[FUNCTIONAL STATE OF PERIPHERAL VESSELS OF THE LOWER EXTREMITIES AND INTRAOSSEOUS PRESSURE IN PATIENTS, SUFFERING OBLITERATING ATHEROSCLEROSIS ON BACKGROUND OF DIABETES MELLITUS].

Results of examination of 46 patients, suffering obliterating atherosclerosis of the lower extremities arteries solely or in combination with diabetes mellitus (DM), were analyzed. The malleolar pressure index (MPI), regional systolic pressure (RSP), velocity of the volume blood flow (VVBF), rheographic index (RI), using test with nitroglycerine, postocclusion venous pressure (POVP) and intaosseous pressure (IOP) in tibiae were studied. The RI reduction, parallel to the arterial ischemia progression, was established. The test indices with nitroglycerine in patients with obliterating atherosclerosis have reduced step by step. With coexistent DM the efficacy of nitroglycerine was practically absent. POVP is upgraded in patients of all the groups and it have lowered step by step in a laying position of the patient, and while transition into standing position--it have upgraded progressively with a progress of arterial ischemia. IOP have upgraded significantly in isolated obliterating atherosclerosis in ischemia stage 3a and have lowered--in stage 3b. In coexistent DM IOP is upgraded in ischemia stage 3b also.

[PROPHYLAXIS OF THROMBOEMBOLIC COMPLICATIONS IN TRANSFASCIAL THROMBOSIS OF THE LOWER EXTREMITIES].

Results of examination and treatment of 339 patients, suffering an acute varicothrombophlebitis, complicated by transfascial thrombosis, were analyzed. Indications for surgical prophylaxis of pulmonary thromboembolism in transfascial thrombosis in a system of vena cava inferior were studied. After the operation in all the patients, while presence of transfascial thrombosis, not taking into account the operation radicalism, the treatment was prescribed, similar to that for the deep veins thrombosis. In the deep veins thrombosis, combined with superficial varicothrombophlebitis , an access for excision of a small subcutaneous vein of lower extremity must be differentiated, depending on spreading of thrombotic occlusion and localization of the calf veins inflowing place. Introduction of active surgical tactic in presence of floating thrombus in the ankle­popliteal venous segment secures conduction of effective prophylaxis of pulmonary thromboembolism

[THE CHOICE OF SURGICAL TREATMENT METHOD FOR THE DEEP VEINS THROMBOSIS IN SYSTEM OF VENA CAVA INFERIOR].

There were analyzed the results of examination and treatment of 455 patients, suffering deep veins thrombosis in a system of vena cava inferior, of whom 175 (38.5%) were operated on. Inclusion of ultrasound duplex scanning, roentgencontrast phlebography, multispiral computer tomography with intravenous contrasting, radionuclide phleboscintigraphy into complex of clinic-instrumental examination of the patients gives possibility to estimate the disorders of the main trunk and collateral venous blood flow in the deep veins thrombosis, as well as to substantiate indications and choice of the operative treatment method.

[Immediate complications of endovascular interventions in chronic ischemia of the lower extremity tissues].

The results of examination and treatment of 66 patients, suffering occlusion-stenotic affection of the lower extremities arteries, to whom transcutaneous transluminal balloon angioplasty was performed, are adduced. Immediate postoperative complications after endovascular interventions have occurred in 4 (6.1%) patients. The immediate complications, causes of their occurrence, methods of treatment, ways of prophylaxis were analyzed. In 50% of patients, suffering complications of endovascular interventions in immediate postoperative period, it is possible to eliminate them, using simple prophylactic measures.

[Surgical treatment and prophylaxis of pulmonary thromboembolism for renal cancer with presence of the implantation clots of the inferior vena cava].

Surgical treatment of 91 patients, suffering the renal cell cancer (RCC), complicated by tumoral thrombosis of inferior vena cava, was analyzed. In accordance to the Mayo clinic classification, there in the patients the tumoral thrombus spreading was revealed, depending on tumoral affection of a kidney (right-sided/left-sided): level 0--in 39 (31/8); level I--in 20 (6/14); level II--in 17(12/5); level III--in 11 (11/0); level IV--in 4 (3/1). Incomplete apparatus cavaplication was performed in 32 patients. There was proved, that incomplete apparatus cavaplication constitutes an effective method of surgical prophylaxis of pulmonary thromboembolism in patients, suffering RCC.

[Surgical treatment tactics for acute varicothrombophlebitis atypical forms].

Changes of phlebohemodynamics under control of ultrasonographic investigation were registered in 237 patients, suffering an acute varicothrombophlebitis (AVTH) of superficial veins of lower extremities (LE). In 21 patients atypical forms of AVTH were revealed, including reflux toward a big subcutaneous vein (BSV) of the leg and/or small subcutaneous vein (SSV); reflux toward insufficient indirect veins on hip and shin; reflux toward insufficient direct perforant veins. For atypical forms of AVTH the urgent operations on hip and shin were performed: crossectomy, short or long stripping, phlebectomy and/or scleroobliteration of tributaries; open subfascial resection (mini-Linton); deferred operations: phlebectomy of the BSV/SSV tributaries, open scleroobliteration, subfascial resection (mini-Linton). Systematization of the AVTH forms in accordance to the LE segments have permitted to determine strategy and tactics of the patients treatment, what have important practical significance.

[Surgical treatment of patients, suffering Crohn's disease].

In surgical clinic of Zakarpattya's Regional Clinic n. a. Andriy Novak (City of Uzhgorod) 43 patients were observed for complicated Crohn's disease (CD), in whom 79 operations were performed, including in 1 patient--8 interventions, in 10--on 3, in 5--on 2, and in others--on one. Not depending, that the recurrence occurrence rate is definitely high, at average in every 10 yrs for the patients reoperation is indicated, the surgical treatment, conducted in accordance to absolute indications, is considered as highly effective and a sole correct approach for elimination of severe complications of CD, what provides the life span enhancement and its quality rising. Absolute indications for surgical treatment of acute complications of CD are following: perforation, peritonitis, ileus, phlegmon, abdominal and retroabdominal abscesses, profuse bleeding, toxic dilatation of large bowel. Chronic complications of CD--inflammatory infiltrates with the internal organs compression; internal and external fistulas; intestinal stricture with signs of obturation ileus; recurrent paraproctitis; extrasphincteric fistulas; destruction of muscular carcass of anal sphincter.

[Treatment of venous trophic ulcers, using echoscleroobliteration of perforant veins].

In 36 patients, suffering trophic ulcers on a chronic venous insufficiency background in a decompensated stage (C6 in accordance to CEAP), echoscleroobliteration of perforant veins, using a "foam-form" method in accordance to Tessari, was performed. In 29 patients postrombophlebitic syndrome in incomplete recanalization stage was diagnosed, in 7 recurrence of varicose disease of the lower extremities. In all the patients during echoscleroobliteration there was possible to obliterate the insufficient perforant veins, in 3 patients two perforant veins were obliterated in each of them. In a one week a pathological blood flow along perforant veins, in accordance to data of ultrasound duplex scanning, was absent. This effect lasted during 6 mo in 29 (80.6%) patients. In 25 (69.4%) patients a trophic ulcers healing was achieved in 1 - 3 mo. In a one year in 30 (83.3%) patients a stable obliteration was noted, in 3 (8.3%) - partial recanalization, in 3 (8.3%) - complete recanalization of perforant veins.

[Endovascular interventions for critical ischemia of the lower extremities].

There were analyzed the results of examination and treatment of 12 patients, suffering critical ischemia of the lower extremities tissues in the occlusion-stenotic affection of the femoro-popliteo-tibial segment vessels, to whom miniinvasive endovascular interventions were done. Complex clinico-instrumental examination of the patients (ultrasound duplex scanning, roentgenocontrast angiography, multispiral CT with intravenous contrasting) have permitted to substantiate the indications for conduction of endovascular interventions for critical ischemia of the lower extremities. The zone of reconstruction passability was confirmed after performance of endovascular transcutaneous balloon angioplasty in the follow-up terms up to 1 year in 9 (75%) patients, the lower extremities were saved in 10 (83.3%).

[Radical nephrectomy and thrombectomy in patients with renal cell cancer complicated by tumoral thrombosis of the renal vein and vena cava inferior].

Surgical treatment was conducted in 81 patients, suffering renocellular cancer (RCC), complicated by a renal vein and vena cava inferior thrombosis. According to the Mayo clinic classification, the level of a tumoral thrombus spread was established: the 0 level--in 37 patients, the level I--in 19, the level II--in 17, the level III --in 6, and the level IV--in 2. There were substantiated the optimal surgical accesses and technique of radical nephrectomy and thrombectomy for RCC, complicated by a renal vein and vena cava inferior thrombosis. It is recommended to apply transabdominal accesses: the extended median laparotomic, bilateral subcostal of a "Chevron" or "Mercedes" type. There was shown, that the access choice depends on the level of the tumoral thrombus localization.

[Application of the MELD scale for the estimation of treatment efficacy in patients with hepatic cirrhosis and hepatorenal syndrome type II using extracorporeal methods of hemocorrection].

The results of treatment of 69 patients, suffering hepatic cirrhosis (HC) in decompensation stage with hepatorenal syndrome, were analyzed, in whom extracorporeal methods of hemocorrection (extracorporeal sorption with ultrafiltration of ascitic liquor and the albumin peritoneal dialysis) were applied. The patients state severity as well as the therapy efficacy were estimated in accordance with the MELD (Model of End-Stage Liver Disease) scale. High informativity of the abovementioned estimation system was established, concerning prognosis for their life duration in the patients, suffering HC.

[Indices of the external respiratory function in patients suffering from hepatic cirrhosis with ascitic syndrome].

The changes of external respiration indices in the patients suffering hepatic cirrhosis, complicated by ascitis and portal hypertension, were studied. Application of method of the ascitic liquor extracorporeal ultrafiltration and sorption with its subsequent return into venous system was proposed. The morphological changes of pulmonary parenchyma, which coincided with lowering of the external respiration indices in the patients, were studied.

[Surgical methods in the treatment of pancreatic pseudocysts].

The results of treatment of 209 patients suffering pancreatic pseudocysts are adduced. The pseudocyst maturity degree determines the method of treatment choice. Optimal combination of conservative and the puncture methods constitute the main principle of treatment of acute pancreatic pseudocysts.

[The reasons and frequency of early reocclusion origin in vessels of femoro-popliteal-tibial segment].

Main reasons and frequency of early postoperative thrombotic complications were analyzed. The frequency of early postoperative thrombosis in vessels of femoro-popliteal-tibial segment composed 19.1%. The most frequency of early reocclusion observed after the femoro-tibial reconstructive operations (in 32.4% patients), the least--after femoro-popliteal grafting at above knee level (in 14.1%). The main reason for early reocclusion is an inadequate estimation of distal arteries damage.

[Classification of arterial reocclusion of the femoro-popliteo-tibial segment for the choice of the reconstruction method].

The literature data, concerning the issues of terminology and classification of occlusion and reocclusion of the femoro-popliteo-tibial segment arteries were analyzed. Basing on analysis of the results of clinico-instrumental investigations performed, classification of the femoro-popliteo-tibial segment arteries reocclusion was proposed, which it is expedient to apply while making choice of the rereconstruction method.

[Albumin-mediated peritoneal dialysis as method of restorational therapy in hepatic insufficiency].

New method of extracorporeal detoxication of organism, which is applied for temporary restoration of hepatic detoxication function in patients with hepatic insufficiency, albumin-mediated peritoneal dialysis, was presented. The main principle of this technology is a transfer through highly permeable dialysis membrane of toxins, which are in affinity with albumin, from the blood to acceptor. The donor's human albumin, circulating in the closed contour, serves as acceptor. The watersoluble lowmolecular substances are excreted according to the concentration gradient. For rapid restoration of acceptoral ability of the donor's albumin solution it was subjected to hemodialysis and carboperfusion. The performance of the procedure guarantees excretion of toxins, combined with albumin, along with excretion of watersoluble toxins.

[Surgical treatment of chronic venous insufficiency]. / Khirurhichne likuvannia khronichnoï venoznoï nedostatnosti.

Results of surgical treatment of 700 patients with chronic venous insufficiency of the lower extremities are presented. Subfascial endoscopic ligature of perforating veins and catheteric truncal sclerotherapy of v. saphena magna was applied by the authors side by side with traditional operations--venectomy and ligature of perforating veins. In the patients, treated using miniinvasive methods, the lowest frequency of purulent postoperative complications, the veins varicosis and the trophic ulcers recurrence was registered. Good immediate and late follow-up results achieved are due to meticulous selection of patients depending on the venous insufficiency stage and the deep venous system passability. It is necessary to proceed with further investigation of possibilities of the perforating veins endoscopic subfascial ligature and of catheteric truncal sclerotherapy performance in other stages of the disease.

[Mathematical algorithm for the determination of admissible volume of surgical intervention for portal hypertension in patients with liver cirrhosis]. / Matematychnyi alhorytm vyznachennia dopustymoho obsiahu khirurhichnoho vtruchannia z pryvodu portal'noï hipertenziï u khvorykh na tsyroz pechinky.

Basing on analysis of the weighted prognostical criteria the algorithm a determination of the surgical intervention admissible range in patients with liver cirrhosis and portal hypertension, in dependence of state severity, of the diseases degree compensation of were proposed.