Diagnosis and Surgical Treatment of Pyogenic-Sepptic Complications and Vascular Lesions in Patients with Perinatal Opioid Addiction

The research is dedicated to the development and improvement of diagnostic and surgical approaches to the treatment of pyogenic-septic complications and vascular lesions in patients with parenteral opioid addiction. The study analyzes post-injection complications affecting soft tissues and the vascular system, including abscesses, infiltrates, and angiogenic sepsis. Clinico-laboratory criteria for assessing the severity of the endotoxic syndrome have been proposed, the dynamics of cellular and humoral immunity have been investigated, and a comprehensive treatment scheme has been developed incorporating efferent detoxification methods and endolymphatic and lymphotropic antibiotic therapy.

Relevance of the topic. The rapid growth of drug addiction in the last decade causes particular alarm worldwide. Despite significant efforts aimed at reducing drug dependence in the population, the implementation of progressive prevention and treatment technologies, many questions remain unresolved. Among them is the provision of surgical care to patients with complications associated with prolonged intervention using drug surrogates. These surgical complications are diverse: from infiltrates and abscesses of soft tissues to damage to large main arterial and venous vessels, the development of 'angiogenic' sepsis and septicopyemic foci. The number of drug-addicted patients admitted to surgical wards with severe pyogenic-septic processes and vascular lesions increases annually [10, 107, 135, 138, 123, 142, 67 et al.].

Sufficiently deep investigations are presented regarding lesions of the cardiovascular system, liver, kidneys, and other organs [15, 71, 82, 108, 130, 136, 159, 161 et al.].

At the same time, literary data on the diagnosis of pyogenic-septic complications of soft tissues of the extremities in drug-addicted patients are scarce [108]. The questions of efferent therapy, the effectiveness of the use of antibiotics and other antiseptics in patients with parenteral opioid addiction, depending on the method of their administration, are insufficiently studied.

Thus, the questions of diagnosis and complex treatment of patients with parenteral opioid addiction with pyogenic-septic complications and vascular lesions are sufficiently well-grounded and relevant.

Goal of the research. To improve the results of complex treatment of patients with parenteral opioid addiction with pyogenic-septic complications and vascular lesions.

Tasks of the research:

1. To identify the features in the diagnosis of pyogenic-septic post-injection complications and vascular lesions in patients with parenteral opioid addiction.

2. To develop clinico-laboratory indicators of the state of regulatory and effector systems for determining the degree of severity of the course of purulent infection in patients with parenteral opioid addiction.

3. To develop a scheme of efferent therapy methods for the syndrome of endogenous intoxication in patients with parenteral opioid addiction with pyogenic-septic complications.

4. To determine the most optimal method of surgical treatment of vascular lesions against the background of the purulent-inflammatory process in patients with opioid addiction.

5. To comparatively study, based on clinical, laboratory, and immunological data, the results of complex treatment of patients with parenteral opioid addiction with pyogenic-septic complications and vascular lesions with the application of endolymphatic and lymphotropic antibiotic therapy.

Scientific novelty of the research.

For the first time, clinico-laboratory indicators of regulatory and effector systems have been developed for determining the degree of severity of the syndrome of endogenous intoxication in patients with parenteral opioid addiction with post-injection pyogenic-septic complications.

For the first time, changes in homeostasis have been investigated, including biochemical blood studies, markers of endotoxemia, studies of cellular and humoral immunity, in patients with parenteral opioid addiction with pyogenic-septic and vascular complications with the application of a sequential scheme of efferent detoxification methods, endolymphatic and lymphotropic administration of antibiotics.

Propositions to be defended:

1. To clarify the nature and extent of post-injection lesions of anatomical formations, a complex of diagnostic measures is necessary, including puncture examination under ultrasound control. Dopplerographic investigation of main vessels in the affected area, echocardiography, and for the detection of metastatic abscesses — computed tomography.

2. The clinico-laboratory indicators of the state of regulatory and effector systems developed by us for patients with long-term opioid parenteral drug dependence allow determining the severity of the course of purulent infection and the algorithm of complex treatment.

3. Endolymphatic and lymphotropic antibiotic therapy in combination with a sequential scheme of efferent therapy allows, in this group of patients, to comparatively quickly localize the purulent process, eliminate the syndrome of endogenous intoxication, stabilize the indicators of cellular and humoral immunity, and prevent the spread of infection.

Presentation of the work

The main provisions of the dissertation were reported at: sessions of scientific-practical conferences of the Astrakhan State Medical Academy (1999, 2002); scientific-practical conference 'Modern Problems of Narcology', Astrakhan, 1999; in the materials of the interregional scientific-practical conference 'Scientific Developments by Scientists in Solving Socio-Economic Problems of the Astrakhan Region', Astrakhan (2001); scientific-practical conference 'XXI Century Without Drugs'. Astrakhan (2002); at the III All-Army conference with international participation 'Infection in Surgery - Problem of Modern Surgery'. Moscow (2002); the Second International Scientific-Practical Conference 'Health and Education in the XXI Century'. Moscow (2002); at the I All-Russian Congress of Lymphologists of Russia. Moscow (2003); at the All-Russian conference of surgeons 'Improvement of Specialized Care in a Multiprofile Hospital', dedicated to the 80th anniversary of Professor Petrov Valentin Pavlovich. Krasnogorsk (2004); at the III All-Russian conference of general surgeons with international participation. Rostov-on-Don - Anapa (2005).

The propositions and conclusions of the dissertation were reported at the interdepartmental conference with the participation of surgery profile departments of GOU VPO 'Astrakhan State Medical Academy' Roszdrav (March 2, 2006).

Publications

The main provisions of the dissertation are reflected in 10 scientific works and in methodical recommendations.

Implementation in practice

The proposed complex of diagnostic and therapeutic measures has been implemented in the departments of surgical infection, anesthesiology, and intensive care of MUZ GKB №3 named after S. M. Kirov, Astrakhan. The materials of the work are used in the training of students, interns, clinical residents in the department of general surgery, in the faculty of postgraduate education at GOU VPO AGMA Roszdrav.

STRUCTURE AND SCOPE OF THE WORK

The dissertation is presented on 117 pages of typewritten text and consists of an introduction, a literature review, materials and methods, results of original research, discussion of the obtained results, conclusions, and practical recommendations