[Successful treatment of an aortoduodenal fistula after operation on the abdominal portion of the aorta]. / Uspeshnoe lechenie aorto-duodenal'noi fistuly posle operatsii na briushnom otdele aorty.

Gastrointestinal haemorrhage is a common cause of emergency admission of patients to surgical hospitals. Within the structure of nosological entities, not unreasonably referred to the rarest causes of gastrointestinal bleeding is the formation of an aortointestinal fistula whose early diagnosis is of paramount importance. The clinical picture may be different but it is mostly represented by gastrointestinal haemorrhage. The incidence of gastrointestinal fistulas following a surgical intervention ranges from 0.6 to 2.3%. Unless timely diagnosed and with incorrect therapeutic decision-making, the mortality rate amounts to 90%. In this article we present a clinical case report regarding successful treatment of a patient presenting with a secondary aortoduodenal fistula occurring 5 years after previously performed aortofemoral bypass grafting and complicated by relapsing intestinal bleeding and acute ischaemia of the right lower extremity.

[AUTOVENOUS REVASCULARIZATION OF THE LOWER EXTREMITY ARTERIES IN PATIENTS WITH VARIANT ANATOMY OF THE PERIPHERAL BLOOD FLOW AND THE PROGRESSIVE ATHEROSCLEROTIC PROCESS].

Obliterating diseases of the lower extremity arteries occupy a high proportion in the structure of cardiovascular morbidity in the population among the developed countries. The steadily progressing course of obliterating atherosclerosis leads to the critical lower limb ischemia and causes an unfavorable prognosis for preserving the extremity, as well as the patient's life. Nowadays, there are two ways of surgical management of this pathology: endovascular and open reconstructive interventions. The choice of the method is based on a comprehensive keeping of the patient-specific records, including the anatomical characterization of the arterial bed lesions. In case of extended occlusion of the superficial femoral artery, the open reconstructive surgery using a large saphenous vein as a transplant is recommended. This circumstance is confirmed by the autovein patency in the long term compared with a synthetic prosthesis according to the results of randomized clinical trials. Therefore, with the formation of a distal anastomosis below the gap of the knee joint, the patency of the autovein and synthetic prosthesis after 5 years is 71% and 44% respectively. In this article, we represent a clinical case of successful treatment of a patient with progression of atherosclerotic lesions of the infrainguinal segment arteries. A staged revascularization of the femoral-popliteal segment arteries using technique of a reversed vein on both lower extremities after attempts of the conservative treatment and x-ray endovascular intervention was performed. A feature of this case is the creation of a new bifurcation of the popliteal artery during the formation of a distal anastomosis below the fissure of the knee joint under the contitions of a high discharge of the anterior tibial artery.The given clinical case demonstrates the advantages of invasive surgical tactics with the aim of preserving the limb and improving the patient's quality of life.

Quantitative assessment of brain microvascular and tissue oxygenation during cardiac arrest and resuscitation in pigs.

Cardiac arrest is associated with a very high rate of mortality, in part due to inadequate tissue perfusion during attempts at resuscitation. Parameters such as mean arterial pressure and end-tidal carbon dioxide may not accurately reflect adequacy of tissue perfusion during cardiac resuscitation. We hypothesised that quantitative measurements of tissue oxygen tension would more accurately reflect adequacy of tissue perfusion during experimental cardiac arrest. Using oxygen-dependent quenching of phosphorescence, we made measurements of oxygen in the microcirculation and in the interstitial space of the brain and muscle in a porcine model of ventricular fibrillation and cardiopulmonary resuscitation. Measurements were performed at baseline, during untreated ventricular fibrillation, during resuscitation and after return of spontaneous circulation. After achieving stable baseline brain tissue oxygen tension, as measured using an Oxyphor G4-based phosphorescent microsensor, ventricular fibrillation resulted in an immediate reduction in all measured parameters. During cardiopulmonary resuscitation, brain oxygen tension remained unchanged. After the return of spontaneous circulation, all measured parameters including brain oxygen tension recovered to baseline levels. Muscle tissue oxygen tension followed a similar trend as the brain, but with slower response times. We conclude that measurements of brain tissue oxygen tension, which more accurately reflect adequacy of tissue perfusion during cardiac arrest and resuscitation, may contribute to the development of new strategies to optimise perfusion during cardiac resuscitation and improve patient outcomes after cardiac arrest.

Extended porphyrins. New IR phosphors for oxygen measurements.

Tetrabenzoporphyrins (TBP) of Zn, Pd, Lu, Y, Sn and Pb show strong absorption bands in the near IR region of the spectrum. Phosphorescence in dimethylformamide (DMF) solutions at room temperature was measured for Pd and Lu complexes giving quantum yields of 7.9% and 3.5% and lifetimes of 250 microseconds and 870 microseconds, respectively. Pd meso-tetraphenyltetrabenzoporphyrin 1 (PdPh4TBP) shows a red shift of the absorption Q-band to 628 nm. 1 reacted with ClSO3H and obtained chlorosulfonato derivative 2 was converted to a set of water soluble chromophores: Pd meso-tetra(sulfophenyl)tetrabenzoporphyrin (Pd Ph4(SO3Na)4TBP) 3, corresponding sulfonamide (Pd Ph4(PEG)4TBP) 4 with aminopolyethyleneglycol (Av.M.W. 5,000) and sulfonamide derivatives of glucoseamine (Pd Ph4(glucoseamine)4TBP) 5 and aminophenylacetic acid (Pd Ph4(phenac)4TBP) 6. Electronic absorption and phosphorescence spectra of 1 and some of its derivatives were recorded and phosphorescence quantum yields and lifetimes were measured for deoxygenated solutions. The oxygen quenching constants were measured for the water soluble complexes 3 and 4 and found to be suitable for oxygen measurements in vivo. Tetranaphthaloporphyrin (TNP) complexes of Pd and Lu as well as Pd meso-tetraphenyltetranaphthaloporphyrin (PdPh4TNP) were synthesized and their absorption and emission properties were examined.

Oxygen distribution in the vasculature of mouse tissue in vivo measured using a near infra red phosphor.

Oxygen dependent quenching of phosphorescence has been used to measure the oxygenation of tissue in mice, including the differences between normal tissue and that of a murine tumor. Approximately 0.3 mg of the phosphorescence oxygen probe, Green 2W, was injected into the tail vein of tumor bearing mice. The mice were immobilized using an anesthetic cocktail and illuminated with flashes (< 4 microseconds t1/2) of light of 636 +/- 15 nm. The emitted phosphorescence (790 nm max.) was measured using an imaging phosphorimeter with an intensified CCD camera, an instrument which provides two dimensional digital maps of oxygen pressure. Both the illumination light and the phosphorescence were in the near infra red region of the spectrum, where skin and tissue have little absorption. The light can therefore readily pass through the skin and centimeter thickness of tissue. Mice are sufficiently small that the oxygen pressure maps could be obtained by illuminating from either the same or the opposite side as the camera (and tumor). The tumors were observed as regions with oxygen pressures substantially below those of the surrounding normal tissue. Thus, it is possible to non-invasively detect these tumors and to monitor their internal oxygen pressure in real time and through cm of tissue.

Oxygen distributions within R3230Ac tumors growing in dorsal flap window chambers in rats.

R3230Ac mammary tumors were grown in transparent window chambers implanted into the dorsal skin flap of 250 g Fischer 344 rats (see Dewhirst et al, 1992). The oxygen pressure distributions in the tumor and host tissue were measured by the oxygen dependent quenching of phosphorescence (see Vinogradov et al, 1996) after injection of Oxyphor R2 (7 mg, 0.3 ml) into the tail vein. The oxygen pressure maps show the R3230Ac tumors to be hypoxic relative to the surrounding tissue. The excitation spectrum for the phosphor has peaks at 419 nm (blue light) and at 524 nm (green light), and the emitted phosphorescence spectrum and lifetime are independent of the wavelength at which the phosphor is excited. The absorption by tissue is much greater for blue light than green light, due to intrinsic chromophores such as cytochromes, hemoglobin, myoglobin etc. Thus, blue excitation measures the oxygen pressures in a much thinner, superficial, surface layer (< 50 microns) than does green excitation, allowing "optical sectioning" of tissue oxygenation. The tissue can be further optically sectioned by making measurements from both sides of the window. Viewed from the tumor side, the superficial layers (blue excitation) of these tumors were hypoxic whereas the host tissue was well oxygenated. The oxygen pressures in the growing edge of the tumors are lower than those in the central core of the tumor, and much lower than those of the host tissue. This result is in agreement with the micro-oxygen electrode measurements of perivascular oxygen pressures reported by Dewhirst and coworkers (1992).

[Vessels of the macro- and microcirculatory bed of the heart in the early developmental stage of acute myocardial infarct viewed by angioroentgenology, histology and electron microscopy]. / Sosudy makro-mikrogemotsirkuliatornogo rusla serdtsa na rannei stadii razvitiia ostrogo infarkta miokarda v angiorentgenologicheskom, gistologicheskom i élektronno-mikroskopichesm osveshchenii.

A report is based on the investigation of the hearts of persons who died at an early ischemic (up to twenty-four hours) stage of the acute myocardial infarction studied under the light microscope (39 cases) and at the ultrastructural level (5 cases). An original technique of the combined filling of the macro- and microvascular bed was applied as well as the intravascular silver impregnation and special histologic methods for detection of the early lesions of cardiomyocytes were used in some cases. The interrelationship and sequence of lesions of the coronary arteries and vessels of the cardiac microcirculatory bed are shown. The lesions of microvessels bear mainly a secondary character and depend upon the duration of myocardial infarction, its dimensions and its deepness. The ultrastructural alterations of microvessels are characterized by the heterogeneity and dependence on the degree and character of the cardiomyocyte lesion. A morphological estimation of the compensatory-adaptive alterations in the cardiac vascular bed at the early stages of myocardial infarction development is given.

[Changes in the myocardium and coronary vessels during the postoperative period in aged and elderly patients]. / Izmeneniia v miokarde i koronarnom rusle serdtsa v posleoperatsionnom periode u lits pozhilogo i starcheskogo vozrasta.

Data of morphological examinations of 65 hearts of patients dying at the ages of 45 to 89 years in the early postoperation period after cavity operations are presented. Apart from routine histological and histochemical examinations, morphofunctional analysis of the intraorgan vascular architectonics was done using a macro-microroentgen contrast examination of the heart and determinations of volumetric density and location of focal lesions of the myocardium by the histostereometric method. An analysis of the pattern and distribution of myocardial lesions as well as of the elements of structural-functional adaptation and dysadaptation of the heart of senile patients under extreme conditions of operational trauma and early postoperation period is presented. A direct correlation was established between the volumetric density of focal myocardial lesions, the age of the patients and the duration of the stress situation (operational intervention).

[Structural and metabolic changes in the contractile myocardium in experimental acute pulmonary heart disease of vascular origin]. / Strukturno-metabolicheskie izmeneniia sokratitel'nogo miokarda pri eksperimental'nom ostrom legochnom serdtse sosudistogo geneza.

The myocardium of 37 rabbits with a fulminant (Group 1) and acute (Group 2) course of experimental acute pulmonary heart of vascular genesis produced by intravenous administration of thrombin in subcutaneous administration of histamine was studied. The control consisted of 9 hearts of rabbits sacrificed by intravenous novocain injection. Combined methods were used to examine the myocardium, including special staining methods suitable for detection of early cardiomyocyte damage, polarization and electron microscopy, histoenzymological methods, and histostereometry. The volumetric density of focal alterations in comparison of the results between groups both for the heart as a whole and for both its parts was found to be statistically significantly higher than that in the controls. Similar results were obtained in the right to left ventricle ratio. No significant differences in the values compared were found in the controls. The volumetric density of focal lesions reached the maximum values in Group 2 by 24 hours in the right parts. The results indicate that the alterative form of cardiac insufficiency underlies sudden death in acute pulmonary heart of the vascular genesis.