[Comparative 3-year results of phlebectomy and thermal ablation for lower limb varicose veins]. / Sravnitel'nye trekhletnie rezul'taty flebéktomii i termoablatsii pri varikoznoi bolezni nizhnikh konechnostei.

OBJECTIVE: The study was aimed at comparing clinical and ultrasonographic results during 3 years of postoperative follow up of patients presenting with lower limb varicose veins (LLVV) and subjected to either surgical or thermal-ablation procedures for removal of pathological reflux along the great saphenous vein (GSV) within the femur The study included a total of 185 patients with clinical class C2-3 LLVV in the system of the GSV. The patients were divided into three groups: Group One consisted of 63 patients subjected to short stripping of the GSV trunk + treatment of the perforant veins (66.7%); Group Two comprised 61 patients undergoing endovenous laser coagulation (EVLC) of the GSV trunk + EVLC of the perforant veins (73.7%); Group Three was composed of 61 patients undergoing radiofrequency ablation of the GSV trunk + ELVC of the perforant veins (70.4%). Complaints were dynamically assessed by the VCSS scale with ultrasonographic duplex scanning. It was revealed that pathological reflux along the GSV trunk on the crus at 1, 2 and 3 years of follow up was registered: in Group One in 33.3, 36.3 and 39.1% of cases, respectively; in Group Two in 15, 14.2 and 25% of cases, respectively; and in Group Three - in 11, 18.1 and 23.8% of cases, respectively. Group One patients at 1 year were found to have developed vertical refluxes emerging on the femur along the GSV tributaries (22.1% of cases), the presence of horizontal refluxes along newly-formed perforant veins (44.4% of cases). The diameter of the GSV trunk on the crus statistically significantly increased with years in all groups. The average diameter of the perforant veins increased at the same time periods of follow up. Alterations of venous haemodynamics revealed on ultrasonographic examination were accompanied by varicose syndrome but exerted no significant effect on subjective symptomatology in patients during 3 years of follow up. The obtained findings are indicative of progression of LLVV in part of surgically treated patients, which requires dynamic follow up and carrying out systemic pharmacotherapy.

[Molecular organization of the N-terminal region of delta-endotoxin of Bacillus thuringiensis subspecies alesti]. / Molekuliarnaia organizatsiia N-kontsevogo domena delta-éndotoksina podvida alesti Bac. thuringiensis.

The tryptic peptide sequences of the N-terminal domain ("true toxin") of delta-endotoxin of Bac. thuringiensis subspecies alesti carrying 282 amino acid residues were determined. A comparison of these sequences with the primary structures of delta-endotoxin of subspecies kurstaki (K-1, K-73) determined by an analysis of corresponding structural genes revealed a conservative region of "true toxin" (residues 29-346) and a hypervariable region (residues 347-617) carrying multiple (not less than 50%) substituents of amino acid residues. It is essential that the amino acid substituents in the variable region are distributed unevenly, being grouped into several highly variable sites carrying 7 to 31 residues. Besides, tryptic peptides of subspecies alesti delta-endotoxin were found to contain peptides having no homologs in the structures of subspecies kurstaki delta-endotoxins. It seems probable that such an uneven distribution of amino acid substituents in the structures of delta-endotoxins of subspecies alesti and kurstaki reflects the functional differences in the two halves of the N-terminal domain ("true toxin"), one of which (i. e., conservative) may be responsible for the toxic effect, while the other one (i. e., variable) seems to participate in toxin interactions with the appropriate receptors of larvae gut.