The efficacy of cell therapy in the treatment of patients with trophic venous ulcers of the lower limbs.

This paper analyzes the results of cell therapy carried out during multimodality treatment of 23 patients with trophic ulcers of the lower limbs because of varicosity and postthrombotic disease. Twenty-five patients were entered into the control group provided the modern wound dressings Suprasorb. It has been demonstrated that cell therapy applying fibroblasts, strain 11 00/14, noticeably upgrades the treatment efficacy. Ulcer healing was attained in all the patients of the basic group. The times of epithelialization averaged 1.5 week for varicose and 3.2 weeks for postthrombotic ulcers. In the control group, the healing of varicose trophic ulcers was recorded in 86% and of postthrombotic ulcers in 78% of patients. The times of healing averaged 3.6 and 3.9 months respectively, Cell therapy as part of multimodality treatment of trophic venous ulcers excels the modern wound dressings as regards the efficacy.

[Surgical treatment of atherosclerotic lesions of the terminal part of the aorta and iliac arteries].

The operations of semiclosed endarterecromy of the aortofemoral zone arteries were shown to have a number of advantages over shunting interventions with synthetic transplants. They are quick, not traumatic and have better results of long term patency. However, their application is limited by certain indications. Femoral amputations in patients with lesions of the aorta and iliac arteries independent of the age should not be recommended as a method of treatment of critical ischemia of lower extremities. Reconstructive operations on the vessels of this zone provide longer duration and better quality of life of the patients.

[Cell therapy in treatment of trophic ulcers of lower extremities].

The aim of the work was to study the effectiveness of using human embryo fibroblast culture in complex treatment of trophic ulcers of venous etiology in 23 patients with trophic ulcers of lower extremities. The cause of the appearance of ulcers was postthrombophlebitic disease in 16 patients and varicose disease in 7 patients. A control group consisted of 25 patients (postthrombophlebitic disease in 18 patients and varicose disease in 7 patients). The human embryo cell culture grown on the wound cover "Foliderm" was used at the stage of epithelization in the main group, while in the control group the modern alginate, collagen, hydrogel, polyurethane and hydrocolloid covers Suprosorb--Suprosorb A, Suprosorb C, Suprosorb G, Suprosorb F and Suprosorb H were used. Healing of the varicose trophic ulcers in the control group was achieved in 86% of patients, of post-thrombophlebitic--in 78% of patients. The average period of healing was 3.6 and 3.9 months respectively. Healing of trophic ulcers in the main group took place in 100% of patients. The average period of healing was 1.5 week for varicose and 3.2 weeks for postthrombophlebitic ulcers. The cell therapy was shown to be a highly effective method in treatment of venous trophic ulcers.

[The dynamics of the coronary bed state in patients with ischemic heart disease after surgical correction of dyslipoproteidemia].

The investigation included 85 ischemic heart disease patients with the coexistent dyslipoproteidemia. In 39 of the patients the operation of partial shunting was performed for correction of the impaired lipid metabolism. It was found that the partial ileoshunting was an effective method of correction of dyslipoproteidemia. The effect of the operation was due to lowering the total cholesterol level in blood (at an average by 25.6%) and elevation of the HDL level (at an average by 19.6%). The results of the following angiographic examinations have shown a clear effect of the inhibition of progressing coronary atherosclerosis in patients who underwent surgical correction of dyslipoproteidemia that allows the partial ileoshunting to be considered as an effective method of the secondary prophylactics of atherosclerosis. The HDL level is the main marker of the dynamics of the atherosclerotic process in the coronary arteries.

[Effects of dyslipoproteinemia on long-term results of surgical treatment of patients with obliterating atherosclerosis of the lower extremity vessels]. / Vliianie dislipoproteidemii na otdalennye rezul'taty khirurgicheskogo lecheniia bol'nykh obliteriruiushchim aterosklerozom sosudov nizhnikh konechnostei.

The investigation included 120 patients who had undergone different revascularizing operations more than 10 years ago for obliterating atherosclerosis of the lower extremity vessels. Dyslipoproteidemia was diagnosed in 88 of them. It was established that in patients with dyslipoproteidemia the symptoms of ischemia of lower extremities were developed in younger age. Within 5 years after the first revascularizing operations there appear reliable differences in the course of the disease in patients with dyslipoproteidemia and normal levels of lipids in blood. More than 90% of patients with dyslipoproteidemia in the distant period of time have symptoms of generalized atherosclerosis, and the survival is mainly predetermined by cardiac and cerebral complications of atherosclerosis. The life of dyslipoproteidemia patients operated upon is 8 years shorter than of subjects with the normal-level of lipids in blood.

[Semiclosed endarterectomy of the aorto-femoral segment by Vollmar loops]. / Poluzakrytaia éndarteréktomiia aortobedrennogo segmenta petliami Vollmar.

In 1996-1998 131 patients were observed who underwent semiclosed loop endarterectomy of the aorto-femoral segment by Vollmar loops. The control group consisted of 220 patients on whom the operations of uni- or bilateral aorto-femoral bypass with synthetic prostheses were made. The semiclosed loop endarterectomy was mainly fulfilled through the femoral access, the retroperitoneal access was used in 18.3% of the patients. Thus the time of operation was as short as (100 +/- 10.9) min. in mono- and (118.6 +/- 12.9) min. in bilateral reconstructions, and blood loss in typical cases was not more than (327 +/- 24.1) ml. The operation of semiclosed loop endarterectomy gave a high level of patency to the reconstructed aorto-femoral segment. The primary 5-year patency of the iliac arteries was 91.86%, the cumulative one--93.87%. Such parameters for shunting operations were lower: 75.4 and 81.63% respectively (p < 0.05).

[Results of using the domestic vascular prosthesis "Ekoflon"]. / Rezul'taty ispol'zovaniia otechestvennykh sosudistykh protezov "Ekoflon".

The aim of the work was to study long-term results of application of a vascular transplant from modified polytetrafluoroethylene "Ekoflon". The investigation included 121 reconstructions performed during the last 6 year, 53 prostheses being implanted in the aorto-femoral position, 68--in the femoro-popliteal-tibial position. The long-term results have shown that the transplant "Ekoflon" in the position of the aorto-femoral shunt is not inferior to textile analogues and even has a number of advantages. When it is used below the inguinal fold the results of patency were worse than those with the autovenous one. But when there is no adequate autovein, under conditions of critical ischemia, prosthesis "Ekoflon" might be the material of choice for saving the lower extremity. The dynamic ultrasound duplex scanning and histological investigation of the prosthesis samples have shown an original morphogenesis of its "implantation".

[Diagnosis and surgical treatment of pathologic tortuosity of carotid and vertebral arteries]. / Diagnostika i khirurgicheskoe lechenie patologicheskoi izvitosti sonnykh i pozvonochnykh arterii.

The article summarizes an experience with 179 surgical interventions on patients with pathological tortuosity of brachiocephalic arteries. The optimal described diagnostic algorithm for this pathology included ultrasonic dopplerography, transcranial dopplerography, angiography or magnetic resonance tomography in the angiography regimen. Clinical and angiographic indications to surgical treatment of this pathology were determined. The operative treatment was carried on in patients with neurological symptoms having kinks of brachiocephalic arteries. The intraoperative strategy depending on the type and localization of the disease are analyzed. Stabile regression of manifestations of vascular cerebral insufficiency after surgical correction of the pathological tortuosity of the brachiocephalic arteries was achieved in 76% of the patients.

[Preliminary experience with partial ileoshunting in dyslipoproteinemia using endovideosurgical technique]. / Pervyi opyt chastichnogo ileoshuntirovaniia pri dislipoproteidemii s primeneniem éndovideokhirurgicheskoi tekhniki.

The authors have proposed and fulfilled the operation of partial ileoshunting on a 45 year-old woman. The using of endovideosurgical method made the operation less traumatic and minimized the cosmetic defect. The patient was discharged on the 6th day. The authors have made 3 more operations of this kind in patients with hypercholesterinemia.

[Application of different textile vascular grafts in the aorto-femoral location and ways for their improvement]. / Primenenie razlichnykh tekstil'nykh sosudistykh transplantatov v aortobedrennoi pozitsii i puti ikh sovershenstvovaniia.

A comparative analysis of 220 reconstructions of the aortofemoral segment with the application of vascular prostheses of firms "Sever" and "Vascutek" was made. It was established that in patients with obvious anemia and hemodilution (hematocrit less than 25%, hemoglobin less that 80 g/l) an important condition for less total blood loss was to impart the zero surgical porosity to the graft wall at the preoperative stage. However, the biological impregnation used for these purposes reinforces the inflammatory component in the implantation of the vascular graft. The authors propose to use a more inert polytetrafluoroethylene film to impart the zero surgical porosity to the graft wall.

[Dyslipoproteinemia and prognosis of the course of ischemic heart disease after coronary bypass]. / Dislipoproteinemiia i prognoz techeniia ishemicheskoi bolezni serdtsa posle koronarnogo shuntirovaniia.

The article deals with the observation of 88 patients with ischemic heart disease, 62 of them had coexistent dyslipoproteidemia. More pronounced atherosclerotic lesions of the coronary artery were found to develop in patients with dyslipoproteidemia influencing the degree of ischemic heart disease before coronary bypass. Within the period of 10 years after operation dyslipoproteidemia patients have 3.5 times higher risk of the development of myocardial infarction, more than 2 times higher risk of reappearance of stenocardia and death from cardiovascular diseases. Patients with dyslipoproteidemia have 2 times higher probability of generalization of the atherosclerotic process in patients with is chemic heart disease at later terms after coronary bypass.

[Long-term results of the use of different modifications of the partial ileal shunt operation in the treatment of patients with atherogenic dyslipoproteinemias]. / Otdalennye rezul'taty primeneniia razlichnykh modifikatsii operatsii chastichnogo ileoshuntirovaniia dlia lecheniia bol'nykh s aterogennymi dislipoproteidemiiami.

The article presents long-term (up to 20 years) results of performing the classical H. Buchwald operations and its various modifications in 145 patients. Creation of ileoileoanastomoses 5 cm from the ileocecal valve and a standard shunt of 250 cm of the ileum allowed to obtain a necessary and considerable (27% at an average) hypocholesterolemic effect and to eliminate diarrhea at the postoperative period.

[20 years' experience of treating patients with extreme forms of obesity]. / Dvadtsatiletnii opyt lecheniia bol'nykh s krainimi formami ozhireniia.

During 20 years 356 patients with morbid obesity of the III-IV degrees were operated on, 339 of them being subjected to jejunoileal shunting in the authors' modification. The developed measures for the selection of patients, preoperative preparation, anesthesia and operation technique allowed the amount of postoperative complications to be reduced from 15 to 5%. Long-term results were followed-up in 220 patients during 3-17 years. Stable loss of the body mass, regression of the diseases resulting from obesity were noted in 187 of these patients (85%). Electrolytic disorders were found in 16.8% of the patients. The reconstruction of the small intestine because of progressing hepatic insufficiency was performed in 16 patients. Less than 20% loss of the body mass was noted in 18 patients.

AgNORs in cardiomyocytes from surgical patients with coronary heart disease.

AIM: To evaluate the interphase ribosomal RNA cistron activity of cardiomyocytes in surgical patients with chronic ischaemic heart disease by means of the nucleolar organiser region silver staining (AgNOR) technique. METHODS: Nucleoli were investigated in myocardial samples obtained from 46 patients with chronic ischaemic heart disease before, during, and soon after cardioplegia ischaemia. Cryostat sections of 10 microns thickness were air dried, fixed in methanol/glacial acetic acid (3:1) for 15 minutes, rinsed carefully with distilled water, incubated in 2 N formic acid for 10 minutes, and impregnated with silver colloid solution for 2.5-3 minutes at 68-70 degrees C. The lightly counterstained sections were examined under oil immersion at x1000 magnification. For the estimation of AgNOR numbers at least 100 silver stained cardiomyocyte and fibroblast nuclei were counted in each section. On the basis of these data, the mean number of AgNORs in each nucleus was determined. The Student's t test was used to compare the groups tested. RESULTS: The initial mean numbers of AgNORs varied greatly, demonstrating a difference between groups of patients with or without antecedent myocardial infarction (9.5 v 11.0; p < 0.05). During myocardial arrest, the numbers of AgNORs in cardiomyocytes were decreased in all but seven patients, while those in fibroblasts tended to increase. At the stage of reperfusion and myocardial warming, in all but three patients the numbers of AgNORs in cardiomyocytes either normalised or were even higher than the initial value. CONCLUSIONS: The AgNOR count in cardiomyocytes is a very sensitive test for the measurement of cardiac function in surgical patients with chronic ischaemic heart disease and could be useful for monitoring myocardial status during the course of surgery, including cardioplegia. The high risk group for surgery included patients with antecedent myocardial infarction and severe heart failure. It is thought that a reversible nucleolin/fibrillarin/pre-rRNA/small nucleolar RNA modification might account for this fast decline then rise in the AgNOR count in cardiomyocytes at the stages of cardioplegia and reperfusion, respectively.

[The efficacy of antithrombotic therapy after total obliteration-reversing therapy in atherosclerotic arterial occlusion of the lower extremities]. / Effektivnost' antitromboticheskoi terapii posle total'noi dezobliterapii pri ateroskleroticheskoi okkliuzii arterii nizhnikh konechnostei.

The operation of total desobliteration of the arteries (TDA) is a modification of semi-open eversive endarterectomy (EAE). Under study was frequency of thromboses of the desobliteration area, its correlation with postoperative changes of the state of hemorheology and hemocoagulation and the antithrombotic treatment of 150 patients who were operated upon for total desobliteration of the iliofemoral-popliteal segment. The patients were divided into 2 groups which had no substantial difference. At the postoperative period patients of the 1st group (79) were treated with Ticlid ("Sanofi" France) in dosage of 500 mg/day. Treatment of 71 patients of the second group included a combination of two medicines (A + D): aspirin--1000 mg/day and dipiridamol--150 mg/day. A comparative analysis of frequency of the development of cardio-vascular complications at the remote period has shown that in the first group of patients the frequency of development of acute myocardial infarction and acute disturbance of cerebral blood circulation was two times less than in the second group of patients. It is to be noted that in case of the developed in time occlusion in the operation area, the extremity was saved in the Ticlid group in 62% of cases (7 amputations per 18 cases of reocclusion) while in the (A + D) group the extremity was saved in 29% (17 amputations per 24 cases of thrombosis). Thus, the investigation of long-term results of TDA in combination with postoperative antithrombotic therapy of patients with atherosclerotic occlusions of the iliofemoral-popliteal segment arteries has shown high effectiveness of Ticlid. As compared with traditional methods of treatment with aspirin and dipiridamol treatment with Ticlid allowed the cases of restenosis and reocclusions to become more than two times less often.

[Experimental and clinical research on the Russian Vitaflon blood vessel prosthesis]. / Eksperimental'no-klinicheskoe issledovanie otechestvennogo proteza krovenosnykh sosudov "Vitaflon".

The authors have performed an experimental and clinical assessment of a new graft. In 37 mongrel dogs 49 experiments were carried out with the implantation of grafts "Vitaflon" into different parts of the arterial and venous bed. It was shown that the domestic graft from modified polytetraftoroethylene had high biological inertia, good plastic properties, zero surgical porosity, strength and reliable "taking" by the recipient's organism. Following the experimental work the prosthesis "Vitaflon" (30-50 cm long and 8 mm diameter) was implanted in the femoro-popliteal-tibial position to 15 patients suffering from obliterating atherosclerosis of the lower extremity arteries. The period of follow-up observations was about 12 months. Thrombosis took place in two grafts in the early postoperative period. Other shunts were functioning well which was confirmed by the clinical picture and dopplerography.

[The surgical treatment of aneurysms of the abdominal aorta]. / Khirurgicheskoe lechenie anevrizm briushnoi aorty.

Based on an experience with treatment of 107 patients with aneurysms of the abdominal aorta subjected to planned or urgent operations the authors discuss the problems of the clinical course, diagnosis, indications for operative treatment, the technique of operative interventions and their results. In planned operations lethality was 4.1%, in ruptures of the aneurysm-64.2%. One year after the operations 90% of the patients were practically healthy, 5 years later they were 70%.