[Surgical and conservative treatment of the ischemic form of the diabetic foot syndrome].

The efficacy of the prolonged intraarterial infusion (PIAI) of the suspendized hydrocortisole for the correction of the distal angiitis of the lower limbs in patients with the diabetic foot syndrome was analyzed. The 1st group involved 51 patients, who received the hydrocortisole PIAI alone during 3-4 days. The 2nd group of 48 patients received distal autovenous by-pass surgery. The 3rd group of 13 patients received the combination of the surgical treatment and the PIAI. 95.5% patients of the 1st group showed remission of the disease during the first follow up year. Among patients of the 2nd group by-passes were active in 88%. After 4 years of follow up the cumulative by-pass permeability and limb preservation were registered in 45 and 50.9%, respectively. 90% of the patients from the 3rd group, who had received the complex treatment, showed by-pass permeability and limb preservation.

[The autovenous by-pass by distal arterial occlusion of lower limbs in patients with diabetes mellitus].

Results of the autovenous by-pass in situ by distal combined arterial occlusion of femoral-popliteal and ankle arterial segments were analyzed. The main group consisted of 43 patients with diabetes mellitus and lower limbs ischemia grade IV in 81,4%. The comparison group consisted of 77 patients without diabetes and critical lower limbs ischemia in 84,4%. The 30 days by-pass patency was 90,5% in diabetic patients; whereas in the absence of diabetes mellitus the patency rate was 89%. There were no significant difference between two groups within the 2 years following the operation. After 3 postoperative years patients with diabetes showed poorer results: cumulative by-pass patency was 45,4%, limb preservation rate was 58,7%, whereas the relevant rates in the control group were 49,6 and 87,9%, respectively. The hemodynamic features of the by-pass make it suitable for the patients with diabetes mellitus and arterial occlusion by the diabetic foot syndrome.

[Pathogenesis and prophylaxis of venous thromboembolic complications at large ventral hernias].

Overall 188 patients undergone surgical treatment due to large postoperative ventral hernias are analyzed. It is demonstrated that venous hemodynamics at these patients before surgery is characterized by disorders of "abdominal-caval pump" function due to anterior abdominal wall destruction and low mobility of diaphragm's cupula. The recovery of their functions is the key point in prophylaxis of thromboembolic complications.

[Disorders of the system of regulation of the aggregative status of the blood in patients with thromboangiitis obliterans of the lower extremities]. / Narusheniia v sisteme reguliatsii agregatnogo sostoianiia krovi u bol'nykh obliteriruiushchim tromboangiitom nizhnikh konechnostei.

Predominantly regional disorders of blood aggregation control, aggravating with the progress of ischemia, were detected in patients with obliterating thromboangiitis of the legs. Local overstrain and exhaustion of compensatory anticoagulation and thrombolytic factors developed in the presence of critical ischemia of the limbs and were accompanied by developing regional prethrombotic state. Regional administration (intra-arterial infusions) of anticoagulants and thrombolytic agents appears to be the most justified line of remedial therapy in these patients.

[Some features of orthostatic venous hemodynamics of the lower extremities in healthy, subjects and patients with varicose disease according to duplex scanning data]. / Osobennosti ortostaticheskoi venoznoi gemodinamiki nizhnikh konechnostei u zdorovykh i bol'nykh varikoznoi bolezn'iu po dannym dupleksnogo skanirovaniia.

Duplex scanning of the subcutaneous, deep and perforating veins was performed to examine venous return and to establish the diagnosis of valvular venous insufficiency of the lower extremities in 32 clinically healthy subjects (64 extremities) and 38 patients suffering from varicose disease (VD), when the patient was in the horizontal and vertical position. It has been established that in VD patients, the diameter of the deep and subcutaneous veins is greater than that in healthy subjects. When the patient is in the vertical position, the venous lumen expands 1.5-fold on the average (1.6-fold in healthy subjects and 1.4-fold in VD patients) under the influence of orthoshtatic venous pressure (,the sum of hydrodynamic and hydrostatic pressure). The growth of the total venous pressure up to the design values in the distal segments of the lower extremities is removed not only by musculovenous pump (MVP) motion but also by the MVP of free standing (maintenance of body balance) as well as by the action of the arteriovenous pump (AVP). The frequency of recording the retrograde blood runoff at functional exerelse in healthy subjects when they are in the orthostatic position is dramatically reduced. This phenomenon may be related to the orthostatic dilatation of the great veins and tension of the cusps of the unchanged valves, which should be regarded as a functional component of the closing mechanism of the MVP, In YD patients when they are in the orthostatic position, the frequency of revealing the design valvular insufficiency (according to the duration of retrograde runoff) decreases in the deep and rises in the subcutaneous veins. Valvular insufficiency of the perforating veins of the leg was primarily recorded in the veins of Cockett. The data obtained indicate that examination of venous function of the lower extremities is desirable when the patients are in both horizontal and vertical position.

[Intraarterial thrombolytic therapy in obliterative thromboangiitis of the lower extremities]. / Vnutriarterialnaia tromboliticheskaia terapiia pri obliteriruiushchem trombangiite nizhnykh konechnostei.

The article analyses the immediate and late-term results of treatment of patients suffering from thromboangiitis of the lower limbs with acute forms of thromboses of the main arteries and shunts (13 persons) and chronic arterial insufficiency (60 patients). The treatment consisted in intraarterial drug infusion with the use of fibrinolysis activators (celiasa, awelysin) as well as other pathogenetically aimed agents in the form of microcrystal suspensions (hydrocortisone, oxytetracycline, zinc insulin). Regional thrombolysis in acute thrombosis allowed authentic lysis of fresh thrombi in the main arteries in two patients (15%). Local thrombolysis with subsequent course of arterial infusion made possible effective arrest of the local ischemic syndrome in patients with III-IV degree arterial insufficiency and affection of the distal arterial bed and allowed the limb to be preserved during a follow-up period of 2 years in 92.5% of patients.

[Evaluation of efficacy of varicose vein surgery]. / Otsenka éffektivnosti metodov khirurgicheskogo lecheniia varikoznogo rasshireniia ven.

A new system of evaluation of efficacy of varicosity surgery is proposed. This system considers regress of chronic venous insufficiency based on it 4-degree classification and recurrences of the disease. Based on these criteria comparative study of efficacy in long-term period (from 6 months to 6 years) of new method of varicosity surgery--ligation of changed subcutaneous major veins and inflows, perforants of Achilles fat window (104 patients) and standard phlebectomy with open ligation of perforants (94 patients) was carried out. Efficacy of new mini-invasive method was demonstrated including in patients with trophic disorders.

[The role of peroxidation in pathogenesis of varicose veins]. / Rol' perekisnogo okisleniia v patogeneze varikoznogo rasshireniia ven.

The role of lipid peroxidation in varicose disease (VD) was studied and clinically substantiated in case of 32 patients with a compensated derangement of the regional phlebohemodynamics. An oxidant-antioxidant misbalance was detected, which displayed itself through a higher level of oxiradicals in the blood plasma as well as through a reduced general antioxidant activity in erythrocytes and a reduced level of enzymes, i.e. superoxide dismutase and catalase, by 40% as compared to the control values in healthy persons. The study results point at an important role of the oxidative stress developing in the capillary angiogenesis and varicose transformation of the surface veins in the legs at a muscle load in the vertical position, if there is constitutive insufficiency of the anti-oxidant protection.

[Laparoscopy in the diagnosis and treatment of acute diseases of the abdominal organs]. / Laparoskopiia v diagnostike i lechenii ostrykh zabolevanii organov briushnoi polosti.

An analysis of 534 patients has shown that laparoscopy is a method of high diagnostic informative value. The correct diagnosis was made in 515 patients (96.4%). Diagnostic errors were noted in 19 patients (3.6%). The greatest problems appeared in diagnosing thrombosis of mesenterial vessels and acute appendicitis in cases with the retrocecal disposition of the vermiform process. Surgical operations under control of a laparoscope were fulfilled by strict indications. Good immediate results were obtained in 81.9% of the patients.

[Long-term regional (catheter) infusion of anticoagulants and thrombolytics in the treatment of acute and chronic arterial occlusions in patients with thromboangiitis obliterans with severe ischemia of the limbs]. / Dlitel'naia regionarnaia (kateternaia) infuziia antikoaguliantov i trombolitikov v lechenii ostrykh i khonricheskikh okkliuzii arterii u bol'nykh obliteriruiushchim trombangiitom s tiazheloi ishemiei konechnostei.

Catheter heparin therapy combined with the intraarterial infusion of microcrystalline suspensions of antiinflammatory and immunosuppressive agents did not provide elimination of the microcirculation block in the affected limbs of the patients with severe ischemia of the limbs. Thrombolytics used in acute and chronic thromboses in most of cases did not help in complete recanalization of the arteries. Regional thrombolysis conducted before the basic course of the arterial infusion (heparin + immunosuppressants) in patients with distal forms of the arterial affections, promoted a significant improvement of conditions of the regional microcirculation. Application of this method has permitted lowering the rate of limb amputations.