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The results of planimetric investigation, conducted in 82 patients, suffering an acute purulent lactation mastitis (APLM), were analyzed. Of them 42 patients (the main group) were operated on, using radiofrequency scalpel, for the postoperative wounds processing the low-frequency ultrasound and ozonated isotonic solution of sodium chloride were used. In 40 patients (group of comparison) the conventional methods of treatment of APLM were applied.

According to microbial investigation data, conducted preoperatively, intraoperatively, in 7 days postoperatively for an acute purulent lactational mastitis, there was noted significant reduction of the wound microbial soiling while application of radiofrequency scalpel and ozono-ultrasonic method in comparison with such while application of conventional methods of treatment.

Results of treatment of 664 patients with lactation mastitis were analyzed. It was demonstrated that Staph. aureus was the main infectious agent of the disease. Antibacterial therapy must be started with cephalosporins and aminoglycosides and corrected after tests for antibiotics sensitivity. In purulent mastitis breast feeding must be stopped, and drugs suppressing lactation should be added. In severe forms of intramammary purulent mastitis semi-oval incision by Rovinsky is recommended. In infiltrative-purulent mastitis it is better to resect the affected part of the mammary gland and apply delayed sutures in 5-7 days. Surgery must be performed by an experienced surgeon and assistant under general anesthesia.

The investigation results obtained by the authors and the data of literature on the role of the biological properties of staphylococci in the pathogenesis, development and chronization of acute suppurative lactation mastitis are generalized. The concept of lactation mastitis as a monoetiological disease caused solely by bacteria of the genus Staphylococcus is substantiated. The importance of the individual properties of staphylococci at different stages of the pathogenesis of lactation mastitis, as well as their role in ensuring the resistance of the infective agent to the protective mechanisms of the body and in the chronization of the suppurative process, is considered. The data on the use of a number of biological properties of staphylococci as markers for the prognostication of the course of lactation mastitis are presented and their prognosticating effect at different tactics of surgical treatment is evaluated.

The informative value of biological characteristics of Staphylococcus aureus reflecting the ability of microbes to inactivate certain factors of natural resistance (lysozyme, complement, immunoglobulins, bactericidal component of interferon) was established in determining the duration of the caused by them pyo-inflammatory diseases such as postinfection abscesses, lactation mastitis. On this basis the heterogeneous successive procedure of pattern recognition was used to develop algorithms allowing prognosis of the duration of pyo-inflammatory diseases of staphylococcal etiology in 84.6-94.4% of the patients after the quantitative and qualitative assessment of the biological properties of the pathogen with not less than 90% reliability.

Physiotherapeutic methods of therapy were used in complex treatment of 839 from 1435 patients with lactic mastitis diadynamic currents, high frequent ultrasound, ultraviolet irradiation of the wounds, UHF, local oxygen therapy of the wounds combined with UVI. Comparative data of the results of the treatment methods evidence that the most efficient in local treatment are to be ultrasound and oxygen therapy of the mammary glands combined with ultraviolet irradiation.

For the estimation of the intoxication degree an analysis of dynamics of the level of medium-sized molecules (LMM) in blood serum was made in 71 patients with purulent wounds in different courses of the wound process. The results obtained were compared with the parameters of bacteriological and cytological characteristics. It was found that the 1.5 times elevation of LMM with values up to 0.380 units spoke of the compensated degree of intoxication with the following favourable course and disappearance by the 5th day of the postoperative period. While the 2-3 times elevation of LMM parameters--up to 0.710 units lies outside the limits of compensatory potentialities and complex antibacterial therapy normalized them by the 9th day. The comparison of dynamics of the parameters studied shows their clear correlative relationship.

Augmentin was used in treatment of mild forms of postnatal endometritis and serous mastitis. Augmentin tablets proved to be efficient in endometritis due to enterobacteria and obligate nonsporulating anaerobes and mastitis due to Staphylococcus aureus strains sensitive to the preparation. No adverse events were recorded. It was shown that in the treatment of mild postnatal infections the augmentin tablets were not inferior by their activity of combinations of antibiotics against aerobic and anaerobic microflora.

The efficiency of bifidumbacterin was studied in 160 parturients and 160 newborn for the prophylaxis of postpartum lactation mastitis and purulent-septic diseases in the infants 6 months after discharge from the hospital. The incidence of mastitis reduced from 6.88 to 1.25% while the morbidity in the newborn reduced three times. The agent does not inhibit the residence microflora of the breasts, favours early development of bifidoflora of the intestine in the new-born.

A total of 80 patients with postnatal purulent mastitis were treated with gentamicins. The main causative agent was Staph. aureus resistant to the traditionally used antibiotic and sensitive to gentamicin, fusidin, rifampicin and semisynthetic penicillinase-stable penicillins. Gramnegative bacteria contaminated the purulent foci after opening. Gentamicin was highly effective in treatment of postnatal purulent mastitis in cases with mixed Staphylococcus-Proteus infection.

A total of 406 S. aureus strains isolated from wound and mammal secretions in patients with wound infections and mastitis, from the throat of healthy children and those with respiratory disease, as well as during an outbreak of alimentary toxicoinfection, were studied. The capacity of these strains for the production of enterotoxins A, B, C, D, E, as well as the phage groups and phage types of these strains were determined. 34.2% of the strains were enterotoxigenic; the occurrence of this characteristic in staphylococci did not depend on the source of their isolation, but correlated with the results of their phage typing. Enterotoxigenic strains were detected most frequently (56.5--68.0%) in phage groups III, I/III and among staphylococci lyzed by additional phages (Nos. 88--96). Almost half of these strains produced enterotoxin A, each of other enterotoxins was produced by 12--14% of the strains. The isolated from the patients were found to produce mostly enterotoxins A and D, and those from healthy persons B and C. The relatively frequent production of enterotoxin D was found to be characteristic of staphylococci belonging to epidemic phagotype 80/81 isolated in mastitis.

During the period of hospital treatment a change in the composition of would microflora in 145 patients was found to occur, which affected the characteristics of microflora in respect of species, types and strains. This change consisted in the appearance of new (secondary) species, variants and strains and in the disappearance of some original (primary) ones. The populations of staphylococci were found to vary in the level and spectrum of their resistance to antibiotics (resistovars) and in the degree and spectrum of their sensitivity to staphylococcal typing phages (phagovars). Changes in the populations of staphylococci were caused mainly by the cange of S. aureus or by the additional appearance of their new variants which belonged, as a rule, to phage group II, had multiple resistance to antibiotics and corresponded to the phagovars of the hospital flora. The development of hospital variants in open wounds led to an increased general level of resistance of staphylococcal populations to antibiotics.

In the bacteriological survey of 410 patients with purulent mastitis Staphylococcus aureus was found to be the main etiological factor of the disease. In most cases the strains of phage group I, phage type 80 were isolated. In unilateral mastitis during the acute period staphylococci were isolated from the the milk samples taken from the affected mammary gland in 77.4% of cases, and from the milk samples from the healthy mammary gland in 62.3% of cases. The strains isolated from the milk of both mammary glands and the surgical wound were identical. By the time of clinical convalescence staphylococci could be isolated from the milk of the affected and healthy mammary gland in 21.8% and 10.1% of cases, respectively, and from the surgical wound in 31.5% of cases.

A comparison was made between the results of phage and lysogenic typing of S. aureus strains isolated during several outbreaks of staphylococcal infection and S. aureus cultures isolated from the same carriers at different periods. The study of the groups of strains having the same origin showed that the differences in the number of reactions were more pronounced in lysogenic typing than in phage typing. For this reason lysogenic typing can be recommended only for the identification of those strains which cannot be identified with the use of the phages of the International Basic Set. The results of the experiments with induced phages proliferating in a restriction-defective strain indicated that restriction and modification were mainly responsible for the specificity of lytic reactions.

Some properties of hospital staphylococcal strains isolated from the patients with purulent postnatal mastitis were studied. It was found that all the strains of the phage type 80.81 widely distributed in the obstetric hospitals were polylysogenic and polyresistant to antibiotics. The resistance markers in most of the isolates were located on the plasmids. Elimination of the plasmids carrying the antibiotics resistance markers resulted in a simultaneous change in the strain lysogenic spectrum while the phage type and fermentative properties, such as production of plasmocoagulase, DNAase and lecithinase did not change. The capacity for hemotoxin production was lost simultaneously with antibiotic resistance in 1 out of 17 cultures tested.

The etiological picture of lactation mastitis and sensitivity of its causative agent to some antibiotics were studied. Mostly microbial associations were isolated from the patients. Pathogenic staphylococci typed mainly by the phages of group I predominated among the isolates. In addition the strains of Proteus, Pseudomonas, E. coli and others were isolated from the pus of the mastitis cases. Sensitivity of the microflora to some antibiotics was studied. It was found that most of the causative agents of the postnatal mastitis possessed multiple resistance. They were mainly resistant to benzylpenicillin, streptomycin, tetracycline, chloramphenicol, oleandomycin and sensitive to oxacillin, methicillin, kanamycin and rifampicin. It was shown that during the patients stay under tha stationary conditions the postoperative wound were infected for the second time with hospital microbial strains.

The study of antagonism between S. aureus hospital strains and lactic acid bacteria, strain 317/402 "Nariné", revealed that the latter possessed high antagonistic activity. A new method for the sanitation of carriers of S. aureus hospital strains was developed; this method made it possible to limit the epidemiological significance of 82% of these strains.