[Multiple embolism of arterial vessels of the systemic circulation: classification, clinical manifestations, and outcomes]. / Mnozhestvennye émbolii arterial'nykh sosudov bol'shogo kruga krovoobrashcheniia: klassifikatsiia, klinicheskie proiavleniia, iskhody.

Embologenic arterial obstruction remains an extremely important problem of modern medicine. Emboli may affect virtually all arterial vessels of the greater circulation and in some cases arterial emboli may be multiple. The purpose of the present study was to work out a classification of multiple arterial emboli. Analysing the clinical material including over 30 years a total of 1804 patients with embolism of the aorta and major arteries of the limbs made it possible to define the range of the terms used and to submit for discussion a classification describing a situation where emboli affect simultaneously several arteries or occur repeatedly. Both cases involve several emboli migrating from the primary source into the arterial bed, therefore we suggest that all these emboli be called multiple. Simultaneous multiple emboli were classified as combined, multifocal, and layered, with repeated emboli classified as preceding, recurrent, early and remote. Simultaneous emboli were observed in 91 (5%) patients, of these, in 22 - combined, in 49 - multifocal, in 19 - layered, and in 1 case - combined and multifocal. Repeated emboli were revealed at various terms and encountered virtually in each third patient. Overall mortality amongst the patients with embolism of the aorta and arteries of the limbs over 30 years amounted to 13%, having over the last decade decreased to 7.6%. Multiple arterial emboli significantly influenced the outcomes of treatment, with the mortality rate in combined emboli increasing virtually to 50% and that in multifocal and layered emboli exceeding 20% (p<0.05). Early recurrent emboli in the postoperative period were observed in 6.8% of patients, significantly deteriorating the prognosis (mortality - 49.2%). In the remote period, 22.4% of the patients were operated on for recurrent embolism of arteries of the extremities, with more than 25% of the patients having experienced emboli of cerebral or visceral arteries. Recurrent thromboembolic complications played a significant role in the thanatogenesis in each 4th patient.

[Lifespan of patients after endured embolism of the aorta and major arteries of the limbs]. / Prodolzhitel'nost' zhizni bol'nykh, perenesshikh émbolii aorty i magistral'nykh arterii konechnostei.

The authors analysed the remote results of treatment of patients having endured embologenic arterial obstruction. Over the last 47 years, specialists of the Department of Cardiovascular Surgery No1 of the North-Western State Medical University named after I.I. Mechnikov have rendered emergency medical care to a total of 3,455 patients presenting with embolisms of the aorta and arteries of the limbs. The remote results of treatment were followed up in 978 patients within the terms varying from 1 year to 30 years. The cumulative survival of patients at 1 year of follow up amounted to 72±2.9%, at 2 years to 55±3.3%, at 3 years to 46.1±3.3%, at 5 years to 33.5±3.4%, and at 10 years to only 17.8±3.8%. The subanalysis of the remote results of treatment of patients having sustained arterial embolisms was carried out in three groups of patients, depending on the character of the underlying disease. In patients of the 1st group, the development of arterial embolism was caused by atrial fibrillation of non-valvular aetiology, taking course on the background of hypertensive disease, IHD. The cumulative survival of patients of this group at 1 year of follow up amounted to 66.6±4.5%, at 3 years to 37.5±4.8%, at 5 years to 23.1±4.9% and at 10 years to less than 6%. Death was caused by progressing cardiovascular insufficiency in more than 60% of patients, by acute myocardial infarction in nearly 20% of cases and in 10% by impairment of cerebral circulation. In patients of the 2nd group, arterial embolisms were the consequences of endured infarction; their cumulative survival at 1 year of follow up amounted to 70.1±6.5%, at 3 years to 34.5±7.1%, at 5 years to 23.6±6.6%, and at 10 years to 12.5±6.5%. Patients of the 3rd group suffered from acquired heart valve disease of rheumatic aetiology, with the cumulative survival at 1 year amounting to 76.8±5.4%, at 3 years to 56.3±6.4%, at 5 years to 43.3±6.7% and at 10 years to 19.6±6.9%. In the thanatogenesis of more than 60% of patients there were thromboembolic complications, with progressing cardiac insufficiency present in nearly 30% of cases. The pattern of the remote results of treatment of patients with embolisms of the aorta and arteries of the limbs is strongly suggestive of the necessity of working out a comprehensive programme of medical rehabilitation.

[Clinical peculiarities of atherosclerosis of peripheral arteries in patients with abdominal aortic calcification]. / Osobennosti techeniia ateroskleroza perifericheskikh arterii u bol'nykh s kal'tsinozom briushnoi aorty.

The authors analysed clinical peculiarities of atherosclerosis of peripheral arteries (hereinafter referred to as APA) in patients presenting with abdominal aortic calcification (AAC). In order to determine the incidence rate of AAC in the population of patients with APA we analysed medical records of a total of 1,800 patients. The study itself included a total of 193 patients with APA further subdivided into two groups: 108 patients with AAC (Study Group) and 85 patients without AAC. Beside general clinical examination all patients were subjected to transthoracic echocardiography, duplex scanning of the aorta and lower-limb arteries, extended lipidogram and coagulogram. AAC was verified by means of computed tomography. It was determined that in one third of cases AAC was combined with abdominal aortic calcification, with APA on the background of AAC having certain peculiarities, i.e., high incidence of multisegmental lesions (68%) with predominant localization of the process in the aortoiliac and femoropopliteal segments (43%); frequent involvement of the terminal portion of the aorta and pelvic arteries. Patients with AAC also were noted to have a series of peculiarities in the indices of lipid metabolism, as well as signs of procoagulant syndrome and alterations of the structural and functional characteristics of the myocardium. It was stated that peculiarities of APA on the background of AAC should be taken into consideration while working out the program of diagnosis, treatment (including surgical), and rehabilitation of patients.

[Iliac lipoleiomyoma with development of invagination and acute ileus].

Lipoleiomyoma is a benign tumor that consists of smooth muscle and fat components, which occurs in less than 0.5% of cases among all benign intestine tumors. The paper describes a case of acute ileum obstruction with the development of lipoleiomyoma invagination in a 23-year-old woman and presents the endoscopic verification and microscopic and immunohistochemical examination of the removed tumor.

[Stagewise treatment of a patient with multifocal atherosclerosis, limb ischaemia, and surgical infection]. / Étapnoe lechenie patsienta s mul'tifokal'nym aterosklerozom pri ishemii konechnosti i khirurgicheskoi infektsii.

UNLABELLED: The authors share herein their experience in successful treatment of a male patient with multifocal atherosclerosis and lower-limb critical ischaemia complicated by erysipelas. THE AIM OF THE WORK: to show not only efficacy of iloprost (Ilomedin) used as conservative treatment in patients presenting with critical ischaemia and surgical infection in both pre- and postoperative periods in order to save the limb, but also the possibility of postponing reconstructive intervention, improving the patient's quality of life during this period, as well as shortening the duration of the postoperative period, and also to demonstrate both immediate outcomes of endovascular repair of an abdominal aortic aneurysm and remote results of comprehensive treatment for disseminated multifocal atherosclerosis with severe accompanying pathology.

[Embolism of the aortic bifurcation and major arteries of limbs: lessons of the past and present-day trends in solving the problem concerned].

The works deals with a retrospective analysis of the medical records of the Clinic of General Surgery of the North-West State Medical University named after I.I. Mechnikov on treatment of patients presenting with embolism of the aorta and major arteries over 40 years. All in all, over the period from 1971 to 2010 a total of 3,110 patients with embolism of the aorta and major arteries underwent consultations and were operated on. To the present-day trends in surgery of embologenic arterial obstruction one should first of all refer a decrease in the number of patients with embolism of the aorta and major arteries of the limbs, which may be related to achievement in modern cardiology and cardiosurgery in treatment of patients with cardiovascular diseases - potential sources of arterial embolism. Besides, there occurred considerable changes in the structure of embologenic diseases, in favour of an increased number of people suffering from CAD, which to e certain degree modified the incidence of lesions of various vascular basins. Thus, the number of embolisms of proximal portions of the vascular bed decreased considerably. This is largely related to a decrease in the number of patients presenting with decompensated ischaemia of extremities. 86.9% of patients were subjected to emergency operations. An increased number of people with atherosclerosis of peripheral arteries required widening of indications for performing reconstructive-and-plastic operative interventions. Experience of the Clinic shows that a timely performed revascularizing operation, including a reconstructive on, application of modern methods of prevention of ischaemic syndrome, carrying out comprehensive rehabilitation measures in the postoperative period made it possible to considerably improve the immediate results of treatment. While during the first 20 years a total lethality rate amounted to 18.8% with the postoperative one equalling 17.1%, these parameters over the past 10 years were 8.8% and 6.9%, respectively.

[Endoscopic diagnostics of colorectal endometriosis].

UNLABELLED: The purpose of the study is to explore and systematize the endoscopic features of colorectal endometriosis and to evaluate the role of colonoscopy in its diagnosis. MATERIAL AND METHODS: Were analyzed 320 diagnostic colonoscopies performed during the period from March 2011 till November 2012 in patients admitted to the hospital with a diagnosis of "infiltrative form of external endometriosis". RESULTS: Among all the identified cases of intestinal endometriosis (n = 67) pathological process was localized more often in the upper section of the rectum ampullar - 38 (56.7%), less often were revealed lesions of lower ampullar section of rectum and anal canal in 5 (7.4%). In 6 (8.9%) cases were detected multifocal lesions of the intestine. Authentic signs of colorectal endometriosis were detected in lesions of the mucous membrane. These include: polypoid growths above the endometriosis lesion (15 (22.4%)), endometrioid heterotopias in the colon mucosa (7 (10.4%)), the presence of ulceration of the mucous membrane in the projection of endometriosis (4 (5.9%)) geoidal mucosa (3 (4.5%)). Colorectal endometriosis can be systematized according to the following endoscopic criteria: localization of the pathological focus, growth, the presence of mucosal lesions.

[Phlebothrombosis of the amputation femur stump: certain aspects of pathogenesis and prophylactics].

An experience with treatment of 455 patients who underwent transfemoral amputation was analyzed. In 54 patients (11.9%) phlebothrombosis of the femur stump developed in the early postoperative period. Certain little studied problems of pathogenesis of the complication in question are considered, possible variants of the clinical picture are described. Negative role of thrombosis of the femur stump veins is shown in the development of thromboembolism of the lung artery that was a direct cause of death of 20 patients. Prophylactics of stump phlebothrombosis allows getting less frequency of the development of this complication, decreased lethality, improvement of quality of life and duration of life of patients after transfemoral amputation.

[Acute ischemia of the arms]. / Ostraia ishemia verkhnikh konechnostei.

The article analyzes results of the treatment of 162 patients with acute ischemia of upper extremities. Acute ischemia of upper extremities was shown to be an absolute indication for operation aimed at the reestablishment of adequate bloodflow. The character of surgery is predetermined mainly by genesis of acute ischemia. Postoperative lethality was 8.8%.

[Embolism of aorta bifurcation]. / Embolii bifurkastii aorty.

Results of treatment of 146 patients with embolism of aorta bifurcation have been analyzed and compared to that of extremity arteries. The severity of general condition of the patient, ischemic intoxication, postoperative complications are responsible for high death rate: postoperative mortality--53.7%, general--60.9%. The main measures of improving the treatment results are as follows: early hospitalization to a specialized vascular surgery unit, urgent operation, treatment of ischemic intoxication and adequate postoperative rehabilitation.

[Our experience in treating patients with embolisms of the aorta and major arteries of the extremities (on the centenary of the first embolectomy)]. / Nash opyt lecheniia bol'nykh s émboliiami aorty i magistral'nykh arterii konechnostei (k 100-letiiu pervoi émboléktomii).

The modern development of vascular surgery has a real possibility to reduce lethality and the amount of amputations in patients with embolism of the aorta and major arteries of the extremities. An analysis of treatment of 2042 patients during the recent 28 years has shown that the embolism is observed in 62,3% of patients with IHD and its complications, and in 34,5% in rheumatism patients, the arterial impassability prevailing in the abdominal aorta basin and lower extremity arteries (67,5%). Surgical procedures were used in 86,6% with the restoration of the main or collateral blood flow in 91,2% of the patients operated upon. Irreversible ischemia of the extremity was diagnosed in 89 patients at admission to the hospital. For prophylactics of rethromboses and infection, nonmedicamentous methods of treatment played an important role and the amount of rethromboses was reduced to 5,5% and suppuration of the wound to 6,2% which resulted in low percentage of amputations (5,8%).

[Side-effects of glucocorticosteroids in multiple sclerosis: a case report of a patient with global amnesia]. / Pobochnye éffekty terapii gliukokortikosteroidami pri rasseiannom skleroze: opisanie klinicheskogo sluchaia s global'noi amneziei

Pulse-doses of corticosteroids are actively used in the treatment of multiple sclerosis relapses. Short pulse-treatment is usually well-tolerated by patients though side-effects may be observed. We described a rare case of transient global amnesia after the pulse-treatment with corticosteroids. A complex examination excluded other causes of amnesia.

[Acute disseminated encephalomyelitis and multiple sclerosis: open questions of differential diagnosis demonstrated by the example of a clinical case].

Clinical features and MRI-characteristics of two demyelinating diseases: acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are discussed. Despite the seeming obviousness of differential-diagnostic criteria, the individual course of disease can, in some cases, accomplishes the differential diagnosis specifically in cases of recurrent (monophasic) ADEM and the first episode of acute demyelination, resembling ADEM, in MS. A clinical case of MS with acute manifestation resembling ADEM is described.