V. Reference basis of actions

Care of patients at a hydradenitis

At the hydradenitis care of patient includes hanging of hand on a triangular scarf, careful shaving of hairs in an armpit cavity. A patient is necessary to explain importance of hygienical maintenance of armpit area, fight against sweaty (regular rubbing skins of armpit by an alcohol and other).

Care at the diseases of mammary gland

At the cracks of nipple baths do with Dekasan (immerse a nipple in glass or jar with solution of preparation), bandages with ointment of aloe, calendulas, Vundekhil. Before feeding it is necessary to strain off a little bit of milk. At serous and infiltrative mastitis do compresses from 30 % by solution of dimethylsulfoxyde, retromammarial blockades with antibiotics, novocaine, trypsin, hydrocortisone. A patient is necessary to be taught the careful straining of milk (6-8 times per days). Mashing of infiltrate, massage (they can result in distribution of infection) unit admits, and application of folk facilities is special: honey and bread small cakes, pack of gland, sucking of milk a jar and other, the leaves of goose-grass. It is necessary to caution women from self-treatment, to advise them at appearance of compression and pain in a gland at once to speak to the doctor.

At purulent mastitis after wide dissection or excision of infiltrate with imposition of primary stitch apply the through perforated drainage, washing of cavity and aspiration of its content. An operation concerning mastitis is done under anesthesia. A sister prepares for it instruments for dissection of abscess, sterile sheets, towels, gloves, drainages, sucking, solutions of antiseptics and antibiotics. After an operation rubber strips delete on a 3-4th day, drainpipes – on a 7-8th day. For 20 mines to straining of milk it is possible to enter no-spa and oxytocin for the improvement of emptying of mammary gland; for suppression of lactation – Dostineks (to on ½ tab. 2 times per a day during 2 days or for 1 tab. in a day – 2 days). Women with mastitis it is desirable to hospitalize without children, to avoid the infection of child a hospital infection. To feed with a child the staggered breast does not follow, because there can be microorganisms in milk.

Method of conducting of retromammarial blockade

A retromammarial blockade is used for treatment of initial forms venerable or as an element of local anaesthesia at operations on a mammary gland (dissection and draining of abscess). In three points enter at foundation of mammary gland (at overhead and lower poles and from an outward surface) of endermic 0,5 % solution of novocaine. The needle then planted on a syringe, premise its advancement solution of novocaine, is entered in retromammarial space. At each of three sticking needles enter 50 ml 0,25 % solution of novocaine. Thus not it must be felt resistances, but at the removal of syringe novocaine must not follow from a needle. At the correctly made blockade a mammary gland is raised and lies as on a pillow.

Diagnostics of anorectal abscess

Subcutaneous anorectal abscesses

A disease begins usually enough sharply. Pains appear in area of anus, especially increasing during defecation. A patient walks slowly, hardly. Spread the legs from pains in area of anus, can sit only on one healthy buttock area, holding a patient on to weight.

Local signs at subcutaneous anorectal abscess also are enough characteristic. At back of subcutaneous cellulose in the distance 2-4 sm from an anus, sometimes directly under a transitional fold sickly infiltrate appears sharply. Skin in this area a few raised the inflammatory slight swelling, blushes. Radial skin folds, going from an anus, are smoothed out.

Introduction of finger to the anus very painfully.

Sciatic-rectal abscesses

While a process is localized in sciatic-rectal pit, a patient can walk, in spite of weight of the state. With passing of purulent inflammation to the subcutaneous cellulose those signs appear difficulties at walking, which are characteristic for started superficial subcutaneous abscesses.

At examination of area of anus some local signs of inflammation can be absent in the first days. Later the slight swelling of internal surface of buttock area appears on the side of inflammation. A skin becomes tense. Palpation research of visible infiltrate is sharp painfully. Skin folds are smoothed out. Yet later hyperemia of skin appears and can be certain fluctuation at distribution leaving to rot from ischiorectal pit in a subcutaneous cellulose. Research of rectum a finger from the first days gives valuable diagnostic information. Wall of rectum on the side of inflammation of infiltration, painfully and in the beginning little bulges in the road clearance of rectum. Scopes of infiltrate it is succeeded to go round a finger. Later can be found out the distinct thrusting out of infiltrate in the road clearance of rectum, sickliness, immobility, softening influence in a center.

A pus can spread through retrorectal cellulose space on other sciatic-rectal pit with formation of horseshoe-shaped anorectal abscess.

Pelvic-rectal abscesses

A disease usually begins gradually. Indefinite fever and pains at back of lower department of abdominal region or at back of small pelvis hamper a diagnosis. A patient sometimes consistently treats oneself for the doctors of different specialities: internist, urologist, gynaecologist.

At examination and outward inspection of disease discovering is not succeeded. Pressure in the circumference of anus of sickliness does not cause. At research a finger, entered in an anus, highly, through the wall of rectum, more frequent than all from a front side, dense, sickly infiltrate is determined, a few bulging in the road clearance of rectum. To inspect the overhead edge of infiltrate a finger not succeeded usually. As far as growth of the general and local phenomena infiltrate can be increased, squeeze the road clearance of rectum, give the signs of softening influence, fluctuation.

Choice of method of treatment at a suppurative infection

Exciters of erysipelas (sharp inflammation of skin)  streptococci of group A, which overcome protective barriers due to the producted toxins. Rapid distribution of infection is characteristic. A skin is an edema and hyperemia, clear scopes have the staggered areas. If the lymphatic system is engaged in a pathological process, red bars appear on a skin (Limfangiitis). Streptococci cause the also poured out purulent inflammation of subcutaneous cellulose  phlegmon. Diseases, caused streptococci of group A, flow heavily; before opening of penicillin lethality was 90%. Treatment benzilpenicillin (1,25  million  units intravenous each 6  hours) results in death of all of exciters. From opening of penicillin times, he did not lose the role  stability to penicillins for streptococci is not produced.

At inflammatory infiltrates apply UHV, warming compresses, at a sharp edema and hyperemia is a cold. Sometimes utillize a hypothermia brief (no more than 1 mines) dispersion of stream of chloroethyl. Apply also electrophoresis with trypsin. For electrophoresis trypsin (10 mgs) is dissolved in 20 ml of the distilled water and enter from a negative pole. Good results are given by application of compresses with Dimexid in combination with enzymes and antibiotics. A compress is laid on on 12-14 hours. After softening influence abscesses unseal and drainage.

Set of tools for dissection of abscess: syringe, needles (if operation, conducted under local anaesthesia), scalpel, 2-3 clamps of Bilroth, scissors, hooks are sharp, needleholder, needles cuttings (for the stop of bleeding), drainages.

Technique of dissection of superficial abscesses: a cut is done on motion of skin folds, on extremity – on its long ax. Dissect a skin, hypodermic basis, move apart the edges of wound sharp hooks and enter a clamp in a wound. Entering in the cavity of abscess, move apart of clamp and extend a cut for an outflow leaving to rot. Drain a wound a tube or strip of glove rubber.

After dissection abscesses and phlegmons treat as purulent wound. Last years apply the method of treatment of wound the pulsating stream of liquid (antiseptic solution) by the special vehicle. The serve of liquid is provided pressure of oxygen (to 1 atm), frequency of pulsations is 60-100 in 1 mines, to 700 ml of liquid is expended for this time. The number of pulsations can be regulated.

Postoperative conduct of anorectal abscess patients

Main in treatment is looking after the process of cicatrization of wound. During 4-5 days before a chair for 30 minutes analgesics is entered. After a chair is bandaging. The correctly conducted postoperative care is instrumental in cicatrization of wound, warning of appearance of fistula and insufficiency of sphincter. It is carried out by maintenance of maximally effective draining of wounds, use of control of cicatrization of wound a finger in a glove, to warn sticking together of edges of wound and waiver of tamping wounds in an anal ring after days after an operation. A wound is irrigated solutions of antiseptics (Decasan), on a crotch an aseptic gauze bandage is usually laid on with ointment on modern hydrophilic basis or hydrophilic-hydrophobic nanodispersed compositions of «Flotoxan» and «Metroxan» according to the phase of wound process.