[Estimation of regional blood flow in reimplanted segments of upper extremity].

AIM: To examine the state of regional circulation in replanted segment of upper limb and hand, to determine diagnostic and prognostic value of radionuclide scintigraphy. MATERIAL AND METHODS: The study included 26 patients who underwent replantation of upper extremity segments. The control group included 12 patients who underwent autologous transplantation of toes on hand. All patients underwent isotope scintigraphy, ultrasound Doppler and pulse oximetry. Groups were comparable by gender, age, severity of injury. RESULTS: Depending on postoperative course two groups were determined: with favorable (27 patients) and complicated postoperative period (11 patients). Two types of regional circulation were identified according to dynamic scintigraphy: prevalence of blood flow in operated limb (type 1); prevalence of blood flow in healthy limb, or equal volumetric blood flow in operated and healthy limbs (type 2). Favorable early postoperative period was associated with prevalence of blood flow in operated limb. Only in 2 (7.7%) patients patients in this group acute arterial thrombosis was diagnosed. At the same time thrombosis of microanastomosis occurred in 45.4% of cases in the second group what is 5.5 times higher than in the first group. CONCLUSION: Significant prevalence of blood flow in operated limb is favorable prognostic sign of the early postoperative period. On the other hand the identity of blood flow or prevalence of such in healthy limb predispose to acute vascular complications in replantate or autoplantate. Radionuclide scintigraphy provides detailed assessment of regional blood flow in operated limb. However clinical monitoring has leading role in diagnosis of acute circulatory disorders in replantate or autoplantate.

[Clinical and laboratory symptoms of space-occupying hepatic lesions and their prognostic value].

Rational complex diagnostic approach has a critical importance in diagnosis of space-occupying hepatic lesions. Results of clinical and special examinations permit to assess the state of hemostasis and functional reserve of liver, to predict the surgical risk and correct treatment tactics.

[Use of plasmapheresis in the treatment of drug-resistant cardiac arrhythmias]. / Ispol'zovanie plazmafereza pri lechenii narushenii ritma serdtsa, rezistentnykh k lekarstvennoi terapii.

AIM: To study the therapeutical efficiency of plasmapheresis (PA) in patients with drug-resistant cardiac arrhythmias (CA) and its mechanisms. MATERIALS AND METHODS: Discrete PA sessions were carried out in 56 patients with drug-resistant CA: paroxysmal atrial arrhythmia (AA), ventricular and supraventricular premature contractions, supraventricular tachycardia of various etiology. Biochemical blood values, coagulographic parameters, lipid peroxidation (LPO), the spectrum of nonesterified fatty acids (NEFA), the level of medium-sized molecules were determined, ECG monitoring, EchoCG, and left ventricular radioisotope computed tomography were performed before and after a PA session. RESULTS: PA was effective in 50% of cases. The duration of its effect averaged 3.0 (1.25-5.0) months. PA was more beneficial for patients with IHD, AA with normal left atrial dimensions, and hyperlipidemia. The duration of the effect was significantly higher when antiarrhythmic drug therapy was continued after PA. Due to PA, there were significant decreases in the blood concentrations of cholesterol, medium-sized molecules, malonic dialdehyde (MDA) and in the proportion of polyunsaturated NEFA. The antiarrhythmic effect was associated with the decreases in MDA and NEFA, with a tendency for a reduction in the rate of chemiluminescence. CONCLUSION: PA may be used in the treatment of drug-resistant CA. The most significant mechanism of its antiarrhythmic activity is to recover sensitivity to antiarrhythmics. The intrinsic antiarrhythmic activity may be associated with its effect on NEFA metabolism and LPO; however, its mechanisms await further studies.

[Functional reserve in benign volumetric lesions]. / Funktsional'nyi rezerv pecheni pri ee dobrokachestvennykh ob''emnykh obrazovaniiakh.

For evaluation of functional status of hepatocytes in patients with benign volumetric growths of the liver (BVGL) of various genesis the authors performed radionuclide investigation with the use of Tc99m. At the same time the terms of maximal accumulation of the preparation Tmax' the period of half elimination from the liver (T1/2) and the time of entering of the drug into the bowel (T bowel) were evaluated. Basing on the results of the analysis of clinical examinations in 67 patients before and after operations (51 patients with BVGL and 16 patients of control group), the authors have revealed correlation between the size, site disposition of volumetric growth and function of hepatocytes of intact parenchyma of the liver. The results have evidenced that the rate of decrease in functional values of the liver in groups of patients with BVGL < 5 and > 5 cm in diameter significantly (p < 0.05) differed in parameters Tmax (33.3 and 78.3%) and T1/2 (50 and 95.7% of cases, respectively. It has been determined that the more is the size of the growth and the deeper it located in hepatic parenchyma the more significant is the decrease of function of hepatocytes. Comparison of the results of examination in patients with BVGL of various genesis before and after various surgical intervention of decompressive type has revealed significant (p < 0.05) improvement of functional capacity of hepatocytes, depending on the above factors. The results of investigation made it possible to substantiate differential approach to surgical policy in uncomplicated BVGL depending on the size of the tumor (< 5 and > 5 cm in d.), location and position of the growth in the organ, as well as adequately evaluate effectiveness of surgical intervention.