[Subclavian-femoral bypass grafting in treatment of lower-limb critical ischaemia in an elderly patient with an inoperable thoracoabdominal aortic aneurysm].

The authors describe herein a variant of successful palliative treatment of a 73-year-old male patient suffering from an inoperable thoracoabdominal aortic aneurysm accompanied by coronary artery disease, painless myocardial ischaemia, pathological tortuosity of the left internal carotid artery, type 2 diabetes mellitus, and chronic renal insufficiency. The patient was admitted to the Department of Vascular Surgery presenting with critical ischaemia of his left lower limb, complaining of numbness and gnawing pain both at rest and while walking a distance of up to 10-15 metres, demonstrating portions of skin ischaemia up to 2 cm long on the anterior surface of the femoral upper third, clinical signs of a thoracoabdominal aortic aneurysm, the presence of a pulsating formation in the projection of the infrarenal portion of the abdominal aorta measuring 5x6 cm. The diagnosis was made based on the findings of instrumental examination, ultrasonography, multispiral computed tomographic angiography, and coronarography, having confirmed the following: a thoracoabdominal aortic aneurysm, occlusion of the left common artery and anterior iliac artery, coronary artery disease, painless myocardial ischaemia, pathological kinking of the left internal carotid artery, chronic renal insufficiency, and type 2 diabetes mellitus. The first stage of the operation to perform consisted of mammary- coronary bypass grafting of the anterior interventricular artery from the left anterior lateral thoracotomy. Despite certain improvement in the condition of the coronary bed, the patient remained inoperable due to the presence of pronounced multipleorgan pathology and a high risk of lethal complications. Given these circumstances, the second stage of the intervention consisted in performing a palliative operation of subclavian-femoral bypass grafting on the left with a reinforced polytetrafluoroethylene stent graft.

[Plasma lipids oxidation in patients with occlusive atherosclerosis of lower extremities and ischemic heart disease].

Dynamics of lipoprotein oxidation in blood plasma was studied by Cu-induced plasma oxidation in 114 patients with atherosclerosis of lower extremities of various severity with and without ischemic heart disease. Preparedness of plasma lipoproteins to oxidation in patients was higher than in healthy subjects. Degree of oxidizeability increased with increase of severity and extent of atherosclerosis and was highest in patients with atherosclerosis of lower extremities and ischemic heart disease. There were no significant differences between groups of patients with various severity and extent of atherosclerosis in levels of total cholesterol and triglycerides as well as in other parameters of lipid spectrum. Correlation analysis revealed no relationship between age of patients and degree of plasma oxidizeability.

[Mini-invasive technologies in diagnosis and treatment of major vessels diseases].

Experience with 150 endovascular stents and endoprostheses including ones of vertebral and carotid arteries (first experience in Russia) is analyzed. Mini-invasive surgery is indicated for patients with isolated arterial lesions (segmental stenosis, short occlusions), changed and hard for surgery parts of vascular system (renal, visceral arteries, branches of aortic arch), restenosis after traditional surgeries and also for patients with severe concomitant diseases. Rate of complications of carotid endovascular stenting was 4,3%. The follow-up ranged from 2 months to 5,5 years. There were no restenoses in the stented zone. Complete absence of complains and regress of neurological symptoms were seen in 89% patients.

[Anti-Helicobacter pylori antibodies in cases of stomach polyps].

UNLABELLED: The goal of the study was to study the content of anti-Helicobacter pylori antibodies (at-HP), their diagnostic and prognostic significance for stomach polyps. MATERIALS AND METHODS: The content of anti-Helicobacter antibodies (IgG-HP; IgA-HP; IgM + IgG + IgA-CagA-HP) was determined in the blood serum by way of immune-enzyme analysis of 46 patients with stomach polyps. Such test systems as EcoLab (Elektrostal) and Vector-Best (Novosibirsk) were used. RESULTS: Stomach polyps are accompanied by a regular increase of at-HP--serologic markers of helicobacteriosis content in the blood serum. The most significant increase in terms of percentage and absolute values is the IgG-HP concentration increase (88%, average titre 1: 1060, in the control group--1: 110) and summary (IgM + IgG + IgA) antibodies to CagA-HP (86%, average titre 1 : 180, in the control group 1 : 10), while the IgA-HP level is increased in 46%, average titre 1 : 660, in the control group 1 : 120). The IgG-HP content increase reflects the inflammatory process intensity, IgA-HP--atrophic process intensity, (IgM + IgG + IgA)-CagA-HP--1 intensity of proliferative processes of stomach polyps. CONCLUSION: The at-HP content increase is a diagnostic criterion for helicobacteriosis and reflects the intensity of infectious, inflammatory, atrophic and proliferative processes in cases of stomach polyps. A multiple long-lasting increase of the at-HP concentration may be one of the indications for administering an antihelicobacter stomach polyp therapy including administration before polypectomy.

[Noninvasive methods of the examination in surgery of obliterating atherosclerosis of lower extremity arteries]. / Neinvazivnye metody issledovaniia v khirurgii obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei.

The purpose of the study was to determine surgical policy in atherosclerotic lesions of aorta and lower extremities arteries on the basis on non-invasive diagnostic methods--duplex scanning (DS) and computer tomographic angiography (CTA). From 1998 to 1999 47 patients were examined on this program (DS + CTA). At the first stage of the study, 17 patients underwent translumbal aorto-arteriography at the same time with DS and CTA. Analysis of the angiograms revealed that sensitivity of angiography for detection of lesions in aorto-iliac segment was 94%, in femoro-popliteal segment--78%. Diagnostic mistakes were associated with partial thrombosis of aneurysm's lumen, as a result of which the aorta looked non-dilated in angiograms. Femoral arteries contrasted unsatisfactory in 4 patients because of low collateral blood velocity distal to occlusion of iliac arteries. Initial segments of deep and superficial femoral arteries closed each other in angiograms on anterior-posterior projection, and it also led to low potential of angiography in assessment of femoral arteries state. Complex of non-invasive diagnostic methods (DS + CTA) allowed to correct diagnosis in each case. The methods complemented one another: CTA permitted to make three-dimensional reconstruction of vascular tree and to study its on various projections; DS--to study the vascular wall's state and hemodynamical parameters of blood flow. At the second stage of the study, high sensitivity of DS and CTA allowed to reject traditional angiography in preoperative period. Intraoperative findings confirmed the provisional diagnosis completely.

[Ultrasonic diagnosis of complications after bypass operations in lower extremities arteries]. / Ul'trazvukovaia diagnostika oslozhnenií posle shuntiruiushchikh operatsií na arteriiakh nizhnikh konechnosteí.

After reconstructive vascular operations the patients need dynamic control and non-invasive monitoring. The purpose of the study was to reveal the potential of duplex scanning (DS) in assessment of bypasses function and diagnosis of postoperative complications. 148 patients after aorto-femoral and femoro-popliteal bypass, including patients with late postoperative complications (shunt thrombosis, stenosis or spurious aneurysm of anastomosis) were examined. Energy colored DS was performed in scans "Toshiba" SSH-140 and "Acuson" Sequoia-512. In ultrasonic diagnosis the vascular graft was imaged as a tube structure with hyperechogenic walls and distinct pulse; it was easy to detect the material of vascular graft. In examination of distal anastomosis the initial portions of efferent arteries were usually imaged distinctly. In satisfactory distal vascular bed, the shunt's blood flow did not differ from normal blood flow. In patients with multifocal lesions the spectrum of shunt's blood flow was similar to main-changed blood flow. Substantial change of blood velocity was revealed in complications (aneurysm or stenosis of anastomosis). Spurious aneurysm was imaged as a hypoechogenic pulsating formation. Thrombotic masses in aneurysm's cavity were distinctly detected at DS, unlike at angiography. In case of anastomosis insufficiency, the suture's disrupted filaments and free branch's ends could be imaged. Stenosis of anastomosis was characterized by visible lumen's stenosis, local thickening and unevenness of wall, spectrum's change and blood velocity increase. In shunt's thrombosis the DS permitted to follow the thrombed graft's path, to reveal the cause of thrombosis and to detect the condition of outflow tract. The authors regard DS as a method of choice in dynamic control for state of bypasses and arteries in patients after reconstructive operations in lower extremities arteries.