[Remote results of surgical management of chronic cerebrovascular insufficiency].

The work was aimed at studying the remote results of reconstructive operations performed on brachiocephalic arteries in a total of 1,483 patients presenting with chronic cerebrovascular insufficiency. The findings obtained from our experience confirmed that carotid endarterectomy up to now remains the gold standard of treatment for both symptomatic and asymptomatic patients suffering from haemodynamically significant lesions of carotid arteries, requiring, however, timely performance and consequent active follow up of the patients involved.

[Surgical aspects of treatment for bilateral atherosclerotic lesion of carotid arteries].

The present study was aimed at determining surgical policy and terms of intervention in bilateral atherosclerotic lesions of carotid arteries. Depending on the treatment policy, a total of 114 patients were subdivided into two groups. Group One patients underwent the traditional procedure and carotid reconstruction was performed on the side with more pronounced stenosis or in the carotid basin with ischaemic stroke where an ischaemic episode had occurred, with the total rate of complications related to ischaemic stroke or death amounting to 4.4%. In Group Two patients in order to determine the side subject to carotid reconstruction we primarily used a newly developed policy for determining the most affected carotid basin. For this purpose we worked out a special scale making it possible to determine the degree of the lesion of the carotid basin from each side. Using this policy we managed to decrease the complication rate in Group Two patients to 2.1%. According to our data the optimal terms for performing carotid endarterectomy on the opposite side vary from 2 to 3 months.

[Our experience in surgical management of internal carotid artery ocсlusion].

Analysed in the article are the outcomes of surgical management in a total of 42 patients diagnosed as having occlusive lesions of the internal carotid artery. Also studied is efficacy of the operation - resection and ligation of the internal carotid artery, endarterectomy from the common and external carotid arteries with the application of a dilating patch onto the external carotid artery in occlusion of the internal carotid artery in patients with endured ischaemic stroke, depending on severity of neurological deficit and the time having elapsed since the operation performed. Also investigated are peculiarities of cerebral haemodynamics in patients with occlusion of the internal carotid artery and haemodynamic alterations during the stages of surgical treatment. The obtained findings confirm efficacy of reconstructive operations in both prevention of relapsing stroke and surgical rehabilitation.

[Damage to craniocerebral nerves in reconstructive surgery of carotid arteries].

Reconstructive operations on aortic arch branches appear to be the most efficient method of preventing acute and chronic impairments of cerebral circulation. Iatrogenic lesions of the craniocerebral nerves deteriorate the course of the immediate, and especially the remote postoperative period, decreasing quality of life and social status of the patients after endured carotid reconstructions. The authors analysed herein the outcomes in a total of 562 patients after endured carotid artery surgery for atherosclerosis or pathological tortuosity. The authors examined the incidence rate, patterns and risk factor of damage to the craniocerebral nerves in all the patients. Comprehensive prevention of damage to the craniocerebral nerves was carried out in a total of 412 patients from the Study Group and was aimed at excluding or decreasing intensity of the eff ect of the eliminable risk factors. The proposed measures made it possible to decrease the rate of lesions of craniocerebral nerves from 18.7 to 6.9% and to substantially improve the postoperative patients' quality of life.

[The experience with thoracoscopic sympathectomy for the treatment of distal lesions of limb arteries].

The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.

[Diagnostics and strategy of surgical treatment of multifocal atherosclerosis].

The study included 148 patients with different combinations of multifocal atherosclerosis. The inclusion criteria were clinical manifestations of chronic cerebrovascular insufficiency concomitant with diseases of other arterial basins. The treatment strategies were chosen based on the results of examination by non-invasive methods for vascular visualization. Contrast agents were used only for curative purposes. The patients were divided into 2 groups depending on surgical strategy. Patients of group 1 underwent one-step reconstruction of several affected basins, those in group 2 step-by-step revascularization of different arterial basins with the use of X-ray endovascular interventions. The former approach was applied at the initial stage of the work. It creating a high risk of complications, the latter approach was preferred in the subsequent period. The incidence of complications in group 2 was 4.05% and the lethality rate 1.49%. These values were significantly higher in patients of group 1.

[Analysis of long-term outcomes after carotid endarterectomy for stenosing lesions of carotid arteries].

Surgical management of patients presenting with stenosing lesions of carotid arteries is currently included into the International standards of treatment for transient ischaemic attacks (TIAs) and stroke. The present work was aimed at assessing long-term outcomes following carotid endarterectomy (CEA) in patients diagnosed with stenosing lesions of carotid arteries based on the results ofa 6-month follow-up. The study comprised the analysis of remote outcomes after reconstructive operations on carotid arteries as compared to those of conservative methods of treatment in a total of 120 patients suffering from haemodynamically significant stenoses of carotid arteries. The obtained findings demonstrated that managing the patients suffering from stage I-II chronic cerebrovascular insufficiency by means of conservative methods only turned out less efficient and was associated -with a substantially larger percentage of patients who later on experienced ischaemic strokes, as well as with a higher mortality rate versus those in the group of patients subjected to CEA.

[Results of reconstructive surgery for carotid artery occlusion in ischemic stroke survivors].

The authors report results of reconstructive surgery in 316 patients with carotid artery (CA) occlusion operated after ischemic stroke. Its efficiency is estimated with reference to the degree of neurologic deficiency and treatment schedule. The results confirm effectiveness of reconstructive surgery on CA for the prevention of stroke relapses and promotion of surgical rehabilitation.

Diagnostics and surgical treatment of pathological deformation of the carotid arteries.

The most effective way of preventive maintenance of sharp and chronic disturbances of brain blood circulation are reconstructive operations on branches of an arch of an aorta. Pathological deformation meets far quite often in clinical practice and is the reason of cerebral-vascular insufficiency of various degree, including ischemic strokes. Research objective - improvement of diagnostics and tactics of treatment of the patients with pathological deformation of carotid arteries. 132 patients have entered into research with various kinds of pathological deformation. Have been made 143 reconstructive operations. Indications to operative treatment revealed by means of duplex investigation and angiography. At the same time defined hemodynamic changes on carotids with an obligatory estimation of a condition intracranial vascular channel. By the indication to operative treatment of the given category of patients it is considered: hemodynamic significant pathological deformations of an internal carotid, pathological deformation of an internal carotid in a combination with embologenal plaque, pathological deformation of an internal carotid with all types of atherosclerotic plaques narrowing a vessel gleam on 60% and more, in the presence of symptoms of cerebral-vascular insufficiency, especially at transient ischemic attacks and at an ischemic stroke. Positive clinical effect has been reached at 100% of patients with I and II degree chronic vascular-brain insufficiency, at 80,6% of patients with chronic vascular-brain insufficiency of III degree, and at 45,8% of patients which in the anamnesis have transferred sharp infringement of brain blood circulation.

[Experience with thoracoscopic sympathectomy in distal lesions of lower-limb arteries].

We studied the results outcomes of thoracoscopic sympathectomy in 107patients with distal lesions of lower-limb arteries. The best results in the early postoperative period were observed in patients with Raynaud's disease and syndrome, reaching 100% efficacy. Due to implementation of novelties, we managed to preserve the efficiency of sympathectomy in 90% of patients with this pathology in the remote period. In patients with obliterating endarteritis and atherosclerosis, the efficacy of the operation was regarded as a possibility to preserve the supporting function of the extremity. In the postoperative period this goal was achieved in 73.2% and 62.5% of patients, respectively, while in the remote period in 62% and 25%, respectively.

[Analysis of causes contributing to inefficiency of roentgenoendovascular destruction of adrenal glands in hypertensive patients].

The study was aimed at bettering therapeutic outcomes for patients suffering from adrenal-aetiology arterial hypertension, with the objective deemed attainable at the expense of revealing and removing the underlying causes potentially contributing to unfavourable results obtained after roentgenoendovascular ablation of the adrenal glands. We retrospectively examined the medical records of 49 patients having undergone hospital treatment within the time frame from 1992 to 2007 for recurrent arterial hypertension poorly controlled by previously endured roentgenoendovascular (REV) interventions. The identified causes contributing heavily to poor clinical outcomes obtained after the REV-ablation procedures appeared to have been as follows: renal parenchymatous diseases in 20 patients having a long history of arterial hypertension with evidence ofnephroangiosclerosis; insufficient devitalisation of the adrenal glands in a further 19 patients; a pheochromocytoma of the right adrenal gland in only one instance; and newly onset renovascular hypertension in the remaining nine subjects. It was determined that poor therapeutic outcomes had primarily been caused by overestimating the indications for performing REV ablation of the adrenal glands, being seemingly wanton as a corrective measure to have been taken in the presence of inflammatory diseases of the renal parenchyma and secondary hyperplasia of the adrenal gland, with the second-in-order contributory cause appearing to be insufficient devitalisation of the adrenal glands afflicted by hyperplasia and/or aldosteroma. The development of renal artery stenosis in the remote period after REV interventions may also be responsible for a relapse of arterial hypertension, which is quite often the case.

Endovascular embolization of the hepatolienal vessels in the treatment of portal hypertension.

PURPOSE: to study the characteristics and variants of changes in the structure of celiac trunk and portal vein pool vessels, to define the tactics of most effective use of endovascular interventions in the treatment of portal hypertension. MATERIAL AND METHODS: the immediate and long-term results of angiographic studies and endovascular interventions are analyzed in 329 patients with portal hypertension induced by liver cirrhosis. The compensated stage of portal hypertension was identified in 62, subcompensated in 93 and decompensated in 174 patients. The patients underwent embolization of the splenic, left gastric and gastro-omental arteries, varices of the esophagus and cardial part of the stomach. In the long-term period, appropriate corrective medical endovascular interventions were performed in the event of the identification of recanalization of the previously embolized vessels and occurrence of the collateral pathways. RESULTS: after embolization of the splenic artery the positive shifts in blood readings, reduction of the splenic size, and abatement of ascites were revealed in the majority of cases. In the long-term period, the efficacy of the procedure diminished as a result of restoration of the lumen of the previously embolized vessels or development of the collaterals which demanded repeat endovascular intervention. The hospital lethality among patients with portal hypertension who had been provided endovascular interventions because of esophageal bleeding accounted for 29.8%, with the incidence of early recurrences being equal to 4.8%. The best results were obtained in a group of patients who had undergone embolization of bleeding gastroesophageal varices coupled with occlusion of the splenic artery for decompression and intraportal infusion therapy.

[Choice of approach for transhepatic endovascular and biliary procedures]. / Vybor dostupa dlia vypol'neniia chrespechenochnykh éndovaskuliarnykh i éndobiliarnykh vmeshatel'stv.

Results of diagnostic and therapeutic transhepatic procedures in 185 patients with portal hypertension and 292 patients with obstructive jaundice are analyzed. Optimal angles for introduction of instruments, optimal intercost and the most convenient for manipulation biliovascular structures of the liver were determined. These principles permitted to reduce the failure rate in endovasculary procedures from 10.5 to 3.8%, in endobiliary--from 13.2 to 0.97%.

[The role and place of long-term intraarterial catheter therapy in the treatment of pyo-necrotic lesions of the foot in the presence of diabetes mellitus]. / Dlitel'naia vnutriarterial'naia kateternaia terapiia pri lechenii gnoino-nekroticheskogo porazheniia stopy na fone sakharnogo diabeta.

Results were studied of examination and treatment of 127 patients with diabetes mellitus complicated by pyo-necrotic lesions of the foot. Group I (control group) comprised 90 patients who were given a long-term intraarterial catheter therapy involving administration of antibiotics on a continuous drop-by-drop basis. Group II (main group) was 37 patients who received the above therapy with a stream-like (half the daily dose) intraarterial administration of antibiotics at regular intervals against the background of their drop-by-drop administration. Exudation and necrotic tissues taken from the wound served as material for the microbiological procedures to be done. In the control group, results were considered to be good, satisfactory, unsatisfactory in 24 (36.4%), 36 (40.5%), 25 (27.5%) patients respectively. There were five fatalities (5.6%). Eight patients were reoperated on. In the main group, good results were obtained in 37.7 percent of cases (n = 12), with 24 (59.8%) patients having displayed satisfactory, 1 (2.7%) patient--unsatisfactory results. There were two deaths. Four patients were reoperated on.

[Optimization of surgical treatment of suppurative-necrotic lesions of the foot in patients with diabetes mellitus]. / Optimizatsiia khirurgicheskikh vmeshatel'stv pri gnoino-nekroticheskikh porazheniiakh stopy u bol'nykh sakharnym diabetom.

The analysis of treatment results in 559 patients with diabetes mellitus complicated by foot pyonecrotic lesions was carried out. Surgical treatment was performed in 448 patients considering route of infection spread (basic group), conventional methods of treatment were used in 111 patients (control group). It is shown that one of the causes of unsuccessful treatment results was the infection spread from foot to leg by toes tendons and synovial sheaths. The study of microbial contamination in wound exudate, distal and proximal sites of tendons revealed a significant difference in proximal-distal gradient for aerobes (2.8 +/- 0.19 lg/g) and anaerobes (1.71 +/- 0.16 lg/g, p < 0.01). Methods of surgical treatment of foot pyonecrotic lesions allowing for route of infection in patients with diabetes mellitus were developed. Use of these methods allowed to decrease more than 2 times the number of femoral amputations, and to increase the rate of surgical interventions with salvage of limb's support function from 71.2 to 87.7%.

[Minimally invasive surgery in cholelithiasis]. / Maloinvazivnye vmeshatel'stva pri zhelchekamennoi bolezni.

The results of minimally invasive surgical interventions (percutaneous transhepatic cholecystostomy, retrograde cholangiopancreatography with endoscopic papillosphincterotomy, percutaneous transhepatic cholangiostomy with endobiliary intervention, extracorporeal shock wave lithotripsy, laparoscopic cholecystectomy) in 1590 patients were analyzed, 2 methods and more were used in 74 of them. In 155 patients minimally invasive interventions were combined with open surgery. Rational combination of minimally invasive methods in cholelithiasis permits to cure majority of the patients, to avoid open operation and associated complications.

[Role of prolonged intraarterial catheter therapy in general peritonitis]. / Rol' i mesto dlitel'noi vnutriarterial'noi keteternoi terapii pri rasprostranennom gnoinom peritonite.

The analyses of treatment results in 82 patients with general purulent peritonitis are presented. In these patients long-term intraarterial catheter therapy (IACT) was included in the complex of postoperative treatment after elimination of infection source. Postoperative peritonitis was in 66 patients, 52 patients of them underwent reoperations for persisting general peritonitis. Use of IACT promoted arrest of abdominal inflammatory process and polyorganic insufficiency due to high concentration of antibiotics in the affection focus, improvement of regional circulation, reduced number of postoperative complications and a sharp fall of lethality of 8.5%.

[Epidemiologic aspects of echinococcosis]. / Epidemiologicheskie aspekty ékhinokokkoza.

The performed studies showed, that morbidity of the population with echinococcosis substantially varies even within the boundaries of any administrative region and depends on a number of factors. According to climato-geographic conditions it is possible to single out three zones: arid zone (deserts, semi-deserts, salt-marshes) with minimal level of invasion of the population with echinococcosis; zone of semi-deserts and alpines with medium level of invasion; and zone of oases, valleys, middle-mountains and tugays--with high level of invasion. Among the risk group--cattle-breeders--2 subgroups could be singled out: steppe and mountains cattle-breeders, the risk of invasion in the laffer subgroup is substantially higher. It is necessary to include into the risk group also country housewives who are in constant contact with domestic animals, and schoolchildren who an in constant contact with dogs. The significance of aerogenic route of invasion is especially pronounced in children, and frequency of pulmonary form of echinococcosis has reached 50% and more. Besides studying the structure of morbidity and echinococcosis disease in relation to age, sex, occupational activities, for evaluation of epidemiologic conditions on territories it is advisable also to perform mapping of regions according to mass prophylactic examinations data with the use of serological reactions and US examinations, as well as to analyse epidemiologic conditions with the use of such criteria as indices of invasion, morbidity and detectability.

[Peritoneal dialysis in treatment of diffuse purulent peritonitis]. / Peritoneal'nyi dializ v lechenii rasprostranennogo gnoinogo peritonita.

Peritoneal dialysis (PD) as a method of sanitation of the abdominal cavity was used in treatment of 221 patients (140 males and 81 females aged 17-89 years) with extended purulent peritonitis. In all patients toxic (138) of terminal (83) stage of purulent peritonitis was diagnosed. PD was carried dut in flow-fractional regimen with the use of 10-15 l of isotonic physiologic solution with the addition of antibiotics and heparin 4 times per day during 4-6 days. Carrying out PD in patients with purulent diffuse peritonitis resulted in improvement of general condition of the patients, normalization of hemodynamics, diuresis, and in lessening the paresis of gastro-intestinal tract as well as decrease of intoxication. Thus, in the group of patients in whom PD was not used the mortality rate was high--36%, and including PD in the complex of treatment contributed to the decrease of lethality to 23%.