[Efficacy of two-level infrainguinal reconstructions in treatment of chronic critical lower limb ischaemia].

AIM: to determine the scope of infrainguinal revascularization of the limb in patients with multilevel lesions of arteries in chronic critical lower limb ischaemia (CCLLI). MATERIAL AND METHODS: A retrospective analysis of graft patency and limb salvage included a total of 76 patients undergoing a total of 78 bypass procedures consisting of: 1) two-level infrainguinal reconstructions (n = 35), 2) femoral-tibial (n = 36) and femoralplantar (n 7) bypass procedures. All patients had an isolated segment, of the popliteal artery in a combination with bifurcation arterial occlusive disease. Autovenous reversed retrograde and orthotopic in (situ vein grafts were used. All patients underwent intraoperative haemodynamic measurements. Graft patency was assessed by Doppler monitoring. The two groups studied were compared by demographic features and risk factors by means of the Student's and chi-squared tests. RESULTS: Life-table analysis showed demonstrated that two-level infrainguinal reconstructions provided better primary 3-year patency (76.2%) as compared with femoral-tibia! and plantar bypasses (60.4%, p<0.05). Intraoperative mortality occurred in 2 patients (2.5%). Early and mid-term thromboses appeared to be most frequently encountered in the group of femoral-tibial, and plantar reconstructions (18.6% vs 11.4%, p<0.38 and 30.8% vs 10.3%, p=0.04, respectively). CONCLUSION: Two-level infrainguinal arterial reconstruction in patients with CCLLI is an acceptable procedure alternative providing better graft patency higher limb salvage rate as compared with femoral-tibial or femoroplantar bypass.

[Causes of leptospirosis morbidity in Krasnodar region]. / Prichiny zabolevaemosti leptospirozom v Krasnodarskom krae.

The situation in leptospirosis morbidity in the Krasnodar Territory has been analyzed. The tendency towards a decrease in the number of water outbreaks and a growth in the number of sporadic cases has been noted. Antibodies to Leptospira ictrohaemorrhagiae, whose natural carriers are gray rats, are most often detected in the blood of patients. Among leptospirosis patients, persons engaged in fishing, work on plots of land adjoining their summer cottages, dog breeding are mostly registered. The detailed characterization of the outbreak of 1997, an outstanding outbreak among those observed in recent years, is given. This outbreak was caused by abundant precipitations and the subsequent flooding of vast areas, a growth in the number of Leptospira-infected rodents. In this connection attention is drawn to the necessity of greater efforts in carrying out deratization, as well as sanitary and veterinarian measures.

[Epidemiology and epizootiology of rabies in Krasnodar region]. / Epidemiologiia i épizootologia beshenstva v Krasnodarskom krae.

In 1995-1999 the aggravation of the epidemiological situation in rabies took place in the Krasnodar Territory. In the region of Great Sochi this was due to the emergency situation (armed conflict) on the adjoining territory (in Abkhazia), which led to the migration of domestic animals, turning wild, to the Black Sea coast where the situation with this infection had earlier been favorable. In 1995-1997 on the territory of Great Sochi 4 persons died of rabies as a consequence of getting dog bites and then failing to apply for medical assistance. A threat for human health is also created by cutting down work on the extermination of stray dogs and cats, the insufficient provision of medical institutions with antirabic preparations. The efforts of the medical service of the Territory should be concentrated on the prophylactic measures for controlling rabies.

[Hemodynamic criteria of prognostication of the outcome in revascularization of the lower limbs in severe ischemia]. / Gemodinamicheskie kriterii prognozirovaniia iskhoda revaskuliarizatsii nizhnikh konechnostei pri tiazheloi ishemii.

Experience of surgical treatment of 166 patients with severe lower limbs ischemia is summarized. The parameters of regional hemodynamics got with the help of ultrasound dopplerography, electro-magnetic flowmetry, percutaneous pO2 monitoring in the foot skin and registration of peripheral resistance of artery in distal anastomosis zone were used for prognostication of the vascular transplant function while aorto-femoral and femoro-popliteal segments reconstruction. The choice of surgical procedure tactics in accordance with prognosticated outcome permitted to lower the prevalence of an early postoperative complications from 17 to 8.4%.

[The potentials of polarography in predicting the effect of a reconstructive operation in patients with severe ischemia of the lower extremities]. / Vozmozhnosti poliarografii v prognozirovanii éffekta rekonstruktivnoi operatsii u bol'nykh s tiazheloi ishemiei nizhnikh konechnostei.

Possibilities to prognose the effect of reconstructive operation on the lower extremity vessels are shown on the basis of transcutaneous of oxygen on the dorsal surface of the foot in complex with ultrasonic Dopplerometry in patients with severe ischemia of lower extremities. Effectiveness of the test with the orthostatic growth of Po is proved. An examination of 60 patients with severe ischemia of lower extremities and 10 patients without pathology of main vessels (control group) was performed. Operations were performed on 48 patients, in 35 of them reconstructive operations were made. No correlation was found between preoperative value of Po and a result of the reconstruction. A correlation was found between the value of the orthostatic growth of Po and outcome of the reconstructive operation. The average growth of Po in the group of patients with a negative outcome of the reconstruction made up 9.93 + 2.78 mm Hg, with a positive outcome it was 14.137 + 2.30 mm Hg (p < 0.05). In patients with malleolus index of the regional systolic pressure > 0.3 with the orthostatic growth of Po > 20 mm Hg the probability of positive prognosis of the reconstruction made up 88.8%.

[The potentials for noninvasive diagnosis in predicting the effect of a reconstructive operation in patients with severe ischemia of the lower extremities]. / Vozmozhnosti neinvazivnoi diagnostiki v prognozirovanii éffekta rekonstruktivnoi operatsii u bol'nykh s tiazheloi ishemiei nizhnikh konechnostei.

The paper discusses whether the outcome of reconstructive surgery can be predicted by using the orthostatic test in Doppler sonography and transcutaneous polarography. A total of 97 patients with severe lower extremity ischemia were studied, of them 87 were operated on. Reconstructive operations on the vessels were performed in 72 patients. There was no relationship between the value of the humero-mallear index of regional systolic pressure as well as TcpO2 and the outcome of an operation. At the same time there was a correlation between the orthostatic rise in regional systolic pressure on the tibial arteries at the ankle-bone and the orthostatic increase in pO2 in the feet and the outcome of a reconstructive operation. The orthostatic rise in pO2 and regional systolic pressure was 8.06 +/- 4.0 and 58.2 +/- 5.43 mm Hg in patients with poor outcomes and inoperable patients, respectively. In good outcomes, these figures were 17.8 +/- 2.14 and 91.3 +/- 3.64 mm Hg (p < 0.05), respectively. The positive outcome of a reconstructive operations was observed in 88.8 = 92.0% patients with an orthostatic rise of pO2 in the feet by more than 20 mm Hg and that at the ankle-bone by more than 90 mm Hg.

[Surgical treatment of combined occlusions of the aorto-femoral and femoro-popliteal vascular segments in patients with severe ischemia of the lower extremities]. / Khirurgicheskoe lechenie sochetannoi okkliuzii sosudov aorto- bedrennogo i bedrenno-podkolennogo segmentov u bol'nykh s tiazheloi ishemiei nizhnikh konechnostei.

The experience with surgical treatment of 107 patients with severe ischemia of the lower extremities, including 52 with associated lesion of the vessels of the aorto-femoral and femoro-popliteal segments, is summarized. A complex of preoperative and intraoperative assessment of regional hemodynamics was used. This permitted to avoid the amputation of an extremity in 86.6% of the patients.

[Endolymphatic antibiotic therapy in the prevention and treatment of purulent-septic complications in vascular surgery]. / Endolimfaticheskaia antibiotikoterapiia v profilaktike i lechenii gnoino-septicheskikh oslozhenii v sosudistoi khirurgii.

With the aim of prophylaxis and treatment of purulent-septic complications, in 12 patients with IV stage chronic arterial insufficiency (group 1) before the operation, the direct endolymphatic antibioticotherapy (ELAT) was performed, in 13 patients with IIB-III stage of the disease (group 2) after the operation with the aim of treating purulent septic complications. The control group consisted of 10 patients with IV stage chronic arterial insufficiency. In group 1 patients, after the operation, there were no inflammatory changes in the wound, the wound healed by primary intention. In 7 control patients, the suppuration of inguinal wounds was noted. In group 2 patients, against the ELAT background, the regress of inflammation, reduction of the degree of bacterial contamination of the wounds, their cleaning and healing by secondary intention were noted.