[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.

Double diffractive cross-section measurement in the forward region at the LHC.

The first double diffractive cross-section measurement in the very forward region has been carried out by the TOTEM experiment at the LHC with a center-of-mass energy of sqrt[s]=7 TeV. By utilizing the very forward TOTEM tracking detectors T1 and T2, which extend up to |η|=6.5, a clean sample of double diffractive pp events was extracted. From these events, we determined the cross section σDD=(116±25) µb for events where both diffractive systems have 4.7<|η|min<6.5.

[A case of successful treatment of angioma of the middle and external ear]. / Nabliudenie uspeshnogo lecheniia rasprostranennoi angiomy srednego i naruzhnogo ukha.

A rare form of benign tumour (angioma of the middle and external ear) is described. The preoperative treatment with the use of embolization of the feeding vessel made possible surgical intervention on a practically "dry" operating field.

[Surgical treatment of fibromuscular dysplasia of renal arteries in adults].

The authors have analyzed an experience with treatment of 16 patients. All the patients had renovascular hypertension (RVH) and 3 of them had renal dysfunction. Revascularization of the kidneys (RK) was fulfilled in 11 patients by shunting (9) or prosthesis (2) of the renal arteries. In 7 patients percutaneous endovascular angioplasty (PEA) was used. There were neither complications nor lethal outcomes. Arterial pressure normalized in 7 patients and in 9 RVH was better. In the long-term period (at the average within 21 months) 14 patients were followed-up. In 3 patients having perimedial and intimal fibroplasty of RA after PEA restenoses were diagnosed. They had repeated RK. Renal function became better in 1 patient, in 2 patients there was no substantial dynamics. All shunts were passable. The analysis of the data has shown that liquidation of RVH in patients with FMD of RA has inverse dependence on its duration, and decision on the method of RK depends on the type of RA, experience of the specialists, the patients desire included.

[Percutaneous angioplasty and stenting in treatment of chronic occlusions of renal arteries].

The article presents results of examination and treatment of 14 patients aged from 46 through 79 years with chronic occlusion of one of the renal arteries in each of them and subocclusion of the contralateral renal artery in 13 patients due to atherosclerosis. At first percutaneous intraluminal angioplasty and stenting were performed in 13 out of 14 patients with stenosis of the renal artery. Then at once only percutaneous intraluminal angioplasty of the occlused renal artery was performed in 10 out of 14 patients and within 36 hours on average the implantation of stents in case of patency of the renal artery proper and its branches, according to the findings of control angiography, in these arteries with the optimal result. The percutaneous intraluminal angioplasty and stenting are relatively safe and effective methods of reestablishment of patency of the renal arteries after their chronic occlusion.

[Transjugular intrahepatic portosystemic shunt (TIPS): an experience with treatment of portal hypertension in patients with cirrhosis of the liver].

TIPS procedures have been successfully performed in 18 of 21 patients aged 34-64 (mean age 40 years) with cirrhosis of the liver with acute gastroesophageal bleedings (5) or history of bleeding episodes from gastroesophageal varices (13). The patients were classified according to Child (1964): A--4; B--8 and C--6. The portal pressure before creation of the shunt measured 17-39 (mean 28.1 +/- 7.6) mm Hg. Dilation of the hepatic tissue was performed by a balloon 10 mm in diameter and 4-6 cm long with placement of metallic endoprostheses 10-12 mm in diameter and 80 mm long. The portal pressure after anastomoses were made dropped to 6-28 (mean 20.3 +/- 5.7) mm Hg. The angiogram showed a rapid flow of the contrast medium through the portocaval anastomosis towards the right heart and no filling of the esophageal veins was seen. TIPS procedure is an effective measure to stop variceal gastroesophageal bleeding in patients with portal hypertension. The necessity of regular surveillance and reinterventions makes this approach a temporary measure to reduce hazardous consequences of gastroesophageal hemorrhages.

Anatomic observations of the carpal tunnel in cadavers with a report of unusual thickening of the perineurium of the median nerve.

The carpal tunnel of 50 cadavers (100 hands) was dissected. Macroscopic finding included 14 median nerves with pressure signs (in 4 cadavers, unilaterally and 5 bilaterally). In three cadavers, marked synovitis was seen around the tendons and the nerve; in one, lipoma was evident; and in the rest, thickening of the volar carpal ligament was seen. Microscopic examination of the compressed nerves showed concentric thickening of the perineurium, thrombosis of veins, and intrafascicular fibrosis. In one nerve, the thickening of the perineurium was not concentric, but only at that part of the fascicle adjacent to the volar carpal ligament in an "onion peel" form.

Trapezius transfer for paralysis of the deltoid.

A case of selective paralysis of shoulder muscles with its reconstructive procedure, is presented. The deltoid, infra- and supraspinatus paralysed, leaving one of the steering group of muscles around the shoulder--the subscapularis--intact, made the transfer of the trapezius to deltoid feasible, utilizing a modification of Saha's technique. An excellent result with full range of motion of the paralysed shoulder has been achieved.

[Endovascular intrahepatic portacaval shunting]. / Endovaskuliarnoe vnutripechenochnoe portokaval'noe shuntirovanie.

Pilot experience in Russia of transjugular intrahepatic portosystemic shunting is presented. Results of endovascular shunting in 14 patients with cirrhosis of the liver were analyzed. Four patients underwent emergency endovascular shunting when conservative treatment was not effective. Ten patients underwent elective surgery. Repeated esophagealgastric bleedings were indications for shunting. Relapse of bleeding was seen in 1 patient 5 days after surgery. Regular dopplerography permitted to reveal timely stenotic process. When stenosis of portosystemic shunt was diagnosed, ambulatory balloon dilatation of anastomosis through transjugular approach was performed. It was enough for opening of anastomosis lumen and decrease of pressure gradient.

[Original nitinol monowire stent for percutaneous iliac arterial reconstructions]. / Original'nyi stent iz mononiti nitinola v chreskozhnoi rekonstruktsii arterii podvzdoshnogo segmenta.

Nitinol monowire stents of original construction were implanted to 35 patients (aged from 36 to 84, mean 53.9) with atherosclerotic lesions of iliac arteries. Arterial stenosis ranged from 50% to 100% (mean 72.2%), ankle-brachial index (ABI) averaged 0.45+/-0.12. Initial success was achieved in 97.1% of procedures. Ultrasonography 3 days since the procedure showed the increase of ABI up to 0.78+/-0.16. Restenoses in the stented site was revealed during follow-up period (mean 24.3+/-18.3 months) in 3 patients (8.3%). In conclusion, new stent appeared to be effective tool for treatment of iliac atherosclerotic lesions. However long-term restenoses resulting from intimal hyperplasia can require repetitive revascularization.

[Role of spermatic vein phlebography and scleroembolization in treating varicocele and preventing its recurrence]. / Znachenie flebografii i kombinirovannoi skleroémbolizatsii vnutrennikh semennykh ven dlia lecheniia i preduprezhdeniia retsidivov varikotsele.

The phlebograms and intravascular treatment of varicocele were performed in 406 patients aged from 10 to 60 years. Scleroembolization of the left internal spermatic vein was successfully used in 402 of them. Dilatation and retrograde flow through the right internal spermatic vein were recorded in 101 of 238 patients during transjugular catheterization. This investigation has confirmed high effectiveness of the method of the intravascular combined scleroembolization in treatment of varicocele. Using the transjugular access facilitates not only performing the left side intervention but represents the only efficient means to fulfill the right side phlebography of the spermatic vein and its obliteration. The strategy of using the bilateral intervention for the detection of retrograde contrast of the right internal spermatic vein considerably improves the results of treatment of varicocele and decreases risk of relapses.

[Arteriography in critical changes in the iliac arterial bed]. / Arteriografiia pri kriticheskikh izmeneniiakh podvzdoshnogo arterial'nogo rusla.

The authors share their experiences with performing arteriography in 33 patients with spread atherosclerotic occlusions of the iliac vessels. When the traditional accesses were not possible, accesses through the explant (in 22 patients) and the occluded artery (in 11 patients) were used. Investigations with the simultaneous portional administration of heparin were fulfilled in 27 patients with progressing ischemia of the lower extremities and in 6 patients having anastomosis aneurysms. No complications were noted. The femoral access is thought to be preferable in order to reduce the amount of local complications. The experience and up-to-date technical equipment allowed the recanalization of the iliac arteries to be successfully fulfilled which turned the diagnostic measures into the curative endovascular intervention in some patients.

[The large-pore stent in the treatment of abdominal aortic aneurysms]. / Krupnoiacheistyi stent v lechenii anevrizm abdominal'noi aorty.

The authors have performed 8 endoprostheses for aneurysms of the abdominal segment of the abdominal aorta. The open cellular stent of nitinol was implanted with diameter 32 mm, bringing system 9.0 F. The implantation was carried out without problems in 7 patients, in one patient there was dislocation of the distal fragment of the endoprosthesis which required surgical intervention. The average time of operations was (7.6 +/- 4.5) min. The open stent allowed the invasiveness of operation, its technical complexity and duration to be reduced.