[Treatment of necrotizing infection in patients with chronic arterial insufficiency of the lower extremities]. / Rezul'taty lecheniia nekrotiziruiushchei infektsii u patsientov s khronicheskoi arterial'noi nedostatochnost'iu nizhnikh konechnostei.

OBJECTIVE: To analyze the effectiveness of complex therapy of necrotizing infection using the original method of stimulation of angiogenesis in patients with chronic arterial insufficiency of the lower extremities. MATERIAL AND METHODS: In 53 patients, operations were performed using the proposed technologies for stimulation of angiogenesis. A control group consisting of 56 patients was formed to compare the results of treatment. They had standard vascular therapy for the correction of ischemia. Morphological studies of the muscles of the lower extremities included assessment of capillary bed density and spatial orientation of the capillaries before and after treatment. Computed angiography of the lower extremities followed by calculation of perfusion index was performed to assess changes in the microvasculature. Clinical evaluation of the results was carried out using R. Rutherford scale. RESULTS: Revascularization resulted significant augmentation of capillary bed density and the number of functioning capillaries in muscular tissue. This was accompanied by increased perfusion index and TcPO2 values. The effect of treatment is observed in 12-14 days after surgery and persists for a long time. The best outcomes are found in patients with ischemia grade IIb-III. Incidence of lower limb amputations was more than 2 times lower in the main group compared with the control group. CONCLUSION: Combined stimulation of angiogenesis including mechanical tunneling of the muscles of the affected limb and administration of platelet rich plasma is effective procedure. This method does not require complex equipment and may be used in the treatment of patients with complications of chronic lower limb ischemia and contraindicated direct arterial reconstruction.

[The advisability of performing excretory urography in renal colic]. / O tselesoobraznosti vypolneniia ékskretornoi urografii pri pochechnoi kolike.

Basing on their experience with 1115 cases of prehospitalization excretory urography, the authors think it misleading to reject excretory urography at the height of renal colic because normal kidney completely excretes contrast medium. It is shown that a part of the latter is deposited by the affected kidney and fills the upper urinary tracts up to the level of the obstacle causing acute urostasis. Excretory urography at the height of renal colic is valid in hospitals with 24-hour x-ray service and in cases of urgent surgery.