[Functional assessment of primary lesion of the great saphenous vein when deciding upon stripping]. / Funktsional'naia otsenka pervichnogo porazheniia bol'shoi podkozhnoi veny pri reshenii voprosa o stripinge.

The purpose of the study was to examine a possibility of functional assessment of the great saphenous vein (GSV) with the help of a day orthostatic loading test for prognosis of restoration of the function of the GSV afterremoving its varicose tributaries in patients with primary varicose veins. Our prospective study included a total of sixty-five 29-to-53-year-old patients (15 men and 50 women, mean age - 36.7 years). The total number of the lower limb examined amounted to 87. All patients underwent ultrasonographic examination (duplex scanning) prior to operation, 1 and 12 months thereafter. The study was carried out using a day orthostatic loading test consisting in duplex scanning performed twice during 24 hours: in the evening after 18:00 hours and in the morning before 10:00 hours after a good night's rest. It was demonstrated that the day orthostatic loading test characterized the degree of preservation of the muscular-tonic properties of the GSV, making it possible to predict reversibility of reflux along it after removing the varicose tributaries, hence it may be used as a criterion for individualization of the choice of the scope of surgical intervention. A high orthostatic gradient prior to operation suggests preservation of the potential of the muscular-tonic function of the GSV; its decrease after surgery demonstrates reduction of the volemic loading on the GSV.

[Monitoring of the state of the proximal portion of thrombus in conservative treatment of patients with varicothrombophlebitis].

Ultrasound duplex scanning (USD) was used to study dynamics of the state of the proximal portion of the thrombus in patients presenting with acute varicothrombophlebitis of saphenous veins during conservative treatment. We examined a total of fifty-four 29-to-78-year-old (mean age 53.5 years) patients with acute varicothrombophlebitis of saphenous veins, including 15 (27.8%) men and 39 (72.2%) women. USD was used to determine: localization and extent of thrombosis, proximal level of the thrombus, presence of the free portion of the thrombus, density and structure of the proximal and distal portion of the thrombus, thickness of the inflamed venous wall and paravasal fat at the level of the proximal and distal portions of the thrombus. Twelve (22.2%) patients were found to have signs of thrombus flotation with high embologenic risk; these patients underwent the operation of Troyanov-Trendelenburg and were excluded from the study. The remaining 42 patients received conservative treatment and were dynamically followed up by means of USD. All patients on the background of comprehensive conservative treatment showed positive dynamics consisting in decreased mass and density of the thrombus, shift of its proximal border in the distal direction, decreased thickness of the inflamed venous wall and paravasal fat. Two variants of dynamics were singled out: relatively rapid (during a week) - group 1 (n=11) and relatively slow (during one month) - group 2 (n=31). It was determined that the most significant factors promoting rapid lysis of the proximal portion of the thrombus were as follows: the term of seeking medical attention (duration of thrombosis), low echogenicity of the thrombus, cellular pattern of the thrombus and thickness of the paravasal fat. A conclusion was drawn that monitoring of the state of the proximal portion of the thrombus by means of USD makes it possible to maximally approach solving the problem of individualized treatment of patients with thrombosis of saphenous veins.

[Condition of the proximal portion of the thrombus in varicophlebitis of the great saphenous vein].

AIM: To assess the state of the proximal portion of a thrombus of the great saphenous vein (GSV) in patients with varicophlebitis by means of duplex scanning of veins. MATERIAL AND METHODS: We examined a total of 40 patients with acute varicophlebitis of the GSV: 11 (27.5%) men and 29 (72.5%) women, the patients' average age amounted to 53.5 years (range 29-78). Duplex scanning (DS) was used to determine: localization and extent of thrombosis, the presence of a free portion, density and configuration of the contour of the proximal portion of the thrombus, proximal level of the inflammatory wall and paravasal fat. RESULTS AND DISCUSSION: Inflammation was located on the crus in 12 (30%) patients, on the femur in 10 (25%), on the crus and femur in 18 (45%) patients. According to the findings of DS, of 28 (70%) patients with femoral inflammation the upper end of the thrombus was located in the lower third of the femur in 9 (22.5%) patients, in the middle third in 11 (27.5%) patients and in 8 (20%) patients in the upper third. In 29 (72.5%) patients the thrombus had no free part, eleven (27.5%) were found to have a floating portion 1.0-10 cm long (averagely 3.58 cm). The incidence of floating thrombi is determined by the diameter of the thrombosed vessel: in femoral localization the floating part was in 9 (22.5%) patients, in crural localization - in 2 (5%). A distinct edge of the proximal contour was present in 30 (75%) patients, diffuse contour in 10 (25%). In 8 (20%) patients the proximal portion of the thrombus by density did not differ from the patients' body. In 3 (7.5%) patients it approximated to density of blood. In the majority of cases (60%) the proximal portion was of cellular character with alternation of portions of various density. Thickness of the altered paravasal fat amounted to 7-20 mm (averagely 8.68 mm). The boarder of the thrombus in 56 (90%) patients located proximal to inflammation of the wall and paravasal fat by 4.0-60.0 cm (averagely 6.0 cm). This demonstrates that clinical symptoms induce phlebitis and paravasal cellulitis. CONCLUSION: Detailed examination of the proximal portion of the thrombus in patients with varicophlebitis of the GSV by means of DS makes it possible to accurately evaluate its condition: assessment of density and configuration provides a more detailed characterisation of the degree of maturity of the proximal portion of the thrombus. Thrombus density comparable with density of liquid blood in combination with its extended free portion may increase the risk of thrombus migration.

[Experience with six-month administration of red vine leaf extract in hormone-induced phlebopathy]. / Opyt 6-ti mesiachnogo primeneniia ékstrakta krasnykh list'ev vinograda pri gormonindutsirovannoi flebopatii.

OBJECTIVE: The study was aimed at assessing efficacy and tolerability of six-month administration of a red vine leaf extract (Antistax® - 360 mg/day) in women presenting with orthostasis-dependent phlebopathy of the lower limbs on the background of long-term hormone replacement therapy. Of the 62 women included into the study, 59 completed it. Treatment with Antistax® was accompanied and followed by a distinct decrease in the circumference of the calf as early as during the first 3 months from 36.77±2.892 cm to 35.98±2.831 cm (p=0.001), which remained stable for the subsequent 3 months despite taking hormonal agents. A decrease in the ankle circumference was similar, but less demonstrative. The evening diameter of the great saphenous vein (GSV) also decreased from 0.70±0.11 to 0.65±0.099 (p=0.001) and did not increase within the subsequent 3 months. There was a subjectively perceived decrease in the intensity of the venous symptoms along the 10-cm visual analogue scale (VAS), being also more pronounced during the first 3 months. Quality of life according to the CIVIQ2 questionnaire, in spite of continuing hormone therapy, improved from 42.03±7.634 to 30.36±8.646 (p=0.000001). Administration of Antistax® was well tolerated. Mild undesirable events were observed in 3 (5.08%) women and disappeared spontaneously. Patient compliance amounted to 99%. CONCLUSION: Antistax® (360 mg/day) orally administered in women suffering from orthostasis-dependent phlebopathy and taking hormonal replacement therapy is safe during 6 months, leading to a decrease in the measurements of the lower extremities and veins diameter, relieving venous symptoms, occurring to a greater extent within the first 3 months, and exerting a stable maintaining effect during the subsequent 3 months, and hence may be used in cases of prolonged replacement therapy.

[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy].

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Therapy of rapid ejaculation using dietary supplement "NeyroDoz": results of a multicenter non-randomized clinical study].

The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.

[Medicamentous protection of lower limb veins in a subacute period of varicophlebitis of the great saphenous vein].

The study was aimed at determining the dynamics of saphenous veins in patients with varicophlebitis of the great saphenous vein (GSV) in a subacute period (during compression therapy) and at assessing efficacy of 4-month medicamentous protection thereof. We examined a total of 32 patients presenting with the first episode of non-embolic varicophlebitis of the great saphenous vein. The comparison group comprised 16 patients undergoing 4-month compression (degree 2) therapy alone, and the study group patients (n = 16) were subjected to compression therapy combined with a 4-month course of micronized diosmin (1 tablet twice a day). The patients were included into the groups alternately as they attended our medical facility. Duplex scanning before and after the treatment course was used to measure the following parameters: 1) the evening diameter of veins and 2) an increase in the vein's diameter measured overnight as compared to the morning measures - the orthostatic gradient. The obtained results showed that the subacute period of varicophlebitis of the GSV is accompanied and followed by an increase in the diameter of the GSV and SSV and that of their orthostatic gradient, caused by imparted tonicity and viscoelastic properties. Compression therapy alone in the subacute period of varicophlebitis does not provide complete safety of saphenous veins from secondary lesions. Compression therapy combined with a 4-month-long course of taking micronized diosmin increases the efficacy of treatment.

[Awareness of the patients about detection of prostatic cancer].

We introduced an original simple anonymous questionnaire for urological patients in Moscow and Omsk outpatient clinics and hospitals. A total of 580 patients aged between 40 and 70 years (mean age 61.48 years) responded from February to June 2008. The questions concerned PSA test. In Omsk more men were tested for PSA: 77% against 67 in Moscow. Men with higher education made PSA test more often (88 and 60%, respectively). Only 31% responders know why PSA test is made. Of men over 70 years of age in Moscow, 43% responders made PSA test for the first time at the age from 60 to 69 years, the rest patients made it at the age 70 years and older. In Omsk, 88% responders made PSA test at the age of 70 and older. In men aged 40-49 years a mean IPSS point was 4, QOL--3. The highest IPSS (20 points) and QOL (4 points) were registered in men over 70. Among the responders over 70 years old, 38% were sexually active. The results of our questionnaire survey demonstrate that age of the patients who undergo PSA test in Moscow and Omsk is over 70. Quality of life is not adequately understandable for elderly questionnaire responders and should be simplified. Regular check-ups are effective for early detection of prostatic cancer and other diseases.

[Assessment of dose-dependent effect during phlebotropic therapy of chronic diseases of lower-limb veins].

Described herein are the findings of an open, prospective, comparative study of 2-month use of Antistax in a total of one hundred and nineteen patients presenting with clinical manifestations of chronic venous disease of class C0 (60 subjects) and class C2,3 (59 patients). Each group was subdivided into two subgroups of patients receiving Antistax at a daily dose of 360 and 720 mg, respectively. The authors studied the dynamics of the extremity's volume during direct plethysmography by means of liquid displacement, measuring the extremity's circumference under the ankles and in the muscular portion of the crus. The degree of subjective symptoms of CVI (increased fatigue of the legs and pain) was assessed by means of a 10-point visual analogue scale. The points of the study were the baseline state and the condition 2 months after medicamentous therapy. It was determined that administration of Antistax at daily doses of 360 and 720 mg for 2 months resulted in a significant decrease in the volume of the affected extremity, which was accompanied by regression of complaints related to venous insufficiency. The patients with class C0 and C2,3 CVI showed a pronounced dose-dependent effect, being more significant in class C2,3 CVI. We conceive it to be expedient that patients presenting with clinically pronounced variants of CVI inducing an increase in the extremity's volume should be given Antistax at a daily dose of 720 mg.

[Drug-mediated correction of negative phlebotropic effects of hormone replacement therapy in women].

OBJECTIVE OF THE STUDY: to specify a negative effect of hormone replacement therapy (HRT) on lower-limb veins in women and to assess feasibility of its correction with phleboprotectors. Examined were a total of thirty-seven 45-to-68-year-old (average age 55.4 +/- 13.7 years) women with the CEAP grade 0-2 chronic venous disease of the legs. Of these, grade C0 was diagnosed in 14 patients, grade C1 in 17, and grade C2 in the remaining six cases. Inclusion criterion: administration of oestrogen-progestin drugs with the replacement purposes. EXCLUSION CRITERIA: a history of previously sustained operations on the veins and venous sclerotherapy, as well as venous thrombosis. Of the 37 women receiving hormone replacement therapy for more than 4 months, 31 (66.7%) complained of uneasiness and a feeling of dilatation in the crural region, cramps, convulsions, pain, and leg heaviness. Eleven women reported to have had no such complaints prior to HRT, and twenty were found to have an apparent progression of the previously existing complaints. The comparative study using duplex scanning of limb veins before and 4 months after HRT revealed enlargement of the lumens of the common femoral, posterior tibial and great saphenous veins, as well as an increased incidence rate of reflux along the femoral and great saphenous veins. The women after 4 months of HRT were assigned to simultaneously undergo a therapeutic course with Phlebodia 600 taken at a dose of I tablet once a day for 2 months. On the background of this therapy, there was a decrease in and gradual disappearance of such symptoms as a feeling of heaviness, pain and dilatation in 31 patients, occurring 7 to 10 days after the beginning of treatment. Thirty (81.0%) women self-assessed the results of treatment with Phlebodia 600 as good, five (13.5%) as satisfactory, and two (5.4%) women reported no positive effect. Duplex scanning performed in women after 2 months of taking the bioflavonoid on the background of the continuing HRT revealed a decrease in the lumens of the common femoral, posterior tibial and great saphenous veins, as well as a decrease in the orthostatic gradient of the veins' diameter. Also observed was a decrease in the incidence rate of reflux along the femoral and great saphenous veins, with clinically diminished symptoms and improved well-being of the women. A conclusion was drawn that hormone replacement therapy in women for a period longer than 4 months leads to the development of orthostasis-dependent phlebopathy of the lower extremities, manifesting itself in decreased venous tonicity and the development of refluxes. The course of treatment with the phlebotonic notable for high compliance (a single morning administration) for two months was noted to have resulted in a significant decrease in the intensity of both subjective and objective signs and symptoms of phlebopathy secondary to long-term administration of oestrogen-gestagen-containing hormonal drugs.

[The effect of oral contraceptives on the orthostatic diameter of lower limb major veins and its correction].

UNLABELLED: The study assessed the effect of combined oral contraceptives (COCs) on the lower limb major vein diameter during orthostasis and the possibility of its medical correction in 214 women aged 17-42 with chronic venous insufficiency (CVI), including 37 women with CEAP class C0, 76 - with class C1 and 101 - with class C2. Venous diameter was measured by duplex scanning; its increment between evening and morning measurements was calculated in 3 groups. In the first group (n=68) venous diameter was measured before COC indication and after 2 months of COC use. In this group the second assessment revealed significant increase in venous diameter among women with CVI classes C1 and C1. The second group (n=69) received COCs for at least 6 months; then COC was withdrawn and Flebodia 600 was indicated. In this group venous scanning was fulfilled during COC use and after 2 months of its withdrawal and Flebodia 600 indication. Statistically significant decrease of orthostatic venous diameter was demonstrated for all scanned veins, evidencing diosmine-induced enhanced venous tone. The third group (n=77) did not interrupted COC intake and received Flebodia 600 concurrently. In this group venous measurements were fulfilled before and after 2 months of Flebodia 600 intake. Significant, though not ubiquitous decrease of venous diameter was registered in this group. CONCLUSION: Phlebopathic effect of COCs was demonstrated in women with CVI, CEAP classes 0-1-2, as well as safety and efficiency of Flebodia 600. The results prove the feasibility of Flebodia 600 indication for this population in case of COC intake.

[The results of pulsed compression therapy by pneumatic massage in patients with chronic venous insufficiency].

An open prospective observational study was conducted in 68 patients (aged from 32 to 78) with chronic venous insufficiency (CVI) treated with pulsed compression therapy (PCT) by means of Air Massage Slimmer, SB-432 (Seo Hung Mechatec Co., Ltd, South Korea). Outcome parameters included rheoplethysmography measurements of limb volume, limb circumference at different level, ultrasonic features of subcutaneous tissue and patient's subjective assessment of treatment success during and one month after PCT course. PCT was shown to decrease effectively limb volume, venous congestion, and intracellular component of edema syndrome in patients with CVI. Patient subjective feelings normalized in short time, the therapeutic effect of PCT maintained for a month in 83.8% of patients.

[Results of administering Phlebodia 600 in fertile women with orthostasis-dependent phlebopathy].

Presented herein are the findings of a prospective, non-comparative study of the clinical efficacy of semisynthetic diosmine (preparation Phlebodia 600) in patients presenting withCEAP class 0-1 chronic venous insufficiency (CVI) manifesting itself as orthostasis-dependent phlebopathy. Based on a total of 67 case reports, it was shown that Phlebodia 600 exerted a positive effect on the functional symptoms of CVI, oedematic and convulsive syndromes. A conclusion was made of a high efficacy and safety of the drug in treatment of initial-grade CVI in fertile women with orthostasis-dependent phlebopathy, including hormone-induced variants. Noted was positive dynamics of the preparation with the necessity of continuing to take oral contraceptives by the medical indications.

[Syndrome of lower limb volume enlargement in varicosity: causes and medical approaches].

This paper provides the results of examination of 413 patients aged 15 to 79 years (mean age 43.2 years) with different stages of CVI seen from 1995 to 2005. A complex of methods was employed: the clinical nmltimodality examination, multilevel volumetric monitoring before and after daily orthostatic loading, occlusion plethysmography, multilevel ultrasound duplex scanning of the venous system arid subcutis as well as radiography. Only in the third of cases (n=149, 36.0%) was primarily of distal character attended by lesion of the foot and leg, with clear daily dynamics and dependence on the daily orthostatic loading-eaema proper. Two types of edema were distinguished: 1)with pronounced daily dynamics and return to the initial parameters in the morning hours (131 patients) and 2) with moderate daily dynamics of edema and the lack of return to the initial parameters in the morning hours (18 patients). Such difference stems from the type of coexistent lymphatic insufficiency (with a high and low drop). However, only the first type is initially determined by venous insufficiency. The majorityof this group patients were found to suffer thrombosis of the ti-bial veins in the presence of varicosity running a prolonged course. Hinetyone patients (22.0%) had a proximally oriented enlargement, with pronounced orthostasodependerice, of the muscle segments of the limb because of orthostasodependent phlebopaxhy. In the remaining 173 (41.9%) patients examined, vascular eaema was coupled with non-vascular causes of limb size enlargement (arthrosis of leg joints, lipoedema) or the latter ones were isblated. The aim of the present study was to analyze the causes of the syndrome of limb size enlargement in varicosity with the purpose of upgrading the efficacy and trend of the treatment.

[Transinguinal ligation of the internal seminal vein in varicocele through the mini-approach].

The protocol of ultrasonic examination of patients with varicocele is proposed. The method of endoscopic ligation of the internal seminal vein through open mini-approach has been developed. Forty-five endoscopic transinguinal procedures for left-sided varicocele have been performed. The age of the patients was 17.5+/-0.9 years. Renospermatic reflux was diagnosed in 40 patients, mixed one--in 5 cases. Varicocele of the second grade was revealed in 38 patients, the third grade--in 7. One patient has been operated for varicocele recurrence. Depth of surgical wound was 9.1+/-1.2 mm, number of trunks--from 2 to 8. There was no blood loss. Duration of surgery was 31.5+/-4.4 min. All the patient were examined on day 10 and one month after the surgery with mandatory ultrasonic examination. Neither complications nor recurrences were observed.

[Precision surgery of varicosity: techniques and results].

The paper describes an experience gained with surgical treatment of 211 patients suffering from different forms of varicosity, seen between 1998 and 2003. In these patients, use was made of the technical procedures that provide for application of microaccesses. The complex of such procedures was in a good agreement with the notion "precision surgery of the veins" which implied: 1) the high precision of the topical diagnosis of varicose veins; 2) the use of a specialized kit of miniaturized tools and local bias lighting adapted to microaccesses; 3) primary use of microaccesses for venectomies of varicose vessels; 4) location of microaccesses above the involved veins, first of all, in the area of their tributaries. For integral evaluation of the degree of skin lesion the authors propose the use of an objective characterization, namely "the total length of skin incisions". It is determined by summarization of the lengths of all surgical incisions performed. In patients who underwent operation on one leg, it accounted for 15 to 50 mm (28+/-3 mm.). The precision approach to venous surgery provided for rapid painless return to the initial status after operation and complete rehabilitation of the patients for the first week, with positive rememberances evidencing the high easiness of the treatment carried out. All the patients operated on in such a way noted the high level of the quality of life both on the day of operation and subsequently in the immediate postoperative period.

[Quality of life in endoscopic treatment of varicocele].

A total of 46 patients with varicocele aged 15-28 years (mean age 17.1 +/- 1.3 years) were operated endoscopically by means of ligation of the internal seminal vein from an open gas-free mini-approach. The intervention was on the left side (n = 45) and right side (n = 1). Varicocele of the first, second and third degree was diagnosed in 2 (4.3 +/- 3.0%), 35 (76.0 +/- 6.3%) and 9 (19.6 +/- 5.9%) patients, respectively. There were no conversions. Duration of the operation was 28.4 +/- 2.7 min. Early after surgery anesthesia with ketorolac trometamine (2.1 +/- 1.1 injections, on the average) was made in 37 (80.4 +/- 5.9%) patients. Seven (15.2 +/- 5.3%) patients refused anesthesia. Control examination was made on day 7. Hydrocele developed in one case (2.2 +/- 2.2%). It was managed conservatively. A mean length of the scar was 2.8 +/- 0.34 cm. The second postoperative examination was conducted 6.7 +/- 1.6 months after the first one. The recurrence arose in one patient (2.1 +/- 2.1%). The patient was reoperated from an open mini-approach. A mean level of pain syndrome was 1.8 +/- 0.5 points. It had no influence on the patients' condition. On postoperative day 3-5 the patients were discharged. Thus, good quality of life in use of the proposed endoscopic operation of ligation of the internal seminal vein from an open gas-free approach makes this surgery an operation of choice in surgical treatment of varicocele.

[Varicosis of the lower extremities as a consequence of connective tissue dysplasia]. / Varikoznaia bolezn' ven nizhnikh konechnostei kak sledstvie displazii soedinitel'noi tkani.

An analysis was made of two groups of patients presenting with varicosis. The first group comprised 82 patients aged 15 to 30 years without risk factors. The second group accrued 85 patients with traditional risk factors: pregnancy and birth, overweight, considerable dynamic and physical loading, age from 30 to 50 years, and intake of hormonal contraceptives. It has been established that the key role in the development of varicosis is played by connective tissue dysplasia (CTD), the intensity of which predetermines the origination of phlebopathy and varicosis as well as the rate of their progression. The most frequently occurring is the mechanism of the development of phlebopathy as structural and functional defectiveness of all venous vessels of the extremity, leading to the rise of the deposited blood volume in the leg because of the high elasticity of venous walls. Secondly, CTD that initially impairs valve morphology, results in local varicosis under the effect of reflux hydrodynamic strokes at the weakened venous wall.

[Gas-free lateral retroperitoneoscopy from an open mini-approach for adrenalectomy]. / Ispol'zovanie bezgazovoi bokovoi retroperitoneoskopii iz otkrytogo mini-dostupa dlia adrenaléktomii.

The aim of the study was assessment of efficacy of gas-free lateral retroperitoneoscopy from the open mini-approach for adrenalectomy. Arguments are given for location of the mini-cut in the anterior segment of the 10th intercostal space and analysis was made of operative space parameters in retroperitoneoscopy from open mini-approach. The wound aperture 5.0 cm in size and 15.0 cm in depth is good as it provides the diameter of the monofocal zone 16.0 cm and bifocal zone 4.0 cm. If the size of the wound increases to 7.0 cm, the above parameters rise to 20.0 and 7.9 cm, respectively. Such visualized space is sufficient for adrenalectomy. Variants of the intervention are proposed depending on the side and kind of the lesion. A total of 21 patients with various adrenal pathology were operated. The operation lasted for 114.7 +/- 1.5 min. Overall blood loss reached 22.0 +/- 3.2 ml, transfusion--137.8 +/- 1.0 ml. The intestinal function normalized on day 1-2. In the postoperative period mean number of narcotic analgetics injections made up 4.9 +/- 1.5. Body temperature returned to normal on day 5.3 +/- 1.6 after the intervention. The length of the scar was 4.2 +/- 0.6 cm. None lethal cases were registered. Conversion to the classic open procedure had to be made in four cases. Gas-free lateral retroperitoneoscopic adrenalectomy from open mini-approach is minimally invasive operation. In well selected cases this is a safe and effective alternative to conventional and endovideoscopic gas surgery.

[Quality of life in surgical treatment of varicose disease]. / Kachestvo zhizni bol'nykh pri khirurgicheskom lechenii varikoznogo rasshireniia ven nizhnikh konechnostei.

A decrease of surgical trauma and improvement of anesthesia quality are the key points in quality life improvement after surgical treatment of varicose disease. Two variants of incisions were used: mini approaches of length not more than 20 mm and micro approaches of length to 2 - 3 mm. During surgery instruments of decreased sizes were applied. Direct and distant mini approaches were used for crossectomy. Disjunction of Coccett's perforated veins in trophic disorders was performed through distant mini approach, valvuloplasty of the femoral vein - through two mini approaches. Removal of subcutaneous and communicated veins was performed through few micro approaches. One hundred and seventy-four patients with various forms of varicose disease underwent surgery under combined (general - fentanil, sibazon, propofol and local - lidocain, novocain) anesthesia. Total length of cutaneous incisions ranged from 15 to 85 mm. Fast achievement of primary state after surgery and complete recovery during first week was seen. High index of quality of life both in the surgery day and nearest days after it was noted.