[The specific features of ocular blood flow and brachiocephalic arteries in patients with non-exudative senile macular degeneration].

A hundred and twenty patients (240 eyes) aged 40-65 years (mean age 56.9 +/- 2.1 years) who had non-exudative age-related (AMD) macular degeneration (AMD) were examined. Ultrasound studies, including Doppler color mapping, were conducted to study blood flow in ophthalmic vessels and brachiocephalic arteries. Hemodynamic parameters deteriorated in all patients with non-exudative AMD, which suggests that blood flow deficit in the ophthalmic arterial system, central retinal artery, and posterior ciliary arteries. 88.3% of patients with non-exudative AMD were diagnosed as having brachiocephalic arterial deformities of which bilateral C- and S-shaped pathological tortuosity of carotid and vertebral arteries were most common.

[Role of valvular insufficiency of the femoral vein in clinical course and relapse of lower limb varicosity].

The authors carried out a comparative analysis of 488 patients with varicose disease. Of these, 107 patients suffered from class 4 varicosity and reflux along the femoral vein down to the middle third of the femur and below with the duration of more than 1.5 s, and 381 subjects had class 2 - 3 varicose disease without reflux along the femoral vein. The patients in the both groups were sex- and age-matched, with the overwhelming majority of them being women. Group One patients in the preoperative period had clinical class II and III chronic venous insufficiency (CVI) according to the CEAP classification, with the prevailing of class III. The majority of these patients were postoperatively transferred to CVI of clinical classes 0 and I. A similar picture with a difference in the outcome was observed in Group Two patients, the majority of whom had clinical class II CVI according to the CEAP classification, with the overwhelming majority of them having postoperatively been transferred to clinical class 0 and I CVI. Initially, all the patients from Groups One and Two were diagnosed to have been suffering from varicosity of lower-limb subcutaneous veins. During one year after the operation, varicosity was virtually absent in the patients of the both groups, however by ten years of dispensary follow-up the pathology was observed to have reappeared in approximately the same percentage of the patients involved. Studying the long-term surgical outcomes showed that the number of relapsing varicosity in the both groups did not differ significantly, having amounted to 25% and 23% of the patients in Groups One and Two, respectively. According to the findings obtained, the relapses having developed in the overwhelming majority of the patients in the both groups were caused by a reflux along the perforated veins, which either reappeared, or had not been duly removed intraoperatively, as well as by a long stump of the great saphenous vein with an altered influx, or varicosity in the previously intact basin. The integral score of the quality of life (according to the CIVIQ 2 scale) in the groups after the operations did not differ significantly. However, within the groups, there was certain difference between the subgroups comprising the patients in whom complete recovery was attained and those having developed relapses, with this difference in Group One patients commencing to emerge approximately after 7 - 8 postoperative months, to become statistically significant by the 4th - 5th year of the dispensary follow-up, while in Group Two patients this difference began to be seen as early as 2 months after surgery, also becoming statistically reliable 4 - 5 years later. According to our findings, a vertical venous reflux is not the cause of recurrent lower limb varicosity, nor does the dynamics of the quality of life of the patients involved depend upon either presence or absence of a reflux. Therefore, a reflux along the femoral vein does not exert any significant influence on either the course, or relapses of varicose disease.

[Cerebral oximetry in the perioperative evaluation of the reserve of cerebral circulation in patients with brachiocephalic artery lesions]. / Tserebral'naia oksimetriia v otsenke rezervov krovoobrashcheniia golovnogo mozga v perioperatsionnom periode u bol'nykh s porazheniem brakhiotsefal'nykh arterii.

The reactivity of cerebral vessels and the reserve of collateral compensation of cerebral flow were studied in 71 patients with perioperative carotid stenosis of different degrees. Cerebral oximetry was made at rest and during hypercapnic and compression loads. The method's efficiency was demonstrated for the preoperative evaluation of the cerebrovascular reserve in patients with atherosclerotic affection of vessels in the brachiocephalic stem. A comparison of the preoperative and intraoperative dynamics of rSO2 at compression points at the feasibility of using the cerebral oximetry in predicting the degree of reduced regional oxygenation of the brain in the basin of an intraoperatively pinched artery.

[Comparison of variceal surgery methods]. / Sravnitel'naia otsenka metodov khirurgicheskogo lecheniia varikoznoi bolezni.

Combined ablation of great saphenous vein (GSV) remains the most common way of lower limb variceal management. In recent years different surgical methods were proposed for the treatment of varices. Nevertheless, their invasiveness, poor esthetic outcome, prolonged postoperative rehabilitation and recurrences cail for the development of new minimally invasive and highly effective methods. In the last 5 years a new procedure of intraoperative trunk catheter scieroobliteration of GSV and its tributaries was introduced. From 1997 to 2002 total 493 surgical corrections of lower limb varices were fulfilled, among them 374 patients were operated for primary variceal vein dilatations including 188 standard combined venectomies (1st group) and 186 trunk obliterations (2nd group). Groups were similar in age, sex and lesion extension. Outcomes were followed up to 4 weeks - 5 years. Outcomes comparison between groups has demonstrated significantly lower incidence of postoperative subcutaneous hematomas in the 2nd group, absence of saphenous nerve injuries, better esthetics in the absence of additional incisions (remaining variceal tributaries were sclerosed postoperatively by puncture scieroobliteration). Besides postoperative rehabilitation period was double shorter in ihe 2nd group then in the 1st one. Recurrence rate in long-term period was similar in both groups. Thus intraoperative trunk scieroobliteration of GSV can be a valuable alternative for standard combined venectomy.