RESUMEN

AIM: To evaluate the possibility of using spectral analysis of cough sounds in the diagnosis of a new coronavirus infection COVID-19. MATERIALS AND METHODS: Spectral toussophonobarography was performed in 218 patients with COVID-19 [48.56% men, 51.44% women, average age 40.2 (32.4; 51.0)], in 60 healthy individuals [50% men, 50% women, average age 41.7 (32.2; 53.0)] with induced cough (by inhalation of citric acid solution at a concentration of 20 g/l through a nebulizer). The recording was made using a contact microphone located on a special tripod at a distance of 15-20 cm from the face of the subject. The resulting recordings were processed in a computer program, after which spectral analysis of cough sounds was performed using Fourier transform algorithms. The following parameters of cough sounds were evaluated: the duration of the cough act (ms), the ratio of the energy of low frequencies (60-600 Hz) to the energy of high frequencies (600-6000 Hz), the frequency of the maximum energy of the cough sound (Hz). RESULTS: After statistical processing, it was found out that the parameters of the cough sound of COVID-19 patients differ from the cough of healthy individuals. The obtained data were substituted into the developed regression equation. Rounded to integers, the resulting number had the following interpretation: "0" - there is no COVID-19, "1" - there is COVID-19. CONCLUSION: The technique showed high levels of sensitivity and specificity. In addition, the method is characterized by sufficient ease of use and does not require expensive equipment, therefore it can be used in practice for timely diagnosis of COVID-19.

Asunto(s)

COVID-19 , Tos , SARS-CoV-2 , Humanos , Tos/diagnóstico , Tos/etiología , Tos/fisiopatología , COVID-19/diagnóstico , Femenino , Masculino , Adulto , Persona de Mediana Edad , Espectrografía del Sonido/métodos

RESUMEN

Despite the widespread occurrence of ischemic diseases of the lower extremities, including atherosclerosis and diseases with an autoimmune component of their pathogenesis, the pathohistological signs of damage and concomitant chronic ischemia, compensatory tissue responses as intracellular and cellular regeneration remain out of the field of vision in researchers. OBJECTIVE: To assess the signs of damage (the extent of necrosis and apoptosis, capillary density (CD)) and regeneration (the cross-sectional muscle fiber area (CSMFA), the proportion of centrinucleated muscle fibers (CNMFs), and that of connective tissue), by using the gastrocnemius medial head biopsy specimens obtained from patients with heterogeneous forms of chronic lower limb obliterating diseases (CLLODs). SUBJECTS AND METHODS: The investigation included the biopsy specimens obtained from 44 men under 65 years of age (their mean age was 54±9.8 years) with Stage IIB-IV chronic limb ischemia (according to the A.V. Pokrovsky-Fontaine classification) with its history of at least six months. The nosological entities were atherosclerotic lesion in 33 patients (distal atherosclerosis n=13), multistage lesion (n=8), and Leriche's syndrome (n=12); autoimmune-mediated vascular injury in 11 patients (Buerger's disease (n=7) and nonspecific aortoarteritis (n=4)). The similar muscle fragments obtained during autopsy from the deceased without obvious signs of cardiovascular system diseases were examined as a control. RESULTS: It was found that there was a statistically significant difference between the nosological entities, as compared to the control in terms of CD and CSMFA (a decrease), the proportion of CNMFs and that of connective tissue (an increase). No substantial differences were found in the studied parameters between the nosological entities. CONCLUSION: The findings may suggest the universal mechanism for damage to striated muscle tissue because of circulatory hypoxia, regardless of its etiology and the common character of tissue compensatory-adaptive responses (regeneration).

Asunto(s)

Aterosclerosis , Tromboangitis Obliterante , Adulto , Estudios Transversales , Humanos , Isquemia , Masculino , Persona de Mediana Edad , Músculo Esquelético

RESUMEN

Analyzed herein are the results of surgical treatment of true diffuse aneurysms of the permanent vascular access in 44 patients. Of these, there were 29 men and 15 women, mean age 48.1±2.3 years (19-78 years). The average time having elapsed since the formation of the native access was 109.4±9.5 months (12-276, median - 108 months). The indications for surgical treatment were as follows: haemorrhage including recurrent bleedings (3), thrombosis of the permanent vascular access (26), its dysfunction (5), high flow syndrome (3), large-size aneurysm with disordered function of the limb, pain syndrome or a pronounced cosmetic defect (7). In 14 cases, reconstruction was not performed. We carried out ligating operations, in some instances with partial removal of the aneurysm and establishing a new vascular access. 3 patients underwent resection of the aneurysm with replacement by a graft. In the remote period 1 patient at 46 months developed infection of the prosthesis, resulting in loss of the access. Follow up of the remaining 2 patients demonstrated satisfactory function of the vascular access at 6 and 60 months. 16 patients were subjected to total plasty of the aneurysm using autotissues. On a cylindrical template measuring 6 mm in diameter after dissection of excessive tissues along the posterior wall of the vein, an uninterrupted suture was formed followed by placing the formed transplant into a new bed. 11 patients underwent the operation according to the analogous technique, but the formed autotransplant was reinforced with a thin-wall exoprosthesis made of polytetrafluoroethylene up to 0.2-mm thick and 10 mm in diameter ('Ecoflon'). Two (12.5%) of 16 patients subjected to reconstruction of the aneurysm without reinforcement developed haemorrhage in the early postoperative period, and one developed thrombosis thus resulting in loss of the access. In-hospital patency amounted to 81.3%. In plasty with reinforcement, there were no complications in the early postoperative period. Long-term primary patency after total plasty without reinforcement at 1, 3, and 5 years amounted to 68.2±11.8%, 56.8±14.3%, and 22.7±13.7%, respectively, with secondary patency of 68.2±11.8% at the above-mentioned terms. In the majority of patients aneurysmatic transformation of the transplant occurred again in the remote period. Primary patency at 1, 3 and 4 years after plasty with reinforcement amounted to 80.8±12.2%, 80.8±12-2% and 60.6±19.8%, respectively, with the secondary patency rates of 90.9±8.7% at the above mentioned terms.

Asunto(s)

Aneurisma , Derivación Arteriovenosa Quirúrgica , Implantación de Prótesis Vascular , Adolescente , Adulto , Anciano , Aneurisma/diagnóstico , Aneurisma/cirugía , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Adulto Joven

RESUMEN

Permanent vascular access is the basis of renal replacement therapy by the method of programmed haemodialysis, on whose stable functioning depends the life of patients with end-stage renal disease. At the present time, there is significant deficit of scientific and methodological Russian-language literature on this problem, with no Russian consensus documents concerned. This article is a review of the contemporary world literature dedicated to the problem of permanent vascular access, including currently in force European (2018) and North American (2019) guidelines for good clinical practice, also discussing the problems of strategy and tactics of creating a permanent vascular access, monitoring its dysfunction, pathophysiology of functioning of arteriovenous fistulas. Presented herein are unified approaches to diagnosis and treatment of thrombolytic and haemorrhagic complications associated with the access, as well as local infectious and non-infectious complications. Special attention is paid to indications for the operation and rational therapeutic decision-making.

Asunto(s)

Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Fallo Renal Crónico , Derivación Arteriovenosa Quirúrgica/efectos adversos , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Diálisis Renal/efectos adversos , Federación de Rusia

RESUMEN

Iliac artery aneurysms are relatively uncommon, however requiring early diagnosis and treatment because of high mortality once ruptured. Endovascular correction is currently a method of choice. The standard iliac components of aortic stent grafts have a linear or distally widening shape, whereas the anatomy of aneurysms of iliac arteries requires, as a rule, a larger diameter of the proximal zone of shrinkage. Optimal is considered to be the use of reversed stent grafts, i. e. those tapering distally. The authors herein share their experience in treating iliac artery aneurysms using a flared reversed endograft of the iliac branch of the Anaconda stent graft in three patients presenting with iliac artery aneurysms. Technical success was achieved in all cases. In the remote period (6-12 months postoperatively) the grafts were patent, with no leakage.

Asunto(s)

Implantación de Prótesis Vascular , Aneurisma Ilíaco , Prótesis Vascular , Humanos , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma Ilíaco/cirugía , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/cirugía , Stents

RESUMEN

Presented herein are two clinical case reports concerning surgical treatment for superior vena cava syndrome in patients suffering from end-stage renal disease and undergoing programmed haemodialysis. Initially attempted roentgen-endovascular recanalization turned out to be unsuccessful. The patients were then subjected to ipsilateral extrathoracic bypass grafting, which made it possible to preserve the vascular access for programmed haemodialysis and to relieve venous hypertension of the limb and the brain, as well as to improve quality of life. In one case, the duration of graft patency amounted to 6 months, during which time collateral circulation developed, with no relapse of venous hypertension observed, and the access functioned for a further 14 months. Thus, survival of the permanent vascular access increased by 20 months. In the second case, the duration of graft patency and functionality of the vascular access at the time of writing this article amounted to 12 months.

Asunto(s)

Derivación Arteriovenosa Quirúrgica/métodos , Procedimientos Endovasculares , Fallo Renal Crónico/terapia , Diálisis Renal/métodos , Síndrome de la Vena Cava Superior , Adulto , Derivación Arteriovenosa Quirúrgica/efectos adversos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Femenino , Oclusión de Injerto Vascular/diagnóstico , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/prevención & control , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Masculino , Flebografía/métodos , Reoperación/métodos , Síndrome de la Vena Cava Superior/diagnóstico , Síndrome de la Vena Cava Superior/fisiopatología , Síndrome de la Vena Cava Superior/cirugía , Resultado del Tratamiento , Grado de Desobstrucción Vascular

RESUMEN

This review article presents the data on the epidemiology of renal cell carcinoma and describes minimally invasive surgery for this disease. The authors discuss the use of warm and cold ischemia, vascular microdissection, and artery embolization in renal tumor surgery, and analyze treatment outcomes.

Asunto(s)

Carcinoma de Células Renales , Neoplasias Renales , Laparoscopía , Humanos , Riñón , Neoplasias Renales/cirugía , Nefrectomía , Nefronas

RESUMEN

AIM: To evaluate the functional state of the renal parenchyma after partial nephrectomy, depending on surgical technique. MATERIALS AND METHODS: The study comprised 21 patients with kidney neoplasms of stage T1-2N0M0. The patients underwent either laparoscopic partial nephrectomy with superselective balloon embolization of the renal artery (study group, n=11), or partial nephrectomy with vascular clamping (control group, n=10). The mean age of the patients in the study group (3 men and 8 women) was 56.8 years. The tumor was located in the right kidney in 5 patients and in the left kidney in 6 patients. The size of the neoplasm ranged from 0.9 to 3.8 cm, averaging 1.9 cm. The complexity of the surgery was evaluated using R.E.N.A.L. Nephrometry Scoring System based on MSCT findings. The mean nephrometry score was 5.1, which corresponds to low complexity of the intervention. Patients of the control group underwent partial nephrectomy with vascular clamping and renal ischemia time of no more than 20 minutes. The mean age of the control group patients was 57.3 years. The tumor was located in the right kidney in 4 patients and in the left kidney in 6 patients. The tumor size ranged from 1 to 4.1 cm, averaging 2.2 cm. The mean nephrometry score based on MSCT findings was 6.1. In both groups, the difference in creatinine clearance between the operated and intact kidney was estimated before the operation and in the early postoperative period to assess the changes in glomerular filtration. RESULTS AND DISCUSSION: The level of serum creatinine remained within the normal range throughout the study period in both groups. In the postoperative period, the creatinine clearance of the operated kidneys showed 1.02-fold decrease after super selective embolization and 1.92-fold decrease after vascular clamping. The 1-minute diuresis of the operated kidney decreased by 83.21% and 43.53% after vascular clamping and embolization, respectively. CONCLUSION: The studys findings show there was no significant dysfunction of operated kidneys after superselective balloon embolization of the renal artery.

Asunto(s)

Oclusión con Balón , Neoplasias Renales , Riñón , Laparoscopía , Nefrectomía , Arteria Renal/fisiopatología , Adulto , Anciano , Femenino , Humanos , Riñón/fisiopatología , Riñón/cirugía , Pruebas de Función Renal , Neoplasias Renales/fisiopatología , Neoplasias Renales/terapia , Masculino , Persona de Mediana Edad

RESUMEN

AIM: To use superselective balloon embolization of segmental branches of the renal artery for intraoperative hemostasis during partial nephrectomy for renal malignancy. MATERIALS AND METHODS: From October 2015 to September 2016, 11 patients, including 3 males and 8 females aged 29-72 (mean 56.8) years underwent laparoscopic partial nephrectomy with superselective balloon embolization. In 5 and 6 cases the tumors were located in the right and left kidney, respectively, and in 7, 1 and 3 cases they were found in lower, upper and middle segments, respectively. The of tumor size ranged from 0.9 to 3.8 cm (mean 1.9 cm). All patients underwent standard preoperative evaluation including urinary tract ultrasound, multislice computed tomography (MSCT) with contrast enhancement, renal scintigraphy and separate assessment of each kidney function. The complexity of the planned partial nephrectomy was evaluated using a R.E.N.A.L. nephrometry scoring system based on MSCT data. The mean score averaged 5.1 points, which corresponds to a low complexity for resection. RESULTS AND DISCUSSION: The mean blood loss was 50 mL. The duration of laparoscopic stage was reduced from 150 to 60 minutes averaging 104.3 minutes. Mean total operating time from the beginning of selective renal angiography to laparoscopic wound suturing was 168.5 minutes. The mean renal ischemia time was 112.5 (90 to 150) minutes, which was due to performing different stages of the operation in different operating rooms. Given superselectivity of embolization, ischemic changes occurred only in a limited part of the parenchyma surrounding the tumor. Using balloon occlusion, unlike permanent embolization by microgranules, coils or other embolic agents, minimized ischemic injury of intact parenchyma around resected tumors. At the same time, it provided completely dry resection margins for full control. Renal ultrasound on the 3d-4th day postoperatively showed no pathological formations in the perirenal space and no changes in the pelvicalyceal system and kidney size. CONCLUSION: The proposed method of superselective balloon embolization of renal artery branches helped maintain blood circulation in intact parenchyma, which was an important factor in preventing acute renal injury during organ-sparing operations.

Asunto(s)

Oclusión con Balón , Neoplasias Renales/cirugía , Arteria Renal , Adulto , Anciano , Femenino , Humanos , Riñón/irrigación sanguínea , Riñón/cirugía , Neoplasias Renales/terapia , Laparoscopía , Masculino , Persona de Mediana Edad , Nefrectomía

RESUMEN

Presented in the article is retrospective analysis of the results of treatment of patients with lymphedema. We treated a total of 33 patients with primary (n=6) and secondary (n=27) lymphedema. Stage II lymphedema was diagnosed in 18 (54.5%) patients, stage III lymphedema in 15 (45.5%) patients. The 33 patients had a total of 44 affected limbs (9 hands and 35 legs). All patients were subjected to comprehensive physical antiedematous therapy including: manual lymph drainage massage, formation of compression bandage, selection of individual class 3 plain stitch compression knitwear, special complex of therapeutic exercises, care of the skin of the affected limb. A positive effect was achieved in all cases. In patients with upper limb lesions the volume of the extremity decreased averagely by 1'235.0±283.7 cm3 (22.6% of the baseline volume, p<0.005), in patients with lower limb lesions it decreased by 2'712.0±350.3 cm3 (22.1% of the initial volume, p<0.005). The carried out therapeutic course resulted in improvement of quality of life at the expense of decrease of the deformity and improvement of the function of the limb, increase of the scope of movements in the joints, regression of trophic alterations, widening of possibilities of wearing footgear and clothes. A conclusion was made that comprehensive antiedematous physical therapy is an effective method of treatment of patients with limb lymphedema, making it possible to attain regression of trophic disorders and to improve patients' quality of life.

Asunto(s)

Vendajes de Compresión , Terapia por Ejercicio/métodos , Linfedema/terapia , Masaje/métodos , Calidad de Vida , Terapia Combinada/métodos , Femenino , Humanos , Extremidad Inferior/patología , Linfedema/diagnóstico , Linfedema/fisiopatología , Linfedema/psicología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Federación de Rusia , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Extremidad Superior/patología

RESUMEN

The authors retrospectively analysed therapeutic results of treatment in a total of 749 patients of the Pyoseptic Surgery Unit with signs of lower limb critical ischaemia. Of these, 101 (13.5%) patients were found to have a pronounced septic process (successfully arrested in 88 patients). A further 86 (11.5%) patients were diagnosed with extended trophic alterations making revascularization unpromising. The incidence rate of "major" amputations in this group amounted to 34.2%, with a lethality rate of 5.9%. Severe somatic pathology was revealed in 106 (14.2%) patients, with the incidence of "major" amputation in this group equalling 27.4% and lethality rate - 10.4%. The neuropathic form of diabetic foot syndrome with no evidence of ischaemia was noted observed in 174 (23.2%) patients, "major" amputations in this group were performed in 3 (1.7%) patients, with a lethality rate of 0.6%. Impossibility of revascularization had previously been ascertained in 98 (13.1%) patients; "major" amputations in this group were performed in 38 (38.8%) patients, with a lethality rate of 6.1%. Sixty-nine (9.2%) patients were admitted for further treatment after previously performed reconstructive operations, including unsuccessful ones; the frequency of major amputations and lethality rate in this group amounted to 13.0 and 2.9%, respectively. Of the total number of the analyzed patients, 207 (27.1%) required considering the problem concerning possibility of revascularization. Surgical revascularization was performed later on in 34 (16.7%) patients in this group, and the incidence of "major" amputations amounted to 5.9% remaining at the same level in the remote period of follow up. In patients who were not subjected to revascularization, the incidence of "major" amputations during 3 months amounted to 9.5% reaching 27.2% by 42 months of follow up. The survival rate after 42 months in these groups amounted to 72.7 and 68.0 %, respectively.

Asunto(s)

Amputación Quirúrgica , Pie Diabético , Isquemia , Recuperación del Miembro , Extremidad Inferior , Procedimientos de Cirugía Plástica , Procedimientos Quirúrgicos Vasculares , Anciano , Amputación Quirúrgica/métodos , Amputación Quirúrgica/estadística & datos numéricos , Pie Diabético/diagnóstico , Pie Diabético/mortalidad , Pie Diabético/fisiopatología , Pie Diabético/cirugía , Femenino , Humanos , Incidencia , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/mortalidad , Isquemia/fisiopatología , Isquemia/cirugía , Recuperación del Miembro/métodos , Recuperación del Miembro/estadística & datos numéricos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/patología , Masculino , Necrosis , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Federación de Rusia/epidemiología , Servicio de Cirugía en Hospital/estadística & datos numéricos , Tasa de Supervivencia , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricos

RESUMEN

Presented herein are the results of treatment of 28 patients with stenosis/occlusion of central veins undergoing replacement therapy by means of programmed haemodialysis for terminal renal failure. The clinical symptomatology in all patients manifested itself by chronic lymphovenous insufficiency of the upper limb, dysfunction of the vascular access (14 patients, thrombosis of the vascular approach (5 patients), venous hypertension of the brain (4 patients). 17 patients had aneurysms of the vascular approach in the zone of puncture. In 18 cases for correction of the venous outflow we performed roentgenoendovascular angioplasty, including 3 cases in combination with stenting. Technical success amounted to 83.3% (15 of 18 cases). 13 patients underwent open reconstructive operations, including 5 cases of thrombectomy from the vein (in all cases failed one), in 8 cases bypassing operations (cross cephalic anterior jugular shunting - 5, subclavian-femoral bypass grafting - 1, transposition of the external jugular vein into the internal jugular vein - 1. In-hospital patency of bypasses amounted to 87.5% (7 shunts of 8). The remote results were followed up within the terms up to 43 months (averagely 12.3 ± 2.2 months). In the group of endovascular treatment more than half of patients (8 of 15) required secondary endovascular interventions. The cumulative requirements in re-do manipulations amounted to 52.4% during the first year and to 89.4% during the second year. The function of the approach was preserved in 93.3% of patients. Of the seven shunts patent in the early postoperative period, occlusion occurred in three cases at 1, 5 and 13 months. The 1-year patency amounted to 50.0%. The function of the approach was preserved in 75.0% of cases.

Asunto(s)

Angioplastia de Balón/métodos , Derivación Arteriovenosa Quirúrgica , Oclusión de Injerto Vascular/cirugía , Diálisis Renal/métodos , Adulto , Anciano , Angioplastia , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/fisiopatología , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Vena Subclavia , Grado de Desobstrucción Vascular

RESUMEN

Analyzed herein are the outcomes of 1,079 reconstructions of the aortofemoral segment, performed for Leriche s syndrome using polytetrafluoroethylene grafts "Ecoflon" during the period from 1997 to 2012. Hospital lethality amounted to 3.1%, frequency of thromboses was 0.53% and that of amputations equalled 0.53%. The patients were followed up at terms varying from 6 to 180 months. Cumulative patency of the bypass grafts at 1 year amounted to 99.3±0.2%, at 5 years to 97.3±0.6%, at 10 year to 91.9±1.9%, and to 90.0±2.7% after 15 years. Primary patency amounted to 97.6±0.4%, 90.9±1.1%, 75.9±2.7% and 71.4±4.1%, respectively. Grafts infection occurred in 1.3% of cases (0.2% in the early, and 0.83% in the remote postoperative periods). False aneurysms of distal anastomoses were registered in 0.5% of cases. A total of 137 reoperations were performed (104 for graft thromboses, 9 for pseudoaneurysms of anastomoses, and 7 for graft infection). Seventeen operations were carried out for ischaemia relapse due to progression of the occluding process in patent grafts. The amputation rate amounted to 6.6%. Based on the obtained findings a conclusion is drawn that polytetrafluoroethylene grafts "Ecoflon" comply with the current standards of quality.

Asunto(s)

Aneurisma Falso , Oclusión de Injerto Vascular , Síndrome de Leriche , Politetrafluoroetileno/uso terapéutico , Complicaciones Posoperatorias , Injerto Vascular , Amputación Quirúrgica/estadística & datos numéricos , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Aneurisma Falso/etiología , Aneurisma Falso/fisiopatología , Aneurisma Falso/cirugía , Aorta Abdominal/cirugía , Prótesis Vascular/efectos adversos , Prótesis Vascular/normas , Femenino , Arteria Femoral/cirugía , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/cirugía , Humanos , Isquemia/fisiopatología , Isquemia/cirugía , Síndrome de Leriche/diagnóstico , Síndrome de Leriche/fisiopatología , Síndrome de Leriche/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Injerto Vascular/efectos adversos , Injerto Vascular/instrumentación , Injerto Vascular/métodos , Grado de Desobstrucción Vascular

RESUMEN

Analysed herein are the results of the joint work of the Pyoseptic Surgery Department of the Centre "Diabetic Foot" with the Vascular Surgery Department based in various clinics over 2 periods - 2010 and 2011. During the first period, a total of 126 patients with critical ischaemia were treated without using revascularizing methods, during the second period, a total of 205 patients with critical ischaemia were examined by vascular surgeons deciding upon the problem concerning possibility of revascularization. In 148 cases (72.2%) revascularization was regarded impossible due to pronounced trophic disorders and/or severity of the general somatic status. Fifty-seven patients were subjected to angiography. Of these, five patients were found to have contraindications to vascular reconstruction, with the remaining 52 patients being subjected thereto (65 operations, of which 22 roentgen-endovascular ones). One (1.9%) patient died. Clinical improvement was achieved in 47 (90.3%) cases, and with no dynamics in four (7.7%) subjects. Using a multidisciplinary approach resulted in a decrease in the incidence rate of high amputations in patients with lower limb chronic ischaemia at the department of Pyoseptic Surgery from 51.6% in 2010 to 35.4% in 2011 (p=0.0000). Of these, the number of the above-the-knee amputations decreased from 41.3% to 15.1%, respectively (p=0.0000). The proportion of crural amputations increased from 20.0% to 46.6% (p=0.04).

Asunto(s)

Isquemia/cirugía , Pierna/irrigación sanguínea , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Femenino , Humanos , Isquemia/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento

RESUMEN

The immediate and long-term results of 500 reconstructive operations on the aorticfemoral segment using a miniaccess were analyzed. 443 patients suffered from the obliterative atherosclerosis and 57 were operated on the infrarenal aortic aneurism. The size of the surgical access was 5-12 sm (418 through laparotomy, 82 through the retroperitoneal access). The access enlargement was necessary in 5.0% of cases. The mean time of the operation was 166.6±7.8 min (90-255 min). Time of the aortic clamping was 26.2±1.5 min by the aortic by-pass and 32.3±4.5 min by the aortic resection. The postoperative leathality rate was 1.6%, the morbidity rate was 20.0% (local vascular complications 7.2%; local non-vascular complications 7.2%, systemic complication 7.6%). 5-year by-pass patency was 91.9±2.8%, the limb was preserved in 93.6±2.4%.

Asunto(s)

Aorta Abdominal/cirugía , Arteria Femoral/cirugía , Complicaciones Intraoperatorias/prevención & control , Complicaciones Posoperatorias/prevención & control , Enfermedades Vasculares/cirugía , Procedimientos Quirúrgicos Vasculares , Adulto , Anciano , Aorta Abdominal/fisiopatología , Femenino , Arteria Femoral/fisiopatología , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Monitoreo Intraoperatorio/métodos , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/fisiopatología , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/mortalidad

RESUMEN

The ankle-brachial index (ABI) was determined in a total of 1,751 employees of industrial enterprises of the Republic of Tatarstan aged from 45 to 84 years old (mean age 55,3 ± 0,14 years). An abnormal ABI was registered in 5,1% of the examined people (4,1% in the age group from 45 to 55 years, 5,4% in 56-65-year-old patients, and 12,1% in subjects over 65 years (p=0,001). An abnormal ABI was registered in 8.3% of men, and 3,1% of women (p=0,000), in 4,1% of rural population, 5,9% (p=0,138) of urban population, in 14,8% (p=0,000) of smokers, and in 45,4% (p = 0,000) of patients with a history of a cardiovascular event.

Asunto(s)

Índice Tobillo Braquial , Enfermedades Asintomáticas/epidemiología , Enfermedad Arterial Periférica , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial/métodos , Índice Tobillo Braquial/estadística & datos numéricos , Demografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , Medición de Riesgo , Factores de Riesgo , Federación de Rusia/epidemiología

RESUMEN

Based on a meta-analysis of the literature and own experience in a total of 490 reconstructions of the aortofemoral segment using a miniapproach, the authors carried out a comparative analysis of the main minimally invasive methods employed for treatment of the pathology concerned.

Asunto(s)

Aorta Abdominal/cirugía , Arteria Femoral/cirugía , Laparoscopía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Investigación sobre la Eficacia Comparativa , Humanos , Tempo Operativo , Evaluación de Resultado en la Atención de Salud , Cirugía Asistida por Video/métodos

RESUMEN

Presented herein is a case report regarding successful endovascular prosthetic repair of an abdominal aortic aneurysm in its retroperitoneal rupture in a 56-year-old male patient treated by implantation of the unilateral stent-graft «Aorfix¼, cross femoro-femoral bypass grafting, and ligation of the contralateral common iliac artery.

Asunto(s)

Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Prótesis Vascular , Urgencias Médicas , Tratamiento de Urgencia , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector , Resultado del Tratamiento

RESUMEN

Presented herein are the outcomes of using autologous peripheral blood stem cells (SCs) in patients with stage II В lower limb chronic obliterating diseases (according to A.V. Pokrovsky's classification). Autologous SCs had previously been stimulated by means of the recombinant granulocytic colony stimulating factor (G-CSF) for five days. On day six, we performed mobilization of the peripheral blood stem cells on the MSC+ unit by means of leukopheresis followed by intramuscular administration of half of the obtained dose into the affected extremity. The mean number of the transplanted mononuclears amounted to 6.73 ± 2.2 x 10(9) cells, with the number of CD34+ cells averaging 2.94 ± 2.312 x 10(7). Assessing the therapeutic outcomes at 3 and 6 months of follow-up showed a statistically significant increase in the ankle-brachial pressure index (ABPI) [being at baseline 0.59 ± 0.04, at 3 months - 0.66 ± 0.04 (P=0.001), and after 6 months - 0.73 ± .08 (P=0.035)], accompanied and followed by improved measures of the treadmill test, with the pain-free walking distance at baseline equalling 102.2 ± 11.55 m, after 3 months - 129 ± 11.13 m (P<0.001), and after 6 months - 140 ± 13.11 m=0.021 vs baseline). The findings of the immunohistochemical study confirmed the development of neoangiogenesis in the skeletal muscle and a 25 percent increase in the capillary-network density following administration of autologous stem cells into the muscle. The method of transplanting peripheral-blood autologous stem cells for treatment of patients presenting with distal forms of chronic obliterating insufficiency of the lower limbs proved safe and efficient. The findings obtained during this study made it possible to recommend extending the indications for its application at the expense of patients with critical ischaemia.

Asunto(s)

Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Neovascularización Fisiológica/efectos de los fármacos , Enfermedad Arterial Periférica/terapia , Trasplante de Células Madre de Sangre Periférica , Flujo Sanguíneo Regional/efectos de los fármacos , Trasplante Autólogo/métodos , Adulto , Índice Tobillo Braquial , Recuento de Células Sanguíneas , Monitoreo de Drogas , Prueba de Esfuerzo , Movilización de Célula Madre Hematopoyética/métodos , Humanos , Inyecciones Intramusculares , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/sangre , Enfermedad Arterial Periférica/fisiopatología , Índice de Severidad de la Enfermedad , Resultado del Tratamiento

RESUMEN

Results of 269 reconstructive operations on infrarenal aorta (among them 30 - for aneurysms) applied using mini-laparotomy (abdominal midsection 5-10 cm) were analyzed. Complexities during the operation occurred in 12,6% of patients; among them complications were observed in 4.8%. In 7.1% of cases it resulted in conversion of access. With accumulation of experience frequency of complications decreased from 6.1 to 3.8% (p=0,616) and frequency of conversions - from 12.2 to 3.2% (p=0.017). Comparison with group of 162 patients operated using standard laparotomy showed that despite rather more frequent complexities with infrarenal aorta reconstruction from mini-access (12.6% against 9.4%, p=0.505) amount of complications didn't differ significantly (4.8% and 5.6% respectively, p=0.930). Authors consider abdominal aorta reconstruction from mini-access to be a safe operation.

Asunto(s)

Cavidad Abdominal/cirugía , Aorta Abdominal/cirugía , Enfermedades de la Aorta/cirugía , Complicaciones Intraoperatorias , Laparotomía/normas , Complicaciones Posoperatorias , Cavidad Abdominal/irrigación sanguínea , Aorta Abdominal/patología , Aorta Abdominal/fisiopatología , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/fisiopatología , Femenino , Humanos , Complicaciones Intraoperatorias/fisiopatología , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/normas