Acute diffused purulent peritonitis: conceptual aspects of the modern surgical tactics

Objective. To accentuate an attention on conceptual aspects of surgical treatment of patients on acute purulent diffused peritonitis (APDP). Materials and methods. Were treated a 371 patients on APDP in age from 18 to 87 years; males – 207 (56 %), females – 164 (44 %). In structure of factors of peritonitis development predominated an acute destructive appendicitis (23 %), perforated ulcer of pyloroduodenal part of the stomach (21 %), acute pancreatitis / purulent-necrotic pancreonecrosis (18 %), acute destructive cholecystitis (14 %). Results and discussion. Carried out analysis allowed to determine the next conceptual aspects of the problem. In particular, according to recommendations of the World Society of Emergency Surgery (WSES, 2016), APDP necessary to interpret as “complicated intraabdominal infection” with evaluation of clinical state of patient, localization of source of infection, its spreading, availability of the multiorgan insufficiency, characteristics of bacterial pathogens and their antibacterial sensitivity. Is appropriate an usage of the single classification of degree of peritonitis spreading with terminological definition its as “local”, “diffused” and “total”. Helping carried out a bacterial investigations were revealed domination of aerobic bacteria as monoculture (37 %) and aerobic-anaerobic associations (39 %) with gram-negative sign (56 %) and species composition as enterobacteria and anaerobic nonclostridial microbs. The initial antibiotic therapy induces the high level of polyresistance of flora, that causes necessarily of permanent determination of bacteria sensitivity to antibiotics and timely change of regimens their administration. Operational intervention, excepting a control of the source of infection, must to foresee a measures of correction of appeared pathologic intraabdominal syndromes, in particular compartment-syndrome, enteral insufficiency and redundant contamination of digestive tract by microflora of the large intestine. The very important compound of treatment is full-fledged infusion therapy. Relaparotomy represents an effective instrument with performing its for regulated clearly indications. Conclusions. Realization of the outlined medical tactics compaunds will promote to the rise of efficiency of ADPP treatment.

MP01: Use of an unmanned aerial vehicle to provide situational awareness in a simulated mass casualty incident

Introduction: Situational awareness (SA) is essential for maintenance of scene safety and effective resource allocation in mass casualty incidents (MCI). Unmanned aerial vehicles (UAV) can potentially enhance SA with real-time visual feedback during chaotic and evolving or inaccessible events. The purpose of this study was to test the ability of paramedics to use UAV video from a simulated MCI to identify scene hazards, initiate patient triage, and designate key operational locations. Methods: A simulated MCI, including fifteen patients of varying acuity (blast type injuries), plus four hazards, was created on a college campus. The scene was surveyed by UAV capturing video of all patients, hazards, surrounding buildings and streets. Attendees of a provincial paramedic meeting were invited to participate. Participants received a lecture on SALT Triage and the principles of MCI scene management. Next, they watched the UAV video footage. Participants were directed to sort patients according to SALT Triage step one, identify injuries, and localize the patients within the campus. Additionally, they were asked to select a start point for SALT Triage step two, identify and locate hazards, and designate locations for an Incident Command Post, Treatment Area, Transport Area and Access/Egress routes. Summary statistics were performed and a linear regression model was used to assess relationships between demographic variables and both patient triage and localization. Results: Ninety-six individuals participated. Mean age was 35 years (SD 11), 46% (44) were female, and 49% (47) were Primary Care Paramedics. Most participants (80 (84%)) correctly sorted at least 12 of 15 patients. Increased age was associated with decreased triage accuracy [-0.04(-0.07,-0.01);p=0.031]. Fifty-two (54%) were able to localize 12 or more of the 15 patients to a 27x 20m grid area. Advanced paramedic certification, and local residency were associated with improved patient localization [2.47(0.23,4.72);p=0.031], [-3.36(-5.61,-1.1);p=0.004]. The majority of participants (78 (81%)) chose an acceptable location to start SALT triage step two and 84% (80) identified at least three of four hazards. Approximately half (53 (55%)) of participants designated four or more of five key operational areas in appropriate locations. Conclusion: This study demonstrates the potential of UAV technology to remotely provide emergency responders with SA in a MCI. Additional research is required to further investigate optimal strategies to deploy UAVs in this context.

ONCOPLASTIC RESECTION OF THE MAMMARY GLAND WITH A SLIDING DERMOGLANDULARY FLAP WITH A Z-SHAPED INCISION

Oncoplastic resections are a radical surgical treatment for breast cancer, as well as a method for the rehabilitation of patients, since operations are classified as organ preserving. When the tumor node is localized in the upper-inner quadrant of the breast, it is difficult to achieve good aesthetic results. One of the solutions to the problem is the use of a sliding flap with a Z-shaped incision. In P. Hertsen MORI from 2014 to 2016, the operation with the use of a sliding flap was performed in 13 patients. The prevalence of the process, patients were distributed as follows: ТisN0 М0–1, Т1N0 М0–7, Т2N0 М0–3, Т1N1 М0–2 .Molecular subtypes distribution was the following — luminal type A— 8, luminal type B — 3, triple-negative subtype — 1 patient. Localization of the tumor site in the breast: the upper-internal quadrant — 9, upper — 1, lowerinner quadrant — 3 .The upper Zshaped flap was used in 10 patients, the lower Zshaped flap in 3 cases. Postoperative period in all patients was without com plications. The wound healed by primary intention in all patients. Cosmetic effect was good. The observation period is from 6 months to 2 years, the median is 1.1 years. Data for local recurrence and distant metastases were not detected. 2 patients had only surgical treatment, in the remaining 8 cases, radiation therapy with or without drug therapy. In all cases the operation is performed on one breast, correction of the second breast was not required.The article presents the clinical observation of patients with oncoplastic resection of the Zshaped flap, a detailed procedure of the operation.

An online-processing critical patient monitoring system- an interoperability overview

With the increasing expansion of Healthcare Information Systems, platforms for interoperability and monitoring systems have become vital tools to support the clinical practice. Under this scenario, the creation of knowledge in real-time to feed decision support tools is essential. INTCare is one the solutions that adapts the way that information is gathered and processed in order to obtain that knowledge. Once new information arrives, it triggers the ETL (extract, transform, load) procces enabling real-time processes like data mining. However, the system fails in recognize if a patient is absent from bed or not. This problem led to the development of the Patient Localization and Management System (PaLMS), a Radio-Frequency IDentification (RFID) serving as localization and monitoring system. This paper describes the PaLMS implementation as well as an intelligent Multi- Agent System for the integration of PaLMS into the hospital platform for interoperability named AIDA (Agency for Integration, Diffusion and Archive of Medical Information). At the end, an usability evaluation was performed in order to assess the level of usability of the existing systems at Centro Hospitalar do Porto, such as the PaLMS, the INTCare and the AIDA platform. In terms of usability, the system got very positive evalutions, despite the fact some medical staff argued that they lose too much time elaborating the records.