[Comparative efficacy of various thrombolytic agents in treatment of pulmonary embolism]. / Sravnitel'naia éffektivnost' razlichnykh tromboliticheskikh preparatov v lechenii tromboémbolii legochnoi arterii.

The authors carried out a retrospective analysis of clinical efficacy of streptokinase and alteplase (actilyse®) in patients presenting with high- and intermediate-to-high risk pulmonary artery thromboembolism (PATE) who were discharged from hospital after appropriate treatment performed. Of the total number of the treated patients, we formed 2 groups comprising 20 patients each, receiving alteplase (group 1) and streptokinase (group 2). The patients were comparable by the main clinical characteristics, predisposing factors, severity of pulmonary artery thromboembolism (PATE) and duration of treatment. Efficacy of thrombolytic therapy assessed clinically and instrumentally did not differ. However, by the stratified risk and frequency of PATE relapses, the condition of patients receiving alteplase turned out to be more severe. Based on the obtained results, a conclusion was made that actilyse is a drug of choice for treatment of patients with PATE.

[Temporary tamponing of the canal while removing the great saphenous vein in elderly patients]. / Vremennoe tamponirovanie kanala pri udalenii bol'shoi podkozhnoi veny u bol'nykh pozhilogo vozrasta.

The purpose of the study was to optimize the technique of removing the trunk of the great saphenous vein (GSV) in patients over 60 years. The study included a total of eighty-five patients aged over 60 years and presenting with primary varicose veins of the lower limbs and undergoing operations performed on the superficial venous system, including all stages of classical phlebectomy - crossectomy, stripping of the GSV, removal of tributaries and ligation of incompetent perforant veins. The patients were divided into two groups: the Study Group (n=44) patients endured removal of the GSV with the use of the technique of temporal tamponing of the canal, while in Group Two patients, composing a comparison group (n=41), the GSV was removed without the use of a tampon. The groups of the patients were comparable by the main characteristics, as well as by the CEAP class and the types of the operations performed. The results of treatment were studied clinically with the use of the Venous Clinical Severity Score (VCSS). In the Study Group patients, the average VCSS score decreased from 1.52±0.11 to 0.47±0.05 (p=0.007) and in the Comparison Group from 1.21±0.11 to 0.85±0.06 (p=0.028). In the remote terms after the operation, in the Study Group patients the average VCSS score appeared to be 2 times lower than in the control group, amounting to 0.47±0.05 and 0.85±0.06, respectively (p=0.007). A conclusion was drawn that in surgical treatment of varicose veins in elderly and aged patients while removing the grate saphenous vein, it is appropriate to use the technique of temporary tamponing of the canal, which is associated with better results in the remote period as compared to the traditional stripping.

[Structural alterations of a biological prosthesis]. / Strukturnye izmeneniya biologicheskogo proteza.

The authors studied dilatation of a biological prosthesis (a specially treated xenograft made of bovine arteries) used as a femoropopliteal bypass in patients presenting with diseases of peripheral arteries. Structural alterations (ectasia) were examined in a total of 15 patients within the terms varying from 1 year to 7 years after the operation, resulting in working out a methodology of calculating structural changes of the conduit with characteristics of the composite index of dilatation of the conduit. The presence of aneurysmatically dilated portions whose dimension exceeded the initial size of the xenograft 3-4-fold did not influence the long-term patency of the shunt with preserved blood flow approximated to the major one. This made it possible to avoid a repeat surgical intervention.

Dynamics of clinical semiotics in children with pathological tortuosity of internal carotid arteries in remote period after surgical management.

The present study enrolling a total of eighty-eight 4-to-16-year-old children and adolescents was aimed at detailed elaboration and formalization of clinical signs of the internal carotid artery pathological kinking syndrome. To achieve these objectives, the authors carried out a comparative analysis of clinical manifestations of the disease in the surgically treated subjects (constituting the Surgery Group comprising 43 children and adolescents) and non-operated patients (making up the Comparison Group consisting of 45 age- and gender-matched subjects). There were no baseline differences in the incidence rate of clinical syndromes and symptoms between the groups of the would-be operated and conservatively treated patients. Also studied were the remote outcomes (1-to-12-year follow up) of surgical correction for pathological tortuosity of the internal carotid artery. The incidence rate of regression of neurological symptomatology along different clinical signs after surgery was shown to vary within a wide range from 11.6% to 96.3%. Resection of the proximal portion of the internal carotid artery with re-implantation into the old ostium turned out to be clinically effective in 90.0% of cases, with the haemodynamic efficacy amounting to 83.3%. Arteriolysis of the internal carotid artery rendered a clinical effect in 75% of cases, with a haemodynamical effect thereof equalling 25.0%. The decision as to the type of a surgical intervention to perform was primarily made based on the findings of angiography of the internal carotid artery. The operation of arteriolysis did not lead to deterioration of the child's condition.