[Ischaemia of a femoral stump in short- and long-term periods after limb amputation]. / Ishemiia kul'ti bedra v rannem i pozdnem periodakh posle amputatsii.

The authors retrospectively analysed medical case histories of 287 patients subjected to femoral amputations over the period from January 1, 1998 to December 31, 2013. The studied parameters were as follows: the frequency of and risk factors for femoral stump ischaemia, as well as the effect on patients' survival after femoral amputation. Amongst 156 patients having endured transfemoral truncation of the limb performed as the first amputation, early femoral stump ischaemia (EFSI) within 3 postoperative months was found to have occurred in 43 (27.6%) patients, whereas amongst 127 patients first subjected to amputation of the crus and then to femoral truncation it occurred in 15 (13.2%) cases; p<0.05. The incidence rate of late femoral stump ischaemia (LFSI) was virtually similar in both groups, amounting to 5.8% (9 of 156) and 5.5% (7 of 127), respectively; p>0.05. The survival rate for patients without stump ischaemia at 12 months after amputation amounted to 79.4%, for those with EFSI to 50.0% (p=0.00928), and for those with LFSI to 71.4% (p=0.22576), whereas by the end of a 5-year follow up period these values appeared to equal 49.2%, 32.1% (p=0.13225) and 7.1% (p=0.01385), respectively. The obtained findings demonstrated that the risk factors for EFSI were as follows: the presence of a femoral stump on the contralateral side, grade III ischaemia, and proximal localization of the lesion of the arterial bed (odds ratio 3.3, 2.7 and 3.8, respectively); a risk factor for LFSI was the presence of a femoral stump on the contralateral side (odds ratio 6.0).

[Semiclosed endarterectomy from iliac arteries under duplex scanning].

The investigation included 149 cases of semiclosed endarterectomy from iliac arteries in 134 patients. Intraoperative duplex scanning were used in 32 patients as a deobliteration control. Other 117 cases were performed by using of traditional method. Specific deobliteration complications such as thrombosis of operated segment and embolism of operated and contralateral limbs arteries with atherogenic masses were observed 10 patients. Intraoperative control was not performed in these cases. Arterial wall perforations with loop tool were observed in two groups, but the frequency was statistically significant lower in the group with duplex scanning. Mortality rates did not differ. Amputation number of lower limbs was statistically lower in case of deobliteration control using.

[Dynamics of the incidence of major amputations and mortality rates in peripheral arterial diseases over 1993-2007: findings of a population-based study].

Analysed were a total of 17,695 cases of hospital admission of patients presenting with arterial insufficiency of extremities, complications of diabetes mellitus, ulcers and necroses of the lower limbs, including 11,773 cases of hospitalization of patients diagnosed with peripheral artery diseases according to ICD-9 (till 1998) or ICD-10 (commencing from 1999) over the periods from 1993-1997 (period 1), 1998-2002 (period 2) and 2003-2007 (period 3). The correlation dependence was studied using the Pearson criterion, with the statistical significance of differences between the relative incidence of the parameters being calculated by means of the chi-square (chi2) test. The obtained findings showed a decrease in the number of amputees, the incidence of lethal outcomes and mortality rates, being most significant in the group of patients under 60 years of age. There was an inverse correlation between the above measures and the indices of the number of operations on the arteries performed in grade IV limb ischaemia.

[Comparative assessment of methods used for predicting efficiency of lumbar sympathectomy in patients with lower-limb critical ischaemia].

The article deals with the findings of examination and treatment of patients presenting with lesions of the distal-bed arteries and critical lower-limb ischaemia who were subjected to lumbar sympathectomy (LSE). The methods aimed at predicting efficacy of LSE in seventy-five patiens included Doppler ultrasonography with the nitroglycerine test and with the epidural blockade. Of these forty-five patients were subjected to laser Doppler flowmetry (LDF) and measurement of the transcutaneous oxygen tension in tissues before and after the epidural blockade. Presented herein are remote results of LPE obtained at terms up to 36 months for sixty-nine patients (92%) and analyzed depending on the parameters of the functional tests. Our findings suggest that the most statistically significant methods of study for predicting the outcome of lumbar sympathectomy turned out to be LDF and Doppler ultrasonography performed before and after the epidural blockade.

Specific complications of semi-closed endarterectomy from the iliac arteries.

Altogether 104 patients were examined. Semi-closed endarterectomy from the iliac arteries was attempted in 110 limbs of these patients. In 13.6% of cases, operation was unsuccessful. In 3.6% of cases, the failure was caused by arterial perforation when applying a loop-shaped tool. Ninety-five patients underwent deobliteration of the iliac arteries. In the short-term postoperative period, 2 (2.1%) patients developed reocclusion of the operated segment and 5 (5.3%) had acute ischemia of the contralateral limb. The causes and the clinical importance of errors and complications from semi-closed endarterectomy are discussed.

[Surgical treatment policy during motor rehabilitation of patients with a single ischemic lower extremity]. / Taktika khirurgicheskogo lecheniia v protsesse dvigatel'noi reabilitatsii bol'nykh s ishemiei edinstvennoi nizhnei konechnosti.

Altogether 218 patients suffering from obliterating arterial diseases with unilateral postamputation defects (PAD) of the lower extremities and 13 patients with bilateral PAD were examined. A study was made of the data pertaining to the age, motivation for rehabilitation, occupational and social status, degree of social independence, and severity of circulatory disorders. The surgical treatment and rehabilitation policy for patients with unilateral PAD of the lower extremities was defined taking into account the social factory.

[Treatment and rehabilitation strategy for patients with lower extremity stump ischemia]. / Taktika lecheniia i reabilitatsii bol'nykh s ishemiei kul'ti nizhnei konechnosti.

The paper is concerned with evidence for the choice of the treatment and rehabilitation policy of patients suffering from lower extremity stump ischemia. Altogether 446 patients with obliterating diseases of arteries and unilateral post-amputation defects of the lower extremities were examined. Of these, degree III-IV stump ischemia was verified in 90 patients, transient stump ischemia was present in 259 patients. In 30 patients, stump pains or defects of the skin were determined by defects and discuses of the stump; 67 patients were identified to have no clinical signs of ischemia and no defects or diseases of the stump, 43 patients underwent arterial reconstructions whereas reamputations of the extremity were undertaken in 29 patients. The remaining patients with stump ischemia received conservative therapy. The algorithm of the choice of the treatment policy and rehabilitation of patients was worked out depending on the severity of the clinical manifestations of stump ischemia and the level of post-amputation defect.

The function of endogenous protective systems in patients with insulin-dependent diabetes mellitus and polyneuropathy: effect of antioxidant therapy.

alpha-Lipoic acid is a very efficient antioxidants for the treatment and prevention of diabetic neuropathy. The aim of the present study was to evaluate the function of nitric oxide (NO) and stress proteins (HSP72) in insulin-dependent diabetes complicated by polyneuropathy and possible contribution of these systems to the therapeutic effects of alpha-lipoic acid. Plasma content of nitrites and nitrates in diabetic patients was almost 2-fold below the normal. The treatment with alpha-lipoic acid completely normalized the plasma content of these stable NO metabolites. The majority of patients had also low level of HSP72. Positive clinical effects of alpha-lipoic acid were accompanied by normalization of HSP72 synthesis. Thus, activation of the NO and HSP protective systems is involved in the therapeutic effect of alpha-lipoic acid in diabetic patients (type 1 diabetes mellitus) with polyneuropathy.

[Choice of level and establishment of limb stump in patients with obliterative arteries diseases]. / Vybor urovnia i sposoba formirovaniia kul'ti konechnosti u bol'nykh obliteriruiushchimi zabolevaniiami arterii.

335 patients with obliterative diseases of arteries of the low extremities were examined. Results of motor rehabilitation depend on the severity of post-amputation defect of the extremity and functional condition of the stump. The lower is the level of the amputation the higher is the effectiveness of the rehabilitational measures. Ischemia of femoral stump springs up rarely but its course is mare severe than ischemia of the stump of the shin, which is confirmed by the data of clinical examination, investigation of biochemical parameters of the blood and mortality rate. For prophylaxis of ischemia of the stump it is suggested simultaneously with the amputation of the extremity to perform reconstructive procedures on the arteries, aimed at restoration of blood flow through the profound femoral artery. This policy provides the possibility to form a long functional stump of the extremity and to improve results of motor rehabilitation.

[Surgical treatment of ischemia of the stump of the lower extremity]. / Khirurgicheskoe lechenie ishemii kul'ti nizhnei konechnosti.

The authors observed 22 patients who had obliteration of leg arteries and stage III-IV leg stump ischemia. The reconstruction of the stump circulation by using a deep artery of the thigh allowed to stop the ischemia and make the stump more functional or gave an opportunity to make Gritty operation.

[The significance of the mu- and delta-opiate receptors in realizing enkephalin action on the course of hypoxic hypoxia]. / Znachenie miu- i del'ta-opiatnykh retseptorov v realizatsii deistviia énkefalinov na techenie gipoksicheskoi gipoksii.

New enkephalins analogues have been synthesized. They are characterized by linear, cyclic and branched peptide chain. A relationship has been established between antihypoxic activity of opioid peptides an their interaction with opiate receptors. Compounds efficiently interacting with mu-receptors irrespective of delta-receptors affinity, promote longer survival of mice in hypoxia. The antihypoxic effect of opioids is proportional to their specificity to mu-receptors.

[Relationship between metabolic changes in regional blood and tissues in ischemia of the extremities]. / Sootnoshenie mezhdu metabolicheskimi izmeneniiami v regionarnoi krovi i tkaniiakh pri ishemii konechnosti.

The authors examined 56 patients with obliterating diseases (OD) of arteries of the lower extremities and conducted experiments on 97 male albino rats. In patients with OD the lactate content in the regional venous blood of the involved extremity increases proportionally to the severity of ischemia. No essential changes occur in the concentration of ATP and glucose. In rats with transitory ischemia of the extremities the lactate level in venous blood increases in the absence of changes of the ATP and glucose content; reduced concentration of ATP and glycogen was encountered in the ischemic muscles of the extremities. The mechanisms and significance of the disorders of metabolic parameters in ischemia are discussed.

[The effect of dalargin on the hemodynamics in acute myocardial infarct complicated by clinical death]. / Vliianie dalargina na gemodinamiku pri ostrom infarkte miokarda, oslozhnennom klinicheskoi smert'iu.

Cardiac output and myocardial contractility have been studied in dogs with experimental myocardial infarction complicated by 5 min clinical death. Control animals (16 dogs) were intravenously injected physiologic saline, while test animals (12 dogs) were administered leu-enkephalin analogue dalargin at a dose of 100 micrograms/kg, 20 min and 6-h after recovery. It has been established that dalargin improved basic hemodynamic parameters due to normalization of cardiac contractility, arrhythmia removal and reduction of the peripheral resistance. The data obtained make it possible to recommend dalargin for combined therapy of postresuscitation hemodynamic disturbances in acute myocardial infarction.

[Functional state of the endogenous opioid peptide system in traumatic shock in rats]. / Funktsional'noe sostoianie sistemy éndogennykh opioidnykh peptidov pri travmaticheskom shoke u krys.

The experiments have been performed on 120 Wistar rats and 546 CBWH mice. Met-enkephalin (ME) and beta-endorphin (BE) levels were determined to increase in blood and mid-brain 3 hours later after soft tissue compression of pelvic extremities. 48 hours later after six-hour compression BE and ME level in blood was increased, BE concentration in blood was also increased, and enkephalins' content in brain and blood was decreased as against the control. Opioid peptides influence on the host compression period has been studied. D-agonists were established to decrease, but mu-agonists were established to increase mice survival in shock. Opioid peptides' significance in traumatic shock pathogenesis is being discussed.

[Blood cyclic nucleotide content in acute regional ischemia of the extremities]. / Soderzhanie tsiklicheskikh nukleotidov v krovi pri ostroi regionarnoi ishemii konechnosti.

Fifty healthy males aged from 19 to 34 years were examined. Experiments were conducted on 30 male mice weighing 200-250 g. After 10- and 20-minute ischemia of the upper limb the concentration of cAMP and cGMP in its venous blood increases in direct proportion to the duration of ischemia. Increase of the level of cyclic nucleotides (CN) in the blood does not depend on hypersecretion of catecholamines. Increase of the CN level coincides in time with increase of blood CPK. The mechanisms of changes in the blood CN level in ischemia are discussed.

[Regional blood lactate level in arterial occlusive diseases]. / Issledovanie kontsentratsii laktata v regionarnoi krovi pri obliteriruiushchikh zabolevaniiakh arterii.

Fifty-seven patients with obliterating diseases of the lower limb arteries were examined. The concentration of lactate in the venous blood and the venous-arterial difference in the blood lactate level in the affected limb were found to be increased. A relationship between the marked character of these shifts and the severity of the ischemic syndrome was noted. The authors discuss the possibility of using the values of the lactate content in the regional blood as criteria for evaluating the efficacy of treatment and the prognosis of obliterating diseases of the lower limb arteries.

[Pathophysiological and clinical evaluation of the effectiveness of dalargin in the treatment of arterial occlusive diseases of the lower extremities]. / Patofiziologicheskaia i klinicheskaia otsenka éffektivnosti dalargina pri lechenii obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei.

Eighty seven patients with Stages II-III vascular occlusions in the lower extremities were examined. The clinical and biochemical parameters of the course of the disease were found to improve in the patients who received in earlier periods dalargin supplemented to the combined therapy than in those from a matched group. There was a decrease in femoral venous blood lactate concentrations in the diseased extremity, blood cholesterol and parathyroid hormone levels. The mechanisms responsible for effects of dalargin on metabolic parameters and clinical indices of the patients' condition were also discussed. Whether it is possible to use dalargin in the combined therapy for extremity vascular occlusive diseases is considered.