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Aim: To analyze early postoperative period in patients with diffuse pulmonary emphysema after palliative surgical correction of respiratory failure., Material and Methods: The study included 196 patients who underwent bullectomy (n=111) and surgical reduction of pulmonary volume (n=85)., Results and Discussion: Overall morbidity and mortality were 40.8% and 12.2% respectively. Among patients older than 60 years these values were significantly higher (58.0% and 22.6% respectively). It was shown that age over 60 years is associated with high risk of complications and mortality after excision of large and giant bulls. In patients <60 years morbidity is comparable after bullectomy and surgical reduction of pulmonary volume., Conclusion: Selection of patients for palliative surgical correction of respiratory failure is generally corresponded to that for lung transplantation. However, these methods should be considered complementary rather competing.

The problem of venous thromboembolic complications (VTECs) in patients with cardiovascular implantable electronic devices (CIEDs) is extremely important today because of an annually increasing number of surgical interventions for life-threatening arrhythmias and chronic heart failure. There are hitherto no clearly defined reliable risk factors for VTECs due to heterogeneity of the available literature data. Some sources point to elevated thrombus formation in patients with a large number of electrodes, in repeat operative interventions, in the presence of a temporary pacemaker, in implantation on the left side, silicon cover of an electrode, others refute these facts. Still undetermined remains the choice of antithrombotic therapy for prevention and treatment of VTECs in this cohort of patients. Implantation of a VTEC may be accompanied by thrombosis of deep veins of the upper extremities up to the development of total occlusion of veins. In rare cases, thrombosis extends proximally, there appears superior vena cava syndrome which may require surgical treatment. Diagnosis of these diseases is complicated by their symptom-free course in the majority of cases. The most dangerous VTEC is pulmonary thromboembolism very commonly not accompanied by clinical symptomatology or taking its course under the mask of other more frequent diseases. Despite the fact that pulmonary thromboembolism with a source in the system of the superior vena cava is rarely massive, it may lead to the development of chronic postembolic pulmonary hypertension and to decreased quality of life. The article contains a review of the present-day literature and a clinical case report concerning the development of VTECs in a patient with a CIED in the form of thrombosis of the right internal jugular, subclavian and brachiocephalic veins, pulmonary embolism of small branches of the right pulmonary artery, suppuration of the pacemaker's bed and sepsis. Therapy with antibiotics, low-molecular-weight heparins, antiplatelet drugs and anti-inflammatory agents with regular sanitation of the pacemaker's bed turned out effective.

This literature review dedicated to the importance of an integrated assessment of external respiratory function in cardiovascular diseases (CVDs), including an analysis of up-to-date techniques, such as spirometry, body plethysmography, examination of the diffusing capacity of the lung, determination of O2 consumption with evaluation of the effectiveness of pulmonary ventilation. It considers the pathogenetic components of impairments in pulmonary ventilation and gas exchange, which develop in different CVDs, as well as during and after cardiac surgery. The authors analyze the results of international investigations and their own experience, which emphasize the prognostic value of lung function tests and suggest that there is a need for a comprehensive functional assessment of the respiratory system in cardiac surgical patients for their effective preoperative preparation, assessment and reduction of operational risks, and improvement of the prognosis of surgical treatment.

Aim: To analyze the factors contributing to the increased risk of persistent postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass surgery (CABS) under extracorporeal circulation (EC)., Subjects and Methods: 257 male patients aged 45 to 69 years with coronary heart disease (CHD) undergoing elective CABS under EC were examined. In addition to conventional clinical examination, all the patients underwent neuropsychological testing 3-5 days before, 7-14 days and 1 year after CABS. Persistent POCD was diagnosed if there was a 20% decline in cognitive domains at 1-year postoperatively versus preoperatively in 20% of the tests of an entire neuropsychological battery. Binary logistic regression analysis was applied to identify the factors supposedly increasing the risk of persistent POCD., Results: It was found that high baseline cognitive status, early POCD after CABG under EC, low adherence to the prescribed treatment regimen, as well as progressive carotid artery (CA) stenosis could predict with a high (85%) probability that persistent POCD might develop at 1 year after surgery., Conclusion: The findings are suggestive of the multifactorial origin of persistent POCD, a significant role in the development of which is played by not only the preoperative cognitive status, but also by postoperative factors, such as the degree of adherence to the prescribed treatment regimen, early POCD, and progressive CA stenosis.

Over the years, glaucoma surgery has improved from iridectomy by A. Graefe and traumatizing procedures performed without magnification tools or microsurgical instrument to high-technology interventions that are not only microscopic, but also pathogenetically oriented. Various modifications of trabeculectomy, initially introduced by J. Cairns back in 1968, had been the gold standard for several decades and were notable for pronounced and stable hypotensive effects. However, there was also a strong association with such complications as choroidal detachment and hyphema, thus, boosting the development of so called nonfistulizing surgeries. Of the latter, the most widely used are non-penetrating procedures, including deep sclerectomy and viscocanalostomy. Although very safe, they appear unable to produce a truly long-lasting hypotensive effect. Moreover, just as fistulizing trabeculectomy, non-penetrating procedures damage the limbus and adjacent conjunctiva reducing the possibility of a second intervention. This fact together with other drawbacks mentioned above, on the one hand, and technical progress, on the other, were essential prerequisites for the appearance of a new type of surgery - minimally invasive glaucoma surgery (MIGS). Parameters that should be met for a procedure to be considered minimally invasive are debated. The main requirement has, however, been established: ab interno approach through a corneal incision. As surgical tools are enhanced and new techniques arise, options for glaucoma treatment widen greatly, ensuring our future move to higher level standards in the field. This review contains all recent data on minimally invasive techniques currently in use in glaucoma surgery or those under investigation. The authors have also analyzed effectiveness reports and present their conclusions regarding the current state of MIGS worldwide.

Analysed herein are both immediate and remote results of surgical treatment of 93 patients presenting with chronic atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. The patients were subjected to autovenous femoropopliteal bypass grafting to the isolated arterial segment or balloon angioplasty with stenting of the superficial femoral artery. While choosing the method of arterial reconstruction we assessed concomitant diseases, primarily lesions of the coronary and cerebral circulation. In order to objectively evaluate the patient state, we worked out a scale for assessing surgical risk. Survival rate without amputation after three years in patients with low risk amounted to 71.4%, in those with moderate risk to 60.0%, and in high-risk patients to 43.3%. Patients with initially high risk were found to have a high incidence rate of cardiac and cerebrovascular complications, exceeding 40%. It was shown that the worked out system of assessing the level of surgical risk objectively reflects the prognosis of patient survival following a reconstructive operation. This system of assessment may be appropriate while choosing an optimal method of arterial reconstruction (bypassing operation or endovascular intervention) in patients with atherosclerotic lesions of arteries of the femoropopliteal-tibial segment and critical ischaemia accompanied by severe concomitant pathology. Patients with high surgical risk should preferably be subjected to endovascular reconstruction, while those with low surgical risk should better undergo open shunting bypassing operation, and for those with moderate risk it is acceptable to perform both methods of arterial reconstruction.

The study included 138 patients who had 193 reconstructive operations on carotid arteries (CA) in the acute period of ischemic stroke. The 1st group included 22 patients with bilateral stenosis, age under 60 years; the 2nd group - 33 patients with a bilateral stenosis at the age more than 60 years; the 3rd group consisted of 83 patients with bilateral stenosis of the ipsilateral CA were operated in an acute period of ischemic stroke, but with contraindications and/or refused the surgery on the contralateral CA. Brain computer tomography, ultrasound duplex scanning of the CA with the assessment degree of stenosis and structure of plaques, also MSCT-AG of the head and neck vessels were performed for all patients. Cerebral oximeter was used for assessing adequate cerebral perfusion during cross-clamping of the CA. Indications for the installation of a temporary intraluminal shunt during cross-clamping of the CA performed according to the method.

In the review published data on what modern antithrombotic drugs are used to support percutaneous coronary intervention in the treatment of acute coronary syndrome with ST segment elevation on the electrocardiogram in patients of older age groups. It was shown the effectiveness and safety of new pharmacological combinations using both anticoagulants and antiplatelet agents as in patients with acute coronary syndrome in elderly. It was highlighted also the need to find new combinations of anticoagulants and antiplatelet agents, to improve the prognosis in elderly persons subjected to percutaneous coronary intervention in patients with ACS.

Aim: To present possibilities of transcatheter arterial embolization (TAE) in duodenal bleeding management., Material and Methods: Treatment of 212 patients with acute duodenal bleeding for the period from 2012 to 2014 was analyzed. In 32 (22.5%) patients of the study group bleeding recurrence or its high risk was indication for TAE., Results: Change of surgical tactics for bleeding from upper gastrointestinal tract including endoscopic hemostasis optimization, wide introduction of TAE and sharp decrease of surgical activity reduced overall mortality to 1.6% in 2012--2014., Conclusion: TAE is effective to control bleeding and reduces mortality rate especially in high risk and elderly patients.

Aim: To estimate thrombin generation test parameters in patients with coronary heart disease during coronary artery bypass surgery under extracorporeal circulation after transfusion of donor platelet concentrates during long-term therapy with acetylsalicylic acid (ASA)., Subjects and Methods: A total of 148 patients with coronary heart disease who had undergone elective primary coronary artery bypass surgery under extracorporeal circulation during preserved therapy with ASA (75-100 mg/day) were examined. According to donor platelet concentrate transfusion, all the patients were divided into 2 groups: 1) 76 patients undergoing donor platelet transfusion and 2) 72 without this procedure. A control group consisted of 20 apparently healthy individuals. At the pre-, intra-, and early postoperative stages, the investigators evaluated the following thrombin generation test parameters: lag time (min); peak thrombin concentration (nM/l); time to peak (min); the area under the thrombin generation curve (nM), and thrombin generation rate (nM/min)., Results: During long-term ASA therapy, the patients were found to have an activated endogenous thrombin potential in the pre- and intraoperative periods, as evidenced by the high peak concentration of thrombin and the increased rate of its generation. At the same time, the time of prothrombinase complex activation and that of thrombin generation were longer than those in the control group. In the early postoperative period, the patients who had not been transfused with platelet concentrates with a further increase in the temporal parameters, showed a decreased hemostatic potential, reaching the control level, whereas donor platelet transfusion stimulated endogenous thrombin generation: the time to initiate clotting and that to reach the peak were shorter; in this case, the thrombin generation rate and concentrations increased, but the preoperative level was not reached. No perioperative (hemorrhagic or thrombotic ischemic) events were noted in the examined groups., Conclusion: The hemostatic potential was preserved in patients receiving long-term therapy for ASA. Taking into account laboratory and clinical findings, platelet concentrate transfusions are unnecessary for preventive purposes. The appropriateness of donor platelet transfusion should be strictly individually approached with regard to the laboratory parameters of the thrombin generation test, by minimizing the risk of perioperative ischemic and hemorrhagic events in each specific patient.

Severe comorbidity significantly limits the use of active surgical tactics in patients of older age groups suffering from colorectal cancer (CRC), leading to the abandonment of the necessary operations in 20 % of cases. The low use of radical surgical tactics are not always related to objective difficulties, but often can be due to the stereotypical approach to solving the question of the treatment of the elderly patient, which leads to unreasonable refusal of surgical intervention. Today is not defined by a single concept of surgical treatment of patients with colon cancer in elderly and senile age. There is no universally accepted system for determining the functional operability in this group of patients, not developed specific algorithms for their preoperative preparation and perioperative management. In this regard, the search for new approaches to surgical treatment of geriatric patients with CRC, allowing, on the one hand, to increase the percentage of completion radical surgery, and on the other, to reduce the number of postoperative complications in this numerous group of patients, is one of the priority tasks of Oncology.

Aim: To define the role of endoscopic hemostasis in treatment of gastroduodenal ulcers complicated by bleeding., Material and Methods: The results of endoscopic hemostasis in 770 patients with peptic ulcers were analyzed., Results: Injection hemostasis had the highest efficacy in case of recurrent bleeding. No other method showed significant advantage in its efficiency. The efficacy of injection method was 52%, argon-plasma coagulation - 83.3%, radiowave technique - 78%, combined endoscopic method  - 96%. In case of recurrent bleeding endoscopic hemostasis is effective alternative to surgery especially in high-risk patients. Repeated endoscopic hemostasis significantly decreases mortality from 45% to 23% in case of recurrent bleeding.

Research of a functional condition of kidneys at patients of advanced and senile age before and in 24, 48, 120 hours after carrying out X-ray endovascular intervention. Patients of age groups are examined: 34-59 years (49,7±7,8) - 35 people (group of control), 60-74 years (66,1±4,1) - 48 people and 75-82 years (78,8±4,2) - 22 people. Сonclusion: it is confirmed the fact that at patients of advanced and senile age dynamic control of a functional condition of kidneys after 1st, 3rd and 5th days and till 3 weeks after carrying out X-ray endovascular interventions is necessary.

Aim: To evaluate effectiveness of electroneurostimulation of the shin muscles as a constituent part of the prevention of TEC in the hip joint pathology at the hospital stage of treatment., Material and Methods: With this purpose, there was conducted the extended comparative analysis of the parameters of the blood coagulation system in 27 patients with pathology of the hip joints and the stated concomitant vascular insufficiency. The comparison group comprised 50 patients with uncomplicated pathology of the hip joint who underwent hip joint replacement surgery. In the patients of both groups the product dabigatran etexilate in the standard dosage (220 mg/day) was used for specific prevention., Results: The authors managed to confirm qualitatively and quantitatively the effectiveness of the new variant of non-specific prevention in patients with a high risk of TEC development. Similar changes of the parameters of blood coagulation system were obtained at the use of electroneurostimulation of the shin muscles against the background of the use of the direct anticoagulant dabigatran etexilate. The numbers of thromboses in the group of patients with degenerative and dystrophic diseases of the hip joint with and without arterial insufficiency of the lower extremities are quite comparable (3.7 and 6%). Recanalization of the veins of the lower extremities in every individual case was achieved at the use of therapeutic doses of dabigatran etexilate (300 mg/day). The use of dabigatran etexilate permitted to minimize the risk of deep venous thrombosis (DVT) at hip interventions and contributed to recanalization of veins in recent thromboses in the postoperative period.

There is evidence that acetylsalicylic acid (ASA) is effective in preventing events in a number of cardiovascular diseases. However, there is a number of unresolved problems concerning the efficiency and suitability of its use as an agent for the prevention of cardiovascular events (CVEs) (myocardial infarction (Ml) and/or ischemic stroke (IS) and/or death) in subjects without any clinical manifestations and/or diagnosed coronary heart disease (primary prevention of CVEs). The aim of the review is to compare the current recommendations of, professional communities for the.use of ASA as an agent for the primary prevention of CVEs, to analyze cohort studies and meta-analyses that are not included in the above recommendations (2013-2014), and to consider particular issues on ASA administration (resistance to ASA; barriers to its preventive use). The analysis performed suggests that there is no convincing evidence that it is reasonable to use ASA as a population-wide prevention strategy. The studies and meta-analyses often show conflicting data, which is likely to be associated with the clinical features of population groups included in the studies, with the presence or absence of ASA resistance and motivation for therapy. According to the current clinical recommendations, the results of studies and meta-analysis, and expert's opinions, deciding whether it is expedient to use ASA as an agent for the prevention of primary MI and/or IS and death from atherosclerostic vascular events should be based on the assessment of an individual's risks for the above disorders, which are related to a risk for hemorrhages due to ASA intake.

Unlabelled: Analysed herein are the results of an experimental study performed on 30 rabbits and a clinical study of treating a total of 60 patients presenting with critical ischaemia of lower limbs on the background of bilateral atherosclerotic lesions of the aortoiliac segment and running high operational-anaesthesiological risk. The animals were subdivided into three groups: an intact group consisting of 6 animals and two study groups comprising 12 rabbits each. In the first study group onto the wall of the abdominal aorta we implanted a synthetic polytetrafluoroethylene prosthesis, the second study group animals received biological graft "Kemangioprotez" from bovine internal thoracic arteries. The biological prosthesis on day three after implantation onto the arterial wall induced 3.2 times and on day seven 1.2 times more pronounced inflammatory reaction than the polytetrafluoroethylene prosthesis. 30 days after implantation of the synthetic graft the degree of repair connective-tissue processes in the arterial wall was 1.8-fold and 70 days after was 3.3-fold more pronounced than after implantation of the biological prosthesis at the same terms. In the connective-tissue capsule around the synthetic prosthesis predominated cellular elements while around the biological prosthesis - fibrous structures predominated. The patients were subdivided into 2 groups consisting of 30 patients each. In Group One patients the shunt used was a synthetic polytetrafluoroethylene prosthesis, in Group Two being a biological graft from bovine internal thoracic arteries. All patients suffered from severe concomitant diseases in the decompensation stage and a multi-level lesion of lower-limb arteries. Revascularization of the ischaemized extremity was carried out through the system of the deep femoral artery system. The use of a biological prosthesis made it possible in the immediate postoperative period to decrease the frequency of early postoperative complications by 13.3%, that of late graft thromboses by 30%, to prolong the average term of grafts functioning 1.8-fold, to increase the physical component of health by 12.8% and the mental one by 9.1%., Conclusion: For femorosubclavian shunting in high-risk patients it is appropriate to use a biological graft while establishing a distal anastomosis with the deep femoral artery.

Increasingly, there are patients with concomitant coronary artery disease and aortic valve, especially in elderly patients, who often have severe comorbidities and high surgical risk, which is undoubtedly a certain effect on the choice of method and tactics of treatment. Today, there are several approaches to the treatment of patients in this category, and all of them have certain advantages and disadvantages.

Objective: Studying the results of endovascular prosthetic repair in patients with abdominal aortic aneurysms., Material and Methods: A retrospective study of 34 elderly and aged patients (mean age 67.4±1.24 years) with severe concomitant pathology and the risk of Euroscore averagely amounting to 13.16±0.19, subjected to endoprosthetic repair for the presence of AAA., Results: In all 34 cases we obtained good immediate results of endoprosthetic repair of the infrarenal portion of the abdominal aorta: positioning of stent grafts was adequate, expansion complete, with no sign of endoleak. Hospital lethality rate was 0%. The intra- and postoperative periods were not accompanied by the development of neither cardiological nor neurological complications. Analysing by the McNemar criterion showed that there was a statistically significant trend towards elevation of leukocytosis and ESR after surgery (p=0.074), and for other indices the shifts were statistically insignificant or absent. Since no signs of an inflammatory process were revealed, in all cases the postoperative wounds healed with fist intension, the alterations in the blood formula were associated with resorption of thrombotic masses in the paraprosthesis space., Conclusion: In all cases, implantation of the stent graft resulted in achieving the main objective, i. e. adequate isolation of the aneurysmatic sac in AAA. Dynamic follow up did not reveal any cases of stent graft dislocation, aneurysm rupture, thrombosis of endograft branches, or type 1a leaks.

A high percentage of patients undergoing coronary angiography which revealed no coronary lesions persists among patients with stable CHD. This problem persists in spite of the application of existing recommendations for the management of patients with stable CHD. Data of Russian and foreign authors analyzed in this article, which dedicated to this subject.

The article describes the results of laparoscopic cholecystectomy in patients with acute cholecystitis. 97 patients including 13 men and 84 women aged from 20 to 74 years were included in the study. There was not the conversion to laparotomy and intraoperative complications in all cases. 83 patients, which amounted to 85.7% of the patients, were discharged on the next day after operation. The last 14 patients had the variation of postoperative hospitalization period from 2 to 4 days. Laparoscopic cholecystectomy is a safe and effective procedure in patients with acute cholecystitis.

This article presents results of surgical treatment of 2963 patients with cholelithiasis. The majority of them (71.8%) had an elective surgery, though 28.2% of patients underwent an emergency operation. A comparative assessment of obligate treatment criteria was made in 2 groups. A first group consisted of 803 patients and it was before introduction of Roman selection criteria used for surgical treatment of patients. A second group included 2963 patients in the period after introduction of selection criteria. Preoperative planning of surgery with evaluation of technical complexity of all stages of intervention with prognosis for possible complications should be the base of reasonable choice of surgical method of treatment of cholelithiasis and safety protection of surgery. The study completed and results obtained allowed decrease of the rate of postoperative complications to 1.4% and lethality--to 0.3%, respectively.

It was performed cohort prospective study of treatment results of 69 children with through-capsule spleen injuries for the period from 2002 to 2013. Patients were divided into 2 groups. The first group included 63 patients after non-surgical treatment. The second group included 6 children who underwent surgery. In the first group 95.3% of patients had stable hemodynamics at admission. In the second group only 2 patients had the signs of deferred bleeding. Continuing abdominal bleeding was the indication for surgery in 4 patients although stable hemodynamics. Hemoperitoneum in case of spleen injury is not significant prognostic factor defining the tactics of treatment. The physiological response on bleeding but not the amount of blood in abdominal cavity determines tactics of treatment. Hemodynamic status is single statistically significant criterion for choose of surgical treatment of children with spleen injuries. Unstable hemodynamics increases the risk of surgical treatment in 20 times (p<0.007).

It was analyzed the treatment results of 60 male patients with critical limb ischemia in case of atherosclerotic lesions of the aorta-iliac segment and severe somatic diseases. All patients were divided into 2 groups. Every group consisted 30 patients. The first group included axillary-femoral bypass by using of synthetic polytetrafluoroethylene prosthesis. The second group - by using of bioprosthesis of bull's internal thoracic arteries. Using of bioprosthesis allows to reduce early postoperative complications in intermediate postoperative period on 13.3%, late bypass thrombosis on 30%. Also there was elongation of average time of bypasses functioning in 1.8 times. Physical health was increased on 12.8%, mental - on 9.1%.

Main methods of bronchus suturing after lung resection are presented in the article. The safest methods of bronchus closure are manual and mechanical suturing with use of UB apparatus. Use of UO or TL-TLH apparatus with longitudinal orientation of tantalic brackets significantly increases the frequent of bronchus suture failure. It is determined by deterioration of bronchus blood supply and poor trophic healing of bronchus wound.

The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used to treat acute and chronic pain in locomotor system (LMS) diseases. However, their administration may be accompanied by the development of dangerous complications as organic and functional disorders of the cardiovascular system (CVS) and gastrointestinal tract (GIT). Physicians have currently a wide range of NSAIDs at their disposal; but none of the representatives of this group can be considered the best. Thus, highly selective cyclooxygenase-2 inhibitors (Coxibs) are substantially safer for GIT; however, their use is clearly associated with the increased risk of severe cardiovascular events. Nonselective NSAIDs, such as naproxen or ketoprofen, are safer for CVS, but more frequently cause significant GIT organic and functional disorders. Moderately selective NSAIDs, such as meloxicam (movalis), conceivably could be the most acceptable choice for treating the majority of patients in this situation. This drug has been long and extensively used in global clinical practice and has gained the confidence of physicians and patients. The major benefits of meloxicam are its proven efficacy, convenient treatment regimen, relatively low risk of complications as organic and functional disorders of the GIT and CVD and good compatibility with low-dose aspirin.

Unlabelled: The study was aimed at assessing efficacy and safety of using graduated compression bandage with the level of pressure in the area of the middle ankle amounting to 20-40 mm Hg as compared to the conventional profile (10-20 mm Hg in the ankle area) in the composition of comprehensive prevention of postoperative venous thromboembolic complications (VTEC) in patients of a high-risk group. For this purpose we carried out a prospective randomized clinical study including a total of 100 surgical patients (general surgery, neurosurgery) from a group of high risk for the development of VTEC with the presence of 3 and more conditions predisposing to venous thrombosis. All patients were subdivided into two subgroups 50 patients each. Patients in both groups received anticoagulants in standard preventive doses from the first day after surgery or in the remote period. The Study group patients were treated by applying on the ankle a bandage of medium distensibility with the target pressure in the ankle area of 20-40 mm Hg measured by means of a portable manometer. The control group patients were treated by a similar bandage applied onto the ankle and femur with a pressure of 10-20 mm Hg. In all cases a special lining material was placed under the bandage. With the purpose of active screening of postoperative VTECs, prior to the beginning of the study and then each 3-5 days we performed ultrasound angioscanning and in case thrombosis was revealed we performed static perfusion scintigraphy of the lungs and/or echocardiography for verification of pulmonary embolism. The patients who died were subjected to post-mortem examination. We also assessed the frequency of correcting the bandage on the femur and crus., Results: The incidence rate of postoperative venous thrombosis in the Study Group amounted to 16.0% (95% CI: 5.8-26.2%) and in the Control Group 36.0% (95% CI: 22.7-49.3%, p=0.039), with no significant differences in the incidence of proximal thrombosis or pulmonary embolism revealed. Maximal reduction of the development of venous thrombosis was revealed in patients with lower-limb paralysis amounting to 69.5%. The frequency of the development of cutaneous lesions under the bandage did not differ significantly between the subgroups, being 8% and 12%, respectively. The total number of corrections of the compression in the Control Group was significantly higher, amounting to 0.64±0.23 time a day versus 0.32±0.05 t/d (p<0.0001)., Conclusion: The use of an elevated compression profile makes it possible to decrease the incidence of postoperative VTECs, especially in patients with palsy, not increasing the rate of cutaneous lesions under the bandages. Femoral compression provides no additional reduction of the incidence of thrombosis but creates an additional necessity of correcting the bandages.

The article analyzed risk factors after operations for pancreatonecrosis in order to predict a course of the disease and carefully plan the treatment. It was revealed that the lethality level depended on different factors: the sex, age, a period of admission to the hospital, prevalence of necrotic suppurative process and severity of operative trauma. The authors made a conclusion of radical change to treatment approach. The open operations should be reduced at the expense of introduction of low-invasive methods of treatment in the case of pancreatonecrosis.

The article presents an experience of treatment of 180 patients with esophageal carcinoma. A resection of the esophagus with the gastric graft plasty was performed using original methods in 163 patients. There were 74 patients at a mature age and 89 patients at an elderly and senile age. The method of Doppler-echocardiography was applied for the assessment of cardiovascular and respiratory systems. Results of surgery correlated with both groups. It allowed the recommendation of more wide application of surgical aids in elderly age group. Postoperative lethality consisted of 4.1% for mature patients and 10.1% for the patients at the elderly and senile age.

The article discusses various options of anticoagulant therapy for pulmonary thromboembolism and the main criteria of medication choice including the use of unfractionated heparin, low-molecular-weight heparins, and rivaroxaban. The data presented are based on the own experience and results of international clinical trials.

The present report describes a clinical case concerning a two-stage hybrid operative intervention in a patient presenting with an aortic arch aneurysm associated with coronary artery disease. The first stage consisted in performing mammary coronary artery bypass grafting of the anterior descending artery, coronary artery bypass grafting of the right coronary artery, endoventricular plasty of the left ventricle according to the Dor technique, switching over of the brachiocephalic arteries to the ascending portion of the aorta with the vascular multiple-branch prosthesis Intergard. The second stage consisted in endoprosthetics of the aortic arch with a stent graft. The patient concerned belongs to a high-risk group for the development of postoperative complications. Endovascular techniques in the pathology involved may be an alternative to the conventional surgical treatment, since there is no necessity to use extracorporeal haemocirculation or deep hypothermal circulatory arrest. It is necessary to analyse the remote results, to work out the indications for the interventions concerned, especially in elderly and aged patients presenting with a variety of accompanying pathology.

One of actual problems of modern cardiology is assessment and correction of risk of cardiac complications of noncardiac surgery. Recommendations on this issue propose reduction of preoperative examination and wide use of drug therapy, primarily statins and β-blockers. However, new data accumulated in recent years, as well as the recognition of scientific inconsistency of the DECREASE research series, force a new outlook at the problem. In this review in light of new facts the following important issues of perioperative medicine are discussed: administration of β-blockers and statins, volume of preoperative cardiac examination, value of preventive myocardial revascularization.

It was operated 17 patients with kidney and bladder cancer against the background of severe concomitant coronary artery disease (52.9%), aortic aneurysm (35.3%) or combination of coronary artery disease with Leriche syndrome (5.9%) or hemodynamically significant stenosis of internal carotid artery (5.9%). Patients were operated for the period from 1998 to 2012. All patients were male at the age from 39 to 80 years (mean 62.1 years). The first stage of kidney cancer was diagnosed in 8 (53.3%) patients, the second stage - in 1 (6.7%) patient, the third stage - in 2 (13.3%) patients and the fourth stage was observed in 4 (26.7%) patients. Bladder cancer had 1 and 2 stages. Simultaneous operations were performed in 3 (17.6%) patients. 12 (70.6%) patients were operated consequentially. Surgery for kidney cancer was not done in 2 (11.8%) of 17 patients because of patient death after coronary bypass surgery or patient refusal of surgery after carotid arteries stenting. Intraoperative and postoperative complications have been developed in 9 (52.9%) of 17 patients. 2 (11.8%) patients died. The complications frequency and mortality after simultaneous operations were 25% (1 of 4) and 0. These parameters were 57.1% (8 of 14) and 14.3% respectively in case of consequent tactics. It was not observed myocardial infarction and aortic aneurysm rupture after surgeries for kidney and bladder cancer. Overall 1, 3, 5 - year survival of patients with kidney cancer and severe concomitant cardiovascular diseases was 100%, 73.3% and 52.4% respectively. It was concluded that surgical treatment of severe concomitant coronary artery disease and aortic aneurysm in patients with kidney and bladder cancer decreases risk of myocardial infarction and aortic aneurysm rupture in intraoperative and postoperative periods.

In pronounced concomitant pathology and high risks of open operative treatment endovascular prosthetic repair of the abdominal aorta is a method of choice. Presented herein is a clinical case report concerning successful surgical treatment of a patient with an aneurysm of the infrarenal portion of the aorta and high risk of open operative treatment. The patient underwent unilateral endovascular prosthetic repair of the abdominal aortic aneurysm and crossover femoro-femoral bypass grafting with a good postoperative outcome.

The present paper reports a rare combination of Cooley's disease (thalassemia B) and the decompensated variant of chronic tonsillitis in a 14-year old girl. The patient presented with the severe form of hypochromic anemia and degenerative changes of erythrocytes. She was treated by means of bilateral tonsillectomy associated with the high risk of postoperative hemorrhage. In the preoperative period, the child received drop intravenous infusion of tranexam at a dose of 15 mg/kg body weight together with hemostatic agents. Hemorrhage during the surgical intervention was stopped by pressing tampons impregnated with tranexamic acid known to exert local and systemic hemostatic and antifibrinolytic action. The patient was discharged from the hospital for the further treatment of the primary disease.

We present in this review current data on specificities of efficacy and safety of antiplatelet therapy in patients with atherosclerosis of various localizations. Reduced priority of aspirin monotherapy in several clinical situations is shown. Controversial issues of the use of dual antiplatelet therapy including its application in patients with acute coronary syndrome are discussed. Novel groups of antiplatelet agents as well as individual new drugs are also presented.

Aim: The study was aimed at comparative analysis of efficacy of endovascular and surgical revascularization in patients presenting with lower limb critical ischaemia (LLCI) due to lesions of infrainguinal arteries., Material and Methods: The retrospective study included a total of 236 patients with LLCI undergoing revascularization of lower extremities performed at our Institute from 2007 to 2011. The patients were subdivided into two groups. Group One consisted of 135 patients subjected to transcutaneous endovascular interventions. Group Two comprised a total of 101 patients having endured bypass grafting operations. Limb salvage and survival of patients during five years were assessed by means of the Kaplan-Meyer method., Results: Technical success and clinical improvement in the both groups did not differ significantly, amounting to 90%. The complication rate and the number of major amputations turned out considerably higher in the group of surgical treatment as compared with that in the group of endovascular treatment. After 1, 3 and 5 years the indices of limb salvage and survival (LSS) in the both groups did not differ significantly amounting respectively to 94.4, 72.7, and 52.2% in the surgical group and 89.7, 67.2 and 46.3% in the endovascular group (p=0.196). The number or re-do operations in the remote period due to relapses of LLCI was considerably higher in the group of endovascular treatment., Conclusion: Endovascular and surgical methods demonstrate similar immediate and remote outcomes in patients with LLCI induced by lesions of infrainguinal arteries, but the choice of the method of revascularization should obligatorily take into consideration the localization and extension of arterial lesions, the presence of an appropriate autovein for the bypass graft, the level of perioperative risk, and life expectancy.

Hybrid operations combining open and endovascular surgeries are used in cardio-vascular surgery for the last 10-15 years. It leads to decrease complications frequency and mortality in case of pronounced comorbidities and severe heart, aorta and its branches disease. Authors have experience in performing of 10 hybrid surgeries and 7 aneurysms endoprosthesis of abdominal aorta. All operated patients had severe comorbidities which significantly increase risk of open surgery. These comorbidities were contraindication for open surgery in patients with abdominal aorta aneurysm. Thanks to introduction into practice hybrid operations and aorta aneurysms endoprosthesis the authors decreased complications frequency and avoided deaths in operated patients.

Introduction: It is generally known that Stanford type A aortic dissection has up to now been a serious problem of cardiothoracic surgery. The current state of the art of aortic surgery, anaesthesiological support, and perfusion strategy make it possible to achieve acceptable results in the early postoperative period in various-difficulty aortic arch reconstruction. Taking into consideration that the pathological process to some extent involves the brachiocephalic arteries, of special interest are remote results of various in aggressiveness and radicality types of reconstruction of the aortic arch in its proximal dissection from the point of view of the development of delayed impairments of cerebral circulation., Material and Methods: Over the period from 1999 to 2011, specialists of the Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the Ministry of Public Health and Social Development operated on a total of 124 patients presenting with DeBakey type I aortic dissection. All factors supposedly influencing the development of cerebral ischaemia were subdivided into the qualitative and quantitative ones. The qualitative factors included gender, aetiology, type of dissection, type of aortic arch reconstruction, type of cerebral perfusion, type of intervention on the aortic root, previous operations on the heart, and the presence of accompanying CAD, arterial hypertension, chronic obstructive pulmonary diseases, and renal pathology. The quantitative factors were as follows: age, height, body weight, duration of assisted circulation (AC), duration of aortic occlusion (AO), duration of circulatory arrest (CA). We examined a total of 80 patients within the terms of 11-124 months (mean 48,3±26,0 months) after surgical treatment. We studied interrelationship between the factors and the development of cerebral circulation impairments in the remote postoperative period., Conclusion: In the remote postoperative period virtually all cases of focal impairments of cerebral circulation were associated with accompanying atherosclerosis, i. e. the already compromised brachiocephalic vascular bed. Amongst the qualitative parameters the most significant variables were: aetiology, accompanying diseases, and the type of cerebral perfusion.

Aim: To estimate effectiveness of ambulatory treatment of gouty arthritis (GA) using non-steroidal anti-inflammatory agents (NAIA) and detect factors associated with the impairment of the functional state of kidneys during short-term therapy., Materials and Methods: The functional state of kidneys in 100 patients with GA was estimated from creatinine clearance (CC) calculated by the Cockroft-Gault formula on day 2 after their examination in a polyclinic and prescription of NAIA to stop the gout attack or during the first days after hospitalization. Mean duration of NAIA therapy was 10.8 ± 4. 77 days., Results: 18% of the outpatients with CC < 60 ml/min were given high doses of NAIA, 47% patients received them during the entire period of treatment, 36% were prescribed combined therapy with two or more NAIA. A short course of NAIA therapy resulted in the enhancement of CC in 46% of the patients and its fall in 54%. In 1 patient CC decreased by more than 50% compared with initial level; in 12 patients the decrease exceeded 25%. The risk of CC reduction under effect of NAIA increased in case of high NAIA doses (OR = 1.52, 95% CI 1.05 = 2.20, p = 0.024), combination of several NAIA (OR = 2.74, 95% CI 1:95-3.87, p = 0.02), concomitant infection and antibiotic therapy (OR = 11.51, 95% CI 8.76-15.13, p = 0.005), II-III NYHA FC chronic cardiac insufficiency (CCI) (OR =4.88, 95% CI 9.83-1681, p = 0.019)., Conclusion: Physicians of outpatient facilities do not always take account of the functional state of kidneys when prescribing NAIA for the treatment of GA. Kidney conditions in such patients deteriorate in case of high NAIA doses or combination of two and more NAIA during the entire period of therapy, in the presence of infection requiring antibiotic therapy or CCI.