[Efficacy of treatment of lower-limb critical ischaemia by methods of indirect revascularization]. / Éffektivnost' lecheniia kriticheskoi ishemii nizhnikh konechnostei metodami nepriamoi revaskuliarizatsii.

AIM: The study was aimed at comparing the efficacy of implantation of autologous bone marrow cells with that of revascularizing osteotrephination in treatment of lower limb chronic critical ischaemia in patients with a poor distal vascular bed. PATIENTS AND METHOD: We analysed the results of comprehensive examination and treatment of a total of 60 patients presenting with lower limb chronic critical ischaemia due to atherosclerotic lesions of the femoropopliteal-tibial segment. According to the technology of treatment, the patients were divided into two statistically homogenous groups of 30 people each. Group One patients underwent standard revascularizing osteotrephination and Group Two patients in accordance with the original technique received intramuscular implantation of 40 ml of autologous bone marrow cells, with this volume distributed in 2-ml injections to 20 points of the muscles of the crus and femur along the internal and external surface. RESULTS: The use of the original technique of treatment made it possible to achieve the clinical status in the form of moderate or minimal improvement 6 months after bone marrow cells implantation in 29 (96.7%) patients and after 12 months in 28 (93.3%) patients, whereas after revascularizing osteotrephination in 25 (83.3%) and 20 (66.7%) patients, respectively. In the remote period after 12 months, the limb was saved in 28 (93.3%) and 26 (86.7%) patients in Group Two and Group One, respectively. The patients of the second group as compared with those of the first group after 12 months demonstrated a statistically significant increase in the physical health component by 19.8% and the mental health component by 9.8%. CONCLUSION: Implantation of autologous bone-marrow cells in chronic critical limb ischaemia is pathogenetically substantiated and makes it possible to optimize the results of treatment of patients.

[Effect of actovegin and solcoseryl on microcirculation in experimental critical lower limb ischaemia]. / Vliianie aktovegina i solkoserila na mikrotsirkuliatsiiu pri kriticheskoi ishemii nizhnikh konechnostei v éksperimente.

The authors examined the effect of actovegin and solcoseryl on microcirculation parameters in treatment of experimental critical lower limb ischaemia. The study included a total of 130 male Wistar albino rats divided into four groups: intact, control, first and second study groups. The intact group consisted of 10 animals used for assessment of the normal indices of microcirculation, with the remaining three groups comprising 40 rats each. All animals, except the intact ones, were subjected to modelled critical ischaemia of a hind limb. The control group animals received no treatment, with the rats of the first and second study groups given intraperitoneal actovegin and solcoseryl, respectively, at a dose of 50 µg/kg first injected 3 hours after the operation and then once daily for five days. The level of microcirculation in the murine crural muscles was assessed by means of laser Doppler flowmetry on postoperative days 5, 10, 21 and 28. At the same time intervals, we performed histological examination of the ischaemized muscles, determining the level of microcirculation, the level of arteriovenular shunting, the area of necrosis and capillary network density. It was determined that actovegin and solcoseryl exerted a positive effect on formation of new capillaries in the ischaemized muscles, increasing density of the capillary network, decreasing arteriovenular shunting, increasing the level of microcirculation, decreasing the specific area of muscular tissue necrosis. The obtained findings showed advantages of actovegin over solcoseryl by the dynamics of the parameters of microcirculation, arteriovenular shunting, and capillary network density.

[Experimental study of cardioprotective and endothelioprotective action of macrolides and azalides].

The cardioprotective and endothelioprotective effects of the macrolide antibiotics roxithromycin, azythromycin, and midecamycin have been studied on laboratory animals with models of the coronaro-occlusional myocardial infarction and endothelial dysfunction. The drugs led to a dose-dependent decrease in lethality, reduced the zone of necrosis of the left ventricle after coronary occlusion, and produced a positive effect on the functioning of endothelium.

[Pharmacological correction of experimental chronic limb ischemia].

In tests on a group of 250 rats, we studied (i) the level of microcirculation in the muscles of a healthy limb in the norm and (ii) the dynamics of microcirculation for 6 h after treatment with pentoxifylline in a dose of 60 mg/kg dose and L-arginine in a dose of 30 and 200 mg/kg. The chronic ischemia was modeled by excision of basic femoral artery. There was no significant difference in pentoxyfilline-treated animals in comparison to the control. In the group treated with L-arginine in a dose of 30 mg/kg, a significant increase in microcirculation was observed on the 28-th day of experiment. In the group treated with L-arginine in a dose of 200 mg/kg, there was an increase of microcirculation in all terms of the experiment in comparison to the control. The results of laser doppler flow measurements are correlated with the results of morphological investigation.

[Endothelioprotective properties of L-arginine in a nitric oxide deficiency model].

In laboratory animals with endothelial dysfunction (nitric oxide deficiency) modeled by the introduction of NO-synthase inhibitor L-NAME, the activation of endothelioprotective effects of enalapril, lozartan, amlodipine, indapamide and nebivolol is revealed for their introduction in combination with L-arginine. This result was confirmed by the behavior of a generalizing parameter, the coefficient of endothelial dysfunction (CED) calculated using the results of tests on endothelium-dependent and -independent vasodilation.