[SURGICAL ANATOMY OF THE TRIBUTARIES OF INFERIOR VENA CAVA].

The results of the anatomical study of the inferior vena cava (IVC) and its tributaries on 27 fresh cadavers were analysed. It was established that in past hepatic part of IVC fall from 7 to 23 veins. The diameter of the main hepatic veins on average 12.3 mm, and back ­ 4.8 mm. In 63% of cases between the main and back hepatic veins have a free box of length 10 ­ 18 mm. Lumbar vein 2 ­ 8 pairs of branches in 92.6% of cases merge and flow into the IVC by one trunk, often closer to her left hemi circle. The diameter of the joint lumbar vein average 5.2 mm. Upper joint lumbar vein falls into the IVC at a distance of 13 ­ 23 mm from the confluence of the right renal vein. Back hepatic and joint lumbar vein may be a source of intraoperative bleeding, that is difficult to control. Identified anatomical features tributaries of IVC below the diaphragm should be borne in mind when removing blood clots from the IVC.

[Assessment of risk associated with the contamination of drinking water with chemicals to population health of the Voronezh region].

THE THEME: Assessment of health risk from water chemicals to population health in the Voronezh regio. OBJECTS: Water sources, population of municipalities of the Voronezh region. THE NATURE AND AIM OF THE WORK: The substantiation of priority measures aimed at minimizing the human health risk due to chemical contamination of water fed for the needs of centralized water supply of population of the Voronezh region. METHODS: Method of human health risk assessment from environmental chemicals. THE RESULTS OF THE WORK: The priority pollutants of drinking water in municipalities are established. Also area of risk and the number of exposed population are identified.

[Simultaneous reconstructive operations in combined lesions of the coronary arteries, abdominal aorta and arteries of the lower extremities]. / Odnomomentnye rekonstruktivnye operatsii pri sochetannom porazhenii koronarnykh arterii, briushnoi aorty i sosudov nizhnikh konechnostei.

The work deals with the results of one-stage reconstructive surgical interventions in 15 patients with affection of the coronary arteries, abdominal aorta, and lower limb arteries. All patients underwent operation for the creation of an aortocoronary shunt in combination with various types of vascular reconstructive operations, including the formation of an ascending aorta -bifemoral shunt in 3 patients. The total hospital mortality was 26.7%. The authors discuss the indications and the surgical tactics of one-stage reconstructive interventions in combined affection of the coronary and peripheral arteries.

[Tactics of the surgical treatment of combined occlusive diseases of the coronary arteries, the abdominal aorta and the arteries of the lower extremities]. / Taktika khirurgicheskogo lecheniia sochetannykh okkliuziruiushchikh porazhenii koronarnykh arterii, briushnoi aorty i arterii nizhnikh konechnostei.

On the basis of experience in reconstructive operations on 250 patients with combined affection of the coronary arteries, abdominal aorta, and arteries of the lower limbs the authors discuss the diagnostic and tactical features of surgical management of these patients. The article dwells upon the necessary preoperative diagnostic algorithm as well as that in tactical variants of surgical treatment: (1) one-stage reconstructive operations on several vascular beds; (2) successive stage-by-stage treatment of patients with combined vascular pathology; (3) reconstructive vascular intervention on only one of the vascular beds. Correct practical solution of all these problems allowed the authors to reduce postoperative lethality to 5.4% among this grave contingent of patients with combined vascular pathology.

[Experience in the surgical treatment of combined atherosclerotic lesions of the coronary arteries, abdominal aorta and arteries of the lower limbs]. / Opyt khirurgicheskogo lecheniia sochetannykh ateroskleroticheskikh porazhenii koronarnykh arterii, briushnoi aorty i arterii nizhnikh konechnostei.

A comprehensive clinicoangiographic and functional examination was made of 180 patients with combined coronary and vascular abnormalities. With this, a diagnostic algorithm was developed, which determined the authors' approach to evaluation of the severity of patients and the choice of surgical policy. A total of 150 patients were operated on, the total mortality being 7.3%. The examination of operative and hospital mortality rates in patients with combined abnormalities showed that pre-aortocoronary bypass surgery before a reconstructive vascular operation in patients with severe coronary diseases made it possible to avoid serious coronary events in the following postoperative period.

[Surgical treatment of patients with combined stenosis of the coronary arteries, abdominal aorta and arteries of the lower extremities]. / Khirurgicheskoe lechenie bol'nykh s sochetannym stenoziruiushchim porazheniem venechnykh arterii, briushnoi aorty i arterii nizhnikh konechnostei.

The authors in 145 patients with combined atherosclerotic lesion of the coronary arteries, abdominal aorta and vessels of the lower extremities performed the one-stage, staged operations, aortocoronary shunting alone, the vascular operations alone. The total lethality was 7.6%, the postoperative--6.3%.

[Reconstructive vascular operations in patients with an inoperable form of ischemic heart disease]. / Rekonstruktivnye sosudistye operatsii u bol'nykh s neoperabel'noi formoi ishemicheskoi bolezni serdtsa.

The authors performed 153 reconstructive vascular operations in patients with associated atherosclerotic lesion of the coronary arteries, abdominal aorta and arteries of the lower extremities. According to the findings of ventriculography and coronarograms, in 13 patients, the inoperable form of the ischemic heart disease was revealed. In all these patients, the vascular operations were performed. The indications for the different reconstructive vascular operations in inoperable coronary pathology have been developed.

[Indications for aortocoronary bypass in patients with combined lesions of the coronary arteries, abdominal aorta and blood vessels of the legs]. / Obosnovanie pokazanii k aorto-koronarnomu shuntirovaniiu bol'nym s sochetannym porazheniem koronarnykh arterii, briushnoi aorty i sosudov nizhnikhonechnostei.

The literature and original research data on the incidence of combined lesions of coronary arteries, abdominal aorta, and lower-limb vessels are presented. Operative intervention was undertaken in 112 of 170 examined patients with combined coronary and vascular abnormalities. Fifteen patients underwent one-stage reconstruction of the coronary artery and aortofemoral segment; in 57 patients aortocoronary bypass was performed as the first stage; in 40 patients only vascular reconstruction was performed. Operative risks in these patients are discussed, as well as the diagnostic problems, surgical tactics, and the sequence of operation stages in combined coronary and vascular abnormalities.

[Coronary circulation in patients with ischemic heart disease with various degrees of arteriosclerosis obliterans of the leg during selection surgical treatment]. / Sostoianie koronarnogo krovobrashcheniia u bol'nykh ishemicheskoibolezn'iu serdtsa s razlichnoi stepen'iu stenoziruiushchego ateroskleroza sosudovnizhnikh konechnostei pri otbore k khirurgicheskomy lecheniiu.

First in the literature, the relationship between the coronary and lower limb circulation is detailed on the basis of objective findings. Comparison of the two patient groups (the patients categorized according to the degree of lower limb ischemia revealed by Doppler ultrasound echocardiography) in respect to the clinicomorphofunctional characteristics of the coronary flow in IHD patients suggested the absence of a significant correlation between them. Varying severity of lower limb ischemia does not influence the gravity of IHD manifestation in the same patients.

[Surgical treatment of high occlusion of the abdominal aorta associated with lesions of coronary, renal and visceral arteries]. / Khirurgicheskoe lechenie vysokoi okkliuzii briushnoi chasti aorty, sochetaiushcheisia s porazheniem venechnyk, pochechnykh i vistseral'nykh arterii.

The results of surgical treatment of 158 patients with high occlusion of the abdominal aorta associated with lesion of the coronary, renal and visceral arteries are presented. The technique of aorto-femoral shunting from the descending aorta with isolated plasty of its branches in patients with concomitant severe coronary disease, permitting to reduce the incidence of complications and lethality, is suggested.

[Effectiveness of the modified Linton operation in post-thrombophlebitic syndrome in the light of remote results and medical, social and vocational rehabilitation]. / Effektivnost' modifitsirovannoi operatsii Lintona pri posttromboflebiticheskom sindrome v svete otdalennykh rezul'tatov i mediko-sotsial'no-trudovoi reabilitatsii.

The results of surgical and conservative treatment of 207 patients with the post-thrombophlebitic syndrome in pedal veins suggested that modified Linton's operation produced very good long-term effect in late postoperative period. Therefore it can be used as an operation of choice in surgical treatment for this pathology. The efficiency of the operation is improved significantly, if postoperative medical, social and occupational rehabilitation is conducted on a consistent basis.