[Endoscopic biopsy of a frontal lobe tumor infiltrating the lateral ventricle using intraoperative navigation]. / Endoskopicheskaya biopsiya opukholi lobnoi doli golovnogo mozga, prorastayushchei v bokovoi zheludochek, s ispol'zovaniem intraoperatsionnoi navigatsii.

The authors describe the clinical observation of a patient with a paraventricular tumor of the left frontal lobe and demonstrate the effectiveness of endoscopic biopsy of a volumetric mass of such localization through the lateral ventricle using intraoperative navigation. The disease manifested with convulsive seizures two years before the patient was admitted to the hospital. During this period of time, he was repeatedly examined. The dimensions of the volumetric formation remained unchanged. Based on the data obtained, it was not possible to accurately verify the type of tumor. Anticonvulsant therapy was ineffective. The patient underwent surgery - endoscopic partial removal of the tumor (biopsy) and opening of the tumor cyst through the left lateral ventricle using intraoperative navigation. Clinical improvement in the patient's condition was achieved. After the operation, the headaches and the seizures stopped.

[Carotid endarterectomy with stent removal in a patient with early bilateral restenosis of the internal carotid arteries in the acute period of recurrent ischemic stroke]. / Karotidnaya endarterektomiya s udaleniem stentov u patsienta s rannim dvustoronnim restenozom vnutrennikh sonnykh arterii v ostrom periode povtornogo ishemicheskogo insul'ta.

We present a rare clinical observation of a patient with an early reoperation performed up to 2 weeks after a recurrent stroke. Carotid endarterectomy with removal of previously installed stents for critical stenoses of the internal carotid arteries after the first stroke was performed. Early bilateral restenosis up to 80-90% of the lumen in the stents of both internal carotid arteries was observed 6 months after stenting. Open interventions were performed in the acute period of recurrent ischemic stroke in two stages with a favorable outcome. No data on the increase of neurological symptoms were obtained for 2 years of observation. Treatment and application of early rehabilitation methods, improved the patient's general condition, strength in the left extremities increased up to 4.5 points, left-sided hemihypesthesia decreased, speech disorders regressed. The patient walks and serves himself independently.

[Primary retrograde distal access for endovascular interventions in patients with lower limb ischemia]. / Pervichnyi retrogradnyi distal'nyi dostup pri endovaskulyarnykh vmeshatel'stvakh u patsientov s ishemiei nizhnikh konechnostei.

OBJECTIVE: To evaluate safety and technical efficiency of primary retrograde distal access for endovascular interventions in patients with lower limb ischemia. MATERIAL AND METHODS: A prospective analysis included 25 endovascular procedures via primary retrograde distal access in 23 patients with chronic obliterating diseases of lower limb arteries. Occlusive lesion of femoral-popliteal segment was observed in 68% of cases, occlusion of at least one tibial artery was also found in 68% of cases. In 44% of cases, occlusive lesion was localized at several levels. Percutaneous intervention via anterior tibial artery or dorsalis pedis artery was performed in 68% of cases, posterior tibial artery - 24% of cases, peroneal artery - 8% of cases. We used 2 accesses in 92% of cases (the main one for intervention and additional one for angiography). In 8% of cases, intervention was carried out through a single access. Angiosome artery was punctured in 65% of cases. The only patent tibial vessel was used in 20% of cases. In 24% of cases, we performed antegrade recanalization of 'adjacent' tibial artery via distal access. RESULTS: Primary retrograde distal access was successfully performed in 100% of cases. Retrograde revascularization was not successful in all cases (successful recanalization rate 96%, retrograde intervention rate - 92%). Femoral access was performed in 8% of cases. Antegrade blood flow through at least one tibial artery was restored in all cases. Direct revascularization of the affected angiosome was performed in 15 patients with foot necrosis, indirect revascularization through collaterals - in 5 patients. Local complications of surgical access occurred in 12% of cases. CONCLUSION: Endovascular revascularization via primary retrograde distal access was technically effective in most cases. There were no complications with systemic consequences.

['Life-saving' interventions in subacute thrombosis of crural and plantar arteries]. / 'Zhiznespasaiushchie' interventsii pri podostrom tromboze arterii goleni i stopy.

The authors report a clinical case concerning successful endovascular treatment for subacute thrombosis of crural and plantar arteries in a patient with the only leg, substantiating therapeutic decision making with due regard for the duration of thrombosis and localization of the lesion of the arterial bed. Taking into consideration the statistical data on survival in case of performing major amputation in this cohort of patients, an 'aggressive' endovascular approach including three vascularizations made it possible not only to preserve the leg but also to save the patient's life.

[Severe carotid stenosis: cerebral autoregulation in the ipsilateral region]. / Kriticheskie stenozy vnutrennikh sonnykh arterii: tserebral'naia autoreguliatsiia v ipsilateral'nom basseine.

AIM: To study cerebral autoregulation (CA) in region of the stenotic carotid artery. MATERIAL AND METHODS: The study involved 35 patients with critical stenosis of the carotid arteries, including 24 patients were asymptomatic and 11 patients with symptomatic course. Blood flow velocity in middle cerebral arteries was monitored using Multi Dop X (DWL, Germany) with simultaneous noninvasive systemic blood pressure registration (CNAP, Austria). CA was assessed by calculating the phase shift (PS) between spontaneous oscillations of blood flow velocity and blood pressure within the range of systemic Mayer waves (80-120 mHz). RESULTS: In 18 patients, the CA indicators were in the normal range (PS 1.2±0.3 rad). Seventeen patients, including asymptomatic as well as symptomatic types, had impaired CA (PS 0.2±0.2 rad and 0.3±0.2 rad, respectively). Reconstructive surgery, irrespective of clinical manifestations, led to the significant increase in PS (p<0.001) in the early postoperative period (0.9±0.5 and 0.9±0.3 rad, respectively). CONCLUSION: A significant variability in the cerebrovascular reserve capacity in symptomatic and asymptomatic types of carotid artery stenosis was found. CA can be used in determining the indications for surgical treatment and evaluation of its effectiveness in patients with stenosis of carotid arteries.

[Assessment of functional state of microcirculatory bed of the foot in patients with lower limb critical ischaemia]. / Otsenka funktsional'nogo sostoianiia mikrotsirkuliatornogo rusla stopy u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

The authors assessed perfusion of the foot in patients presenting with lower limb critical ischaemia before and after endovascular revascularization, as well as analysed the interrelationship between the change of perfusion and the clinical result of treatment. The study includes a total of 15 patients presenting with ulcerative-necrotic defects of the foot. All patients underwent study of 2D-perfusion of the foot before and after the endovascular intervention. The '2D-perfusion' package was used within the framework of an angiographic examination, and required neither increase in the volume of the contrast medium nor radiation load. Four parameters of perfusion were evaluated: the time of ingress, the time of reaching the peak value, the peak value and the area under the curve. After the intervention, as compared with the baseline values there were statistically significant differences by the time of ingress (a 2.4-fold decrease; p<0.0001), the peak value (a 1.8-fold increase; p<0.0001) and the area under the curve (a 2.4-fold increase; p<0.0001). No statistically significant differences were revealed while comparing the time of reaching the peak value before and after the intervention (p=0.767). Trophic defects healed in 11 (73.3%) patients, and in 4 (26.7%) patients the process of healing continued with positive dynamics at the check-up examination. Hence, our first experience of using the assessment of 2D-perfusion demonstrates simplicity of the method with no increase of the radiation load and the dose of the contrast medium. The method makes it possible to obtain important data about the state of microcirculation of the foot in patients with lower limb critical ischaemia, to evaluate alterations after the endovascular intervention. Improvement of the parameters of perfusion is associated with a good clinical outcome.

[Bilateral stenoses of carotids. The surgical treatment in acute period of ischemic stroke in patients of different age groups].

The study included 138 patients who had 193 reconstructive operations on carotid arteries (CA) in the acute period of ischemic stroke. The 1st group included 22 patients with bilateral stenosis, age under 60 years; the 2nd group - 33 patients with a bilateral stenosis at the age more than 60 years; the 3rd group consisted of 83 patients with bilateral stenosis of the ipsilateral CA were operated in an acute period of ischemic stroke, but with contraindications and/or refused the surgery on the contralateral CA. Brain computer tomography, ultrasound duplex scanning of the CA with the assessment degree of stenosis and structure of plaques, also MSCT-AG of the head and neck vessels were performed for all patients. Cerebral oximeter was used for assessing adequate cerebral perfusion during cross-clamping of the CA. Indications for the installation of a temporary intraluminal shunt during cross-clamping of the CA performed according to the method.

[Transluminal balloon angioplasty as a method of choice in treatment of critical ischemia of lower extremities].

The authors analyzed results of treatment of 127 patients. A new direction in the endovascular treatment of critical ischemia of the lower extremities is substantiated on the basis of a combination of methods of subintimal and intraluminal angioplasty. For the first time all the patients with critical ischemia of lower extremities, and having no irreversible changes of the extremity requiring amputation at the level of the low leg or femur, must be considered as good candidates for translumbar balloon angioplasty.

[Transluminal balloon angioplasty in treatment of lower limb critical ischaemia].

OBJECTIVE OF THE STUDY: To evaluate efficiency of transluminal balloon angioplasty (TLBAP) in treatment of lower limb critical ischaemia (LLCI). MATERIALS AND METHODS: Over the period from November 2004 to April 2008, we performed a total of 89 TLBAPs in eighty-two patients presenting with LLCI. The patients' age averagely amounted to 67.8 +/- 9.8 years. Fifty (61%) patients had an ischaemic ulcer on the foot, seventeen (20.7%) had gangrene, and fifteen (18.3%) patients suffered from ischaemic pain at rest. Forty-five (54.9%) patients suffered from diabetes mellitus, including thirty-three (40.2%) subjects with insulin dependent DM. Sixty (73.2%) patients were diagnosed as having coronary heart disease (CHD), sixty-five (79.3%) had arterial hypertension, twenty-five (30.5%) - cerebrovascular disease, and thirteen (15.9%) - chronic renal insufficiency. Six (7.3%) patients were on chronic haemodialysis. The distribution of the patients by the level of the lesion were as follows: iliac 4 (3.6%), femoropopliteal 55 (49.5%), crural artery 52 (46.8%) Type-C and type-D lesions (TASC) were encountered in 89.2% of cases. Occlusions were observed in 82% of all lesions of the crural artery. 42.2% of the patients were treated by means of subintimal angioplasty. Stenting was used in fourteen (7.3%) cases. RESULTS: The angiographic and clinical success of the procedure was achieved in seventy-five (91.5%) patients. No LLCI was observed either after one or three years in 79.4 and 52.9% of the patients, respectively.

[Influence of polymorphism's of endothelial nitric oxide synthase gene and polymorphism of NADPH oxidase gene on development of complications of arterial hypertension].

The aim of the study was to analyze the prevalence of polymorphism Glu298Asp of endothelial nitric oxide synthase gene and C242T p22 phox polymorphism of NADPH oxidase gene in patients with arterial hypertension (AH) and their influence on AH complications. The study included 272 AH patients, average age 50,7 years. The following analyses were performed: clinical analysis of the blood, general analysis of the urine, lipid spectrum, plasma electrolytes, creatinine, glucose, electrocardiography, echocardioscopy, examination of eye vessels, ultrasound examination of the carotid arteries, determination of microalbuminuria. The polymorphism Glu298Asp of endothelial nitric oxide synthase gene and C242T p22 phox polymorphism of NADPH oxidase gene were detected with two methods: polymerase chain reaction and restrictase reaction. The control group for Glu298Asp polymorphism detection included 102 healthy Russian donors aged 18 to 50 years. Genotypes prevalence in AH patients was as follows: GG 58,8%, GA 32,3%, AA 8,9%, and CC 48,2%, CT 44,9%, TT 6.9%. In the control group: GG 53%, GA 36%, AA 11% and CC 42%, CT 54%, TT 4%. These polymorphisms did not affect the incidence of complications, such as obliterating atherosclerosis of the lower extremity vessels, ischemic heart disease, and acute insufficiency of cerebral circulation, chronic heart failure, left ventricular hypertrophy, microalbuminuria, carotid arteries atherosclerosis.

[Epidemiologic situation of arterial hypertension on industrial enterprise].

Arterial hypertension is widely prevalent disease (38.1% in Russia) and increases death rate with coronary heart disease 3-fold, with stroke--6-fold. Multiple prospective studies proved that opportune diagnosis of arterial hypertension and other risk factors, as well as their sufficient correction considerably lower risk of occurrence and unfavorable outcomes of arterial hypertension complications. With this, organization of prophylactic programs on outpatient basis seems extremely important.

[Laparoscopy at early postoperative intraabdominal bleedings].

Results of treatment of 46 patients with intraabdominal bleeding as complication of abdominal surgery are analyzed. Laparoscopy and ultrasonic diagnosis assisted with earlier diagnosis of complication. Eleven patients underwent repeated surgery at abdominal bleeding with laparoscopic techniques. Favorable outcome was seen at all the cases. Diagnostic algorithm of early postoperative intraabdominal bleedings is proposed.

[Method of surgical treatment of critical ischemia of lower extremities in patients with occlusive injuries of shin arteries].

The work describes a new method of restoration of blood circulation in patients with critical ischemia of the lower extremities of atherosclerotic genesis with a distal type of damage of the arterial bed. In 52 patients with the saved lumen of the distal part of the shin and little capacity of the distal bed reconstructive operations were performed by the developed technique. Reconstructive operations were fulfilled on 45 (86.5%) patients with the saved patency of the distal third of the posterior tibial artery, in 7 (13.5%) patients--of the anterior tibial artery. Thrombosis of the arterial bed occurred in 2 patients with saved patency of the vein in 3 weeks after operation. No recurrence of the critical ischemia of the extremity was observed. Thrombosis of the distal segment of the foot vein was found in 3 patients with the saved patency of the arterial bed in the period from 3 days to 4 weeks. Thrombosis of the venous shunt due to embolism of the cut off cusps of the venous valve was observed in 2 patients on the first day after operation. Thromboectomy from the shunt was fulfilled in these patients followed by recovery of blood circulation. Long-term results were followed up to 24 months. The shunt patency was 68%, the extremity was saved in 87% of the cases.

[Problems of diagnosis and surgical treatment of early postoperative abdominal complications].

Results of treatment of 419 patients with early postoperative abdominal complications have been analyzed. Diagnosis of complication has been made at postmortem examination at 26 patients (1st group). The indications to relaparotomy at 165 patients (2nd group) were based on clinical and laboratory data. Lethality at this group was 35.8%. Complex method of diagnosis including special methods (laparoscopy, ultrasound) was used at 228 patients (3rd group). Mini-invasive surgical treatment technologies were used at 118 of them. Lethality at this group was 17.1%.

[Postoperative complications of gallstone disease in elderly and aged patients].

Here we have analyzed the results of surgical treatment of gallstone disease and its complications in 1208 senior-age patients. In 875 patients planned operations were performed, whereas in 333 patients the interventions were urgent. Post operational complications occurred in 5.2% of cases, and lethality amounted to 4.1%. The complications and post operational lethality depended on how traumatic and urgent the intervention was. Diagnostics of intraperitoneal complications was based on instrumental examination methods, with primary significance assigned to laparoscopy. In 21 patients early post operational intraperitoneal complications were treated with the use of mini-invasive methods. Guidelines for surgical treatment of gallstone disease and its complications in senior patients have been worked out.

[Left ventricular myocardial geometry in arterial hypertension in patients with stenosing cerebral atherosclerosis].

The aim of the study was to define more exactly correlations between circulatory disturbances in the common carotid artery (CCA) basin, and hemodynamic disturbances and structural myocardial remodeling in patients suffering from arterial hypertension (AH) and cerebral atherosclerosis. The subjects were 83 patients evaluated by means of carotid arterial Doppler ultrasonography and echoCG; the variables of central homodynamic were measured as well. The study revealed that patients with AH and moderate CCA stenosis displayed hyperkinetic hemodynamic type more often than patients with severe CCA stenosis, of whom hypodynamic hemodynamic type was more typical. Left ventricular (LV) myocardial remodeling was more frequent in the latter group of patients; asymmetric LV hypertrophy prevailed. The study shows that the process of remodeling, caused by dissociation between central and regional hemodynamics, develops together with the progress of atherosclerotic arterial lesion.

[The role of laparoscopy in the diagnosis and treatment of early postoperative complications].

Results of 276 laparoscopic operations performed for diagnostic and therapeutic purposes in the early postoperative period in 198 patients are analyzed. All the patients had been previously operated on the organs of the abdominal cavity and retroperitoneal space: in 131 patients the investigations were performed with a diagnostic purpose; in 67 patients a laparoscopic method was used for treatment of complications of the early postoperative period. This problem can be solved by using the methods allowing diagnosing the complication as early as possible, before the development of irreversible alterations, and allowing to choose the most rational methods of treatment.

[Laparoscopy in early postoperative period in elderly and old patients].

For diagnosis and treatment of early postoperative intraabdominal complications 118 laparoscopic procedures were performed in 95 patients aged 55 to 94 years. Examination was carried out from 2 hours to 17 days after the first surgery. Diagnostic laparoscopy after surgeries on the liver and bile ducts was performed in 51 patients (most often), after ones on the intestine -- in 12 patients, on the stomach and the duodenum -- in 7, on organs of the small pelvis -- in 6, after appendectomy -- in 6 and after herniotomy -- in 8 patients. Primary surgery was emergency and urgent in 76, elective -- in 19 patients. Results of treatment of similar complications were studied in 91 patients (control group) who underwent laparotomy without previous laparoscopy. Both groups of patients were comparable by sex, age, severity of disease and types of primary surgical procedures. It is demonstrated that diagnostic and curative laparoscopic procedures in early postoperative intraabdominal complications in elderly and old patients permit to reduce lethality 2.4 fold.

[On a unified approach to nomenclature of sequelae from compression injuries and acute impairment of main blood circulation]. / O edinom podkhode k terminologii posledstvii kompressionnoi travmy i ostronarushennogo magistral'nogo krovoobrashcheniia.

Different compression traumas and various acute disturbances of the main blood circulation, chiefly of extremities, result in similar ischemic and reperfusion lesions leading to the development of life-threatening endotoxicosis. In the literature there are diverse interpretations of these phenomena. These notions are not similar in medical Encyclopedia either. The authors consider that its pathogenetical essence must be called "postischemic endotoxicosis" or as an alternative "a reperfusion syndrome". For such interpretations to be complete in different clinical situations, it is necessary to mention the specific (or similar but different) causes of ischemia and its localization, and in such a diversity they can not have a common designation. So the interpretation of this pathology in such cases should consist of two parts--a pathogenetical basis common for all, and a diverse etiological characteristic.

[Treatment of early postoperative intra-abdominal complications in elderly and senile patients]. / Lechenie rannikh posleoperatsionnykh vnutribriushnykh oslozhnenii u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of treatment of 334 patients who had intra-abdominal complications in the early postoperative period were analyzed. Among them there were 160 patients (47.9%) aged 60 years and older. Reoperations for different complications were performed on 311 patients including 141 patients from the older age group that made up 45.3%. The primary operations were performed on 131 elderly and senile patients for emergency and urgent indications. Planned operations on organs of the abdominal cavity were performed on 29 (18.1%) patients. Our experiences include 114 laparoscopies in 92 elderly and senile patients with the aim to diagnose and treat early postoperative intra-abdominal complications. A suspected intra-abdominal complication or high risk of its appearance was considered as an indication for the investigation. The laparoscopic method for diagnosing and treatment of this category of patients is thought to be a perspective direction for the improvement of results of treatment of a pathology of the early postoperative period.