[Extracorporeal reconstruction of arteries of a transplant of the liver for its subsequent implantation and surgical aspects of arterial anatomy the hepatoduodenal area].

Orthotopic liver transplantation (OLT) remains the only and radical method of treating patients with terminal stages of chronic diffuse hepatic diseases (cirrhoses), of patients with various congenital metabolic lesions of the liver, autoimmune diseases characterized by lesions of bile ducts, as well as series of both primary and secondary tumorous hepatic lesions. Liver transplantation is one of the most complicated operative interventions. Difficulty of OLT is determined by multifactorial and well-coordinated work of various medical services at the pre-, intra- and postoperative stage of management. One of the important components of success in transplantation consists in providing adequate arterial blood flow of the transplanted organ, which is achieved by extracorporeal reconstruction of the transplant. Variants of arterial blood supply of the liver are observed in each third donor. These anatomical peculiarities increase probability of a surgical error, which is considerably higher if not taking into consideration the complicated anatomy of the donor organ and its misalignment with the anatomical peculiarities of the recipient. Surgeon's responsibility is especially great during taking out the liver from the donor, as well as during its preparation for implantation. Procurement of the liver and pancreas from the same donor for transplantation to two different recipients may be accompanied and followed by the so-called conflict of interests which the surgeon has to decide in favour of the both during procurement of the organ for its extracorporeal processing. The sequence of the presented surgical manipulations on hepatic and pancreatic vessels, as well as anatomical reference points make it possible to preserve the vessels of the maximum length for the both organs. A wide variety of the structure of hepatic vessels may be divided into three types, depending upon the number of the sources of arterial blood supply.

[Laws and regulations affecting the development of national service of clinical toxicology].

In the formation and development of the national specialized toxicological service the important role was played by legislative initiatives, distinguished with continuity and improvement of the quality of care in acute poisoning, principles of interaction of units of service. Since the beginning of the organization of specialized toxicological service in the country, without taking into account the regional regulations, there were published over thirty ones, impact and significance of which can be very positively evaluated by formed a unique and authoritative national school of clinical toxicology, with its wealth of organizational, methodological and diagnostic and treatment practices, valuable scientific and human resources.

[Biological implants for hernioplasty].

The combined method of hernioplasty with the use of biologic and sunthetic implants has been worked out. 12 patients have been operated on: the "open" technique was used in 5 patients, the rest 7 have been operated on laparoscopically. The use of dura mater as an implant for hernioplasty allows avoiding tissue tension by muscle sheath plasty. By the combined use of the synthetic implant and dura mater plate, the latter assumes the mechanical load, preventing the hernia recurrence. Besides, the dura mater plate isolates the synthetic implant from the abdominal cavity and subcutaneous fat. No postoperative complications or lethal outcomes were registered.

[Selective adsorption of endotoxin in the complex treatment of patients with severe sepsis].

Severe sepsis and septic shock remain the most serious problem of critical care medicine today with a mortality of 25-80%. Bacterial endotoxin is of considerable importance in the pathogenesis of sepsis. A selective hemosorbent in which endotoxin adsorption is accomplished via its binding to a synthetic peptide (LPS-A) has been recently designed in Sweden. The purpose of the study was to evaluate the efficiency of using the LPS-A in the complex treatment of patients with severe sepsis. Eight patients in whom the course of the underlying disease was complicated by the development of gram-negative sepsis in the postoperative period were examined. The patients had an APACHE II score of 20.4 +/- 4.5 LPS-A was performed using the hemosorbent Alteco LPS (Lund, Sweden) and an Aquarius hemoprocessor (Edwards Lifesciences) (U.S.A.). The use of LPS-A caused a significant reduction in endotoxin levels by 2.9 times. The level of procalcitonin was increased in all patients; after a LPS-A session, it was significantly decreased by 1.9 times. The use of LPS-A resulted in diminished tachycardia, elevated blood pressure and could reduce the doses of vasopressor amines. There was an improvement in lung gas exchange parameters. A study of the effect of LPS-A on the immune system showed a significant reduction (36.6%) in neutrophil oxygen-dependent metabolism according to the data of the spontaneous HCT test, a 2.4-fold decrease in large circulating immune complexes, and a rise in the count of mononuclear cells that died both by necrosis and apoptosis, the count of the cells significantly increased by 5.3 times in late apoptosis. A LPS-A session caused a significant drop in the blood level of endotoxin and procalcitonin and it was accompanied by a trend toward better hemodynamics and lung gas exchange and alleviated organ dysfunction. At the same time LPS-A showed the ambiguous effect on immune system parameters, which calls for further study.

[Extended indications for percutaneous coronary interventions after successful thrombolysis].

UNLABELLED: The study compared the efficiency of percutaneous coronary interventions (PCI) into infarction-related coronary artery (IRCA) in high-risk patients with acute myocardial infarction (AMI), that were fulfilled 12-24 hours since the pain syndrome onset or during recurrent ischemic episodes 3 days after successful thrombolysis. In the first group (68 patients) invasive restoration of blood flow was fulfilled in 3 days (at average 48 hours) after AMI onset due to recurrent ischemia. In the second group (56 patients) IRCA recanalization was fulfilled in 12-24 hours (at average 20 hours) since pain syndrome onset due to clinical signs of unfavorable outcome high risk. IRCA recanalization was successful in 91% and 97% of cases in the first and second groups, respectively. In all cases injection of contrast media Ultravist 370 was diagnostically significant and visualized coronary arteries free of adverse events. In control group (conservative treatment) IRCA occlusion or subtotal stenosis was diagnosed in 18% and 39% of cases, respectively; stenosis >75% and <75% - in 27% and 16%, respectively. CONCLUSION: in high-risk patients with AMI percutaneous coronary interventions into IRCA can be effective 12-24 hours after successful thrombolytic therapy.

[Vasculopathy of the grafted heart: the synergism of proinflammatory and proatherogenous factors and viral infection].

The authors analyze the pathogenetic significance of hyperhomocysteinemia, antiphospholipid syndrome, the hyperexpression of cell adhesion molecules, inflammation, and oxidative disorders for, as well as the role of viral infections in the development of coronary artery disease of the grafted heart. The paper shows that viral infections in recipients lead to the development of proinflammatory, proatherogenous, and prothrombogenous status, expressing themselves in an increase in the corresponding laboratory markers in recipients' blood plasma, and points out the role of viral infection in the pathogenesis of coronary artery disease of the transplanted heart. Control and treatment of viral infections, as well as pharmacocorrection of proinflammatory, proatherogenous, and prothrombogenous status would made it possible to influence the development of coronary artery disease of the grafted heart.

[The peculiarities of bone exchange disorder and its regulation in men after long terms following orthotopic heart transplantation and cadaveric kidney transplantation].

The study found bone exchange disorder manifested by accelerated bone resorption, retarded bone formation, and the loss of the bone mineral density (BMD) of the axial and peripheral skeleton in 19 men (39 observations) 66 +/- 44 months following orthotopic heart transplantation (OTHT) and in 92 men 45 +/- 28 months after cadaveric kidney transplantation. An accelerated bone resorption, more pronounced in cadaveric kidney (CK) recipients, is associated with hyperparathyroidism (HPT) and renal dysfunction, while bone formation retardation is associated with a decrease in insulin-like growth factor-1 level. An increase in osteoprotegerin level is of compensatory character. The prominence of HPT depends on the degree of renal dysfunction; in CK recipients it also depends on the degree of the reduction in the levels of biologically active testosterone and estradiol. Reduction in BMD of the peripheral skeleton after OTHT are associated with the degree of renal dysfunction and a decrease in free testosterone index; after CK transplantation it is associated with HPT, the cumulative dose of glucocorticoids, reduction in the levels of biologically active testosterone and estradiol, as well as sex-hormone binding globulin (SHBG); reduction in spine BMD is only associated with SHBG.

[Filtration of media for infusion-transfusion therapy as a measure of prevention of systemic inflammatory reaction in surgery using artificial blood circulation]. / Fil'tratsiia sred dlia infuzionno-transfuzionnoi terapii kak mera profilaktiki sistemnoi vospalitel'noi reaktsii pri operatsiiakh s iskusstvennym krovoobrashcheniem.

Sixty-five coronary patients were subjected to aortocoronary bypass surgery. Three groups were distinguished: 1) controls-no filters; 2) patients in whom hemotransfusion (40 mu) and infusion filters were used during and on day 1 after surgery; and 3) in whom leukocyte filters for filtering residual perfusate from artificial circulation device were used in addition to the filters used in group 2. In the controls plasma level of leukocytic alpha-glycoprotein after artificial circulation increased 22 to 36 times, whereas in groups 2 and 3 it did not increase at all. After surgery the severity of leukocytosis, hyperthermia, and hyperenzymia assessed from the level of SGOT was reliably lower in patients in whom the filters were used. The time course of the oxygenation index (PaO2/FiO2) indicated an improvement of gas exchange due to filtration of infusion-transfusion media. The minimal values of PaO2/FiO2) and plasma content of C-reactive protein were observed in group 3. The mechanisms of systemic inflammatory reaction and organ dysfunction and some aspects of the protective effect of filters are discussed.

[Criteria for determining the degree of body intoxication in patients with acute intestinal obstruction]. / Kriterii opredeleniia stepeni intoksikatsii organizma u bol'nykh s ostroi neprokhodimost'iu kishechnika.

The analysis of their own observations, criteria of determination of organism intoxication degree, methods of an acute ileus treatment are adduced. The effectiveness of an active organism detoxication method plasmapheresis was noted.

[Noninvasive assisted blood circulation]. / Neinvazivnoe vspomogatel'noe krovoobrashchenie.

The experience of the use of noninvasive assisted circulation in patients with cardiac pathology is summarized. It has been demonstrated that rhythmic pneumo-compression of the lower extremities, abdominal compression, muscular electrical stimulation of the lower extremities and the abdomen have a pronounced effect on circulation compartments with low pressure. All the above pre-determines the role of these techniques in the management of cardiac failure and in intensive care.

[Clinical use of artificial heart ventricles]. / Klinicheskoe primenenie iskusstvennykh zheludochkov serdtsa.

The article discusses the results of applying for the first time Soviet-made "Modul" and "Yasen" artificial ventricles of the heart (AVH) in a left ventricular bypass regimen in patients with refractory cardiac insufficiency. Improvement of AVH design and rational tactics of attendant drug therapy allowed the period of the safe application of the AVH in the organism to be increased to more than 8 days.

[Surgical treatment of different variants of tachycardia]. / Khirurgicheskoe lechenie nekotorykh vidov takhikardii.

The paper presents a generalized experience in the surgical treatment of patients with frequent attacks of paroxysmal tachycardia associated with additional cardiac conduction pathways, that are not affected by the drug treatment. The results are described of 27 operations of destruction of anomalous cardiac conduction pathways. The use of a special ultrasound destructor permits the surgeon to perform the operation on the functioning heart, thus providing maximal radical surgery with minimal cardiac trauma and best effects.