[EFFICACY AND SECURITY OF A CONVENTIONAL PROCEDURE OF PLASMAPHERESIS IN COMPLEX OF TREATMENT OF NONBILIARY ACUTE PANCREATITIS IN EARLY PHASE OF THE DISEASE].

Abstract Efficacy and security of a plasmapheresis procedure in complex of treatment of nonbiliary acute pancreatitis in early phase of the disease were established, basing on the treatment results analysis in 48 patients. The plasmapheresis results were estimated in accordance to changes revealed in the intoxication leukocytic index (ILI), a general protein (GP) content, general calcium (GC) in the blood plasm and of the activated partial thrombin time (APTHT). Application of plasmapheresis in patients, suffering purulent pancreatitis in the enzymal phase, have guaranteed a staged reduction of ILI by (34.86 ± 1.27)%, the APTHT enhancement from (35.15 ± 0.37) to (52.01 ± 0.62) sec, a trustworthy lowering of the GP by (4.35 ± 0.02) g/L at average and of GC in a blood plasmby (10.45 ± 0.38)%.

[THE RISK FACTORS OF THE DIALYSIS PERITONITIS (THREE-YEARS PROSPECTIVE INVESTIGATION)].

The risk factors of the dialysis peritonitis occurrence were determined in patients with chronic renal disease, to whom a substitute renal therapy, using peritoneal dialysis, was conducted. The results of a three-year prospective investigation and treatment of 73 patients in Kyiv City Oleksandrivska Clinical Hospital on the base of the general surgery and nephrology departments in 2007 - 2010 yrs were studied. The dialysis peritonitis (first episode) have occurred in 42 (57.5%) patients. Cumulative rate of a dialysis peritonitis in accordance to a censored data (the dialysis peritonitis suspension or other causes) have constituted 67.7%. Due to the dialysis peritonitis occurrence the peritoneal dialysis was stopped in 14 (19.2%) patients. The obesity, raising of a serum albumin level, constipation, preliminary injection into the site of the catheter exit site we consider a risk factors for the dialysis peritonitis occurrence.

[Correction of hemocoagulation disorders in complicated forms of acute cholecystitis]. / Korrektsiia narushenii gemokoaguliatsii pri oslozhnennykh formakh ostrogo kholetsistita.

The comparative analysis of the low-molecular-weight heparin Clexane influence and the unfractionated heparin on the parameters of blood coagulation homeostasis in 70 patients with complicated forms of acute cholecystitis. The tendency for hypercoagulation is observed. Prophylactic use of Clexane in patients with complicated forms of acute cholecystitis, in comparison with unfractionated heparin, is accompanied by the decrease of coagulating potential of blood.

[Clinical efficacy of alprostan in treatment of obliterating multifocal atherosclerotic affection of arteries in patients with critical ischemia of lower extremities]. / Klinicheskiaia éffektivnost' alprostana pri lechenii obliteriruiushchego multifokal'nogo ateroskleroticheskogo porazheniia arterii u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

Experience of application of alprostan (PGE1, alprostadil) in 19 patients with atherosclerotic affection of vessels, chronic and acute ischemia of lower extremities in III-IV stage in combination with affection of other vascular basins was summarized. In 10 patients, to whom operative vascular reconstruction was contraindicated and/or technically unrealizable, the conservative treatment was conducted using alprostan during 12-25 days up to the clinical effect achievement (total dose up to 1.6 mg). In 9 patients after performance of conservative treatment using alprostan the vascular bed reconstruction was done. Daily infusion of alprostan in 0.1 mg dose diluted in 250-400 ml of isotonic solution of sodium chloride during 2.5-3 h with duration of course not less than 15 days and 1.2-2.2 mg total dose of preparation constitutes an optimal scheme of treatment. Good result was noted in treatment of patients in stage II of ischemia, application of alprostan in stage IV of ischemia had permitted to reduce the extremity amputation volume or to escape it on the whole, and to restore more rapidly the cutaneous integrity in the trophic disorders regions. The alprostan usage is trustworthy in patients with multifocal atherosclerosis with the cardiac coronary vessels affection in an ischemic heart disease.

[Application of clexane in reconstructive surgery of the aorta arch vessels for the arterial thrombosis prophylaxis]. / Ispol'zovanie kleksana v rekonstruktivnoi khirurgii sosudov dugi aorta dlia preduprezhdeniia vozniknoveniia arterial'nogo tromboza.

Results of treatment of 114 patients for ten-year period, operated on for diseases of extracranial vessels, were adduced. Up to 1998 after performance of reconstructive operation as anticoagulant heparin was used in 80 patients and in last time--low-molecular heparin clexane in 34. After operation all patients survived. An ischemic insult occurred in 2-3 days after the operation in 2(2.5%) patients, while application of heparin, in 5--positive changes of the disease course were absent, in 19(23.75%)--postoperative hemorrhagic complications occurred. When clexane was administered in 2(5.9%) patients the cerebral hemodynamics improvement was not noted, complications in the early and late postoperative periods were absent. In term of observation up to 5 years good results was noted in 21(62.3%) patient, fair--in 9 (27.2%). In late postoperative period the brain hemodynamics improvement was not noted in 2 (5.9%) patients. Application of clexane for the arterial thrombosis prophylaxis is clinically substantiated and permits to reduce significantly the risk of the complications occurrence, which are observed with usage of heparin.

[The evaluation of the elastic properties of the arterial wall by ultrasonic study data in patients with atherosclerotic vascular lesions]. / Otsenka élasticheskikh svoistv arterial'noi stenki po dannym ul'trazvukovogo issledovaniia u bol'nykh s ateroskleroticheskim porazheniem sosudov.

Ultrasonic scanning method in a real scale of time was used in examination of 10 patients with abdominal aorta (AA) aneurysm, 10-with arterial hypertension (AH), 10-with obliterating atherosclerosis of the lower extremities vessels (OALEV) without AH and practically healthy controls aged 32-45 years. AA aneurysm and OALEV diagnosis was made according to the ultrasonic investigation and roentgen-contrast angiography data obtained. The statistically significant (P < 0.05) reduce of AA wall distentivity and its rigidity increase was disclosed while there were no differences of the values of vessel diameter, normalized for the body surface square, determined by the measured magnitude of the relative vessels deformation caused by the pulse change in arterial pressure. The changes of the vascular wall elastic-viscositive properties in patients with OALEV and AH were directed similarly but they lacked intensity. The AA aneurysm magnitude did not correlate with the degree of vascular wall distentivity (r = 0.46).

[Use of vazaprostan in the treatment of multifocal peripheral obliterating lesions of arteries of the lower limbs]. / Primenenie vazaprostana pri lechenii mul'tifokal'nykh i perifericheskikh obliteriruiushchikh porazhenii arterii nizhnikh konechnostei.

Vazaprostan was prescribed to 13 patients with the lower limbs obliterating atherosclerosis and the coronary arteries atherosclerotic lesion (first group) and in 17--with obliterating atherosclerosis and endarteritis of the lower limbs vessels (second group). The treatment was found to be effective one in all of the patients of the first group and in 13--of the second. The authors consider vazaprostan application to be expedient in patients with the lower limbs obliterating lesions as a supplement to operative intervention and also in coincidence of this pathology with the ischemic heart disease.

[Surgical treatment of multiple occlusions of the aortic arch arteries]. / Khirurgicheskoe lechenie mnozhestvennogo okkliuzionnogo porazheniia arterii dugi aorty.

The results of treatment of 174 patients with lesions of the arteries of the aortic arch are presented. Multiple lesions of the coronary arteries were revealed in 78 patients, of the brachiocephalic trunk--in 45, their combination--in 52. In patients with the ischemic heart disease, in average, 3,4 aortocoronary shunts were placed. In patients with the impaired cerebral circulation, reconstruction of 2-3 arteries was performed simultaneously in their unilateral lesions. In case of their bilateral lesions, the blood flow restoration was performed in two stages with a 2-4 week interval. Improvement of the indices of intravascular hemodynamics was achieved in 97.5% of the patients, neurologic symptoms were completely eliminated in 71% of the patients. Three patients died from cardio-vascular failure.

[Postextrasystolic potential in patients with a left ventricular postinfarct aneurysm]. / Sostoianie postékstrasistolicheskoi potentsii u bol'nykh s postinfarktnoi anevrizmoi levogo zheludochka.

The author analyzes the effect of postextrasystolic potentiation of contraction of the asynergic regions of the myocardium in 18 of 34 patients with postinfarction aneurysm of the left ventricle evaluated by contrast ventriculography. There was a statistically valid increase of the extension of the zones of hypokinesia due to reduction of the relative length of akinetic regions as compared with data of control contractions, a significant rise of reduction of the sizes of hypokinetic zones, increase of the fraction of ejection of the contractile segment in the general fraction of ejection. It is recommended to use the effect of postextrasystolic potentiation of contraction on the function of asynergic regions of the myocardium with the purpose of assessment of their vitality, determination of resection borders and expediency of their revascularization in the course of aneurysmectomy.

[The therapeutic procedure in thromboembolism of the pulmonary artery]. / Lechebnaia taktika pri tromboémbolii legochnoi arterii.

Clinical symptomatology, ECG, roentgenography, echocardiography, blood biochemistry, angiopulmonography with manometry of the pulmonary artery and right heart compartments were used to diagnose in 14 patients (age: 25-65 years) massive and submassive pulmonary artery thromboembolism. The angiopulmonographic index exceeded 18 points. Treatment included embolectomy, medical therapy (heparine, indirect anticoagulants), thrombolytic agents (celiase) and symptomatic therapy. The results of medical treatment were good in 80% of patients. Good results in embolectomy were observed in 77.7%. The authors formulate absolute and relative indications to urgent embolectomy in conditions of artificial circulation.