[Surgical service for patients with purulonecrotic complications of diabetic foot].

The article deals with staging surgical service for patients with ulceronecrotic damages of the distal parts of lower extremities associated with diabetic foot. The authors grounded the deadlines of sanitive operations, performing after reconstructive vascular operations, on the basis of assessment of outflow tract according to Rutherford and index of TcPO2 increase. High efficiency of revascularization in order to maintenance of lower-extremity function in patients with complicated forms of diabetic foot is proved.

[Comparision of stress response severity during intravenous, inhalation and combined anesthesia (inhalation plus local) for pituitary transsphenoidal adenomectomy].

Transsphenoidal pituitary surgery is usually accompanied by severe hemodynamic stress response which is hardly treated with fentanyl. The main goal of the study is to compare anesthetic methods for endonasal endoscopic transsphenoidal pituitary adenomectomy and single out the most effective way of reducing or preventing the stress reaction. 65 patients underwent endonasal endoscopic transsphenoidal pituitary adenomectomy. In all the patients general an- esthesia was induced with propofol. Analgesia was provided by phetanyl boluses. The patients were divided into three groups. In the first group of patients TIVA with propofol-TCI was used. In the second group of patients anesthesia was maintained by N20 plus sevoflurane. The third group of patients received an additional bilateral endoscopic mucosal 2% lidocain 5 ml infiltration of the pterygopalatine nerve branches zone. Pipecuronium was used for neuromuscular blockade. The simultaneous HR, ABP and metabolism increase were qualified as stress response. In the first and second groups of patients the maximum stress response was recorded on the stage of mucosal coagulation and on the opening of the blades of bivalve nasal speculum. No major difference in stress response severity was noted in these groups. In the third group stress response was significantly lower. According of the results of the study bilateral endoscopic mucosal lidocaine infiltration of the pterygopalatine nerve branches zone for anesthetic management of endonasal endoscopic transsphenoidal pituitary adenomectomy can be recommended.

[Advantages of endovenous laser coagulation in surgical management of varicose disease].

Presented in the article are the results of endovenous laser coagulation of the greater saphenous vein in a total of ony hundred seventeen patients suffering from varicose disease. Favourable outcomes consisted in achieving complete removal of the vertical reflux, accompanied and followed by rapid rehabilitation, an utterly low complication rate, and an excellent cosmetic effect obtained.

[Analysis of outcomes of surgical management of patients presenting with ischemic etiology pyonecrotic lesions of lower limbs].

The authors assessed the outcomes of surgical management of eighty-four patients presenting with ulcerative and necrotic lesions of the lower extremities, who were subjected to various reconstructive interventions performed on the major arteries. The duration of the hospital stay in these patients was increased to 23.1 +/- 5.6 days. It was determined that in 63.2% of cases, trophic ulcers of the feet had developed on the background of "multi-storey" occlusive and stenotic lesions of the lower-limb major arteries. Trophic alterations in the distal portions of the lower extremities had developed during averagely 3.5 +/- 1.6 years following the appearance of the symptoms of intermittent claudication. Destructive changes of the feet in patients with diabetes mellitus and thromboangiitis developed rapidly, were more pronounced, and required performing a postponed operation. The authors revealed a series of laboratory indices, i. e., blood platelets, stab leukocytes, ESR, as well as the degree of the occlusive lesion of the crural arterial segment, correlating with severity ofnecrotic changes on the foot. Early thrombosis of the bypasses were caused by unsatisfactory pathways of arterial outflow and a high level of blood haematocrit. The postoperative mortality rate amounted to 4%, that after six months - to 5%, after one year - to 5%, and after two years - to 8%. The limb salvation rate immediately after surgery amounted to 98.8%, equalling 92.1% after six months, 92.1% after one year, and 88.9% after two years. The purpose ofpresent work consisted in analysing the outcomes of treatment and determining the factors influencing the limb salvation rate in patients presenting with stage IV ischaemia of the lower extremities.

[Surgical management of a patient presenting with stage IV lower limb ischaemia and being on programmed haemodialysis].

Presented herein is a clinical case report of a male patient suffering from ischaemic gangrene of the foot on the background of an atherosclerotic-genesis multifocal occlusive-and-stenotic lesion of the major arteries of the lower extremities and undergoing programmed haemodialysis for terminal-stage chronic renal insufficiency. The patient was successively subjected to three-stage surgical management, with the first stage consisting of revascularization of the extremity involved by means of "in-situ" femoropopliteal auotovenous bypass grafting, the second comprised resection of the calcaneum with the removal of the osteomyelitis focus, and the third one was composed of dermatoautoplasty of the defect of the foot with a split cutaneous flap.