[ASYMPTOMATIC INTRAHEPATIC CHOLANGIOCARCINOMA].

Objective: To analyze the cases of intrahepatic cholangiocarcinoma posthumous diagnosis in patients with concomitant atherosclerotic lesions of the femoral arteries. Key points: The present report describes the clinical observation of a rare tumor - intrahepatic cholangiocarcinoma. Difficulties of its early diagnosis is a combination of symptoms of tumor progression with pain in the lumbar spine, the latter in the presence of concomitant femoral arteries of atherosclerotic lesions, characterized by pain similar localization has led to delay cancer research. Conclusion: Upgrading differential diagnostic procedures with a combination of pain in the lumbar spine with symptoms of tumor progression through the use of a computer and / or positron emission tomography study of plasma levels onkomarkёra CA-19-9, magnetic resonance contrast holangiopankreatikografii, would in this clinical case in a timely manner to make the correct diagnosis.

[A combined method to protect the brain during operations on the brachiocephalic arteries].

Based on the outcomes of surgical management of thirty-six patients diagnosed with atherosclerosis of carotid arteries and a further thirty-five 35 patients presenting with atherosclerotic lesions of the subclavian and vertebral arteries the authors substantiated a differentiated therapeutic policy aimed at protecting the brain from ischaemia, having demonstrated efficiency of cerebral protection with nimodipine and rheopolyglukin in patients subjected to operations on the subclavian and vertebral arteries and feasibility of combining this method with the application of a temporary puncture carotid-artery bypass graft during carotid endarterectomy. Functional possibilities of puncture-mediated bypass grafting of the carotid artery was confirmed by studying the blood flow in the common, internal carotid and median cerebral arteries on the operated side and ipsilateral side in patients with and without a bypass graft applied.

[Assessing clinical efficacy of the generic clopidogrel "Egutromb" in roentgenosurgical practice].

The study comprised a total of ten 47-to-62-year-old (mean age 52.8±2.05 years) patients presenting with coronary artery disease. All patients underwent coronography whose findings were used to determine the indications for stenting of coronary arteries in order to correct coronary insufficiency with due regard for the international guidelines. All the patients received therapy with acetylsalicylic acid at a dose of 75-125 mg/day. As preoperative preparation in all cases the patients were given the generic clopidogrel Egitromb at a daily dose of 75 mg given 120 hours (5 days) prior to the intervention. The clinical effect of the drug was assessed by the presence or absence of relapses of cardiac angina, or the development of acute coronary syndrome within 1 month following the endovascular intervention performed. The state of the vascular-thrombocytic haemostasis was evaluated by the following parameters: spontaneous blood platelet aggregation, induced by ADP given at a dose of 5 µg/ml and 1.25 µg/ml. The obtained initial positive findings of studying clinical efficacy of the generic clopidogrel "Egitromb" manifesting itself in the absence of early stent's thromboses and relapses of cardiac angina within the first month of treatment, as well as in a significant decrease of induced blood platelet aggregation with ADP at a dose of 5 µg/ml and 1.25 µg/ml suggest the necessity of continuing further study thereof in roentgenosurgical practice.

[Remote results of surgical treatment management for atherosclerotic lesions of the brachiocephalic trunk].

AIM: Optimization of diagnosis and surgical treatment of lesions of the brachiocephalic trunk (BCT) based on analysing the course of cerebrovascular disease in operated and nonoperated patients presenting with atherosclerotic lesions of the BCT. MATERIALS AND METHODS: During the period form 1992 to 2008, we followed up a total of sixty-three patients presenting with atherosclerotic lesions of the BCT, who were subdivided into two subgroups: Subgroup One ("surgical") was composed of the patients subjected to reconstructive operations on the BCT (n =25), and Subgroup Two ("therapeutic") comprised nonoperated patients (n =38). RESULTS: Patients from Subgroup One underwent a total of 25 operations: twelve patients endured intrathoracic reconstruction with linear prosthetic repair of the BCT and the remaining thirteen sustained balloon-mediated dilatation of the BCT. Intraoperative restoration of the BCT's patency was achieved with all interventions. The reoentgenoendovascular operations were accompanied with no complication. In 2 cases (16.7%) prosthetic repair of the BCT was followed by thrombotic complications (1--thrombosis of the BCT and 1 thrombosis of the stenosed ipsilateral vertebral artery) in the early postoperative period. During the follow-up period, patients of the surgical subgroup developed 3 strokes (12.0%), 3 myocardial infarctions (12. 0%) and 1 sudden death (4.0%). Over the 5-year period, patients with the BCT le-sions resulting from the natural course of cerebrovascular disease developed 14 ischaemic strokes (31.6% (chi 2=26.4, p<0.0001), 5 (13.2%) myocardial infarctions (chi 2 =0.14, p =0.712), and 2 (5.3%) cases of sudden death. The relative risk of stroke in the therapeutic subgroup amounted to 32.6%. A decrease in the absolute risk of ischaemic stroke resulting from reconstruction of the BCT amounted to 24.8%. Hence, in order to prevent one stroke it is necessary to operate on four patients presenting with BCT lesions. CONCLUSION: Reconstructive operations on the BCT are efficient in relation to prevention of ischaemic strokes. However, intrathoracic reconstructions were accompanied andfollowed by a relatively high level o fcomplications. Therefore, it is necessary to use noninvasive methods of diagnosis to reveal patients presenting with BCT lesions at the stage of moderate stenoses and to subject them to preventive operation of balloon-mediated angioplasty.