[URINE UNDER CHRONIC DYSFUNCTION OF RENAL ALLO-TRANSPLANT].

The study was organized to provide additional characteristic of chronic dysfunction of renal allo-transplant using such biomarkers of serum and urine as enzymes (alanine aminotransferase), aspartate aminotransferase, gamma- glutamiltransferase, alkaline phosphatase, N-acetyl-ß-D-glucosaminidase, interleukins (IL-2, IL-8, IL-10), beta-2- microglobulin. The chronic dysfunction of renal allo-transplant is characterized by increasing of concentration of IL-10 and beta-2-microglobulin in serum and increasing of concentration of beta-2-microglobulin, IL-2, IL-8 in urine and increasing of activity of N-acetyl-ß-D-glucosaminidase, alkaline phosphatase, aspartate aminotransferase, gamma-glutamiltransferase as compared with patients with satisfactory function of renal allo-transplant. The multivariant logistic regression analysis established that only activity of N-acetyl-ß-D-glucosaminidase in urine was reliably independently related to chronic dysfunction of renal allo-transplant. It is assumed that increasing of concentration of beta-2-microglobulin in serum testifies glomerular dysfunction and in urine--tubular dysfunction of renal allo-transplant. The enzymeuria indicates continuing damage of epithelium of proximal tubules of nephron. The classification of patients with satisfactory function and chronic dysfunction of renal allo-transplant established that the highest indicators of square under ROC-curves had concentration of beta-2-microglobulin in serum (0.858 ± 0.061) and urine (0.733 ± 0.079) and activity of N-acetyl-ß-D-glucosaminidase in urine (0.701 ± 0.061). To specify diagnosis of chronic dysfunction of renal allo-transplant the most useful (ratio of likelihood of positive result 10 and 11 correspondingly) are tests of beta-2- microglobulin in serum (more than 8.55 mkg/ml) and N-acetyl-ß-D-glucosaminidase/creatinine in urine (more than 34 nmol/(sl)/ mmol/l). These discoveries require further validation and confirmation by implementation of morphological analysis of bioptat of renal allo-transplant.

[PRP-therapy and regular physical load in complex treatment of patients with distal form of arterial occlusion].

In a structure of the cardio-vascular system diseases in Ukraine the part of chronical ischemia of the lower extremities tissues constitutes more than 20%. Due to diffuse affection of the distal parts of arterial bed it is impossible to succeed in performance of a direct" revascularization in 40% of patients. In 60-87% of such patients a severe ischemia of the lower extremities tissues occurs, causing the necessity of their high amputation performance on the hip level. The results of surgical treatment of 36 patients, suffering inoperable types of the peripheral arteries occlusion were analyzed. In 18 patients the algorithm of intraoperative ultrasound duplex scanning was applied, surgical interventions were performed using optimized procedures. As a second stage the PRP-therapy was conducted, since the second post-operative day all the patients have had performed the elaborated complex of physical exercises, directed on the shin and hip muscles strengthening. Optimization of the lower extremities indirect revascularization methods have permitted to increase the rate of the treatment positive results from 55.6 to 88.9%, to reduce the unsatisfactory results rate--from 44.4 to 11.1%. The PRP-therapy and complex of regular physical exercises conduction have promoted the VEGF content enhancement in the blood serum by 15.6%. malleolar-brachial index--by 28.9% in the patients, suffering occlusion of femoro-popliteo-tibial segment. PRP-concentrate constitutes a potent cell biological activator of the VEGF, improves metabolism and microcirculation in muscles and cells of the skin.

[Up-to-date techniques of diagnostics, prognosis and prophylaxis of dysfunction of the renal allotransplant].

On the basis of their experience with 530 kidney transplantations and literature data the authors argue the necessity of careful assessment of the kidney allograft state at all stages of its life. An accent is thus done on the necessity of the complex diagnostics with using noninvasive and invasive methods that will facilitate the kidney allograft dysfunction prediction and prevention, and longer time of the kidney allograft survival.

[The state of lipid peroxidation and antioxidant defense system in recipients of renal allotransplant].

The peroxidal oxidation of lipids (POL) and antioxidant defense (AOD) system state in the patients blood before renal transplantation performing and on the fourth day after it were studied, depending on kind of familial or potential agonal with beating (DBH) or nonbeating (DNBH) heart donor applied and the presence of complications--delayed renal autotransplant (RAT) function and acute reaction of rejection (ARR). In chronic renal insufficiency, RAT transplantation from cadaver, DNBH and ARR the POL processes intensification and AOD system activity lowering were noted.

[Surgical treatment of the brain ischemic disease].

There were examined 825 patients, in whom affection of extracranial arteries was revealed, including 340 (41.2%) men and 485 (58.8%) women, 27 to 73 years old. Atherosclerotic stenosis and occlusion of extracranial arteries was diagnosed in 305 (40.0%), pathologic kinking of vessels on atherosclerosis and hypertonic disease background--in 196 (23.8%), pathological kinking, caused by aortoarteriitis and fibrose--muscular displasia--in 197 (23.9%), hypoplasia of arteries--in 54 (6.5%), aortoarteriitis--in 73 (8.8%) patients. Stages I-IV ischemia together with proven affection of extracranial arteries served as indication for surgical treatment of chronic cerebro-vascular insufficiency. Depending on character of the arteries affection 11 kinds of operative interventions were conducted, using complex intraoperative program of the brain defense. Total number of reconstructive operations performed was 967. In 752 (91.2%) patients immediate good and satisfactory results were noted. In the late period 450 patients were examined: good results were achieved in 64.9%, satisfactory--in 22%, in 30 (6.7%) improvement did not occur and 28 (6.2%) died. Introduction of the proposed complex examination and surgical treatment program have permitted to improve the results of treatment of the patients, suffering chronic brain ischemia.

[Surgical methods of correction of the renal transplantation complications]. / Khirurgicheskie metody korrektsii oslozhnenii transplantatsii pochki.

Surgical complications were studied, which occurred in 55 (20.37%) of 244 patients, to whom 270 renal allotransplantation (RAT) operations were performed. In 19 (34.6%) of recipients the urological complications were noted, in 20 (34.4%)--spontaneous rupture of the transplant, in 11 (20%)--lymphocele, in 5 (9.1%)--arrosive hemorrhage from the renal transplant artery. The methods of surgical correction of the RAT complications were optimized. Urological complications and spontaneous rupture of the renal allotransplant were revealed most frequently. An acute rejection reaction constitutes the most frequent cause of spontaneous rupture of the renal allotransplant. While the RAT surgical complications occurrence an active surgical tactics is adopted.

[Elective operative procedures in patients with chronic end-stage renal failure]. / Planovye operativnye vmeshatel'stva u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu v terminal'noi stadii.

The results of 92 elective operative interventions, performed in 71 patients with chronic renal insufficiency (CRI) in terminal stage, were studied. Performance of elective operative interventions in patients with CRI in terminal stage, to whom the treatment, using chronic hemodialysis, was conducted, allows to increase quality of their medical and social rehabilitation considerably and the efficacy of kidney transplantation (KT). They constitute effective and safety method of treatment in complex surgical program of patients preparation to KT performance.

[Causes of renal allotransplant loss during first year after renal transplantation]. / Prichiny poteri pochechnogo allotransplantata v techenie pervogo goda posle peresadki pochki.

The causes of the renal allotransplant (RAT) removal during first year after the kidney transplantation performance were studied. Of 270 renal allotransplantations performed in 56 (20.5%) of recipients the transplant was removed during first year after the operation. In 36 (64.3%) of patients transplantnephrectomy was performed for immune conflict presented, in 12 (21.4%) of observations purulent-septic complications have become the cause of RAT removal and in 8 (14.3%)--the vascular causes (thrombosis of RAT artery, vein).

[Surgical strategies in spontaneous rupture of renal allograft]. / Khirurgicheskaia taktika pri spontannom razryve pochechnogo allotransplantata.

The methods of surgical treatment of spontaneous rupture of renal allotransplant (RAT) were studied up in 21 patients. In 17 (80.9%) of patients the RAT rupture was caused by an acute reaction of rejection (ARR), in 14.3% of observations--by an acute necrosis of tubules, in 2 (9.5%)--by renal vein thrombosis and in 2 (9.5%)--by an ischemic damage of the transplant. Surgical treatment of the RAT spontaneous rupture (except the cases with rupture due to renal vein thrombosis) must be managed by the hemorrhage stoppage, the RAT tissues strain reduction (decapsulation and the cross-like capsulotomy), conduction of its intraoperative anticrisis and antiischemic defense with subsequent complex therapy for ARR and the transplant dysfunction. Application of such a tactics of treatment have permitted to secure the RAT and its functions in spontaneous rupture in 82.4% of observations. The transplant survival was registered in terms up to one year in 64.7% of observations.

[Specifics of preparation of patients with polycystic renal disease for forthcoming kidney transplantation]. / Osobennosti podgonovki patsientov s polikistoznoi bolezn'iu k transplantatsii pochki.

Results of treatment of 28 patients with polycystic kidney were presented. In 12 (42.9%) patients with terminal stage of chronic renal insufficiency transplantation of kidney (TK) was performed without preliminary nephrectomy or nephrectomy was done simultaneously with TK. In 16(57.1%) patients nephrectomy was performed in stage of preparation to allotransplantation. Were established advantages of preliminary performance of nephrectomy in patients with polycystosis on stage of preparation to TK: in one-year follow-up the settle down of renal allotransplant was noted in all patients.

[Surgical infection in reconstructive vascular surgery]. / Khirurgicheskaia infektsiia v rekonstruktivnoi angiokhirurgii.

There were analyzed the results of treatment of 1514 patients, to whom different reconstructive operations on vessels were performed. In 88 (5.8%) of them infectious-inflammatory complications occurred. Three groups of complications were assigned: superficial (in 43.2% observations), deep (in 44.3%) and common infectious (in 12.5%). To all the patients treatment was conducted, in 93.2% of observations positive result was noted, mortality had constituted 2.3%, amputation of lower extremity was performed in 4.5% of patients. There were assigned predisposing factors for the infectious complications occurrence. Complex of curative and prophylactic measures for application in reconstructive vascular surgery was elaborated.

[Technical aspects of revascularizing transplantation of omentum majus on myocardium, upper extremity and brain]. / Tekhnicheskie aspekty revaskuliariziruiushchei transplantatsii bol'shogo sal'nika na miokard, verkhniuiu konechnost', golovnoi mozg.

There was the technique elaborated for the revascularized transplantation of the omentum majus flap on myocardium, upper extremity and brain. There were performed 26 operations of nondirect revascularization of myocardium, 3--of microsurgical transplantation on upper extremity and 3--on the brain.

[The use of greater omentum in revascularization of ischemia-affected organs]. / Ispol'zovanie bol'shogo sal'nika v revaskuliarizatsii ishemizirovannykh organov.

Anatomo--morphological peculiarities of greater omentum (GO) in 63 patients, in whom its flap was applied for revascularization of ischemized tissues of extremities, myocardium and the brain, were studied up. Microsurgical transplantation of the GO free flap was performed in 41 patient, omentocardiopexy without the break of the GO vascular pedicle--in 22. Possibilities of the GO application for the ischemized organs revascularization were estimated.

[Estimation of the cerebral hemodynamics in patients with pathological kinking of arteries originated from the aortal arch according to angiography]. / Otsenka sostoianiia tserebral'noi gemodinamiki u bol'nykh s patologicheskoi izvitost'iu arterii, iskhodiashchikh iz dugi aorty, po dannym angiografii.

The state of cerebral blood flow was studied in 81 patients with chronic disorder of cerebral blood circulation using angiographic investigation. Various kinds of pathological kinking of the vessels, originated from the aortic arch, the reducing of their contrasting, the lowering of the blood flow velocity were disclosed. Enhancement of the capacity reserve of vascular channel while conducting the probe with sodium nitroprusside more than by 10% gave evidence about possibility of the blood flow restoration after reconstruction of the affected artery.

[A method choice in the myocardial revascularization in the ischemic heart disease on the basis of clinico-angiographic data on patients]. / Vybor metoda revaskuliarizatsii miokarda pri ishemicheskoi bolezni serdtsa na osnove kliniko-angiograficheskoi kharakteristiki bol'nykh.

Of 230 patients, examined by coronarography, in 219 the signs of the ischemic heart disease were revealed. The criterions were elaborated for differentiated choice of the myocardial revascularization method.

[Surgical treatment of symptomatic arterial hypertension]. / Khirurgicheskoe lechenie simptomaticheskoi arterial'noi hipertenzii.

During ten years 57 patients with symptomatic arterial hypertension were examined. The suprarenal gland disease was diagnosed in 31 patient, the renal arteries disease--in 16, the thoracic aorta coarctation--in 10; 35 patients were operated on. The radical intervention conduction have promoted the arterial pressure normalization in early postoperative period.

[The choice of the surgical procedure in treating a chronic disorder of the arterial blood supply to the brain]. / Vybor khirurgicheskoi taktiki pri lechenii khronicheskogo narusheniia arterial'nogo krovosnabzheniia golovnogo mozga.

Results of surgical treatment of 336 patients with chronic disorder of the brain arterial blood supply were summarized. Surgical tactics provided for maximum brain revascularization by means of simultaneous intervention on two-three arteries. Technical aspects of operative procedures elaborated in clinic are presented. Late follow-up results noted were good in 60.1% and fair--in 25.7%.

[The effect of ticlid on the late result after the surgery of the brachiocephalic trunk arteries]. / Vliianie tiklida na otdalennyi rezul'tat posle vypolneniia operatsii na arteriiakh plechegolovnogo stvola.

No ischemic insult, myocardial infarction, death due to cardiovascular pathology was observed in 138 patients, to whom after the operation on the arteries of truncus brachiocephalicus the ticlid was administered. At a comparison group (120 patients) in 3 the myocardial infarction have occurred (one patient died), in 2--an ischemic insult. After the ticlid application the positive late follow-up result was noted in 93.1% patients, without it--in 70.5%. The preparation compliance is good.

[Reconstructive surgery in atherosclerosis of the femoral-popliteal- tibial segment]. / Rekonstruktivnye operatsii pri ateroskleroticheskom porazhenii bedrenno-podkolenno-bertsovogo segmenta.

Results of surgical treatment of 368 patients with atherosclerotic occlusions of popliteal-tibial segment are analyzed. The operation method choice was based on classification, discerning five types of lesion: I type--isolated a. femoris superficialis (AFS) occlusion; II type--AFS occlusion, a. femoris profunda stenosis; III type--extended occlusions of superficial, popliteal, deep arteries and shin arteries; IV type--the lesion of distal part of a. femoris communis and a. poplitea; V type--the popliteal artery occlusion with the process transient on shin arteries.