[Minimally invasive technologies of lithotripsy and antegrade hydraulic lithoextraction in complex treatment of choledocholithiasis]. / Primenenie mini-invazivnykh tekhnologii litotripsii i antegradnoi gidravlicheskoi litoekstraktsii v kompleksnom lechenii bol'nykh kholedokholitiazom.

OBJECTIVE: To evaluate the effectiveness of minimally invasive technologies of lithotripsy and hydraulic antegrade lithoextraction in complex treatment of choledocholithiasis. MATERIAL AND METHODS: In the main group, 74 patients with choledocholithiasis underwent complex treatment with minimally invasive lithotripsy and hydraulic antegrade lithoextraction. In the control group, 177 patients with choledocholithiasis complicated by obstructive jaundice underwent complex treatment without minimally invasive lithotripsy and hydraulic antegrade lithoextraction. RESULTS: Both groups were characterized by significant decrease of serum bilirubin, markers of cytolysis and cholestasis with regression of clinical manifestations of obstructive jaundice. At the same time, early and delayed postoperative complications were significantly more common in the control group. Most of these complications accounted for interventions through laparotomy such as external drainage of the common bile duct and hepaticojejunostomy. There were no similar procedures in the main group due to the use of minimally invasive technologies of lithotripsy and antegrade hydraulic lithoextraction. CONCLUSION: Minimally invasive lithotripsy and antegrade hydraulic lithoextraction are safe alternatives to traditional methods of lithoextraction and can be recommended in case of ineffective laparoscopic and retrograde endoscopic lithoextraction.

[Structural alterations of a biological prosthesis]. / Strukturnye izmeneniya biologicheskogo proteza.

The authors studied dilatation of a biological prosthesis (a specially treated xenograft made of bovine arteries) used as a femoropopliteal bypass in patients presenting with diseases of peripheral arteries. Structural alterations (ectasia) were examined in a total of 15 patients within the terms varying from 1 year to 7 years after the operation, resulting in working out a methodology of calculating structural changes of the conduit with characteristics of the composite index of dilatation of the conduit. The presence of aneurysmatically dilated portions whose dimension exceeded the initial size of the xenograft 3-4-fold did not influence the long-term patency of the shunt with preserved blood flow approximated to the major one. This made it possible to avoid a repeat surgical intervention.

Interaction of Serum Antibodies from Breast Cancer Patients with Synthetic Peptides.

The blood serum of tumor patients contains antibodies recognizing tumor-associated antigens and other molecular products of tumor growth. We studied the interaction of blood antibodies from breast cancer patients with synthetic peptides that were applied on the microchip surface. The serum from healthy volunteers and breast cancer patients was shown to contain antibodies that interact with various peptides. Statistically significant between-group differences were observed in the level of binding with 122 informative peptides (0.01% of the total number of peptides on a microchip). Analysis of antibodies that interact with the peptide panel holds much promise for the diagnostics of breast cancer.

[Use of dabigatran etexilate for treatment of deep vein thrombosis and pulmonary artery thromboembolism].

The authors present herein their experience in oral administration of dabigatran etexilate for treatment of lower-limb deep vein thrombosis and pulmonary thromboembolism in patients with thrombophilia, as well as assessment of its efficacy and safety. The study included a total of nineteen 20-to-79-year-old patients (11 men and 8 women) with venous thromboembolic complications. An inclusion criterion was the presence of lower-limb deep vein thrombosis documented in the B-mode in ultrasonography alone or in a combination with pulmonary thromboembolism confirmed by angiopulmonography end echocardiography. The exclusion criteria were as follow: oncological diseases, a history of surgical interventions, acute infections, skeletal injuries and fractures, long-term immobilization, age under 20 and over 79 years. For 6 months the authors evaluated patients' tolerance of dabigatran, its efficacy, as well as the profile of safety concerning the development of major and clinically significant haemorrhage. It was determined that administration of dabigatran in patients with confirmed thrombophilia at a fixed dose (150 mg twice daily) during 6 months for treatment of lower-limb venous thromboses and pulmonary thromboembolism turned out to be effective and safe, with the drug possessing a good profile of safety and its administration requiring no routine laboratory monitoring.

Dynamics of clinical semiotics in children with pathological tortuosity of internal carotid arteries in remote period after surgical management.

The present study enrolling a total of eighty-eight 4-to-16-year-old children and adolescents was aimed at detailed elaboration and formalization of clinical signs of the internal carotid artery pathological kinking syndrome. To achieve these objectives, the authors carried out a comparative analysis of clinical manifestations of the disease in the surgically treated subjects (constituting the Surgery Group comprising 43 children and adolescents) and non-operated patients (making up the Comparison Group consisting of 45 age- and gender-matched subjects). There were no baseline differences in the incidence rate of clinical syndromes and symptoms between the groups of the would-be operated and conservatively treated patients. Also studied were the remote outcomes (1-to-12-year follow up) of surgical correction for pathological tortuosity of the internal carotid artery. The incidence rate of regression of neurological symptomatology along different clinical signs after surgery was shown to vary within a wide range from 11.6% to 96.3%. Resection of the proximal portion of the internal carotid artery with re-implantation into the old ostium turned out to be clinically effective in 90.0% of cases, with the haemodynamic efficacy amounting to 83.3%. Arteriolysis of the internal carotid artery rendered a clinical effect in 75% of cases, with a haemodynamical effect thereof equalling 25.0%. The decision as to the type of a surgical intervention to perform was primarily made based on the findings of angiography of the internal carotid artery. The operation of arteriolysis did not lead to deterioration of the child's condition.