[Russian study on brain aneurysm surgery: a continuation (RIHA II)]. / Rossiiskoe issledovanie po khirurgii anevrizm golovnogo mozga: prodolzhenie (RIKhA II).

OBJECTIVE: To assess the main performance indicators of neurosurgical departments in surgical treatment of cerebral aneurysms in the Russian Federation. MATERIAL AND METHODS: We analyzed 22 neurosurgical departments (19 regional and 3 federal hospitals) in 2017 and 2021. The study enrolled 6.135 patients including 3.160 ones in 2017 and 2.975 ones in 2021. We studied the features of surgical treatment of cerebral aneurysms in different volume hospitals and factors influencing postoperative outcomes. RESULTS: The number of surgeries for cerebral aneurysms decreased from 2.950 in 2017 to 2.711 in 2021. Postoperative mortality rate was 6.3% and 5.6%, respectively. The number of microsurgical interventions decreased from 60% in 2017 to 48% in 2021. The share of endovascular interventions increased from 40% to 52%, respectively. Endovascular embolization was accompanied by stenting in 55% of cases. Simultaneous revascularization was carried out in 2% of cases. In 2021, the number of patients undergoing surgery in acute period of hemorrhage increased to 70% (in 2017 - 61%). The number of hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased from 14 in 2017 to 17 in 2021. CONCLUSION: Certain changes in neurosurgical service occurred in 2021 compared to 2017. Lower number of surgical interventions for cerebral aneurysms, most likely caused by the COVID-19 pandemic, is accompanied by lower postoperative mortality. Endovascular interventions and revascularization techniques became more common. The number of surgeries in acute period after aneurysm rupture and hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased.

[Surgical treatment of cerebral aneurysms in the Russian Federation]. / Khirurgicheskoe lechenie tserebral'nykh anevrizm v Rossiiskoi Federatsii.

OBJECTIVE: The objective of this study was to evaluate the results of surgical treatment of cerebral aneurysms in the Russian Federation. MATERIAL AND METHODS: We analyzed performance indicators in neurosurgical departments of regional and federal health institutions of the Russian Federation for 2017. The results of surgical treatment of cerebral aneurysms (CAs) were analyzed in 19 regional vascular centers (RVCs) in several federal districts and in 3 federal centers (FCs) with the most dynamically developing vascular neurosurgery and smoothly running system of statistical data processing. RESULTS: The study included 3160 patients hospitalized to 22 medical institutions in 2017. Of these, 1808 patients were treated in RVCs, and 1352 patients were treated in FCs. We analyzed factors affecting the treatment outcome in CA patients. We identified features of CA treatment in clinics with a different amount of surgical intervention. CONCLUSION: An increase in the surgical activity in centers and simultaneous development of microsurgical and endovascular treatments for cerebral aneurysms reduce postoperative mortality. Due to the presence of a RVC network in the Russian Federation, many patients could receive necessary specialized treatment. The number of operations for cerebral aneurysms has increased 6-fold for the past 10 years.

[Comparative assessment of antiaggregant efficacy of acetylsalicylic acid and clopidogrel in peripheral atherosclerosis].

Presented in the article are the results of studying antiaggregate activity of acetylsalicylic acid and clopidogrel in a total of 36 patients suffering from various-severity chronic arterial insufficiency of lower limbs on the background of atherosclerosis obliterans. The study was conducted prior to treatment for correct selection of a particular antiplatelet agent. The obtained results showed that clopidogrel was not always more efficient than acetylsalicylic acid, since there is individual sensitivity of each patients to a particular antiplatelet agent. Therefore, an individual approach is necessary to conservative therapy of arterial insufficiency of lower limbs. For some patients it is preferable to administer clopidogrel, for others - acetylsalicylic acid. In a series of cases combined treatment is justified, while some patients having low sensitivity to both acetylsalicylic acid and clopidogrel require careful selection of alternative agents influencing other thrombocyte receptors.

[Peculiarities of arterial reconstructions in pyonecrotic lesions of lower limbs].

Presented herein are the results of treating a total of sixty patients suffering from atherosclerosis obliterans of the lower limbs with degree IV chronic ischaemia according to the Fontain-Pokrovsky classification and accompanied by pyonecrotic alterations. The patients were subdivided into two clinically matching groups, each comprising 30 subjects. All patients after two-week conservative preparation underwent various reconstructive surgical operations performed on major arteries of the lower limbs. The local preoperative treatment was of two different types, i. e. consisting of Levomecol ointment used in the control group patients and Metrogyl 1% topical gel applied in the study group patients. Sampled before treatment, inoculations of the wound discharge demonstrated predominantly anaerobic flora in all patients, with the number of bacterial strains having dramatically decreased once Metrogyl gel 1% had been used, whereas application of Levomecol did not significantly influence the structure of the microbial profile. Following surgical treatment we had to perform high amputation of the lower limb in 5 patients of the control group, whereas in the study group patients only one patient required amputation at the foot level. Hence, prior to carrying out reconstructive vascular interventions in patients presenting with pyonecrotic lesions of lower extremities it is preferable to perform debridement of the necrotic foci using topical antibacterial agents, one of which may be Metrogyl 1% gel.

[Role of low-dose acetylsalicylic acid in comprehensive postoperative treatment of patients with lower-limb chronic arterial insufficiency].

The study comprised a total of 107 patients (all men) after endured femoropopliteal bypass grafting above the genicular fissure with a synthetic stent graft manufactured by the Gore Company for stage IIB and III chronic arterial insufficiency of the lower extremities according to the Fontain-Pokrovsky classification. Group One I (control group) was composed of fifty-four patients permanently taking in the postoperative period at the out-patient stage pentoxiphylline (trental 400 mg 1 tablet 3 times daily) and xantinol nicotinate at a dose of 150 mg one tablet thrice daily. Group Two (Study Group) consisted of fifty-three patients taking after reconstructive vascular surgery at the out-patient stage in addition to pentoxiphylline and xantinol nicotinate acetylsalicylic acid (cardiomagnil 75 mg 1 tablet once daily). The Control Group patients within 3 to 6 months of follow up were found to have a considerable progressing improvement of the functional abilities of the microcirculatory bed requiring in 44 (81.5%) cases hospitalization to the Surgical Department for intensive vascular therapy. Despite this fact four (7.4%) patients within the time frame from 6 to 9 months after surgery developed thrombosis of the vascular implant requiring a repeat surgical intervention. In the Study Group patients, the degree of functional capabilities of the microcirculatory bed in the postoperative period was less considerable, reaching the maximum after 10-12 months of follow up, with eighteen (34.0%) patients requiring hospitalization for additional vascular therapy to perform. There were no cases of implants' thrombosis in the Study Group patients. Pathological alterations in the functional state of the peripheral vascular bed correlated with viscosimetric indices and activity of blood platelet aggregation. The addition of antithrombocytic agents to conservative postoperative therapy considerably improved the outcomes of surgical treatment.

[Prediction of remote results after surgical management of patients presenting with atherosclerosis obliterans of the lower-limb arteries].

Forecasting the development of implants' narrowing appears to be one of the most important problems encountered in vascular surgery today. The present study was therefore undertaken to work out a comprehensive diagnostic methodology making it possible to reliably predict the development of stenosis of vascular anastomoses during the postoperative period in patients presenting with atherosclerosis obliterans. The work was based upon the findings obtained by examining a total of seventy-nine patients diagnosed with atherosclerosis obliterans of the lower-limbs arteries, also including assessment of a large number of haemodynamic and immunological parameters both before and after reconstructive vascular interventions. The study showed substantial dynamics of a series of immunological and haemodynamic indices on the background of the operation and during the postoperative period. Based on the mathematical processing of the obtained data, the authors managed to reveal the factors playing a leading role in the development of stenosis, having also worked out a prognostic algorithm making it possible with high reliability to predict the development of stenosis of arterial anastomoses.

[Functional flowmetry in determining the indications for reconstructive surgical interventions on the major arteries of the pelvis and lower limbs].

The work was based on the findings of the examination and surgical management of 69 patients with obliterating atherosclerosis of the lower limbs with various degree of chronic arterial insufficiency. The authors analyzed the main causes promoting development of early reocclusion of the bypasses and prostheses following reconstructive surgical operations. They also proved the role of high peripheral vascular resistance and, in particular, diminished functional possibilities of the microcirculatory-bed vessels in the genesis of early reocclusions in patients with chronic arterial insufficiency of the lower limbs. They also suggested a new technique of determining the carrying capacity of the microcirculatory channel, the use of which in the preoperative period makes it possible to predict development of early thrombotic complications, and in some cases to wisely abstain from carrying out a reconstructive vascular intervention due to high risk of its poor outcomes. It is preferable for such patients to undergo conservative pathogenetic preoperative therapy aimed at improving the functional possibilities of the microcirculatory vessels.

[Preoperative care of microcirculatory vessels in patients with lower limb arteriosclerosis obliterans].

The paper analyses diagnosis and treatment outcomes for 20 men aged from 55 to 76 with lower limb arteriosclerosis obliterans. Based on exhaustive laboratory and instrumental diagnostic data the authors conclude that 10-days course of Vazaprostan (20 mkg per day) for patients with IIb stage of chronic lower limb arterial insufficiency yields not only improvement in tissue metabolism, but a reduction of peripheral vascular resistance as well. Thus such therapy can be used for preoperative care before reconstructive vascular interventions in order to reduce the risk of implant thrombosis in early postoperative period.

[The nature of macrophage functional heterogeneity exemplified by Fc receptors]. / Priroda funktsional'noi geterogennosti makrofagov na primere Fc-retseptorov.

It is known that functional activity of macrophages (Mph), adhesion and phagocytosis, depends on the local concentration of Fc receptors (Fc gamma R) on the cell surface. Fc gamma R may have a random distribution on cell membrane or form clusters of different sizes. This process depends on the local activity of microfilaments that, in its turn, reflects peculiarities of macrophage microenvironments. One may conceive that the number of opsonized erythrocytes (OE) subject to adhesion (engulfing) to separate Mph depends on the amount of active centres on the cell surface and their activity. The structures, such as Fc gamma R clusters, phagosomes and others, in whose formation numerous components of Mph (cell skeleton, microvesicles, signal receptive system and others) are involved, are arbitrarily called the structural functional units (SFU). Thus, we used two parameters: the average number of SFU per Mph in population, and the average activity of SFU instead of a generally accepted number of OE per Mph. The number of SFU per Mph can be 0, 1, 2 etc., and one SFU may bind (engulf) 0, 1, 2 etc. EA. For the assessment of the parameters, the approximation of experimental histograms by type-A Neyman's distribution was used. To verify the adequacy of the model, observations of OE adhesion and phagocytosis in different conditions were made. The results show that the parameters of the model fit well the biological processes in this system.

[Complications of fibrinolytic therapy in thromboses of the major arteries of the lower extremities]. / Oslozhneniia fibrinoliticheskoi terapii trombozov magistral'nykh arterii nizhnikh konechnostei.

Fibrinolytic therapy with streptokinase preparations was administered to 79 patients. Hemorrhagic, embolic, thrombotic, and allergic complications were observed over the course of therapy. Massive bleedings occurred in 3 (4%) patients, two of them died. Negligible hematomas at the site of vessel puncture were seen in 11 (14.4%) cases. Distal arteries embolization developed in 6 (7.6%) patients. Nine patients (11.4%) developed early re-thromboses soon after therapy was over. Allergic reactions presenting as hyperthermia and short-term chill were observed in one third of the patients. Measures to prevent possible complications of fibrinolytic therapy are strict adherence to thrombolysis methods and a dynamic laboratory monitoring over the course of therapy.

[The efficacy of the combined conservative therapy of patients with chronic obliterating arterial diseases of the extremities in outpatient practice]. / Ob éffektivnosti kompleksnoi konservativnoi terapii bol'nykh s khronicheskimi obliteriruiushchimi zabolevaniiami arterii konechnostei v ambulatornoi praktike.

The paper provides the results of multimodality conservative therapy in 527 patients with chronic obliterating diseases of extremity arteries, which was performed in the outpatient setting. Factors influencing its efficiency were analyzed. The paper emphasizes the value of this direction of treatment whose underestimation sharply aggravates the prognosis of these diseases, including the results of their surgical management. Having obtained positive results in 84.5% of patients, the authors note the efficiency of treatment to be decreased with severe arterial insufficiency of lower extremities (5% of negative results in Stage IIa, 23% in Stage IIb, and 40% in Stage III), in patients with prior surgical interventions, and in elderly patients with atherosclerosis obliterans and younger patients with non-specific aortoarteritis.

[Fibrinolytic therapy in thrombosis of the main arteries]. / Fibrinoliticheskaia terapiia v lechenii trombozov magistral'nykh arterii.

Fibrinolytic therapy (FLT) was applied in 79 patients, aged from 37 to 76 years, suffering from thromboses of the main arteries of the pelvis and lower extremities. The duration of the disease ranged from one day to 8 months. FLT was conducted with streptokinase preparations: streptodekase, avelysin, and celiase. FLT lasted 24 hours on average (from 7 hours to 3 days depending on the duration of the disease). The main blood flow in the affected arterial segment was completely restored in 49 (62%) patients. In 30 (38%) cases attempts to restore the blood flow failed. The affected extremity was amputated in 4 patients. Severe hemorrhagic complications occurred in 4%., small subcutaneous hematomas in 14.4%, fragmentation of thrombi with the development of distal embolism in 7.6% of cases, anaphylactic shock developed in one patient. Four patients died.

[Regional thrombolytic therapy of thrombosis of arteries of the pelvis and lower extremities]. / Regionarnaia tromboliticheskaia terapiia v lechenii trombozov arterii taza i nizhnikh konechnostei.

Regional thrombolysis was performed in 62 patients with thrombosis of the aorta and arteries of the pelvis and lower extremities. The thrombolytics used were avelysin (20 patients) and celiase (42 patients). Complete lysis of the thrombi was recorded in 49 cases. After successful thrombolytic therapy balloon angioplasty of the revealed stenoses was carried out in 39 patients. After thrombolysis was completed 15 patients underwent various reconstructive operations which failed to produce an effect in 4 patients and the extremity was amputated. The complications of thrombolysis included hematomas at the site of catheterization of the arteries in 5 patients, distal embolism in 7, and an allergic reaction in one patient. The authors appraise the dependence of thrombolysis efficacy on the level, extent, and duration of the thrombotic occlusion.

[Thrombolytic therapy of acute thrombosis of the major arteries in the legs with streptokinase preparations]. / Tromboliticheskaia terapiia ostrogo tromboza magistral'nykh arterii nizhnikh konechnostei preparatami streptokinazy.

Thrombolytic therapy was used in treatment of 40 patients with acute thromboses of the aorta, major arteries of the pelvis and lower extremities. Complete lysis of the thrombus was achieved in 21 patients, partial lysis in 13 patients, 6 patients had no effect. The authors consider that the effectiveness of the treatment of acute thrombosis of major arteries is dependent on duration of the disease, character, level and distance of the occlusion, degree of ischemia of the extremity. It is stressed that the method of choice is the selective administration of streptokinase drugs (Awelysin, Celiase).

[Hemosorption in the treatment of occlusive arterial diseases of the legs]. / Gemosorbtsiia pri lechenii obliteriruiushchikh porazhenii arterii nizhnikh konechnostei.

The material of 117 hemosorptions has shown different efficiency of hemosorptions in patients with chronic arterial insufficiency to be dependent on genesis and stage of the disease. Hemosorption as an independent method may be used at early stages of obliterating endarteritis.