[Reconstructive operations for aneurysmatic transformation of veins in patients on programmed haemodialysis]. / Rekonstruktivnye operatsii pri anevrizmaticheskoi transformatsii ven u patsientov, nakhodiashchikhsia na programmnom gemodialize.

Aneurysmatic transformation of a fistulous vein is one of the most frequently encountered complications in patients on programmed dialysis. This complication increases the risk of dysfunction of an arteriovenous fistula. However, there are no common approaches to correction of this complication. This study was aimed at assessing the results of aneurysmorrhaphy for treating aneurysms of fistulous veins in patients on programmed dialysis. For this purpose, we carried out a retrospective analysis of the results of operations in a total of 87 patients with aneurysmatic transformation of an arteriovenous fistula. All patients were subjected to aneurysmorrhaphy supplemented, if necessary, by plasty of stenosis with the use of the tissue of the wall of the resected aneurysm. The vein was placed into a new subcutaneous channel (transposition with transection of the vein) or a pocket formed by the separated subcutaneous tissue (transposition without transection). Secondary patency after 1 year amounted to 95.3%, after 2 years to 91.4%, and after 3 years to 87.6%. At 4.8 years, 69% (95% CI 44.9-84.2) of the arteriovenous fistulas proved patent. CONCLUSION: Aneurysmorrhaphy supplemented with correction of concomitant complications of aneurysms of fistulous veins is an effective and safe operation making it possible to maintain the function of an arteriovenous fistula for a long period of time.

[The clinical course and treatment of fungal infections in the early period after kidney transplantation].

The article discusses the critical issues of clinical manifestations and treatment of fungal infections in patients after kidney transplantation. In fungal infection, which is usually detected in the composition of microbial associations, lungs are more often affected. In this case, mortality reaches 60%. Affecting the renal transplant by Candida spp. or Aspergillus spp. can lead to the loss of function of transplanted kidneys. At the current stage, lipid formulations of amphotericin B are drugs of choice for antimycotic therapy in posttransplant period. Nephrotoxic effect of amphotericin B is reversible and does not represent a serious threat to the function of the transplantate. Administration of lipid formulations of amphotericin B is the most justified, since it does not affect the concentration ofimmunosuppressive drugs in the blood serum of patients after transplantation.

[Kidney transplantation in recipients with renal carcinoma].

Transplantation of the kidney in patients with renal carcinoma is disputable. The article presents the results of kidney transplantation in different cancer lesions of the patient's kidneys. Seven case histories of patients with primary renal tumors are retrospectively analysed. A clinical case of development of the tumor of own kidney in a patient after transplantation is reported. A time factor of kidney transplantation after tumor removal in a recipient is discussed.

[Laparoscopic operations in patients with chronic renal failure on peritoneal dialysis].

The aim of our study was analysis of efficacy of laparoscopic operations for treatment of complications arising in patients with terminal chronic renal failure (TCRF) on peritoneal dialysis (PH). A total of 86 TCRF patients participated in the trial. The study group consisted of 36 patients who have undergone laparoscopic surgery for correction of dysfunction of the peritoneal catheter, for treatment of acute and progressive chronic diseases of the abdomen. A control group included 50 patients treated with laparotomy. All the patients were on the dialysis for 1-48 months. After laparoscopic operations 7 patients were switched on hemodialysis. In the control group peritoneal dialysis was discontinued in 30% patients, lethality in this group was twice higher. Thus, laparoscopic operations allow prolongation of peritoneal dialysis in dysfunction of peritoneal catheter and in development of acute and progression of chronic surgical diseases of the abdomen.

[Some aspects of clinical kidney transplantation from marginal cadaver donors].

The results of kidney transplantation from marginal donors were compared in two groups of patients who had received high-dose dopamine (10-35 mcg/kg/min). Group 1 consisted of 652 patients with grafts from stable donors given dopamine in doses from 0 to 10 mcg/kg/min, group 2--of 112 patients with grafts from donors given high-dose dopamine (10-35 mcg/kg/min). Mean follow-up was 52 +/- 19 months. The following parameters were compared: percent of delayed graft function, primary nonfunction transplants, acute graft rejection, graft survival, biopsy-proven ischemic-reperfusion graft injury. The rate of delayed graft function, primary non function transplants was higher in group 2 (59 and 51%, 7 and 4%, respectively). Five-year survival of the transplants and recipients was less in group 2 (68 vs. 73% and 78 vs. 71%, respectively, p < 0.05). At the end of the follow-up the level of serum creatinine was 151 +/- 50 in group 1 and 165 +/- 80 mcmol/l in group 2 (p > 0.05). Thus, despite worse results in group 2, kidney transplantation from such marginal donors can be used.

[Angiomyolipoma of the secondary contracted kidney in a renal graft recipient].

The special feature of the presented case is a combination of various pathological processes which developed in the recipient's kidney after renal transplantation, such as chronic glomerulonephritis progressing to nephrosclerosis; benign tumor to angiomyolipoma, xantogranulomatosis, and thesaurismosis which develop after massive infusion therapy.

[Continuous low-flow vein-vein hemofiltration in peritonitis: changes in the severity of endotoxicosis as a criterion for the efficiency of the technique].

The efficiency of intermittent and continuous hemofiltration was comparatively evaluated in the complex treatment of 27 patients having multiple organ dysfunction along with pyoseptic complications of abdominal diseases. Based on the study of a broad spectrum of markers of toxicosis and the severity of organ dysfunction, it was concluded that the efficiency of the procedure should be objectively evaluated to optimize the time of its performance.

[Integrated hemodynamic response to hemofiltration and peritoneal dialysis in patients with acute renal failure]. / Integrirovannyi gemodinamicheskii otvet na gemofil'tratsiiu i peritoneal'nyi dializ u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

Central hemodynamics was studied by integral polyrheography in 24 patients with acute renal failure (ARF) during hemofiltration (HF) and in 18 patients with ARF during peritoneal dialysis. All central hemodynamic parameters improved by the end of HF. However stroke volume decreased by 26.6%, stroke index by 24.4%, minute volume by 25.7%, and cardiac index by 24.8% as early as at the moment of extracorporeal contour filling. This was paralleled by an increase of total peripheral vascular resistance from 1321 +/- 124 to 1586 +/- 106 din/(cm*c-5) (by 16.7%). Hence, clear-cut signs of centralization of circulation were seen during the initial period of HF in patients with ARF. Peritoneal dialysis did not lead to centralization of circulation in patients with ARF; moreover, minute heart volume increased by 9% during some stages of the procedure, stroke volume increased significantly (p < 0.05), other parameters increased, but total peripheral vascular resistance was virtually unchanged. After removal of dialysis solution from the abdominal cavity all hemodynamic parameters returned to the initial values. Hence, both hemofiltration and peritoneal dialysis ameliorate the central hemodynamics. However peritoneal dialysis does not involve even temporary centralization of circulation, which has a positive impact on the course of acute tubular necrosis.

[The diagnosis and treatment of arterial hypertension in patients on hemodialysis treatment and after a kidney allograft]. / Diagnostika i lechenie arterial'noi gipertenzii u bol'nykh na lechenii gemodializom i posle allotransplantatsii pochki.

Analysis of examination and treatment of 104 patients who were periodically exposed to hemodialysis and 60 persons who sustained the allotransplantation of a cadaveric kidney enabled the authors to reveal the incidence of arterial hypertension before and after the transplantation. Pronounced arterial hypertension (AH) was documented in patients who were treated with hemodialysis sessions for the proper renal diseases developed in angionephrosclerosis (chronic glomerulo- and pyelonephritis). In those who sustained the transplantation, AH was pronounced in case of acute of chronic rejection, transplanted artery stenosis of renal renin hyperproduction. Higher incidence of AH (2.3-fold higher) was observed in posttransplantation patients with the native kidney left. It correlated with higher peripheral plasma renin activity (RRA). The authors suggested that the scheme should be used for the diagnosis of AH manifestation both before and after the transplantation which included the account for the cause of the disease terminal stage, the character of the AH variance in hemodialysis captopril testing, radiocardiographic examination, indirect renal angiography (99-Tc pertechnetate) or selective blood testing for RPA in case bilateral nephrectomy should be made in two stages. For the patients who had sustained the transplantation of the kidney, the diagnostic scheme should include a double pulse Doppler sonography, arteriographic investigation of the transplant and pharmacorenography with a captopril load test. Advisability of captopril stimulation of renin secretion during the selective sampling of the blood was demonstrated. The authors verified the time-course of renin activity, the concentration of aldosterone, cortisol and adrenocorticotrophic hormone in patients with a history of bilateral nephrectomy, defined the indications for bilateral nephrectomy associated with AH and discussed its possible outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)