[The use of laser doppler flowmetry to assess the microcirculation of the kidney before and after percutaneous nephrolithotomy].

AIM: To evaluate intraoperative changes in renal microcirculation during percutaneous nephrolithotomy (PCNL), as well as its dynamics in the early postoperative period. MATERIALS AND METHODS: A total of 240 patients treated in the Urology Clinic of the Saratov State Medical University in 2021-2022 were included in the study. All patients underwent PCNL. In the first group (n=105) the standard PCNL through 30 Ch access was done. In the second group (n=135), the procedure was performed through an access of 16 Ch. Intraoperatively, intrapelvic pressure was evaluated according to the authors method, which consists in direct measurement in the collecting system during the procedure, allowing for a faster and more accurate assessment. Prior to surgery, Doppler mapping of the renal blood flow was performed, and indirect registration of the microcirculation index (MCI) was done directly on the operating table using laser Doppler flowmetry (LDF). The diagnostic study was performed at the point of intersection of the 12th rib and the psoas muscle, both on the ipsilateral and contralateral side. In addition, during the procedure, a registration of MI of the mucosa of the calyceal fornix accessible in the direct vision through the access tract for 4 minutes was carried out twice. RESULTS: The index of microcirculation (IM) in the fornix of the upper calyx before the fragmentation of the stone in the 1st group of patients was 26.67+/-4.7 pf.u. compared to 25.4+/-5.9 pf.u. in the second group. At the same time, the value recorded on the skin was 13.08+/-1.2 pf.u. in the first group compared to 13.1+/-0.77 pf.u. in the second group (p>0.05). During the initial registration, the PM immediately after stone fragmentation was 19.5 +/- 1.2 pf.u, while on the overlying skin it was 11.2 +/- 0.9 pf.u. In the contralateral kidney area, IM was 10.2+/-0.9 pf.u. In the case of an intraoperative increase in intrapelvic pressure, IM was 22.3+/-1.6 pf.u. compared to 12.1+/-0.7 pf.u on the skin. The dynamics of IM on the skin tended to further decrease and returned to normal values of 10.3 +/- 0.7 pf.u on the 3rd day. When intraoperative intrapelvic pressure exceeded the normal value, IM by the 5th day was 10.1+/-0.4 pf.u. When determining the correlation of IM with RI of the ipsilateral kidney, a direct moderate correlation was revealed (r=+0.516). CONCLUSION: The measurement of microcirculation in the intra- and postoperative period allows to assess changes in the intrarenal microcirculation both directly and indirectly. This method can be used as an additional tool for assessing obstructive changes and the activity of pyelonephritis. A significant correlation between IM and RI indicates that functional changes in the renal and skin microcirculation tend to develop simultaneously.

[Optimization of antisecretory component of severe acute pancreatitis intensive management].

AIM: Improvement of complex intensive care of severe acute pancreatitis with use of continued intravenous infusion of octreotid. METHODS: 85 patients with severe acute pancreatitis were involved into the investigation, were divided into 2 groups. Patients of the control group (44 patients) got an intensive care according to severe acute pancreatitis treatment. Complex intensive treatment of the group of comparison (41 patients) included injections of octreotid (300 mcg 3 times a day). RESULTS: The change of octreotid usege scheme allowed to improve treatment resultes, wchis is the decrease of endotoxemia level and minimization of time spent at emergency department.

[The realization of the program of medical care to patients with vascular pathology in the Central Russia: a three year experience of the Saratov Regional Vascular Center]. / Realizatsiia programmy po okazaniiu meditsinskoĭ pomoshchi patsientam s sosudistoĭ patologieĭ v Tsentral'noĭ Rossii: trekhletniĭ opyt regional'nogo sosudistogo tsentra Saratova.

UNLABELLED: Creation of vascular centers in Russian regions is one of the ways of prevention of spreading of vascular diseases. AIM: To analyze three year (2012-2014) activity of the Saratov Regional Vascular Center (RVS). MATERIAL AND METHODS: Several stages of creation and development of RVS as well as the progress achieved in the treatment of acute coronary and cerebrovascular pathology have been analyzed. RESULTS AND CONCLUSION: The realization of protocols, standards, procedures of medical care to patients with cerebrovascular diseases by RVS personnel, wide use of high-technology methods of diagnosis and treatment during 3 years allowed not only to achieve positive results but to find unrealized possibilities of the activity in this direction.

[COMPREHENSIVE PROPHYLAXIS OF EARLY THROMBOEMBOLISM AND HEMORRHAGE AFTER LARGE JOINT ENDOPROSTHETIC SURGERY].

We examined 160 patients treated by endoprosthetic surgery of hip, knee, shoulder and elbow joints. 80 patients received i/v injections of 250 mg tranexam 30 min before and 4 hr after surgery. 220 mg ofpradax was given within 10-12 hr after surgery and thereafter on a daily basis. Fraxiparin (0.3-0.4 ml) was administered subcutaneously to 80 control patients 12 hr before surgery and once daily in the postoperative period. The intra- andpostoperative blood volume loss, dynamics of hematological parameters, and frequency of thromboembolic complications were determined. A Cell-Trans system was used to drain the surgical wound in the patients of the study group with subsequent reinfusion of blood. In controls, the wound was drained using conventional polyvinyl chloride drains with active aspiration of the contents without reinfusion. It was shown that combined application of tranexam, pradax, and the Cell-Trans system with postoperative blood reinfusion allows to reduce blood losses by 40% at all stages of the study. The total blood loss was 585.4 ± 124.2 ml and 959.8 ± 178.3 ml in study and control groups respectively. The proposed approach provides an effective and safe tool for the prevention of thromboembolic complications and hemorrhage in the early postoperative period after large joint endoprosthetic surgery.