[Modern approach to diagnosis and treatment of acute mesenteric ischemia].

It was proposed the medical and diagnostic tactic in patients with acute mesenteric ischemia on basis of efficiency results of modern laboratory markers and instrumental methods. Positive laboratory D-dimer-test with computed tomography of abdominal organs or abdominal aorta and its branches CT-angiography led to diagnose thrombosis or embolism of mesenteric arteries at early terms and to reduce preoperative period. The authors presented the variant of isolated endovascular intervention in case of superior mesenteric artery thrombosis. This technique may be regarded as the method of choice in the treatment of patients with acute mesenteric ischemia.

[Venous thromboembolic complications in patients with intracranial hemorrhage and tumors of the central nervous system].

It was analyzed the results of diagnosis and prevention of venous thromboembolic complications in 248 patients with intracranial hemorrhages of different etiology (hemorrhagic stroke, subarachnoid hemorrhage, craniocerebral injury, hemorrhages in the tumors of brain and spinal cord). The overall frequency of venous thrombosis in the vessels of the inferior vena cava pool was 24.6% (in 61 patients), the majority of patients had the asymptomatic thrombosis. The crural veins were the main localization of venous thrombosis. Also it was the main origin of thromboembolic complications (60.7%). Surgical treatment in different amount was an independent predictor of venous thromboembolic complications in neurosurgical patients according to the multivariate variance analysis. The frequency of thrombosis was significantly higher in the group of operated patients in comparison with non-operated group (37.1 vs. 17.6% (p=0.008). Early prevention by geparin (the use of direct anticoagulants for 2-4-th day of the founding of an intracranial hematoma) did not reduce the frequency of venous thrombosis in operated patients, but significantly reduced the frequency of fatal pulmonary embolism: 0 vs. 9.1% (p=0.002). Patients with intracranial hemorrhage are the one of the most unfavorable groups in terms of their venous thromboembolic complications.

[Sural sinus as the main source of postoperative venous thromboembolic complications in neurosurgical patients].

The authors analysed the results of diagnosis and treatment of venous thromboembolic complications in a total of 239 patients presenting with various-aetiology intracranial haemorrhage and tumours of the central system. The total incidence of venous thromboses in the system of the inferior vena cava amounted to 25.1%. Thromboembolism of pulmonary artery complicated the course of the underlying disease in 3.3% of cases. Operative treatment of the underlying disease resulted in an increased incidence rate of thromboses of deep veins from 18.5 to 36.4% (p=0.015) and that of pulmonary artery thromboembolism from 2.7 to 4.5% (p=0.5). The most frequently encountered localization of thromboses in the postoperative period turned out to be the sural veins of the crus. The level of consciousness (p=0.0001), operative treatment (p=0.002), putaminal and thalamic intracranial haematomas (p=0.01), as well as dislocation syndrome (p=0.05) according to the findings of the univariate analysis were the risk factors for the development of venous thromboses in patients with haemorrhagic stroke. Independent predictors of the development of venous thromboembolic complications in patients with haemorrhagic-type acute impairments of cerebral circulation according to the data of the univariate analysis were the level of consciousness by the Glasgow coma scale scoring 4-5 points (p=0.01) and deep-seated localization of the intracerebral haematoma (p=0.01). Patients with intracranial haematoma having endured operative treatment are a cohort of patients running the highest risk for the development of postoperative venous thromboembolic complications.

[The possibilities of laser Doppler flowmetry for the estimation of the intestine resection volume by the acute mesenteric ischemia].

The results of the surgical treatment of the acute mesenteric ischemia in 2 groups of patients were comparatively analyzed. The control group (n=52) experienced the traditional way and criteria of detecting the volume of intestinal resection (color and peristaltic activity, arterial pulsation). For the main group (n=57) the intraoperative estimation of the intestinal viability was performed with the help of laser Doppler flowmetry. As a result, the postoperative intestinal gangrene rate was 9.1% among patients of the main group, whereas the complication was registered among 48.6% of the control group. The main group of patients demonstrated the overall lower rate of postoperative complications in comparison with the control group: 67.6 and 40.9% (p=0.01), respectively. The same picture was for the lethality rate: 76.9 and 52.6% (p=0.03), respectively.

[Computed tomography and CT angiography in diagnosis of acute disorders impairment of mesenteric circulation].

Presented herein is the first experience in using two instrumental methods (remote contrast- free computed tomography and CT angiography) in a total of twenty-one patients suspected of having acute mesenteric ischaemia. Contrast-free computed tomography allowed of making a correct diagnosis of acute mesenteric ischaemia in 6 of 7 patients (with sensitivity of 85.7% and specificity amounting to 90%). Thrombosis of mesenteric vessels was revealed in all cases on CT angiography, with both sensitivity and specificity of the method equalling 100%. Also described herein is the incidence rate of various CT signs of intestinal lesions depending on aetiology and the stage of the disease. Minimally invasive nature, high spatial resolution of these two methods, high sensitivity and specificity make it possible to recommend them as the first step for instrumental diagnosis of acute mesenteric ischaemia.

[Safety and efficacy of various regimens of heparin-mediated prevention of venous thromboses in patients with intracranial haemorrhage].

Analysed in the article is the incidence rate of the development of venous thromboembolic complications in a total of 79 patients presenting with various-aetiology intracranial haemorrhage in different regimens of heparin-mediated prevention. The authors have revealed that early (on day 2-4 after the onset of the disease) administration of preventive doses of heparin in patients with intracerebral and intracranial haematomas is a safe and efficient regimen, since it decreases the rate of venous thromboses in the system of the vena cava inferior and fatal thromboembolic complications as compared with a later term (on day 5 and more) of initiating heparin-mediated prevention.

[Treatment and prevention of thromboembolism in patients with intracranial hemorrhage].

Frequency of venous thromboses and thromboembolic complications was retrospectively analyzed in 95 patients with intracranial hemorrhage of various etiology. Thrombosis of inferior caval vessels was registered in 19 (20%) patients; of them 3 patients had thromboembolism of a pulmonary artery, lethal in one case. The high frequency of venous thromboses indicates the necessity of early use of anticoagulants in treatment dosages and importance of the prophylaxis measures. Cava-filter implantation for pulmonary artery thromboembolism prevention should be considered only in patients with strong contraindications for anticoagulant therapy.

[Programmed relaparotomy in treatment of upper mesenteric artery acute occlusion].

Results of surgical treatment and frequency of intestinal necrosis in 44 patients with acute mesenterial circulation failure were analyzed. Instrumental method of detecting the border of necrosis by the infracted intestine should allow refuse programmed relaparotomies in treatment of such patients and perform a sole operation with intestinal resection and anastomosis.

[Long-term results of surgical treatment of patients with IV stage of chronic lower limb ischemia].

Results of surgical treatment of 210 patients with IV stage of atherosclerotic chronic lower limb ischemia are analyzed. Direct revascularization of lower limb permits to increase lifetime of patients and to improve quality of life. All the patients require permanent systematic complex therapy after surgery regardless of its variant.

[Choice of the extent and the terms of sanifying procedures after vascular reconstructive surgeries in patients with stage IV chronic arterial lower limb insufficiency].

Results of vascular reconstructions with the following sanifying procedures performed in 82 patients with stage IV chronic arterial lower limb insufficiency are analyzed. Based on complex evaluation of microcirculation three types of tissues ischemic lesion are revealed: irreversible, severe and mild. Patients with irreversible lesion of the tissues of a distal part of the lower extremity require vascular reconstruction with simultaneous amputation at the upper third of the shank. In a severe reversible ischemic lesion of the tissues radical sanifying surgery with preservation of limb support function is better to perform not earlier than one month after vascular reconstruction. Mild ischemia of tissues permits performing minimal sanifying procedure with primary closure of the wound simultaneously with vascular surgery.