[POSSIBILITIES OF THE FORCED INTRAARTERIAL INJECTION OF MEDICINAL PREPARATIONS IN A COMPLEX OF TREATMENT FOR THE LOWER EXTREMITIES CHRONIC ISCHEMIA].

The efficacy and prognostic significance of the forced intraarterial injection of medicinal preparations in complex of treatment in patients, suffering chronic ischemia of the lower extremities tissues, was studied. In experimental conditions of the main blood flow blockade the forced intraarterial injection of medicinal preparations have promoted the release of vessels from cellular aggregates and the blood clots; and in the ischemia of degree ІІ - ІІІа ­ has determined more pronounced clinical improvement. Appearance of reactive hyperemia of the foot in terms more than 2 min have witnessed the hopelessness of the extremity saving.

[The experience with thoracoscopic sympathectomy for the treatment of distal lesions of limb arteries].

The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.

Multisite infective endocarditis/endarteritis in a young peripartum patient with patent ductus arteriosus and rheumatic heart valve disease: a case report.

Infective endocarditis (IE) is rarely seen in pregnancy and puerperal period, and generally occurs in patients with preexisting heart disease or intravenous drug abuse. In this report, we describe a case of a 27-year-old patient with missed diagnosis of rheumatic heart disease and a moderate size patent ductus arteriosus, in whom multisite culture-negative IE/pulmonary endarteritis developed after uncomplicated vaginal delivery.

Femoral bifurcation infected pseudoaneurysm: a simple and quick arterial reconstruction with reversed bifurcated saphenous vein graft.

Septic endarteritis complicating arterial cannulation is an exceptional condition. The authors report a quick and feasible surgical procedure to reconstruct a femoral bifurcation with reversed bifurcated saphenous vein graft.

[Plastic reconstruction of external genitalia after Fournier's gangrene]. / Plastische Rekonstruktion des äußeren Genitales nach Fournier-Gangrän.

Fournier's gangrene is a rapidly progressing necrotizing fasciitis restricted to the perineal and genital regions. Although rare, it is an acute life-threatening disease, requiring rapid radical surgical debridement and antibiotic treatment, resulting in large soft tissue defects. Various reconstructive methods for defect coverage are applied to satisfactorily reconstitute functionality and esthetics.

Femoral artery infection complicating intraaortic balloon pumping.

Infection of the femoral artery (endarteritis) complicating intraaortic balloon pumping has not been reported. Most reports of complications with this pump have not emphasized wound infection. Whether the balloon is inserted by open or percutaneous technique, infection remains a problem. During the past 7 years, 32 of 50 patients (64 percent) who had intraaortic balloon pump insertion survived balloon removal. In four patients, wound infection of the groin developed with involvement of the femoral artery. Sepsis was due to P. aeruginosa in three patients and E. cloacae in one. All patients required variable degrees of resection of the infected femoral artery wall. One had successful arterial reconstruction with vein patch angioplasty alone after debridement of the vessel wall. In a second patient, resection of the common femoral artery with interposition of a saphenous vein that had been reconstructed to enhance its diameter to that of the femoral artery was accomplished. Dehiscence of a vein patch angioplasty occurred in the remaining two patients with resultant hemorrhage. Further resection of the femoral artery was required with femoro-femoral saphenous vein grafting in one patient and iliofemoral vein grafting in another. Tissue coverage of the reconstructed vessel was best accomplished using a tensor fascis lata myocutaneous flap. All patients survived the infection without amputation.

Salmonella endarteritis, about two cases and their management.

Mycotic aneurysms due to Salmonella are a classical but uncommon complication of Salmonella infections. We report two cases of such aneurysms, the first one having developed two successive aneurysms of the iliac arteries due to Salmonella typhimurium. The literature on Salmonella endarteritis is briefly reviewed. The importance of an aggressive surgical approach of the mycotic aneurysm, with removal of all infected material and extra-anatomic bypass through contaminated tissue is emphasized. The role of antibiotic treatment is also discussed.

[Patent ductus arteriosus and pulmonary artery endarteritis]. / Persistência do canal arterial e endarterite da artéria pulmonar.

We describe a seven year old girl with echocardiographic diagnosis of pulmonary artery endarteritis as a complication of a patent ductus arteriosus, confirmed at surgery. This case illustrates the necessity of complete surgical resection of the infectious source as a way to avoid other complications such as pulmonary embolism.

[Surgical treatment of occlusive lesions of the aorta and major arteries]. / Khirurgicheskoe lechenie okkliuzionnykh porazhenii aorty i magistral'nykh arterii.

Operations were performed on 262 patients with occlusive lesions of the abdominal aorta and major arteries. In 41 patients a lateral venous autograft was applied after endarterectomy, in 42 an autovenous shunt was created after open endarterectomy, 26 patients underwent eversion endarterectomy. Prosthetic alloplasty of the aorta and major arteries was conducted on 63 patients and an allograft shunt was formed in 41. Lumbar sympathectomy was carried out on all patients as a rule after reconstructive-restorative operations. Nineteen patients died after the operation. Complications developed in the postoperative period in 41 patients. Marked improvement or the disappearance of the symptoms of the disease was noted in the immediate postoperative period in 231 patients (95%).

[Surgery of bifurcation of the femoral artery in popliteal-tibial arterial occlusion]. / Operatsiia na bifurkatsii bedrennoi arterii pri okkliuzii podkolenno-bertsovo segmenta.ooa

In vascular surgery department of V. Vakhidov Research Center of Surgery 37 patients with diffuse lesion of popliteal-tibial arterial segment in combination with stenotic lesion of profound and common femoral artery were examined and operated. Examination of regional circulation before operation was made with consideration of profundo-popliteal collateral index (PPCI) which permits to evaluate features and degree of lesion of deep femoral artery (DFA). Angiography failed to defect bifurcation of the femoral artery in 17 (48.6%) cases, in 11 of them stenosis of bifurcation of the femoral artery was revealed in intraoperative revision. In these patients PPCI was 0.34 and more, high peripheral vascular resistance was seen in debitometry. The authors believe that calculation of PPCI is one of the main methods of diagnosis of femoral artery bifurcation lesions. Good and satisfactory results were seen in 29 (78.3%) patients, unsatisfactory--in 8. Amputations were performed in 3 patients. 1 patient died. Suppuration of the wounds was in 6 patients, in 4 of them--in the zone of reconstructed artery with arrhosive bleeding. It is suggested that in diffuse lesions of arteries of popliteal-tibial segment examinations of regional hemodynamics and plastic repair of DFA are most effective.

[Evaluation of the results of reconstructive operations in patients with occlusive diseases of the abdominal aorta and its branches]. / Otsenka rezul'tatov rekonstruktivnykh operatsii u bol'nykh s okkliuzionnymi zabolevaniiami briushnoi aorty i ee vetvei.

The article deals with the results of studying regional microcirculation in 550 patients with chronic arterial insufficiency. Radioisotope study of blood flow in the muscles with isotopes 131I or 133Xe before and after muscular exertion, morpho-histological++ study of biopsies from a skeletal muscle, histochemical and ultrastructural study of the microcirculatory channel were carried out. Analysis of the findings made it possible to distinguish, according to the changes in circulation in the tissues, three clinical groups of patients (compensated, subcompensated, and decompensated), to determine the indications and contraindications for various types of reconstructive operations, and to prognosticate with high authenticity the outcome of the disease.

[Anesthesia in surgical treatment of occlusive diseases of arteries of the lower limbs]. / Ob obezbolivanii pri khirurgicheskom lechenii obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei

The kinetic study of a regional blood flow in the lower extremities (sphigmorphaphy, rheography) indicates its enhancement against the background of peridural blockade, employed by the authors in 480 of the total number of 1013 various operative interventinuous or prolonged peridural blockade, stabilized automatically or manually, is of a higher quality and may be recommended for a wide clinical application in these patients.

[Prognosis of the effect of sympathectomy of the extremity in obliterating lesions of the major arteries]. / Prognozirovanie éffekta desimpatizatsiia konechnosti pri obliteriruiushchikh porazheniiakh magistral'nykh arterii.

Indices of the central hemodynamics were studied by the method of integral rheography in 76 male patients with obliterating lesions of the lower extremity arteries. The elasticity of the arterial vascular bed in these patients was found to reduce. It proved to be possible not only to estimate the effects of operative desympathization of the lower extremities but also to prognoze its nearest results by the data of temporal chemical desympathization of the lumbar ganglia by novocain or peridural blockade.

[Role of hyperbaric oxygenation and skin plasty in wound healing after minor amputations in patients with gangrene stage of obliterating endarteritis]. / O roli giperbarooksigenatsii i kozhnoi plastiki v zazhivlenii ran posle malykh amputatsii u bol'nykh s gangrenoznoi stadiei obliteriruiushchego éndarterita.

The article analyzes the treatment of 45 patients with a gangrene stage of obliterating endarteritis subjected to small amputations in combination with free skin autoplasty. The amputation and skin plasty were preceded by intensive therapy both before operation and in the postoperative period, HBO included. A method of HBO therapy by changing barometric pressure under conditions of hyperbaric oxygenation is described. The patients were also subjected to sympathectomy and continuous intraarterial infusions.

[Gangliectomy in the treatment of obliterating arterial diseases of the lower extremities]. / Gangliéktomiia v lechenii obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei.

The work is based upon the experience with the treatment of 400 cases of obliterating diseases of the lower limbs arteries by means of gangliectomy. The evaluation of the operation is grounded on 2- and 10-years observations over the patients. When the blood flow insufficiency is not too severe, it, most commonly, results in a considerable decrease of the intensity of intermittent limping and favours the removal of destructive lesions. Beneficial results of the surgery most often persist for many years. In a higher obstruction of the arteries the results are somewhat poorer, the same as in case of obliterating atherosclerosis when compared to obliterating endoarteritis.

[Contraindications for lumbar sympathectomy in patients with obliterative lesions of arteries of the legs]. / Protivopokazaniia k poiasnichnoi simpatéktomii u bol'nykh s obliteriruiushchim porazheniem arterii nizhnikh konechnostei.

The authors consider that it is the correct choice of patients for lumbar sympathectomy which is responsible for good remote results in 84.3% of patients subjected to the operation.

[Lasers in the treatment of arterial occlusive diseases of the limbs]. / Lazer v lechenii obliteriruiushchikh zabolevanii arterii konechnostei

The authors have analysed the initial results of treatment in 64 patients suffering obliterating diseases of arteries of upper and lower extremities by means of irradiation with a helium-neon laser the least electric resistance points. The control over the results of treatment is exercised basing on findings of thermovision study and patients' subjective sensations. The best results were gained in treatment of patients with Reynaud diseases and obliterating endarteritis. The therapy employed yielded an insignificant effect in various forms of atherosclerosis of the lower extremities.

[Effects of the anticoagulation therapy regimen on frequency of early thrombohemorrhagic complications after operations on major arteries of lower extremities]. / Vliianie rezhima antikoaguliantnoi terapii na chastotu rannikh trombogemorragicheskikh oslozhnenii posle operatsii na magistral'nykh arteriiakh nizhnikh konechnostei.

The results of 295 reconstructive operations on the major vessels of lower extremities were analyzed. The patients were divided into 4 groups depending on the scheme of anticoagulation therapy in the postoperative period. Under investigation was the state of hemostasis and hemorheology. The frequency of thrombohemorrhagic complications was assessed. It was found that the regimen based on the administration of low molecular weight heparins during the nearest 5 days after the intervention was the most rational regimen of anticoagulation therapy after reconstructive operations on the major arteries of lower extremities.

[Ways of reducing the extent of amputation of the limbs in endarteritis obliterans]. / Puti snizheniia urovnia amputatsii konechnosti u bol'nykh obliteriruiushchim éndarteritom.

As a result of the development of vascular surgery, the interest in so called "minor surgery" (exarticulation of the toes, transmetatarsal amputation of the foot) has been resuscitated of late years. A comparative analysis of various methods of the treatment of 145 patients with obliterating endarteritis of Stages IV and V is performed. An intense pre- and postoperative therapy, hyperoxybarotherapy included, was carried out. The patients were subjected to sympatectomy, intraarterial infusion and skin plasty.