus, that allows robust enough to prevent the development of postpartum endometritis, 't inconvenience for postpartum women and adolescent girls with conduct lavage and sampling the contents of the uterine cavity for bacteriological examination, economically significantly profitable than conventional antibiotic therapy) and shortens the stay postpartum women and adolescent girls after caesarean section in the hospital.
1. The way to prevent endometritis after cesarean section, including preoperative antibiotikogrammou, characterized in that the uterine cavity drain during the operation, while the distal end of the irrigator is output through the operating wound on the anterior abdominal wall, and 2 hours after the operation, the uterine cavity is washed through the irrigator 400 ml of chilled 0,06% solution of sodium hypochlorite with a perfusion rate of 200 ml/hour, 6 times in 12 hours to 3-4 days; after each perfusion directly into the uterine cavity injected with 1 g of kanamycin.
2. The method according to claim 1, characterized in that in the presence of the uterine cavity bacterioides and/or anaerobic flora on the results of preoperative antibiogram in perfusion solution add 100 ml of 3% hydrogen peroxide solution.
SUBSTANCE: method involves administering 1-methyl-2-phenylthiomethyl-3-carbetoxi-4-dimethyl-aminomethyl-5-oxibromoindol or its salts selected from a group containing hydrochloride monohydrate (arbidol) earlier known as immunomodulator, besilate, fumarate, maleate, citrate or their hydrates.
EFFECT: enhanced effectiveness in healing organism from rotavirus.
4 cl, 8 tbl
FIELD: organic chemistry, biochemistry, medicine, virology.
SUBSTANCE: invention relates to derivatives of 2'=amino-2'-deoxynucleosides of the formula:
wherein R means hydrogen atom (H), alkyl, aminoalkyl; R1 means -(R2NR3) wherein R2 and/or R3 means H, -OH, -NH2, alkyl, benzyl under condition that R doesn't represent H or methyl when R2 and R3 mean H. Compounds elicit an antiviral activity with respect to measles and Marburg viruses exceeding that of ribavirin.
EFFECT: valuable properties of compounds.
4 tbl, 2 dwg, 18 ex
FIELD: medicine, virology, pharmacy.
SUBSTANCE: invention proposes an agent for treatment and prophylaxis of infection caused by coronaviruses, in particular, for treatment of atypical pneumonia (SARS), and pharmaceutical composition of indicated designation based on thereof. Agent represents 1-methyl-2-phenylthiomethyl-3-carbethoxy-4-dimethylaminomethyl-5-oxybromoindole or 1-methyl-2-phenylthiomethyl-3-carbethoxy-4-dimethylaminomethyl-5-oxybromoindole monohydrate hydrochloride (arbidol) known early as an immunomodulator and preparation used against influenza viruses. Invention provides reducing accumulation of coronaviruses (on example with TOPS virus) in lung.
EFFECT: valuable medicinal properties of agent.
2 cl, 7 tbl, 9 ex
FIELD: organic chemistry, biochemistry, medicine, pharmacy.
SUBSTANCE: invention relates to macrocyclic peptides of the general formula (I): wherein W means nitrogen atom (N); R21 means hydrogen atom (H), (C1-C6)-alkoxy-, hydroxy-group or N-(C1-C6-alkyl)2; R22 means hydrogen atom (H), (C1-C6)-alkyl, CF3, (C1-C6)-alkoxy-group, (C2-C7)-alkoxyalkyl, C6-aryl or Het wherein het means five- or six-membered saturated or unsaturated heterocycle comprising two heteroatoms taken among nitrogen, oxygen or sulfur atom and wherein indicated Het is substituted with radical R24 wherein R23 means hydrogen atom (H), -NH-C(O)-R26, OR26, -NHC(O)-NH-R26, -NHC(O)-OR26 wherein R26 means hydrogen atom, (C1-C6)-alkyl; R3 means hydroxy-group or group of the formula -NH-R31 wherein R31 means -C(O)-R32, -C(O)-NHR32 or -C(O)-OR32 wherein R32 means (C1-C6)-alkyl or (C3-C6)-cycloalkyl; D means a saturated or unsaturated alkylene chain comprising of 5-10 carbon atoms and comprising optionally one-three heteroatoms taken independently of one another among oxygen (O), sulfur (S) atom, or N-R41 wherein R41 means hydrogen atom (H), -C(O)-R42 wherein R42 means (C1-C6)-alkyl, C6-aryl; R4 means hydrogen atom (H) or one-three substitutes at any carbon atom in chain D wherein substitutes are taken independently of one another from group comprising (C1-C6)-alkyl, hydroxyl; A means carboxylic acid or its alkyl esters or their derivatives. Invention relates to pharmaceutical compositions containing indicated compounds and eliciting activity with respect to hepatitis C virus and these peptides inhibit activity of NS3-protease specifically but don't elicit significant inhibitory activity with respect to other serine proteases.
EFFECT: valuable biochemical and medicinal properties of peptides.
106 cl, 9 tbl, 61 ex
FIELD: medicine, surgery.
SUBSTANCE: at the end of the main stage of operation conducted one should perform paravertebral Novocain blockade by puncturing the sheath of m.erector trunci, the drainage should be introduced towards lateral edge of m.ilipsoas through paracentesis of lumbar area being about 1-2 cm above ilium's ala at the line made via the end of the 12th rib vertically up to ilium's ala. Retroperitoneal space should be, also, drained. The innovation enables to prevent purulent-septic complications and decrease the pain.
EFFECT: higher efficiency.
1 dwg, 2 tbl
FIELD: medicine, surgery.
SUBSTANCE: one should perform decompression of Wirsung's duct with the help of silicone instrument or catheter in case of pancreatogastrostomy in the course of pancreatoduodenal resection. Moreover, the above-mentioned instruments should be fixed in anastomosis with one of the sutures in internal row, their free ends should be loosely located in the stomach and tightened to caprone ligature to be then withdrawn through patient's nose. In 7-10 d either silicone instrument or catheter should be removed due to pulling by caprone ligature. The innovation enables to decrease the risk in the failure of pancreatogastroanastomoses and post-operational pancreatitis.
EFFECT: higher efficiency of draining.
FIELD: medical engineering.
SUBSTANCE: device has liquid-permeable porous lining that is to be placed on or in a wound, flexible plastic film having a set of holes distributed over its surface, liquid-impermeable film napkin and connection means. The porous lining has foamed polymer material having interconnecting cells. The plastic film makes contact with porous lining surface and is between wound surface and the lining when used. The film napkin is placed above the porous lining and is sticky along its perimeter to provide sealing in skin area surrounding the wound. The connection means passes through the film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. Another embodiment has removable wound bandage usable in particular for treating large wounds requiring draining fluids. It has the first porous lining, the second porous lining, elastomer envelope, film napkin and tubular connection means. The first liquid-permeable porous lining contacts the wound and has foamed lining having foamed material based on polymer built of interconnecting cells and isolated transverse holes. The elastomer envelope has the first and the second sheets of elastomer film soldered along their periphery and enveloping said foamed lining. Each of the first and the second elastomer film sheets has spaced-apart holes. The holes in the second sheet are justified with said spaced-apart holes in the first sheet. The second liquid-permeable porous lining is to be placed under the first porous lining. It has foamed polymer material having interconnecting cells. The liquid-impermeable film napkin is placed above the second porous lining. The first porous lining is placed above the wound. The film napkin is sticky along its perimeter to glue the napkin to skin area surrounding the wound. The tubular connection means passes through said film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. The third embodiment has the first elastomer film sheet having spaced-apart holes deviated from spaced-apart holes in the foamed lining. The second elastomer film sheet has spaced-apart holes adjusted to the spaced-apart holes in the foamed lining.
EFFECT: simplified usage; accelerated wound healing.
15 cl, 3 dwg
FIELD: medicine, abdominal surgery.
SUBSTANCE: the present innovation deals with treating patients in case of destructive forms of pancreatitis. One should lance a gastro-colic ligament, mobilize splenic and hepatic angles of large intestine, tighten a middle colic artery, descend mesenteric root cross-sectionally against a colon, dissect parietal peritoneum along the upper and lower edges of pancreas to withdraw it into abdominal cavity, remove necrotized tissues. Then one should apply a rubber balloon with drainage tubes along its upper and lower edges into omental cavity: one balloon's end should be withdrawn through median wound, another one - through contra-aperture being 5 cm below a costal arch along median axillary line. The method suggested enables to form adequate access to patient's pancreas.
EFFECT: higher efficiency of drainage.
6 dwg, 1 ex
SUBSTANCE: method involves puncturing pyogenic cavity with trocar having blunt obturator via skin incision made outside of abscess boundary having length equal to arthroscope diameter. Then, arthroscope is introduced and the cavity is filled with physiologic saline. Pyogenic cavity revision is carried out under arthroscope control, irrigation cannula is set, constant water medium is created. Arthroscopic mill on shaver handle is introduced via another skin incision. Non-viable tissues are removed with stage-by-stage hemostasis using endocoagulator. The cavity is healed. Perforated draining tube is set under arthroscope control. Tube ends are brought out through pierces outside of the cavity and sutured to skin. Active suction of wound exudates is carried out using closed vacuum drain system in postoperative period. The drainage is removed when cleaning the wound from wound microflora and single sutures are placed.
EFFECT: enhanced effectiveness of treatment.
FIELD: medical engineering.
SUBSTANCE: device has suction tube having lateral openings and irrigation tube. The irrigation tube is connected to jet-action atomizer. The atomizer is hollow collapsible cylinder with holes. Ultrasonic radiator having conductor to ultrasonic frequency oscillator is available in the cylinder. The radiator and conductor enable one to introduce ultrasonic oscillations into antiseptic solution.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves puncturing pyogenic abscess cavity under ultrasonic control with draining tube left therein. Laparoscope connected to monitor unit is introduced into abscess cavity. One of introduced drains is set in upper point of the cavity and the other one in lower point. The abscess cavity is filled with ozonized solution to 2/3 of its volume and bubbled with ozone-oxygen mixture during 2-3 min changing the solution until it becomes transparent. The emptied cavity walls are treated from distance of 3-4 cm with laminar airflow heated to 38-40°C under pressure of 1-1.5 atm during 2-3 min. Next to it, the cavity walls are irradiated from distance of 2-3 cm with non-coherent red light during 2-3 min per each area.
EFFECT: improved safety conditions and healing quality.
SUBSTANCE: method involves conducting bougie through the liver. Flexible tube is attached to its end and set in bile ducts. Flexible radio-opaque conductor is introduced through the flexible tube. The tube is removed. Draining tube is introduced along the conductor from porta hepatis to its diaphragmatic surface into the ducts to be drained.
EFFECT: reduced risk of traumatic complications.
FIELD: medicine, pediatrics, hematology.
SUBSTANCE: the present innovation could be applied in treating surgical and oncological diseases in children during treating and preventing anemia of different etiology. One should introduce ceruloplasmin at daily single dosage ranged 50-200 mg depending upon child's age against 100-200 ml 0.9%-sodiumchloride solution intravenously by drops at the rate of 40-50 drops/min. Moreover, for preventing and/or treating posthemorrhagic anemia in case of surgical operations one should introduce ceruloplasmin during 2 d before surgical operation, intraoperationally, and for 2-10 d after operation. For preventing and/or treating anemia in case of purulent-septic diseases ceruloplasmin should be introduced during chemotherapeutic days during the whole period of the course conducted, for preventing and treating radiation anemia at the background of radiation therapy ceruloplasmin should be injected once weekly during the whole period of radiotherapy course, for preventing and treating toxic and radiation anemia at the background of chemoradiation therapy ceruloplasmin should be introduced once weekly on the day of chemotherapy during the whole course of chemoradiation treatment. The innovation enables to avoid inflows of erythrocytic mass and donor's blood along with shortened number of procedures on introduction of ceruloplasmin and 4-times decrease in the risk for the development of severe anemia in children due to matching peculiar mode for ceruloplasmin introduction.
EFFECT: higher efficiency of therapy and prophylaxis.
4 cl, 5 ex