[Glycocalyx as a determining factor in development of endothelial venous dysfunction and possibilities of correction thereof]. / Glikokaliks ­ opredeliaiushchii faktor v razvitii éndotelial'noi venoznoi disfunktsii i vozmozhnosti ee korrektsii.

Modern vascular surgery has the data on a substantial role of the endothelium in pathogenesis of vascular diseases. Endothelial dysfunction is associated with a wide range of pathological processes including those in chronic diseases of lower-limb veins. The discovery of the endothelial glycocalyx made it possible to evaluate its role in the development of endothelial dysfunction as a trigger mechanism in impairment of venous blood flow. The understanding of the unifying role of endothelial dysfunction in pathology in various fields of medicine provides a possibility of predicting the development of serious socially significant diseases such as cardiovascular diseases, diabetes mellitus, obstetrical complications, and to correct the conditions associated therewith. The present study was aimed at carrying out a systematic literature review, thus making it possible to evaluate the role of the endothelial glycocalyx in the development of endothelial dysfunction, as well as to determine therapy with sulodexide capable of decreasing the probability of the onset of endothelial dysfunction at the expense of an anti-inflammatory, antithrombotic, and angioprotective effect on the endothelial wall.

[Standard and new regimens of anticoagulation for pulmonary thromboembolism].

The article discusses various options of anticoagulant therapy for pulmonary thromboembolism and the main criteria of medication choice including the use of unfractionated heparin, low-molecular-weight heparins, and rivaroxaban. The data presented are based on the own experience and results of international clinical trials.

[Endothelium-dependent factors of pathogenesis of a relapse of varicose disease: a diagnostic concept and treatment policy].

A relapse of lower-limb varicose disease (LLVD), despite the development of surgical achievements in surgical technologies is currently an important problem of present-day phlebology. A considerable factor of its pathogenesis is endothelial dysfunction (ED). The results of clinical studies of "false" relapses (n=32) and the control group were indicative of pronounced ED. Studying the level of leukocytes confirmed a hypothesis on a "leukocytic" trap at the level of the varicose veins of lower extremities. The authors analysed the dynamics of certain markers of ED (CECs, VCAM-1, P-selectin, E-selectin t-RA, endothelin-1), suggestive of the degree of ED severity, revealing a tendency towards normalization of the ED markers on the background of phlebotrophic therapy (Antistax). The carried out study also makes it possible to conclude that the level of endothelemia and biochemical indices of ED may serve as an evaluating marker of the activity of processes of varicose transformation of veins in patients with a relapse of the disease.

[Modern capabilities of the diagnostics and surgical treatment of tumors of the small bowel].

During the recent 6 years (2004-2010) tumors of the small intestine were diagnosed in 19 patients. Mean age of the patients with benign tumors was 63 years, with malignant tumors--57 years (age variations from 19 to 82 years). There were 16 (84%) men and 3 (16%) women. In 9 patients tumors were localized in the jejunum, in 10 patients--in the ileum. Complications appeared in 11 patients which was the cause of emergency operations. In 33.3% of the patients clinical manifestations of benign tumors of the small bowel were as episodes of intestinal bleedings which were not intensive as a rule, but were of recurrent character. Malignant tumors of the jejunum had clinical manifestations in 87% of patients. Most frequent symptoms were spastic or diffuse pains in the abdomen (63% of the patients), loss of the body mass (50%), intestinal obstruction (27.7%), intestinal bleedings (5.5%).

[Endothelial dysfunction in patients with lower-limb varicose disease and possibilities of correction thereof].

Endothelium as the main structural unit of the vessel appears to exert a considerable influence on the processes of regulation of the cardiovascular system. The authors generalize herein and present the findings of the studies aimed at investigating endothelial dysfunction in varicose disease. Based on analysing the results of various methods of study they show importance of endothelial dysfunction, followed by discussing possibilities of medicamentous correction thereof, proceeding from pathogenetic mechanisms of its development.

[Treatment of early stages destructive pancreatitis].

The algorithm of the acute destructive pancreatitis' treatment is based on the analysis of 167 patients data. It includes medical activities on patient's admission, basic medication components and indications to the operative treatment. The application of the algorithm ensured satisfactory results of the treatment in 94% of patients with the destructive pancreatitis on early stages.

[Introduction of regulations of administration of blood components into clinical practice].

The authors describe "The regulations of administration of blood components" taking into account the purposeful parameters of homeostasis, which must be obtained during transfusion of blood components. The volume of erythrocytes and plasma transfused in the Center during the first and second quarters of 2006 and 2007 years were compared with the main indicators of the medical activities. The introduction of the limiting strategy of hemotransfusions based on the advantages of the world conclusive medicine was not followed by worse results of treatment, but promoted economy of facilities and blood components for the country.

[Magnetic resonance imaging in the diagnosis of acute pancreatitis].

Overall 52 patients with acute pancreatitis were examined with MRI and spiral CT. The examination was performed during 24 hours from admission time. Results of examination were assessed confidentially by 3 experts with 5-scores scale. Non-parametric chi-square criterion was used for significances detection. MRI demonstrated advantages over spiral CT in diagnosis of fat necrosis, sequestration and hemorrhages. MRI compares well with contrast CT in diagnosis of pancreonecrosis. MRI permits to diagnose destructive lesions in pancreas without contrast agent, and accordingly without additional effect on pancreas and kidneys. It is concluded that MRI is high informative method in diagnosis of acute pancreatitis and its complications.

[Endothelial dysfunction in pathogenesis of venous transformation].

The article deals with the findings obtained by present-day studies in pathophysiology of venous outflow disorders. The authors highlight a considerable role of the endothelium of the vascular wall resulting from its lesion with metabolic products of activated leukocytes in the development of varicose transformation. Also studied was the dynamics of the endothelial dysfunction marker, i.e., the number of the circulating endothelial cells (CECs). In so doing, amongst the patients presenting with segmental subcutaneous varicosity with reflux along the superficial and perforating veins, endothelial dysfunction was revealed most frequently, i.e., in 91% of the cases. It was proved that the CEC index might be used as a marker of endothelial dysfunction in patients presenting with varicose disease. An increase in this parameter above 6 x 10(4) cells per 1 ml of blood should be considered as a reliable manifestation of an endothelial lesion in diseases of the peripheral veins. By the degree of severity of endotheliemia, one may judge of the activity of the process of varicose transformation of veins, which makes it possible to timely take appropriate corrective measures. A priority trend in medical treatment of venous transformation is assigned to diosmine-based phlebotonics.

[Long-term results of surgical treatment of thymomas at the patients with generalized myasthenia].

Results of diagnosis and treatment of 150 patients with thymoma and generalized myasthenia are analyzed. The results of examination were registered before surgery, and also in 1, 3, 5 and 10 years after one. It is demonstrated that thymoma is potentially malignant tumor with risk of recurrence and requires long follow-up of patient after operation. Morphologic type and stage of tumor, severity of myasthenia are the main predictors in the prognosis of surgical treatment. Thymomectomy with excision of fatty tissue of anterior mediastinum is absolutely indicated for this severe category of patients, and it decreases the risk of tumor progression. Mortality of patients depends not only on tumor growth or recurrence but also on concomitant myasthenic disorders.

[The clinical course of portal hypertensive gastropathy after ligation of esophageal varicose veins].

Portal hypertensive gastropathy (PHG) is a pathological process in the gastric mucosa (GM) that develops due to portal hypertension (PH) and bears a high risk of hemorrhage. Eradication of esophageal varicose veins (EVV) is one of important factors influencing the course of PHG. The purpose of this study was to investigate the course of PHG after eradication of EVV in patients with hepatic cirrhosis (HC). Fifty-two HC patients (39 men, 13 women, mean age: 56.5 years), who underwent EVV ligation, were included in the study. The number of patients with PHG increased three months after EVV ligation; the severity of EVV also increased. The course of PHG differed depending on the time of its onset after surgery. Patients who had not had PHG before EVV ligation developed its signs in 75% of cases. In 31.3% of these patients PHG was resolved, while in 43.6% it did not change during the whole term of observation. In patients who had had PHG before EVV ligation, the latter resolved in 8.3% of cases, became more severe in 33.3% of cases, and remained at the same level in 58.3%. The authors distinguish four types of PHG course. Newly-developed PHG that occurred after EVV eradication, the signs of which remained during the whole period of observation (type I), took place in 13.5% of patients; transient PHG, the signs of which disappeared within three months of observation (type II), was seen in 15.4% of patients; persisting PHG, which was observed before EVV ligation and did not change during the whole study period (type III), was found in 40.3% of patients; progressing PHG, observed before or after EVV ligation and the severity of which grew during the observation period (type IV), was revealed in 23.1% of patients. In 4 (7.7%) of patients PHG signs were absent during the whole time of the study. PHG hemorrhage was observed in 11.5% of the patients. Thus, EVV ligation presents a risk factor of the onset and progression of pre-existing PHG in patients with HC.

[Differential treatment of gastroduodenal ulcerous bleedings].

Results of treatment of 827 patients with bleedings from chronic gastric and duodenal ulcers are analyzed. Potentialities of various methods of endoscopic hemostasis were studied. Diathermocoagulation was the least effective method of hemostasis (59%). Irrigation of the bleeding source provided hemostasis in 88.7% patients, combined methods - in 94.1%. Methods of irrigation are appropriate in diffuse bleeding from ulcer (Forrest 1B). Stream bleeding (Forrest 1A) is indication for combined methods of hemostasis. It is demonstrated that type of endoscopic procedure does not influence rate of bleeding recurrences. The main element of conservative treatment of gastroduodenal ulcerous bleedings is antisecretory therapy. Proton pump blockers are more effective than H2-blockers; the rate of recurrences was 5.0 and 28.9%, respectively. Prediction of bleeding recurrences and preventive operations are the main way to treatment results improvement.

[The long-term results of the dynamic observation of patients with adrenal gland adenomas].

The authors demonstrate the results of many years of observing patients with hormone-inactive adrenal gland adenomas. The subjects were 80 patients observed during 8 months to 12 years. The study shows that slow growth is generally typical of these adenomas. In 15% of patients an average growth of 1 mm/year was noted; this growth did not exceed 10 mm throughout the whole period of observation. The researchers also observed changes in the clinical symptoms and hormonal parameters over time. The study demonstrates that long existence of adenomas do not aggravate the clinical course of arterial hypertension and diabetes mellitus, and do not express any hormonal activity. The study established more precise indications to dynamic observation and its algorithm.

[Corrective plastic surgeries as a conclusive stage of surgical treatment of patients with alimentary-and-constitutional obesity].

The authors performed analysis of Russian and foreign literature (64 items) dedicated to long-term postoperative problems following corrective plastic surgery for morbid obesity. The analysis shows that literature does not contain clear criteria for patient selection and timing of surgery, and does not provide sufficient coverage of plastic surgical techniques. There are no data on the rate of complications and complex preventive measures.

[Independent medical processing enterprises as innovative organizational model for market of medical services].

In Russia, current stage of health care development is characterized by occurrence of various problems. Most of them are related to cooperation between participators of market of medical services. Different options are proposed to resolve cooperation problems embedded into medical services market with emphasis on development of ultimately different medical processing enterprise with brand-new organizational and functional structure. Its functioning is based on process management logistics. The company broad professional experience allows to implement above-mentioned managerial structure and make it function as well as claims positive perspectives of described option.

[Echinococcosis of the heart].

Basic clinical and special methods of diagnosis of cardiac echinococcosis are described. Among 12 patients with cardiac echinococcosis 5 patients have been operated and 7 patients have been not. Five of seven non-operated patients died during 1 year due to disruption of the cysts. All 5 operated patients survived. It is demonstrated that surgical treatment should be performed with artificial extracorporeal circulation, and postoperative anti-recurrent anti-helminth therapy is mandatory. Medication before surgical procedures is contraindicated because it leads to cysts disruption with high risk of lethal outcome.