[Technology of puncture cryosurgery for soft tissue tumors].

The technology and the first experience of the local cryotherapy for tumors of the breast, lateral triangle of the neck and lumbar area using ultrasound navigation of cryoprobes and new medical equipment are presented.

[Puncture cryodestruction of recurrent facial area basaliomas with ultrasound scan and surgery monitoring].

Ultrasound scan allows determining tumor border in the area of inflammatory infiltrate, creating a three-dimensional plan of the operation, performing accurate pointing injecting cryoprobes as well as managing a monitor of cryoablation. As a result the frequency of repeated recurrences of infected recurrent tumors in difficult anatomical areas of the face decreased to 4%.

Technology of minimally invasive cryodestruction of recurrent tumors.

In oncology practice it has been introduced minimally invasive technology of puncture access for cryodestruction of tumors of various sites as well as obtained positive clinical results.

[CRYOSURGERY IN ONCOLOGY].

Cryodestruction remains one of the effective methods of treatment. There is collected the sufficient experience of its application in oncology and described the positive changes in the immune status of patients after cryodestruction. The technology of minimally invasive percutaneous puncture cryotherapy expands treatment options but requires training and implementing new equipment of domestic production into practice.

[Stability of bone marrow stromal cells to low temperatures during differentiation].

On the bases of earlier conducted research about the stability of heterogeneous population of keratinocytes to low temperatures according to their stages of differentiation this experiment' studies in vitro the stability to low temperatures of rat bone marrow stromal cells before and after their adipocyte and osteocyte differentiation. Results show that bone marrow stromal cells after their differentiation into either adipocytes or octeocytes became least stable to low temperatures. Findings may serve as foundation for further studies that may explain the changes of processes and mechanisms that play a major role in BMSC stability to low temperatures according to their stage of differentiation.

[The effect of low temperatures on the viability of human epidermal keratinocytes found at different stages of differentiation].

The aim of this study was a comparative analysis to the degree of stability of human epidermal cells found at different stages of differentiation to low temperatures. The effect of different subzero temperatures of liquid nitrogen vapor on keratinocytes found both in human skin fragments and as isolated cells extracted from skin fragments has been studied. The degree of stability of epidermal cells low temperatures was evaluated by their ability to form a multilayer stratum in culture; hence this phenomenon explains the survival of a sufficient amount of proliferative cells after exposure to subzero temperatures. Quantitative analysis of the ratio of epidermal stem, transitory and differentiated cells in a population of viable cells before and after exposure to low temperatures were determined using antibodies corresponding to their different stages of differentiation. The results of this research show that the stability of human epidermal cells to low temperature differs depending on their stage of differentiation both in situ and in vitro. Epidermal stem cells and transitory cells are more stable than differentiated cells.

[The results of the drug therapy of the ischemic syndrome in arteriosclerosis obliterans]. / Rezul'taty medikamentoznoi terapii ishemicheskogo sindroma pri obliteriruiushchem ateroskleroze.

A thorough investigation of 120 patients with obliterating atherosclerosis of lower extremities, treated conservatively at a hospital and observed for 5 years have shown that such a treatment was most effective in patients with the initial stages of the disease. The mechanisms of positive effects is based on the dilatation of the peripheral arteries and the resulting decrease of the peripheral resistance of the vessels, improved cardiac activity, activation of microcirculation and tissue respiration. An important result of the treatment is an increased rate of the oxygen consumption by the tissues in the ischemic zone. It determines the pathogenetic direction of the therapy which leads to a delayed progress of the disease in 20% of the patients and improves the patient's state in 57% of cases.

[Intraoperative changes in the peripheral circulation with different methods for reconstructing the arteries of the extremities]. / Intraoperatsionnye izmeneniia perifericheskogo krovoobrashcheniia pri raznykh sposobakh rekonstruktsii arterii konechnostei.

An examination of 192 patients with obliterating atherosclerosis of lower extremities was made who had different reconstructive operation. Intraoperative measurements of oxygen strain in the foot skin and rheography of the shin have shown that temporary compression of large arteries when making vascular anastomoses cause ischemia of extremities, whose degree and duration is dependent on the technique of the technique of the intervention. Advantages of the method of transprosthetic aortotomy such as less duration and lower degree of ischemia were shown. The possibility was revealed to prognose nearest results of treatment for changing regional hemodynamics and oxygenation of tissues at the moment of termination of the operation.

[The physiological aspects of the efficacy of reconstructive operations in arteriosclerosis obliterans of the lower extremities]. / Fiziologicheskie aspekty éffektivnosti rekonstruktivnykh operatsii pri obliteriruiushchem ateroskleroze nizhnikh konechnostei.

Reconstructive operations in the aorto-iliac and femoro-popliteal segments were performed on 281 patients with obliterating atherosclerosis. An attentive examination of the patients in the nearest postoperative period and within the first 5 years has shown different efficiency of the operation in different patients. Favorable changes took place in regional hemodynamics, while disturbances retained in microcirculation and function of the extremity. Another cause of insufficient efficiency of the interventions was an initial stable suppression of tissue respiration and oxygen utilization in the extremity tissues. The dynamics was positive during a year followed after that by new symptoms of progressing disease.

[An evaluation of the results of intra-arterial injections in treating chronic ischemia of the lower extremities]. / Otsenka rezul'tatov vnutriarterial'nykh in''ektsii v lechenii khronicheskoi ishemii nizhnikh konechnostei.

Intra-arterial infusions used in treatment of ischemia of lower extremities in patients with obliterating atherosclerosis can cause pronounced vasoconstrictory reactions in distal parts of the extremity with reduced pulse blood filling and oxygenation of tissues. As necessary measures of prophylactics of negative shifts in regional blood circulation the author suggests to be valuable anesthesia and atraumatic character of interventions, use of warm solutions, exclusion of irritating drugs and osmotically active substances. The final efficiency of intra-arterial infusions is dependent on the observation of the above conditions.

[Regional blood circulation during stimulation of the sympathetic trunk against a background of arterial ischemia]. / Regionarnoe krovoobrashchenie pri razdrazhenii simpaticheskogo stvola na fone arterial'noi ishemii.

In dogs, the innervation of the sympathetic trunk by pulses 0.5 Hz caused a mild reduction in regional arterial pressure and an uprise in oxygenation of the shin muscle. General and local arterial pressure rose at 20-Hz pulses, and the oxygen level in tissues was lowered. The pulses rate of 20 Hz induced deep disturbances in regional circulation combined with severe and long-term hypoxia and development of metabolic acidosis. In chronic arterial impairment, the regulating influence of the nervous system on regional circulation grows, and the range of its possible functional fluctuations widens. Artificial intrusion in the autonomous nervous system function in arterial ischemia disturbs regional circulation.

[Ergography of crural muscles in the diagnosis of arterial occlusive diseases of the lower extremities]. / Ergografiia myshts goleni v diagnostike obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei.

Under examination there were 280 patients with obliterating diseases of lower extremity arteries using the methods of selective ergometry of musculus gastrocnemius. It was established that initial stages of the disease were characterized by 10-fold decrease of working capacity of leg muscles. With progress of ischemia and longer duration of the disease and simultaneously decreased volume of work the strength of a single muscular contraction dropped, their average and maximum instantaneous power decreased which demonstrates the development of degenerative alterations in muscles. Bilateral lesion of the arteries was diagnosed in 85% of patients with complaints about ischemic pains in one extremity. Selective ergography may be used for diagnosing preclinical forms of the disease and objective evaluation of the results of treatment.

[Viability of tissues of the extremities and surgical tactics in stage IV arteriosclerosis obliterans]. / Zhiznesposobnost' tkanei konechnosti i khirurgicheskaia taktika pri IV stadii obliteriruiushchego ateroskleroza.

Amputation of the extremity was performed in 26 of 52 patients with the IV stage obliterating atherosclerosis. Clinical severity of the disease was confronted with results of special investigations. Three groups of such patients are described: with traumatic necroses, with ischemic necroses and with necrotic ischemia (criteria of its irreversibility are presented). Surgical tactics of treatment in the first group of patients may include sympathectomy with necrectomy. The outcome of treatment of the second group patients is determined by the efficiency of reconstructive operations. Amputation of the extremity is indicated to patients of the third group.

[A method of redoxometry in clinical studies]. / Metodika redoksimetrii v klinicheskikh issledovaniiakh.

Direct estimation of redox-potential in human skin and muscles using platinum electrodes enables to carry out dynamic evaluations of redox-state in these tissues. A similar technique might be used for potentiometric measurement of the rate of local tissue circulation using hydrogen clearance. Increase in the electrodes sensitivity, required for studies of circulation severe impairments, was possible by means of additional platinum overlaying. Examination of patients with obliterating atherosclerosis showed a considerable decrease of redox-potential in ischemic zone; this impairment was partially reduced after surgical operation. The validity of alterations in electrode potential was supported by means of oxygenometry, blood pH-metry and rates of tissue circulation measurements. Interpretation of the data obtained is limited due to requirements of obligatory functional loading and theoretical considerations. However, the procedure of electrode potential registration allowed to obtain an information essential for choice of suitable treatment course.

[Effect of lumbar sympathectomy on tissue blood flow in the extremities in arteriosclerosis obliterans]. / Vliianie poiasnichnoi simpatéktomii na tkanevoi krovotok konechnosti pri obliteriruiushchem ateroskleroze.

Lumbar sympathectomy in patients with obliterating atherosclerosis of lower extremities in the nearest postoperative period results in acceleration of the intracutaneous blood flow and of intramuscular blood flow as well as in greater extra-tissue blood shunting. At remote terms the intramuscular bloodflow is also accelerated. Patients with the IV degree of ischemia should be divided into two groups according to results of special investigations: patients with traumatic and with ischemic necroses. It is of importance for choice of rational surgical methods and for prognosis of outcomes of the disease.

[Evaluation of the effectiveness of sympathectomy using the skin oximetry method]. / Otsenka éffektivnosti simpatéktomii metodom nakozhnoi oksigenometrii.

The use of the method of epicutaneous oxygenometry showed that it reflects objectively the condition of circulation in the extremity. Oxygen tension in the skin of patients with atherosclerosis obliterans of the lower extremities reduced with the gradual advancement of the disease. The operation of lumbar sympathectomy increases the level of skin oxygenation. The efficacy of the operation is highest in stage II but diminishes in stage III of the disease. Sympathectomy fails to improve regional circulation essentially in later stages of the disease.

[Acid-base equilibrium, tissue oxygenation and hemodynamics in arteriosclerosis obliterans after sympathectomy]. / Kislotno-osnovnoi balans, oksigenatsiia tkanei i gemodinamika pri obliteriruiushchem arterioskleroze posle simpatéktomii.

The authors have shown that operation of lumbar sympathectomy increases the skin oxygenation level, increases the volume blood flow in the main arteries and gives rise to positive shifts in metabolic processes in the extremity tissues. The operation is most effective at the 2nd stage of the disease but is getting less effective at the third stage. At the 4th stage of the disease the operation is indicated but with limited necroses of distal parts of the extremity, intact blood flow not less than 40% of the normal, the leg skin oxygenation level higher than 30 mm Hg, shift of blood pH to subcompensated acidosis.

[The blood supply and oxygen balance of the different tissues of the extremities following experimental sympathectomy]. / Krovosnabzhenie i kislorodnyi balans razlichnykh tkanei konechnostei posle éksperimental'noi desimpatizatsii.

The experiments in dogs suggested an essential difference in terms of the rearrangement of regional blood circulation in the skin and muscles of the extremity after experimental sympathectomy. Ganglionectomy induced a reduction of general peripheral arterial resistance on the operated side, an increase in the skin tissue blood flow and its oxygenation rate, a deceleration of the process of biological oxidation reducing the capability of muscles to use blood oxygen and cutting down the maximum of oxidase cytochrome (a3) activity. There was no essential change in the regional acid-alkaline balance. The above changes were due to a disturbance of the neurotrophic sympathetic effect on tissues.