[Surgical treatment of patients with chronic critical ischemia of legs, caused by atherosclerosis]. / Khirurgicheskoe lechenie bol'nykh s khronicheskoi kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskoi etiologii.

208 patients with primary chronic critical ischemia of lower extremities (CCILE) were operated on from 1988 to 1995. The criteria of CCILE were the following: ischemia of an extremity in rest with specific ischemic pain for more than 2 weeks; existence of ulcernecrotic changes in distal parts of the extremity; brachiommalleous index (BMI) less than 0.35; malleous systolic pressure less than 50 mm Hg. Functional condition of the patients corresponded to class 3A, B and 4. The share of patients with CCILE among patients with lower extremities arterial lesions was 35%. In 150 (72%) of them there were lesions of aorto-illo-femoral-tibio-popliteal segment; in 58 (28%)-damage of a femoral-popliteal-tibial segment. The number of patients with trophic changes appear in early stage. 154 reconstructive operations have been performed in patients with multiple arterial lesions higher and lower of the Poupart's ligament, and only one primary amputation and sympathectomy. In 63 (42%) of the patients the "two-floor" reconstruction has been performed. In 142 (92%) of the cases positive results have been achieved. In 78.5% cases the grafts were competent a year after the surgery and the extremities were saved in 88% of the patients. 60 reconstructive operations, 3 primary amputations and 1 sympathectomy have been performed in patients with the lesions, located lower than Poupart's ligament. In 58 (96%) of the patients positive results were achieved. One year after surgery the grafts patency was 63.5%, and extremities were saved in 79% of the patients. The immediate and long-term follow-up results of femoral-politeal and femoral-tibial grafting did not differ significantly. Long-term follow-up results were better in case of less duration of CCILE before surgery. Adequate revascularisation of the extremity is an optimal method of treatment of patients with CCILE.

[Autoarterial grafts for myocardial revascularization and their morphological assesment in coronary heart disease]. / Autoarterial'nye transplantaty dlia revaskularizatsii miokarda i ikh morfologicheskaia otsenka u bol'nykh ishemicheskoi bolezn'iu serdtsa.

A comparative analysis of arterial grafts used for myocardial revascularization has been done. The morphology of arteries, rate and degree of atherosclerotic process were evaluated. 55 thoracic internal arteries, 52 right gastro-epipiolcal arteries, 34 epigastrical inferior arteries have been tested in cadavers of people with signs of coronary heart disease. Arteria thoracica interna appeared to be a vessel with prevalence of elastic elements, while arteria gastro-epiplocia and arteria epigastrica inferior are predominantly muscle-type. Arteria thoracica interna and arteria epigastrica inferior appeared to be rarely affected with atherosclerosis in people under 60 years of age. Atherosclerotic lesions have been found more often in arteria gastro-epiploica without stenotic lesions. In people over 60 years of age the stenotic lesions in arteria thoracica interna and arteria epigastrica are found much more often than in arteria gastro-epiploica. Arteriography should be done in selecting the proper graft for myocardial revascularization.

[Nonspecific aortoarteritis and vasorenal hypertension]. / Nespetsificheskii aortoarteriit i vazorenal'naia gipertenziia.

The article deals with the experience in surgical treatment of 157 patients with vasorenal hypertension consequent upon unspecific aortoarteritis. On the grounds of communications in the literature and their own clinical findings, the authors analyse the character of the affection in unspecific aortoarteritis and the peculiarities of the course of vasorenal hypertension and emphasize the malignancy of its course and inefficacy of nonoperative treatment. The indications and contraindications for various reconstructive operations on the renal arteries and the dependence of the results of surgery on the duration of the disease and the term of the operative intervention are discussed in detail. The authors also describe their experience in the modern methods of kidney revascularization. With the use of radiologically guided endovascular dilatation and an nitinol endoprosthesis they not only expanded considerably the possibilities of intervention on the renal vessels but improved the results of the management of vasorenal hypertension.

[Surgery of chronic hepatitis]. / Khirurgiia khronicheskogo gepatita.

The article deals with the diagnosis and results of surgical treatment of 203 patients with chronic hepatitis. It is shown that complex pre- and intraoperative examination of the organs of the hepatobiliary area is necessary in order to detect the disease and choose the adequate surgical tactics. Intraoperative biopsy of the liver with emergency histologic study of the collected material is said to play the determinant role in the diagnosis of chronic hepatitis. To achieve the best hemodynamic effect of the operation, the authors believe it expedient to conduct arteriolysis and desympathization of the hepatic arteries at the whole length of the common and proper hepatic arteries. The immediate and late results of surgical treatment of chronic hepatitis were favourable. The immediate outcomes were good and satisfactory in 92.3% of cases, the late results, in 89% of cases.

[Experimental-morphological study of the roentgeno-endovascular prosthesis]. / Eksperimental'no-morfologicheskoe obosnovanie rentgenoéndovaskuliarnogo protezirovaniia sosudov.

The authors presented the results of experimental studies on 36 dogs: 66 endovascular spiral wire prostheses made of a metal alloy with a shape "memory" effect were implanted in the aorta and major arteries via an angiographic catheter. Long-term results were followed-up over a period of 14 mos. and demonstrated a good and prolonged permeability of the nitinol prostheses. Morphological investigations showed that the endovascular prosthesis was separated in a ring-like fashion by a thin layer of connective tissue and from within it was lined with a layer of epithelial cells.

[Carcinosarcomas of the lung]. / Kartsinosarkomy legkog.

The authors analysed the literature on pulmonary carcinosarcomas and described two own observations of this rare pathology. The predominant occurrence of this tumor in men of 40-65 years, rapid development of the process, frequent asymptomatic course and late surgical help are noted. Clinico-anatomical manifestations of pulmonary carcinosarcomas are nonspecific. Their histological structure is variable and depends on the nature of tissue components involved in the neoplastic process. The authors emphasize a great diagnostic value of prophylactic fluorographic examinations of the population.

[Indications for mammary-coronary anastomosis in the treatment of ischemic heart disease]. / Pokazaniia k mammaro-koronarnomu anastomozu v lechenii ishemicheskoi bolezni serdtsa.

Anatomo-morphologic and clinico-angiographic peculiarities of the internal thoracic arteries have been considered in the article. The assessment of these arteries is of great importance for defining the indications for the use of these vessels in revascularization of the myocardium. It has been found that mammary-coronary anastomosis is indicated for the patients at the age up to 55, and the branches of the left coronary artery are the most suitable for direct mammary-coronary anastomosis.