Surgical aspects of drug addiction

During the primary inspection of surgical patients it is necessary to pay a regard to narcological anamnesis. As most such patients intentionally hide the fact of abuse of drugs or distort narcological anamnesis, their inspection must be based on the active exposure of objective stigma drug addiction (tracks of injections, existence of bacterial collectors, signs of chronic persistent septicemia, carious teeth), specific psychosomatic status (loss of hygienical skills, demoralization and desocialization personalities, apathy, depression, lability of psyche, decline of intellect, narrowing of circle of interests), and also domestic attributes of drug addiction (utillized syringes, narcotic matters).

Often basic reason of appeal of drug addicts for medical help is manifestation of abstinent syndrome for lack of narcotic matters or inaccessibility of ways of their introduction (inflammatory processes are in the places of usual injection of drug). At that rate patients demonstrate the so-called baron Myunkhauzen syndrome – complaints and anamnesis, imitating different, including surgical illnesses the purpose of which is to get anaesthetizing narcotic preparation, express.

Features of clinical picture and symptomatology for patients-drug addicts by a surgical sepsis: disparity of external objective status of primary purulent hearth of infection to the veritable volume and character of defeat; absence of classic signs of inflammation is hyperthermia, to hyperemia, sharply expressed sickliness, high level of sowing of positive hemoculture.

1986 to, while it was not invented reliable methods of serological diagnostics of HIV-infection, applied credible clinical-laboratory criteria which remain relevant until now (table).

Table. Credible clinical-laboratory criteria of AIDS (for WHO – World Helth Organization)

Clinical

polylymphadenopathy* intermittance fever > 38 °С over 3 months loss of weight over 10% languor protracted diarrhea nightly chill

Laboratory

leucopenia thrombopenia anaemia hyperglobulinemia promoted blastogenesis allergy to skin tests decline of number of Т4-lymphocytes < 400/мм3 diminishing of correlation of Т4/Т8 < 1,0 positive test on antibodies to HIV

Note: * Polylymphadenopaty examine as a generalized increase (> 1 sm) of lymphatic nodes, which lasts over 3 monthes, is determined at least in two extrainguinal places and does not bind to other pathology

Exposure for a patient two clinical and two laboratory criteria is basis for preliminary clinical diagnostics of HIV-infection.

However for establishment of final diagnosis "HIV-infection" today on the realized consent of patient conduct such standard serological testing:

• enzymoimmunoassay in the presence of antibodies to HIV. A reaction can be falsity-positive at pregnant, patients, carrying hemotransfusion, transplantation of tissues or organs, patients collagenosis, autoimmune diseases, malignant new formations. That is why about HIV-infected a conclusion is drawn on the basis of triple positive result of enzymoimmunoassay. Farther the standards of blood are sent in the centralized laboratory;

• a reaction of immunoblotting is the most exact today method of serologic diagnostics of HIV-infection.

The however transferred reactions do not enable to diagnose HIV-transmitter in the period of "blind window", which can last to 6 month from a moment infecting. In order to ratify fact of transmitter of HIV it is possible to apply:

• polymerase chain reaction to RNA- or DNA-viral of origin, and

• selection of virus from blood of patient.

Taking into account the transferred arguments, most expedient is a presumptive doctrine of hyperdiagnostics of HIV-infection which with success is inculcated in leading medical establishments of the world: "regardless of serologic research results of every patient on all of the stages of diagnostic and medical algorithm it is necessary to interpret as infected".

"Distanсe surgery"

The measures of «Distanсe surgery» provide for, that:

• manipulations with tissues conduct only by instruments;

• in the case of conducting of needle through tissues utillize pincers, but not finger only;

• does not touch to the sharp surfaces of instruments;

• surgical knots string instruments;

• an operating nurse mortgages a needle in needleholder, utillizing pincers or clamp.

Considerable part of suboperating damages of surgical gloves safety arises up during the transmission of surgical instruments from one member of operating brigade to other (more frequent than all a surgeon is a nurse and vice versa). For the exception of such cases the standard of "Non-touch" technique was inculcated, which means that a surgeon, nurse and assistants, never simultaneously touch to one and volume sharp object.