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The examination of 76 patients with chronic venous insufficiency has shown that the new method allows visualization of subcutaneous and perforant veins at a depth up to 0.5 cm. Special tests can diagnose pathological venous refluxes suggesting valvular incompetence. Telephleboscanning allows marking the perforant veins that makes the operative interventions more radical.

Under investigation there were 152 patients aged 61 +/- 16 years who were conditionally divided into three groups according to the severity of ischemia. Plasmaphersis was carried out by a standard method. The monitoring of changes of microcirculation was done with the help of high-frequency ultrasonic doppler. Plasmapheresis is considered to be an effective method of treatment of the peripheral artery occlusive disease, it improves the microcirculation in ischemic tissues in critical ischemiae of the legs, normalizes the arterial perfusion due to the disappearance of arterio-venous dump at the microcirculatory level.

Based on the assessment of clinical efficiency of the intravascular and percutaneous photomodification of blood with a helium-neon laser in 170 patients the authors have shown that it is expedient to include the photohemocorrection in the medical programs for the I-III degree ischemia.

The functional (rheovasography, photoplethysmography), ultrasonic (dopplerography) and roentgenological (distal ascending and retrograde popliteal and talocrural phlebography) methods of investigation were used for studying the state of the musculo-venous pump of the crus in 50 patients with the varicose disease in the stage of trophic disorders. It was established that the formation of pathological capacities in the crural muscular veins and leakage of blood from the posterior tibial into deep plantar veins was responsible for the development of the decompensated course of this disease.

An experience with examination and surgical treatment of 156 patients with angiodysplasia of lower extremities shows that the ultrasonic location and dopplerography are highly informative methods of diagnosis of this disease. The orthostatic probe (the Valsalva test effect) allows the spread of angiodysplasia (suprafascial or subfascial) to be determined. The adequate strategy and volume of surgery can be chosen correctly. These methods of examination being noninvasive and easy makes them helpful for the objective assessment of the effectiveness of the surgical procedures and control of further treatment.

Data of echophlebodopplerography on "ULTRA-PVD" (USA) were used for studying the frequency and hemodynamic significance of vertical reflux of blood in the deep veins of lower extremities in varicose patients. A group of 50 healthy men and women and 80 patients with different stage of varicose disease were studied. A comparison of the data obtained allowed determining a reliable static criterion of the retrograde wave duration when performing a test with proximal compression. It was shown that under normal conditions it should not exceed 1.5 sec. Three degrees of the retrograde blood flow were distinguished. Indications for surgical correction of the relative valve deficiency of the deep lower extremity veins must be established in each concrete case. Since 1993 200 patients with primary varicose veins have been examined and operated upon. Good and excellent results (96%) testify to the effectiveness of the correction of deep vein hemodynamics which can improve surgical treatment of this pathological condition.

The regional haemodynamics was investigated in 39 patients by indirect radionuclide angiography, dopplerography, determination of the rate of elimination of radiodrugs from the leg tissue before, during and after a course of photohaemotherapy. It was shown that rheological properties of blood, lymph circulation, blood flow rate were improved at all stages of chronic insufficiency of lower extremities of the atherosclerotic and inflammatory genesis.

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

Retrograde phlebography (pelvic, femoral, popliteal cavography) was used for studying mechanisms of the formation of vertical reflux of blood along deep veins in 176 patients with varicose disease. Two mechanisms were established. The first mechanism is responsible for the retrograde blood flow arising due to descending ectasia of deep veins followed by the development of valve insufficiency, the second one--for the vertical reflux of blood formed isolatedly in deep veins of the femur and leg due to primary injury of valve cusps.

Under study were potentialities of computed tomography (CT) in diagnostics and differential diagnostics of lymphedema of lower extremities by comparing findings of CT in 40 patients (11 men and 29 women) with the I-IV degree lymphedemas. It was shown that data of CT were thought to be an objective basis for the estimation of spreading the injury and efficiency of the operative procedures.

An analysis of complex clinical and phlebographic examinations of 60 patients with the varicose disease has been made. Twelve variants of ways of spreading vertical reflux of blood along the pelvic veins have been established and two ways of its transmission to the lower extremity veins: a direct way of reflux from the iliac to femoral vein and an indirect ways of reflux--from tributaries of the iliac vein to those of the femoral vein. To eliminate the direct reflux the operative correction is necessary of the valve of the common femoral vein located inferior to the inguinal ligament. For patients with the indirect way of reflux ligation of the injured communicating veins of the gluteal area and femur, dissection of the varicose external labial veins are indicated.

CT potentialities in the diagnosis and differential diagnosis of lower limb lymphedema in 40 patients (11 men and 29 women), aged 16 to 56, are illustrated. Eighty studies on the limbs were performed to 20 patients with primary lymphedema, 6 with congenital lymphedema, 26 with secondary lymphedema, and 28 with unaffected limbs. The data were statistically processed according to the following parameters: leg diameter, skin and subcutaneous fat thickness and density, the presence of fibrosis in subcutaneous fat, its localization, shape and spreading, fascial thickness. CT permitted objective assessment of disease and a right choice of a type of surgical intervention.

The paper shows that echography can be used in the diagnosis of most congenital fetal limb developmental defects. The detection accuracy for severe anatomic defects was 83.3%. That for mild hand and foot developmental defects was achieved in 54.8% of the cases. Bilateral coxofemoral joint dislocation was diagnosed only in 2 fetuses. The paper also presents echograms of most malformations detected and emphasizes that it is essential to make a comprehensive and detailed examination of all fetal limbs.

The long-term investigation of the influence of physical exercise upon the structure of human skeleton revealed certain peculiar features in the process of developmental reconstruction of joints of the upper (humeral joint, hand joints) and lower (knee joint, the joints of the foot) extremities resulting from the occupation of the persons under study. Roentgen-anatomical studies performed in 433 industrial and 430 office workers established the fact of retardation and deceleration of ageing of the extremities bone system in representatives of physical labour as compared with office workers. So the significance of spectal physical exercises compensating the progressing with age hypodynamia in persons of non-physical labour gets special importance.

The data on age changes occurring in the height of the articular cleft of the talocrural joint, in morphological components of the diaphysis of the crus and foot bones have been presented in pole-jumpers and in non-sportsmen at the age of 13-21 years. Roentgenological, roentgenogrammetric and x-ray densitometric methods have been used. At the age of 14-15 years the greatest changes in the talocrural joint, crus and foot bones are noted.

In order to improve radiodiagnosis of chronic and venous insufficiency of the lower limbs, the soft tissues and skeleton of the affected limbs were x-rayed in 120 patients with disturbed venous outflow (60 with varicosity and 60 with the post-thrombophlebitic syndrome - PTPS). The limb soft tissue changes in this disease were shown to be of one type and looked like the thickening of subcutaneous fat; obscure boundaries of the muscles with subcutaneous fat, the narrowing of intermuscular layers, the absence of differentiation of separate muscular groups, visible varices, calcifications of soft tissues and phleboliths. Bone changes appeared later than the clinical signs of disease and were as follows: regional and diffuse osteoporosis, various kinds of periostoses (scaled or partially assimilated linear, multilayer and pectiniform) and hyperostosis. Longitudinal platypodia and transverse foot flattening caused by dysfunction of the musculoligamentous apparatus and increasing venous congestion in the lower limbs were seen in most of the patients.

The direct "inferior" lymphography of the medial superficial collector was used for the examination of 45 patients with posttraumatic edemas of lower extremities. The cause of them was shown to be not only a trauma of major collectors but also multiple injuries of smaller lymph vessels, the stabilization of the process and reduced edema being developed at the expense of organization of the lateral lymph flow by branching the lymph vessels of the collector inferior to the blockade level, and in its certain portions by anastomoses between the sources of smaller vessels falling into different segments of the main pathway.

The investigation of average time of transport of radionuclide along the venous system of lower extremities was used by the authors to assess the evacuation function of the musculo-venous "pump" of the leg in 10 healthy people and 50 patients with varicose disease of lower extremities. The direct relation between the degree of incompetence of the musculo-venous "pump" and the degree of the varicose disease speaks of its obvious pathogenetical role in the development of venous pathology.

Findings of clinico-roentgenological examinations of 23 patients with an early stage of the surgical infection of soft tissues (necrotic cellulitis, fasciitis) developing without gas formation are described. Typical roentgenological symptoms were found. It was established that roentgenological symptoms often leave behind the wide clinical picture. It helps to begin timely curative measures.