[X-ray-guided endovascular surgery in patients with benign prostatic hyperplasia and prostate cancer].

AIM: To evaluate the efficacy and safety of superselective embolization and chemoembolization of the prostatic artery as an independent method of treating prostate cancer and BPH. MATERIALS AND METHODS: From 2004 to 2015, 116 patients with BPH (mean age 73.2+/-5.2 years) underwent prostatic artery embolization. Mean prostate volume ranged from 55 to 296 cc3. From 2011 to 2015, 37 patients with prostate cancer (mean age 72.3+/-2.06 years) were treated with X-ray-guided endovascular chemoembolization. All patients had confirmed PCa, of whom 7 had stage T2a and 30 stage T2c disease. PSA ranged from 0.8 to17 ng/ml (mean 13.1+/-3.9). Prostate volume ranged from 61 to 93 cc3 (mean 69.4+/-9.3). The follow-up ranged from 8 to 42 months. RESULTS: Prostatic artery embolization in BPH patients resulted in a significant reduction in IPSS symptom score and increase in Qmax. The volume of prostate and nodular mass decreased on average by 53% and 47%, respectively, maximum by 82%. Chemoembolization was effective in 31 (83.7%) patients. An objective response was achieved in reducing the PSA level and prostate volume measured by TRUS, and improved urination. The median PSA at 6 months was - 3.4 +/- 0.02 ng/ml. In all patients, chemoembolization resulted in a marked reduction in the prostate volume. The greatest decrease in the prostate volume was observed at 6 months after treatment. Chemoembolization led to a marked improvement in the quality of urination confirmed by uroflowmetry and IPSS symptom scores. At 12 months, 16 patients with prostate cancer underwent the follow-up biopsy. In 12 cases pathology showed fibrosis and epithelial degeneration without signs of atypia and in 2 cases curative pathomorphosis was observed. Chemoembolization was well tolerated and did not cause any significant complications. CONCLUSION: Embolization techniques for BPH and chemoembolization for localized PCa showed good effectiveness and safety in patients who had medical contraindications to traditional treatments.

[Inflammation of the vascular wall and hyperhomocysteinemia in patients with atherosclerosis obliterans of lower limb arteries].

Presented herein are the findings of examination of 176 people. Of these, 128 were found to suffer lower limb atherosclerosis (LLA) and 48 were apparently healthy people constituting a control group. Amongst the 128 patients, 74 (58%) had atherosclerotic lesions of the iliac arteries, 54 (42%) subjects had lesions of the femoral and popliteal arteries. The average age of the patients amounted to 62.4±4.3 years. There were ten (8%) women and 118 (92%) men. The control group consisted of 42 (89%) men and six (11%) women. The mean age of the control group patients was 58.9±3.2 years. All underwent functional and laboratory examinations including angiography, duplex scanning and dopplerography of lower limb arteries, as well as determining blood serum markers of inflammation (hs-CRP and IL-6), as well as endothelial lesion markers (ET-1 and VWF). The comparative analysis revealed that patients with LLA had signs of chronic vascular inflammation accompanied in the majority of cases by hyperhomocysteinemia with endothelial dysfunction, as well as direct association between the degree of the vascular inflammatory reaction and severity of clinical manifestations of lower limb ischaemia.

[Formation of vertebral-subclavian steal syndrome in abnormal origin of the left vertebral artery from the aortic ark].

Presented herein is a clinical case report concerning the formation of vertebral-subclavian steal syndrome combined with occlusion of the left subclavian artery and an abnormal origin of the left vertebral artery from the aortic arch. Duplex scanning data and angiography findings showed that the collateral compensation of haemocirculation in the upper extremity took place through the subclavian-vertebral collateral net. Doppler ultrasonography signs of the latent steal syndrome were revealed in the intracranial segment of the left vertebral artery and were confirmed by the findings of the reactive hyperthermia test. Balloon angioplasty with stenting of the 1st portion of the left subclavian artery resulted in normalization of the Doppler spectrum in the intracranial segment of the left vertebral artery.

[The autovenous by-pass by distal arterial occlusion of lower limbs in patients with diabetes mellitus].

Results of the autovenous by-pass in situ by distal combined arterial occlusion of femoral-popliteal and ankle arterial segments were analyzed. The main group consisted of 43 patients with diabetes mellitus and lower limbs ischemia grade IV in 81,4%. The comparison group consisted of 77 patients without diabetes and critical lower limbs ischemia in 84,4%. The 30 days by-pass patency was 90,5% in diabetic patients; whereas in the absence of diabetes mellitus the patency rate was 89%. There were no significant difference between two groups within the 2 years following the operation. After 3 postoperative years patients with diabetes showed poorer results: cumulative by-pass patency was 45,4%, limb preservation rate was 58,7%, whereas the relevant rates in the control group were 49,6 and 87,9%, respectively. The hemodynamic features of the by-pass make it suitable for the patients with diabetes mellitus and arterial occlusion by the diabetic foot syndrome.

[Experience in vitaprost treatment of patients with chronic abacterial prostatitis and prostatic adenoma after prostatic arteries embolism].

Pain and abnormal spermatogenesis are among symptoms deteriorating quality of life in patients with chronic prostatitis. Rectal suppositories vitaprost have no side effects, relieve pain, correct spermatogenesis. The effect of vitaprost treatment persists for 3 months and longer. Prostatic arteries embolization with vitaprost suppositories as preoperative preparation is a good alternative to surgical treatment in patients with prostatic adenoma.