[Plastic reconstruction of external genitalia after Fournier's gangrene]. / Plastische Rekonstruktion des äußeren Genitales nach Fournier-Gangrän.

Fournier's gangrene is a rapidly progressing necrotizing fasciitis restricted to the perineal and genital regions. Although rare, it is an acute life-threatening disease, requiring rapid radical surgical debridement and antibiotic treatment, resulting in large soft tissue defects. Various reconstructive methods for defect coverage are applied to satisfactorily reconstitute functionality and esthetics.

[POSSIBILITIES OF THE FORCED INTRAARTERIAL INJECTION OF MEDICINAL PREPARATIONS IN A COMPLEX OF TREATMENT FOR THE LOWER EXTREMITIES CHRONIC ISCHEMIA].

The efficacy and prognostic significance of the forced intraarterial injection of medicinal preparations in complex of treatment in patients, suffering chronic ischemia of the lower extremities tissues, was studied. In experimental conditions of the main blood flow blockade the forced intraarterial injection of medicinal preparations have promoted the release of vessels from cellular aggregates and the blood clots; and in the ischemia of degree ІІ - ІІІа ­ has determined more pronounced clinical improvement. Appearance of reactive hyperemia of the foot in terms more than 2 min have witnessed the hopelessness of the extremity saving.

A case of pulmonary infective endarteritis associated with patent ductus arteriosus: surgical closure under circulatory arrest.

A 35-year-old man was admitted to the hospital with prolonged high-grade fever. Chest computed tomography revealed multiple pulmonary infiltrations in both lungs, suggesting septic emboli. Echocardiography revealed patent ductus arteriosus and mobile large vegetations in the pulmonary artery. Because of uncontrollable infection and the imminent possibility of massive pulmonary embolism, he underwent transpulmonary surgical closure of the ductus and resection of the vegetations under hypothermic circulatory arrest using cardiopulmonary bypass. We report a rare case of open heart surgery in a patient with pulmonary infective endarteritis associated with patent ductus arteriosus.

[The experience with thoracoscopic sympathectomy for the treatment of distal lesions of limb arteries].

The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.

Multisite infective endocarditis/endarteritis in a young peripartum patient with patent ductus arteriosus and rheumatic heart valve disease: a case report.

Infective endocarditis (IE) is rarely seen in pregnancy and puerperal period, and generally occurs in patients with preexisting heart disease or intravenous drug abuse. In this report, we describe a case of a 27-year-old patient with missed diagnosis of rheumatic heart disease and a moderate size patent ductus arteriosus, in whom multisite culture-negative IE/pulmonary endarteritis developed after uncomplicated vaginal delivery.

Femoral bifurcation infected pseudoaneurysm: a simple and quick arterial reconstruction with reversed bifurcated saphenous vein graft.

Septic endarteritis complicating arterial cannulation is an exceptional condition. The authors report a quick and feasible surgical procedure to reconstruct a femoral bifurcation with reversed bifurcated saphenous vein graft.

Unusual complication of coarctation of the aorta.

The majority of older patients with uncorrected coarctation of the aorta die before the age of 50 years from many complications. We report our experience in treating this type of congenital malformation in a 40-year-old man who developed aortic endarteritis as a rare complication.

[Effects of the anticoagulation therapy regimen on frequency of early thrombohemorrhagic complications after operations on major arteries of lower extremities]. / Vliianie rezhima antikoaguliantnoi terapii na chastotu rannikh trombogemorragicheskikh oslozhnenii posle operatsii na magistral'nykh arteriiakh nizhnikh konechnostei.

The results of 295 reconstructive operations on the major vessels of lower extremities were analyzed. The patients were divided into 4 groups depending on the scheme of anticoagulation therapy in the postoperative period. Under investigation was the state of hemostasis and hemorheology. The frequency of thrombohemorrhagic complications was assessed. It was found that the regimen based on the administration of low molecular weight heparins during the nearest 5 days after the intervention was the most rational regimen of anticoagulation therapy after reconstructive operations on the major arteries of lower extremities.

[Septic endarteritis after angiography]. / Septische Endarteriitis nach Angiographie.

Infectious complications after angiography are rare. We treated a 72-year-old man who developed staphylococcus aureus endarteritis after angiography resulting in delayed rupture of the common iliac artery. Diagnostic problems, type of bacteria involved and therapeutic implications are discussed.

[Surgery of bifurcation of the femoral artery in popliteal-tibial arterial occlusion]. / Operatsiia na bifurkatsii bedrennoi arterii pri okkliuzii podkolenno-bertsovo segmenta.ooa

In vascular surgery department of V. Vakhidov Research Center of Surgery 37 patients with diffuse lesion of popliteal-tibial arterial segment in combination with stenotic lesion of profound and common femoral artery were examined and operated. Examination of regional circulation before operation was made with consideration of profundo-popliteal collateral index (PPCI) which permits to evaluate features and degree of lesion of deep femoral artery (DFA). Angiography failed to defect bifurcation of the femoral artery in 17 (48.6%) cases, in 11 of them stenosis of bifurcation of the femoral artery was revealed in intraoperative revision. In these patients PPCI was 0.34 and more, high peripheral vascular resistance was seen in debitometry. The authors believe that calculation of PPCI is one of the main methods of diagnosis of femoral artery bifurcation lesions. Good and satisfactory results were seen in 29 (78.3%) patients, unsatisfactory--in 8. Amputations were performed in 3 patients. 1 patient died. Suppuration of the wounds was in 6 patients, in 4 of them--in the zone of reconstructed artery with arrhosive bleeding. It is suggested that in diffuse lesions of arteries of popliteal-tibial segment examinations of regional hemodynamics and plastic repair of DFA are most effective.

[Patent ductus arteriosus and pulmonary artery endarteritis]. / Persistência do canal arterial e endarterite da artéria pulmonar.

We describe a seven year old girl with echocardiographic diagnosis of pulmonary artery endarteritis as a complication of a patent ductus arteriosus, confirmed at surgery. This case illustrates the necessity of complete surgical resection of the infectious source as a way to avoid other complications such as pulmonary embolism.

[Ways to enhance the efficacy of treating patients with the terminal stage of arterial ischemia of the lower extremities]. / Puti povysheniia éffektivnosti lecheniia bol'nykh s terminal'noi stadiei arterial'noi ishemii nizhnikh konechnostei.

Experience with treatment of 410 patients with obliterating diseases of lower extremities arteries with the terminal stage of ischemia and occlusions of the femoro-popliteal segment have shown that successful results of small amputations can be obtained but against the background of complex treatment based on a thorough and comprehensive examination of the patient, and aimed at the recovery of adequate blood supply of distal parts of the extremity by operations of direct and indirect revascularization, normalization of microcirculation and struggle against infection. It allows performing amputation distal to the knee joint in 79.5% of cases, and to reduce the amount of postoperative complications in 38.8% of cases.

[Use of vazaprostan in the treatment of multifocal peripheral obliterating lesions of arteries of the lower limbs]. / Primenenie vazaprostana pri lechenii mul'tifokal'nykh i perifericheskikh obliteriruiushchikh porazhenii arterii nizhnikh konechnostei.

Vazaprostan was prescribed to 13 patients with the lower limbs obliterating atherosclerosis and the coronary arteries atherosclerotic lesion (first group) and in 17--with obliterating atherosclerosis and endarteritis of the lower limbs vessels (second group). The treatment was found to be effective one in all of the patients of the first group and in 13--of the second. The authors consider vazaprostan application to be expedient in patients with the lower limbs obliterating lesions as a supplement to operative intervention and also in coincidence of this pathology with the ischemic heart disease.

[Characteristics of blood distribution in the tissues of the lower extremities after lumbar sympathectomy]. / Osobennosti raspredeleniia krovi v tkaniakh nizhnikh konechnostei posle poiasnichnoi simpatéktomii.

By means of a polarographic method, the peculiarities of blood distribution in the tissues of the lower extremities in 34 patients with obliterative atherosclerosis and in 29--with obliterative endarteritis after sympathectomy were studied. In successful intervention, the prognostically significant increase in oxygen tension in the muscles at the level of crura and feet was noted. It is suggested to use this test under conditions of medicinal ganglionectomy with the aim of prognostication of the effectiveness of the forthcoming lumbar sympathectomy.

[Spontaneous aneurysm of the patent ductus arteriosus with endarteritis. A case report]. / Aneurisma espontáneo del conducto arterioso permeable, con endarteritis. Presentación de un caso.

The spontaneous aneurysm of the ductus arteriosus is an extremely rare disease. From a total of 24 adult cases reported in the literature up to 1987, only in one case the ductus was open and other, was recanalized after being closed. We described the second case in the literature in a patient with totally permeable ductus arteriosus who developed a spontaneous aneurysm and endarteritis, showing the great importance of the diagnostic procedures such as echocardiogram, tomography and angiogram, as well as the surgical treatment which was successful in our patient. The probable etiology of this disease is discussed.

[The effectiveness of G. A. Ilizarov's method in treating patients with III- and IV-stage chronic ischemia of the lower extremities]. / Effektivnost' metoda G. A. Ilizarova pri lechenii bol'nykh s III i IV stadiiami khronicheskoi ishemii nizhnikh konechnostei.

The method of treatment after Ilizarov was used in 28 patients with occlusion of lower extremity arteries, mainly of distal localization, with the III and IV degrees of ischemia. Osteotomy of mainly the tibial bone and distraction of the free osseous split was performed during 31-36 days. Two patients had fractures of the bone during operative interventions, after operation four patients had purulent complications or necrosis of the skin around the wire. The immediate positive result was noted in 20 patients. Their fate was followed-up in remote periods from 2 to 19 months, good results were observed in 18 patients. The use of the Ilizarov method was most justified in patients with the III and IV degrees of ischemia when other methods of treatment failed to give any effect and surgical reconstruction of the vessels is impossible. When treating patients with the IV degree, it is necessary to take into consideration the late appearance of revascularization and possibility of temporary deterioration. The use of the Ilizarov method foresees provision of the joint work of an angiosurgeon and a traumatologist-orthopedist.