[Prevalence rate of fatal and nonfatal pulmonary artery thromboembolism at a multimodality hospital].

The authors carried out a retrospective analysis of the causes of fatal and nonfatal pulmonary artery thromboembolisms (PATE) based on the materials of 204 post-mortem examinations of the patients having died at the Republican Scientific Centre for Emergency Medical Care. Of these, PATE as the underlying cause of death was registered in 151 (74.0%) cases, and the remaining 53 (26.0%) patients were found to have had lesions of the pulmonary artery branches on the background of another concomitant fatal pathology. In-life diagnosis of PATE had been made in 42.6% of cases only. Damage to the inferior vena cava (JVC) was recorded in the case history only in 19.9% of those having died of PATE, while of the patients with nonfatal forms of thromb о embolism, having died of other causes, lesions of the venous system had been registered by the attending physicians only in 11.3% of cases. The authors made a conclusion on the importance of improving the organizational, therapeutic and diagnostic measures aimed at prevention and early detection of embolus-threatening phlebothrombosis, as well as implementing more radical and safer methods of preventing PATE.

[Peculiarities of revascularizing operations in traumatic amputations of hand fragments].

The article deals with one of the currently important problems encountered in modern microsurgery, i. e., a possibility of performing restorative operations in complete and incomplete traumatic amputations of hand fragments. Our experience gained in managing a total of one hundred and fifty-one patients has confirmed the necessity of performing primary reconstructive operations on vessels, which in the majority of cases makes it possible to save the damaged segments. Also given herein are the main indications for carrying out restorative operations, with the appropriate conclusions drawn.

[Diagnosis and treatment of inferior vena cava thrombosis].

A total of 572 patients with acute thrombosis in deep veins of the inferior vena cava system were treated in the Department of Vascular Surgery. X-ray contrast retrograde iliocavography (XICG) revealed 96.5 % cases of iliocaval segment thrombosis. Signs of thromboembolism in pulmonary artery branches (TELA) were detected by angiopulmonography (APG) in 92.3% cases. Thrombectomy was undertaken in 62 (39.7%) of the patients, venous clipping or placation without thrombectomy were performed in 94 (60.3%) ones. All operated patients experienced regress of clinical symptoms of deep vein thrombosis in the absence of TELA and were discharged in good clinical condition. It is concluded that surgical techniques for the prevention of TELA should be chosen on an individual basis taking account of thrombus character and location detected by central duplex scanning, XICG and APG.

[Successful brachial replantation in a child after a traction-type traumatic amputation].

The article deals with certain aspects of managing patients presenting with extremital bone-and-vascular injuries known for utter severity and a high incidence rate of postoperative complications. Suggested herein, as the authors believe, is an optimal for both the patient and surgeon policy of emergency reconstruction. Emphasis is placed on the necessity to follow a certain sequence while restoring the anatomical structures destroyed. The conclusions drawn include compulsorily considering a possibility to spare the damaged segment, followed by restoring adequate blood circulation and prevention of wound infection, carrying out osteosynthesis with obligatory shortening of the bones, and postponing orthopaedic measures for the remote postoperative period. Also presented in the article is a photograph-illustrated clinical case report of a successful brachial replantation.

[Symptom-free phlebothrombosis and hereditary thrombophilia in patients with a skeletal injury].

The authors have studied the frequency of revealing phlebothrombosis of the system of the inferior vena cava (IVC) in the acute period of a mechanical injury by means of coloured duplex scanning (CDS). Formulated herein are both treatment policy and principles of prevention of thromboembolic complications in severe lesions of the locomotor system. Carried out was a screening sonographic examination of the IVC bed in a total of 137 injured people on days 3 and 7 after a skeletal wound. Of these, 24 patients who later on were diagnosed with phlebothrombosis signs underwent the molecular genetic testing of DNA by means of the polymerase chain reaction (PCR) in order to determine hereditary predisposition to thrombogenesis (genetically conditioned thrombophilia). It was found that the incidence rate of symptom-free thrombosis of the IVC bed in those presenting with fractures of pelvic bones and lower extremities amounted to 17.5%. As surgical prevention suggested herein is the authors' technique of IVC clipping.

[Renal failure in surgery of abdominal aorta aneurysms]. / Pochechnaia nedostatochnost' v khirurgii anevrizm briushnoi aorty.

The authors analyse the experience in operations for resection of an aneurysm of the abdominal aorta in 70 patients, which were performed at the Vishnevsky Institute of Surgery, AMS of Russia, from 1983 to 1991. Preoperative examination revealed renal insufficiency in 8 (11.4%) patients. Resection of the aneurysm of the abdominal aorta with one-stage prosthetics of the renal arteries was carried out in 10 cases. To prevent ischemic damage to the renal parenchyma and acute renal insufficiency, local methods of kidney protection (isolated cold perfusion--2 and normothermic aorto-renal perfusion--2) were applied in 4 of 70 cases. The work discusses the methods of kidney protection and the indications and contraindications for their use, and factors promoting the development of postoperative renal insufficiency. Postoperative complications are shown and their causes are identified.

[Various aspects of surgical treatment of vasorenal hypertension]. / Nekotorye aspekty khirurgicheskogo lecheniia vazorenal'noi gipertenzii.

The results of examination and treatment by surgery of 103 patients with vasorenal hypertension are analysed. Retromboses and restenoses of the reconstructed renal arteries and grafts and uncorrected hyperaldosteronism were the most frequent causes of the poor results. Adequate reconstruction of the renal arteries leads to correction of hyperaldosteronism in patients with normal or high activity of plasma renin. Low-renin secondary hyperaldosteronism in patients with vasorenal hypertension is an indication for simultaneous correction.

[Surgical tactics in combined lesions of the aortic arch and its thoraco-abdominal segments in nonspecific aortoarteritis]. / Khirurgicheskaia taktika pri sochetannykh porazheniiakh vetvei dugi aorty i torakoabdominal'nogo ee segmenta pri nespetsificheskom aortoarteriite.

Seventy-one patients with unspecific aortoarteritis and affections of the aortic arch and its thoracoabdominal segment were treated in the period between 1984 and 1989. All the examined patients had different variants of affection of the brachiocephalic arteries, in 57 (80.3%) of them there was a coexistent affection of the thoracoabdominal segment of the aorta, and in 14 (18.7%) coexistent affection of the abdominal aorta and the lower limb arteries. Operations were conducted on 56 (78.8%) patients. Reconstruction of the brachiocephalic arteries was carried out in 12 (21.4%), of the thoracoabdominal segment of the aorta and the renal arteries in 30 (53.6%), and of the abdominal aorta and lower limb arteries in 9 (16.1%) cases. Five (8.9%) patients underwent two-stage correction of the blood flow in the branches of the arch of the aorta and its thoracoabdominal segment. The clinical picture, the volume of the affection, the methods of examination, and techniques and the results of reconstructive operations are described in detail. The authors present their point of view on the performance of surgical treatment in stages in coexistent lesions differing in volume.

[Surgical tactics in nonspecific aortoarteritis of the thoracoabdominal region]. / Khirurgicheskaia taktika pri nespetsificheskom aortoarterite torakoabdominal'noi lokalizatsii.

Sixty-six patients with nonspecific aortoarteritis of thoracoabdominal localization were treated at the department of vascular surgery of the Vishnevsky Institute of Surgery, AMS USSR from 1984 to 1989. Operations were performed on 49 (74.9%) patients. Percutaneous angiodilatation of the renal arteries was conducted in 3 (4.5%) patients. Nonoperative treatment was carried out in 14 (21.2%) patients. In view of concurrent affection of the branches of the arch of the aorta, reconstructive operations were performed in 16 (24.2%) cases on the brachiocephalic trunks: aorto-biocarotid prosthetics (6), aortocarotid prosthetics (1), subclavian-carotid autovenous prosthetics (6), carotid-subclavian autovenous shunt (2), carotid endarterectomy (1). Reconstructive operations on the brachiocephalic trunks were preceded by reconstruction of the arteries in 5 (7.6%) cases and were conducted after correction of the blood flow in the thoracoabdominal segment in 2 (3%) cases. In 9 (13.6%) patients only the brachiocephalic trunks were reconstructed. A total of 42 reconstructive interventions on the thoracoabdominal segment were carried out on 40 (60.6%) patients, in 35 (87.5%) correction of the blood flow in the visceral branches and renal arteries was performed simultaneously. The surgical tactics suggested by the authors and the results produced by it are discussed in detail.