Therapeutic angiogenesis for patients with limb ischemia by utilization of fibrin meshwork. Pilot randomized controlled study.

AIM: The aim of this paper is to assess the feasibility and efficacy of fibrin in inducing neovascularization as an angiogenic substance and/or carrier for vascular endothelial growth factor (VEGF) in patients with limb ischemia. METHODS: Twenty-three patients with limb ischemia and referred for below the knee amputations were randomized for treatment: group 1, 7 patients received only a saline injection; group 2, 9 received intramuscular injection of fibrin and group 3, 7 received the fibrin composition with deferoxamine and added VEGF(165). The fibrin meshwork was introduced into the popliteal area of the diseased limbs using a dual syringe system (1 contained thrombin solution [1 mg, 5000 U] and 1 contained fibrinogen [1 mg, Baxter Hyland Immuno] solution). In group 3, Deferoxamine (100 microg) and 500 microg of VEGF(165) were added to the fibrinogen solution. RESULTS: In the control group 5 patients had undergone below the knee amputation at the 3-6 month follow-up. Only 1 patient from Group 2 had below the knee amputation 5 months following Fibrin only administration. Clinical improvement was noted in all 8 patients following fibrin administration and in all 7 patients injected with the fibrin meshwork, deferoxamine and VEGF combination. CONCLUSION: IM injection of fibrin is safe and appears to be an efficient method to treat limb ischemia. These findings indicate that use of fibrin may be a novel and simple method for inducing therapeutic angiogenesis.

[Restoration of blood circulation in reperfusion of ischemic tissues]. / Vidnovlennia krovobihu pry reperfusiï ishemizovanykh tkanyn.

In experiment there were studied changes of the tissue blood circulation and microcirculation during postischemic reperfusion of skeletal muscles with various density of capillaries. It was established that reactive hyperemia, caused mainly by enhancement of extracapillary tissue blood flow. While persistence of durable arterial hypertension the capillaries quantity and potential volume of microcirculatory bed are reducing, negatively influencing the blood circulation restoration process during postischemic reperfusion. In chronic ischemia the potential volume of microcirculation is increasing, securing complete restoration of blood circulation in postischemic reperfusion.

["Reperfusion collapse" phenomenon during post-ischemic reperfusion in experiment]. / Fenomen "reperfuziinoho kolapsu" pid chas postishemichnoï reperfuziï v eksperymenti.

Postischemic changes of central and regional hemodynamic while various reperfusion regimens have been studied on animal experimental model. We had revealed that despite vasodilatation, peripheral vascular resistance in the postischemic extremity rises, as a result of reperfusion by the lowered perfusion volume. Such phenomenon has been named as "reperfusion-collapse". In spite of the microcirculation disorders progression there have been no significant rising of the peripheral vascular resistance as well as worsening of the regional hemodynamic indexes in the postischemic limb during reperfusion by either normal or increased perfusion volume.

[State of lipid peroxidation and blood antioxidant system in patients with occlusive arterial diseases of the limbs]. / Stan perekysnoho okyslennia lipidiv i antyoksydantnoï systemy krovi u patsiientiv z okliuzuiuchymy zakhvoriuvanniamy arterii kintsivok.

In 95 patients with atherosclerotic occlusion of aorto-iliac and femoro-popliteal arterial segments and II-IV grade of ischemia (according to Fontaine) the concentration of malonic dialdehyde and general antioxidant activity of the blood plasma in ischemia period of time and in various terms of revascularization period were determined. The processes rising of peroxide clearance of lipids (PCL) in injured limb and lowering of antioxidant (AO) activity of blood plasma was discovered. In the revascularization period further significant activation of PCL processes (maximally during the first day) and gradual rising of AO activity of blood plasma (maximally on the 3-5th day) was revealed. The magnitude of these processes depended on the tissue ischemia extension and its severity.

[Luminescent diagnosis of blood circulation in the ischemic limbs]. / Diahnostychni mozhlyvosti liuminesstentnoho doslidzhennia krovoobihu v kintsivkakh pry ikh ishemii.

Luminescent investigation data of the tissue blood circulation and microcirculation in the limbs in 29 patients (in 25 of them with the main arteries occlusion) were adduced. Significance of the luminescent investigation of the limbs blood circulation in the diagnosis of the tissue blood circulation and microcirculation infringement degree was determined.

[Possibilities of radionuclide study methods in complex assessment of the state of ischemic segment of the limb]. / Vozmozhnosti radionuklidnykh metodov issledovaniia v kompleksnoi otsenke sostoianiia ishemizirovannogo segmenta konechnosti.

Complex investigation of 122 patients with various degree ischemia of lower limbs was conducted. The site of the blood flow disorder in local arterial basins, the type of lesion (stenosis, occlusion, aneurysm or their combination), the degree of collateral blood flow compensation and the trophic changes of ischemized tissues were truthfully established with the help of radionuclide investigation.

[The colloidal-crystalline properties of the urine and stone formation]. / Koloïdno-krystalichni vlastyvosti sechi i kameneutvorennia.

The data from literature on the problem of urolithiasis pathogenesis have been analyzed. A physico-chemical theory (hypothesis) of the possible mechanism of lithogenesis in urinary tracts is suggested on the basis of results from studies of surface tension, light transmission and crystallization of urine depending on the concentration of exogenous calcium chloride in it.