[Sulodexide in treatment of chronic venous insufficiency. Results of the All-Russian multicenter programme ACVEDUCT]. / Sulodeksid v lechenii khronicheskoi venoznoi nedostatochnosti. Itogi Vserossiiskoi mul'titsentrovoi programmy ACVEDUCT.

INTRODUCTION: Pharmacotherapy occupies one of the leading places in comprehensive treatment of lower-limb chronic venous diseases (CVD) and their complications. At the same time, there are not so many therapeutic agents intended for treatment of CVD and possessing evidence-based efficacy. Sulodexide (registered in Russia as Vessel Due F) is a drug with a confirmed therapeutic effect in patients with a moderately severe course of chronic venous disease or its late stages. However, the experience of using it in Russia for treatment of patients presenting with initial manifestations of chronic venous insufficiency (CVI) is still scarce. PATIENTS AND METHODS: The data concerning the use of Vessel Due F in the routine practice of treating CVD in Russian patients were collected and assessed within the framework of the ACVEDUCT programme. This observational prospective non-controlled multicentre programme included patients routinely prescribed by their attending physician Vessel Due F as a solution for injections and/or soft capsules in accordance with the registered in the Russian Federation instruction for use. A total of 2,263 patients took part in the programme. RESULTS: The majority of the patients prescribed sulodexide were diagnosed as having CEAP class C3 (38.4%) and class C4 (35.6%) CVD. Treatment was accompanied and followed by a decrease in the symptoms' severity observed in 56.4% of patients and a decrease in the number of symptoms in 42.8% of patients (thus positive dynamics was totally noted in 99.2%), with the effect of taking the drug commencing to manifest itself in patients as early as on day 15-20 of treatment. The highest rate of regression of symptoms of CVD was observed in 30-to-40-year-old patients. A statistically significant positive correlation was revealed between efficacy and the duration of treatment, the use of capsules during the term of follow up, with a negative correlation revealed between efficacy of treatment and the patient's age at which the diagnosis had been made, the stage according the CEAP classification, the total number of symptoms, a combination of risk factors. CONCLUSIONS: Sulodexide proved to be an effective, safe, well-tolerated and pathogenetically substantiated pharmacological agent for treatment of patients presenting with lower-limb CVI and should therefore be recommended for patients at early stages of formation of CVD. Patients suffering from venous trophic ulcers require higher doses and prolonged administration of the drug.

[Transabdominal ultrasonic scanning in evaluation of liver parenchyma: new opportunities].

On suspicion of the diffusive liver lesions 117 patients have been performed a transabdominal ultrasound investigation with a visual estimate of the echogenicity of the structure of the liver's parenchyma in comparison with the echogenicity of the cortical substance of the kidney and with the determination of the homogeneity of the liver's structure on its different areas. For the purpose of the elevation of the self-descriptiveness and precision of diagnostics as well as for the reduction of the subjective estimation the authors carried out the evaluation of the structure of the liver's parenchyma and the cortical substance of the kidneys using the histography on the marked area. The elaboration of the efficient quantitative assessment of the changes of the liver's parenchyma allowed to relieve complications in differential diagnostics and to estimate the damage level of the organ's parenchyma objectively during the investigation.

[Delayed results of proximal gastrectomy in patients with esophageal and gastric varices].

An original method of proximal gastrectomy was used to eliminate hemorrhage from gastric and oesophagal varicose veins in 27 patients with portal hypertension. The follow up period varied from 1 to 23 years. The risk of hemorrhage and the degree of vein dilatation were assessed by endoscopy and endoscopic ultrasonography. It is concluded that the method used in the study may be recommended as the first-line surgery for the management of hemorrhage from gastric and oesophagal varicose veins with good functional results in the late postoperative period and rare complications.

[The function of gastric stump and duodenum after proximal gastric resection in patients with esophageal and gastric varicose veins dilatation].

The authors had developed the technique of proximal gastric resection with cardiac orifice plasty. 21 patients with esophageal and varicose veins dilatation were operated on using the technique. Follow-up period came from 2 to 23 years. Results of the operation allow proximal gastric resection with cardiac orifice plasty to be considered the effective way of prevention and treatment of gastric bleedings of portal hypertension aetiology.

[Optimization of prognosis and surgical prophylaxis of bleedings from esophageal varicose veins].

New methods of prediction of bleeding from the esophageal varicose veins improve treatment outcomes. These methods consist of endoscopic assessment of varicose vein and mucous membrane with determination of thickness of the vein wall and mucosa, and also assessment of reflux-esophagitis with endoscopic ultrasonography. Original operation of azigoportal disconnection was performed in 13 patients followed-up after surgery from 1 to 4 years. The results obtained demonstrate high efficacy of this surgery for prophylaxis of repeated bleedings from esophageal varicose veins.

[The treatment in ulcerative hemorrhages in patients with liver cirrhosis and portal hypertension]. / Lechenie pri iazvennykh krovotecheniiakh u bol'nykh s tsirrozom pecheni i portal'noi gipertenziei.

Treatment of 34 patients with bleedings from chronic gastroduodenal ulcers associated with cirrhosis of the liver and portal hypertension was analysed. Overall lethality was 41.2%, postoperative lethality was 41.7%. Temporary hemostasis due to a solution of Caprofen used during fibrogastroduodenoscopy allows the operation to be delayed and complex intensive therapy can be performed in patients with hepatic insufficiency. Control medical endoscopic investigations should be performed 4 and 12 hours after admission to the hospital of patients with sub- and decompensated cirrhosis of the liver with portal hypertension and symptoms of unstable hemostasis. The emergency and delayed operative treatment of patients with subcompensated hepatic insufficiency should include organ-saving operations such as vagotomy with pyloroplasty and/or dissection of the ulcer. Operation is indicated to patients with cirrhosis of the liver at the stage of decompensation but if they have evident reappearance of bleeding and in minimal volume. The attainment of final endoscopic hemostasis will allow to avoid surgical interventions intolerable for this category of patients.