[Prolonged paravertebral analgesia in therapy of chronic pain syndrome in critical lower-limb ischaemia]. / Prolongirovannaia paravertebral'naia analgeziia v terapii khronicheskogo bolevogo sindroma pri kriticheskoi ishemii nizhnikh konechnostei.

Chronic pain syndrome in patients presenting with lower-limb critical ischaemia may have considerable significance in progression of the degree of limb ischaemia, and quality of life of patients appears to be largely determined by adequate analgesia. Currently, there is no 'gold standard' of therapy for chronic pain syndrome in critical lower-limb ischaemia, which makes it necessary to search for new effective and safe methods of analgesia. The purpose of this study was to evaluate efficacy and safety of paravertebral analgesia compared with epidural analgesia in therapy of chronic pain syndrome in critical lower-limb ischaemia. Our prospective randomized double-centre study included a total of 40 patients suffering from atherosclerotic-genesis critical lower-limb ischaemia and pronounced unilateral pain syndrome. The patients were randomized into two equal groups comprising 20 patients each. They were comparable by the main clinical and demographic parameters, as well as by the scope of the comprehensive treatment performed. In the study group, therapy of chronic pain syndrome was provided by the method of paravertebral analgesia, with the comparison group patients receiving epidural analgesia. Paravertebral analgesia was performed with the use of ultrasound navigation, in the prolonged mode by means of using microinfusion elastomeric pumps, epidural analgesia - according to the standard technique. The use of various methods of analgesia was accompanied by a decrease in chronic pain syndrome according to the visual analogue scale by 60% within the first 24 hours, and by 65% at 72 hours thereafter, with the differences being statistically insignificant. The use of prolonged paravertebral analgesia was accompanied by neither considerable haemodynamic reactions nor the development of the motor block, however requiring significant expenditure of a local anaesthetic. The conclusion was drawn that paravertebral analgesia in lower-limb critical ischaemia turned out to be a safe and efficient method of comprehensive therapy of chronic pain syndrome.

[Sulodexide in treatment of chronic venous insufficiency. Results of the All-Russian multicenter programme ACVEDUCT]. / Sulodeksid v lechenii khronicheskoi venoznoi nedostatochnosti. Itogi Vserossiiskoi mul'titsentrovoi programmy ACVEDUCT.

INTRODUCTION: Pharmacotherapy occupies one of the leading places in comprehensive treatment of lower-limb chronic venous diseases (CVD) and their complications. At the same time, there are not so many therapeutic agents intended for treatment of CVD and possessing evidence-based efficacy. Sulodexide (registered in Russia as Vessel Due F) is a drug with a confirmed therapeutic effect in patients with a moderately severe course of chronic venous disease or its late stages. However, the experience of using it in Russia for treatment of patients presenting with initial manifestations of chronic venous insufficiency (CVI) is still scarce. PATIENTS AND METHODS: The data concerning the use of Vessel Due F in the routine practice of treating CVD in Russian patients were collected and assessed within the framework of the ACVEDUCT programme. This observational prospective non-controlled multicentre programme included patients routinely prescribed by their attending physician Vessel Due F as a solution for injections and/or soft capsules in accordance with the registered in the Russian Federation instruction for use. A total of 2,263 patients took part in the programme. RESULTS: The majority of the patients prescribed sulodexide were diagnosed as having CEAP class C3 (38.4%) and class C4 (35.6%) CVD. Treatment was accompanied and followed by a decrease in the symptoms' severity observed in 56.4% of patients and a decrease in the number of symptoms in 42.8% of patients (thus positive dynamics was totally noted in 99.2%), with the effect of taking the drug commencing to manifest itself in patients as early as on day 15-20 of treatment. The highest rate of regression of symptoms of CVD was observed in 30-to-40-year-old patients. A statistically significant positive correlation was revealed between efficacy and the duration of treatment, the use of capsules during the term of follow up, with a negative correlation revealed between efficacy of treatment and the patient's age at which the diagnosis had been made, the stage according the CEAP classification, the total number of symptoms, a combination of risk factors. CONCLUSIONS: Sulodexide proved to be an effective, safe, well-tolerated and pathogenetically substantiated pharmacological agent for treatment of patients presenting with lower-limb CVI and should therefore be recommended for patients at early stages of formation of CVD. Patients suffering from venous trophic ulcers require higher doses and prolonged administration of the drug.

[Results of splenorenal venous bypass grafting in patients with hepatocirrhosis].

Presented herein are the results of surgical treatment of 79 patients with intrahepatic portal hypertension who underwent splenorenal venous bypass grafting after splenectomy. The patients' age varied from 8 to 64 years, averaging 37.3 years. The authors followed up the immediate and remote results of treatment at terms varying from 1 to 20 years. Of the early postoperative complications mention should be made that intra-abdominal haemorrhage was revealed in 4 (5%) patients, six (7.6%) patients were found to develop left-side reactive pleuritis, one patient (1.2%) - bilateral pleuritis and pericarditis, subcutaneous eventration was revealed in 1 patient with pronounced ascites (1.2%). Haemorrhage from varicose dilated oesophageal veins in the early postoperative period was observed in 8 (10%) cases. Posthaemorrhagic anaemia was present in 27 cases (43.1%). The mortality rate in the early postoperative period amounted to 5% (4). We followed up the long-term results in 51 (64.5%) of the 79 patients at terms up to 5 years after surgery, in 17 patients at terms up to 10 years following interventions, in 9 at terms up to 15 years, and in one patient up to 20 years. A total of 3 patients died within the first postoperative year. 48 (94%) patients are alive 5 years after the operation, 10 - after ten years, with 7 having died. Five patients are still alive more than 15 years, four died, one followed up woman is still alive after 20 years with a satisfactory result.

[Possibility of operative treatment of geriatric patients with critical lower limb ischemia].

The experience of treating 106 patients of 70+ years shows the possibility of successful vascular reconstructive procedures with good immediate and long-term results, even in the presence of critical limb ischemia and severe comorbidity in geriatric patients, if not guided by the principle of maximum revascularization of the affected limbs, and minimally sufficient, through a wide use of atypical and small renovations. In addition, not only comprehensive assessment of the reserve and compensatory capacities of the patients is important, but also preoperative prevention of cardiac, pulmonary and other complications.

[Substantiation of an adequate scope of diagnostic methods and surgical procedures in patients with diabetic foot syndrome].

Analysed herein are the results of treating a total of 154 patients presenting with diabetes mellitus and pyo-necrotic alterations in the lower limbs. Duration of diabetes prior to the development of necrotic complications averagely amounted to 15 years, in 76 patients of the Study Group we determined the species-specific composition of the pathogens, the number of microbial bodies in 1 gram of necrotic tissues as well as the state of cellular and humoral immunity, and the complex of therapeutic measures was supplemented by cytokine therapy: Operative treatment in 78 patients of the control group consisted of various-scope necrectomies and open management of the wounds. The operative procedures in the Study Group patients included revascularizing operations, as well as secondary surgical debridement of the wounds with placing sutures. In the control group, the limb salvage rate amounted to 57.7% (29 of 78) and that in the Study Group to 88.15% (67 of 76). In the first group, we performed a total of 29 (37.17%) major amputations and 4 (5.25%) in the study group. Conclusion was made on advantages of a comprehensive approach while assessing all impairments in the body of duibetic patients and adequate therapeutic policy aimed at re-establishing blood flow, removal of the purulent focus and decrease of tissue infectedness, correction of the immune status, as well as application of novel methods of treatment and drug therapy.

[Morphological characteristics and intracellular electrolytic composition of blood cells at surgeries on lower extremities arteries].

Morphological characteristics and trace and macroelement composition of blood cells flowing out of ischemic lower limb before, during and after reconstructive surgeries under different type of anesthesia. A total of 102 male patients aged 45 to 60 years with atherosclerotic occlusions of the arteries of the femoral-popliteal zone were included into the study. According to anesthesia type all the patients were divided into 3 groups: group 1 consisted of 34 patients operated under spinal anesthesia, 37 patients of group 2 underwent surgery under combined anesthesia (spinal anesthesia with intravenous sedation), 31 patients of group 3 - under total intravenous anesthesia with myoplegia and artificial pulmonary ventilation. All the blood examinations were carried out with scanning electron microscope XL-30 ("Philips") and X-ray spectrum microanalyzer Edax ( "Edax International", USA). It is demonstrated that in spinal and combined anesthesia morphological characteristics of blood cells normalized due to optimization of intraerythrocytic and intrathrombocytic electrolytic homeostasis unlike total intravenous anesthesia, when intracellular imbalance of trace and macroelements progresses and ultrastructural cellular alterations persist.