Criteria for Selecting the Optimal Method of Treating Hepatic Hemangiomas.

The aim of the study was to develop criteria for optimal tactics of treating hepatic hemangiomas of various sizes and localization including endovascular, percutaneous puncture ablative, and open resection interventions. MATERIALS AND METHODS: The results of treating 95 patients (65 women and 30 men aged 26-65 years) with hepatic hemangiomas have been analyzed. Tumor diagnosis was based on the data of echosonoscopy, MRI, multispiral computed tomography with intravenously injected contrasting medium, US dopplerography, and puncture biopsy. 78 patients were operated on, 63 of them underwent isolated surgery, whereas 15 patients were treated with a combination of methods. In 17 cases, the decision was made not to use operative treatment. RESULTS: After open resection operations (n=34), complications in the form of bilomas were observed in 3 patients in the postoperative period, in 1 patient the tumor growth continued two months after the resection of liver segment IV. Sclerotherapy of hepatic hemangiomas with ethanol (n=13) resulted in the recovery of 10 patients, massive intravascular hemolysis has developed in one patient, two patients died. After radiofrequency thermoablation of hepatic hemangiomas less than 5 cm in diameter (n=4), recovery was achieved. Echosonoscopy showed the reduction of blood flow and absence of tumor growth in 12 patients after isolated endovascular embolization of the vessel nourishing hepatic hemangioma. The combined treatment according to the method developed by us resulted in clinical recovery of all 15 patients. CONCLUSION: Sclerotherapy of hepatic hemangiomas with ethanol, especially those being large in size, may cause unpredictable complications and individual pathological reactions with severe outcomes. Surgical treatment is not required if morphologically verified hepatic hemangiomas are less than 3 cm in diameter without evident clinical manifestations and growth. When the diameter of hepatic hemangiomas is in the range of 3-5 cm with a tendency to growth, radiofrequency thermoablation is preferred. Hemangiomas of the left liver lobe more than 5 cm in size should be treated by resection methods. Our combined method is designed to treat hemangiomas of the right liver lobe exceeding the size of 5 cm. If the right lobe tumor is more than 10 cm, it is advisable to make a decision in favor of open operation.

[Prediction of the outcomes of renal replacement therapy for acute renal failure after cardiosurgical interventions].

The aim of the study was to evaluate the influence of different predictors on the outcomes of acute renal failure (ARF) in cardiosurgical patients. A hundred and five cases of ARF in January 1995 to August 2004 were retrospectively analyzed. Sixty-one patients received continuous renal replacement therapy (CRRT) and 44 patients had intermittent RRT (IRRT). Eighteen preoperative, perioperative, and postoperative risk factors were assessed. The overall hospital mortality was found to be 42%: 48.4% in the CRRT group and 33.3% in the IRRT group. A statistical analysis revealed 8 significant predictors of fatal outcomes: (1) the severity according to the APACHE II scale (25 +/- 1 scores); (2) the number of organ dysfunctions (3.6 +/- 0.2); (3) large-dose inotropic support; (4) artificial ventilation; (5) oliguria; (6) severe concomitant hepatic failure; (7) moderate-to-severe concomitant posthypoxic encephalopathy. CRRT improved survival in AFR associated with severe cardiorespiratory failure, oliguria, and cerebral dysfunctions. The paper discusses criteria for choosing the modes of renal replacement therapy.

[Effectiveness of plasmapheresis and its modifications in the treatment of cardiosurgical patients]. / Effektivnost' plazmafereza i ego modifikatsii v lechenii kardiokhirurgicheskikh bol'nykh.

The efficiency of plasmapheresis in the treatment of infectious complications and multiple organ dysfunctions was evaluated in 66 patients after heart surgery. Early plasmapheresis attenuated the cytokine-related systemic inflammatory response and organ damage. The optimal use of plasmapheresis modifications (membrane plasma filtration, plasma carboperfusion, cryoapheresis) improved the clinical outcomes.