Treatment of suppurative lymphadenitis in children in the postoperative period 
 

Danylov O. A., Rybalchenko V. F., Talko M. O., Mikhnusheva O. S.

Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Kyiv Municipal Clinical Hospital No1, Ukraine

Objective — to increase the efficiency of combination treatment for suppurativelymphadenitis in children, to compare the effectiveness of the gel form of tyrothricin and povidone-iodine in the local treatment of suppurative lymphadenitis in the postoperative period.

Materials and methods. To address the problems, in the surgery department No2 of Kyiv municipal clinical hospital No1 we have selected 50 children of all ages, including young children, with acute suppurative lymphadenitis of various locations. According to the method of influence on suppurative focus, the patients were divided into two groups of 25 people: in the first (compara tive) one, the treatment was carried out with the use of hypertonic aseptic dressings and povidone-iodine 10% on ointment base, and in the second (control) one, respectively, we have applied the same hypertonic solution of sodium chloride and tyrothricin (tyrosur). The distribution of patients in these groups according to the age, localization of the process was the same. Treatment in these groups of patients included: surgical technique — the dissection of suppurative lymphadenitis and draining the wounds; antibacterial (in both groups we have used lymphotropic injection of gentamicin), antiinflammatory and detoxification therapy. In the first phase of treatment, we applied hypertonic sodium chloride solution on the aseptic napkin to the end of active suppurative exudation that accounted for 1–2 days. Next, tyrosur gel or ointment povidoneiodine 10% were used 1 time a day by applying to the wound surface coated with aseptic bandage. As the main criteria for assessing the efficacy of these drugs, laboratory parameters (total lymphocytosis, erythrocyte sedimentation rate, leukocytic intoxication index), cytology of wounds smear, bacteriological examination of discharge, dynamics of wound process were considered.

Research results. It was found that children in the control group had a significant reduction in erythrocyte sedimentation rate by the 7th day, a decrease in leukocytic intoxication index was more rapid (on the 7th day, these indicators in the control group reduced to 1.12±0.09 c.u., whereas in the comparison one specified values amounted to 1.46±0.14 c.u. by the same period). The results of bacteriological study of wound exudate showed a positive culture only in 64% of the material. The dominant group of pathogens consisted of Staphylo coccus aureus (74%), Staphylococcus epidermidis (12%), Staphylococcus haemolyticus (10%), Streptococcus β-hem. (4%). Already on the 3rd day, there was no bacterial growth in the control group, in the comparison group positive growth of microorganisms was marked in only 3 patients (12%). The cytological study of smears shows that the use of gel form of tyrothricin accelerates the course of the I phase of wound process compared to the use of povidone-iodine. Wound cleansing from suppurative necrotic content and termination of suppurative exudation have been observed significantly earlier in the control group (1st group — on the average 6th day after surgery, 2nd one — on the 4th day after surgery). In phases of regeneration, scar formation, more pronounced positive dynamics was clearly observed in the 2nd group. When using povidone-iodine, dynamics of wound contraction averaged 6.16±1.82%, the rate of retraction of wound edges — 7.82±0.44%, while during the use of tyrosur gel — respectively 9.93±2.42% and 9.72±0.13%. Formation of scar in the control group started on average on 9th day, while in the comparison group — only on the 11th.

Conclusions. Results of the study show that the use of hypertonic sodium chloride solution in combination with tyrosur during the treatment of children with suppurative lymphadenitis significantly reduces the time of wound cleansing from suppurative necrotic masses, accelerates regeneration and scar formation and reduces the length of stay in hospital compared to traditional methods of local effects. The application of tyrosur gel in this pathology prevents the development of secondary infections and makes a significant positive impact on regenerativereparative processes.

Key words: suppurative lymphadenitis, wound process, adsorbents, tyrosur gel.

References

1. Goncharov YaP, Sapozhnikov AR, Petrusha AO et al. 2011. Differentsialnyiy diagnoz pri generalizovannoy limfadenopatii. Therapia UkraYinskiy medichniy vIsnik. 9: 66-70.

2. Voytsehovskiy VV, Landyishev YuS, Grigorenko AA, Govorov ND. 2014. Differentsialnyiy diagnoz pri sindrome limfadenopatii. Novyie Sankt-Peterburgskie vrachebnyie vedomosti. 1: 32-43.

3. Harlamova FS et al. 2013. K voprosu o differentsialnoy diagnostike limfadenopatii u detey. Detskie infektsii. 12; 2: 62-64.

4. Nagornaya NV, Bordyugova EV, Vilchevskaya EV et al. 2013. Limfadenopatiya u detey. Zdorove rebenka. 6: 166-176.

5. Minaev SV, Vinyarskaya IV, Tsutsieva VV. 2010. Optimizatsiya programmyi lecheniya detey s ostryimi nespetsificheskimi limfadenitami. Voprosyi prakticheskoy pediatrii: nauchno-prakticheskiy zhurnal dlya neonatologov i pediatrov. 5; 5: 27-30.

6. Aminova GG, Grigorenko DE, Rusina AK et al. 2000. Morfologicheskie osobennosti limfoidnyih struktur u novorozhdennyih detey. Morfologiya. 118; 6: 53-56.

7. Tereschenko SYu. 2013. Sheynaya limfadenopatiya infektsionnoy etiologii u detey: voprosyi differentsialnoy diagnostiki. Detskie infektsii. 12; 1: 36-42.

8. Kaliuzhna LD, Patselia MV, Boichuk AM. 2011. Dosvid zastosuvannia tyrotrytsynu u likuvanni piodermii. Alerhiia u dytyny. 9–10: 35-37.

9. Hirurgicheskie infektsii kozhi i myagkih tkaney. Rossiyskie natsionalnyie rekomendatsii. Rukovodstvo. Pod red VS Saveleva. M, 2009: 89.

10. Abaev AK, Prokopchuk NR, Adarchenko AA. 2008. Effektivnost antiseptikov i znachenie mikrofloryi v protsesse ranevogo zazhivleniya. Detskaya hirurgiya. 1: 25-29.

11. Botyakov AA. 2008. Mehanicheskie sposobyi v kompleksnom lechenii gnoynyih ran myagkih tkaney: eksperimentalno-klinicheskoe issledovanie. Avtoref dis … kand med nauk. 14.00.27. Kazan gos med akad. Kazan: 26.

12. Gostischev VK. 2007. Infektsii v hirurgii. Ruk dlya vrachey. M. GEOTAR-Media: 761.

13. Vinnik YuS et al. 2008. Ispolzovanie kriogennoy stimulyatsii v lechenii hronicheskih ran. Vestn hirurgii im II Grekova. 167; 1: 27-28.

14. Halilov MA. 2009.Voprosyi optimizatsii mestnogo lecheniya gnoynyih ran. Kursk nauch praktich vestn Chelovek i ego zdorove. 3: 31-37.

15. Hachatryan AB. 2009. Optimizatsiya mestnogo lecheniya ran i ranevoy infektsii kozhi i myagkih tkaney: eksperimentalno-klinicheskoe issledovanie. Avtoref dis … kand med nauk. 14.00.27. Samar gos med un-t. Samara: 22.

16. Prohotskiy AN. 2006. Applikatsionnaya ranevaya sorbtsiya v kompleksnom lechenii gnoynyih ran. Avtoref dis … kand med nauk. 14.00.27. Yaroslav gos med akad. Yaroslavl: 22.

17. Yarboro SR, Baum EJ, Dahners LE. 2007. Locally Administered Antibiotics for Prophylaxis Against Surgical Wound Infection. An in Vivo Study. J Bone Joint Surg Am. 89: 929-933.