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Fibrinolytic therapy with streptokinase preparations was administered to 79 patients. Hemorrhagic, embolic, thrombotic, and allergic complications were observed over the course of therapy. Massive bleedings occurred in 3 (4%) patients, two of them died. Negligible hematomas at the site of vessel puncture were seen in 11 (14.4%) cases. Distal arteries embolization developed in 6 (7.6%) patients. Nine patients (11.4%) developed early re-thromboses soon after therapy was over. Allergic reactions presenting as hyperthermia and short-term chill were observed in one third of the patients. Measures to prevent possible complications of fibrinolytic therapy are strict adherence to thrombolysis methods and a dynamic laboratory monitoring over the course of therapy.

The paper provides the results of multimodality conservative therapy in 527 patients with chronic obliterating diseases of extremity arteries, which was performed in the outpatient setting. Factors influencing its efficiency were analyzed. The paper emphasizes the value of this direction of treatment whose underestimation sharply aggravates the prognosis of these diseases, including the results of their surgical management. Having obtained positive results in 84.5% of patients, the authors note the efficiency of treatment to be decreased with severe arterial insufficiency of lower extremities (5% of negative results in Stage IIa, 23% in Stage IIb, and 40% in Stage III), in patients with prior surgical interventions, and in elderly patients with atherosclerosis obliterans and younger patients with non-specific aortoarteritis.

Fibrinolytic therapy (FLT) was applied in 79 patients, aged from 37 to 76 years, suffering from thromboses of the main arteries of the pelvis and lower extremities. The duration of the disease ranged from one day to 8 months. FLT was conducted with streptokinase preparations: streptodekase, avelysin, and celiase. FLT lasted 24 hours on average (from 7 hours to 3 days depending on the duration of the disease). The main blood flow in the affected arterial segment was completely restored in 49 (62%) patients. In 30 (38%) cases attempts to restore the blood flow failed. The affected extremity was amputated in 4 patients. Severe hemorrhagic complications occurred in 4%., small subcutaneous hematomas in 14.4%, fragmentation of thrombi with the development of distal embolism in 7.6% of cases, anaphylactic shock developed in one patient. Four patients died.

Regional thrombolysis was performed in 62 patients with thrombosis of the aorta and arteries of the pelvis and lower extremities. The thrombolytics used were avelysin (20 patients) and celiase (42 patients). Complete lysis of the thrombi was recorded in 49 cases. After successful thrombolytic therapy balloon angioplasty of the revealed stenoses was carried out in 39 patients. After thrombolysis was completed 15 patients underwent various reconstructive operations which failed to produce an effect in 4 patients and the extremity was amputated. The complications of thrombolysis included hematomas at the site of catheterization of the arteries in 5 patients, distal embolism in 7, and an allergic reaction in one patient. The authors appraise the dependence of thrombolysis efficacy on the level, extent, and duration of the thrombotic occlusion.

Thrombolytic therapy was used in treatment of 40 patients with acute thromboses of the aorta, major arteries of the pelvis and lower extremities. Complete lysis of the thrombus was achieved in 21 patients, partial lysis in 13 patients, 6 patients had no effect. The authors consider that the effectiveness of the treatment of acute thrombosis of major arteries is dependent on duration of the disease, character, level and distance of the occlusion, degree of ischemia of the extremity. It is stressed that the method of choice is the selective administration of streptokinase drugs (Awelysin, Celiase).

Eight-year experience in conducting antithrombotic prophylaxis, by methods elaborated by the authors, in 93 patients operated on for acute thrombosis in the system of venae cavae superior and inferior is generalized. On the basis of the results, the authors advanced the main principle of antithrombotic prophylaxis, the necessity for simultaneous correction of disorders of blood coagulation, fibrinolysis, and aggregation of formed elements of the blood. They showed that the efficacy of postoperative antithrombotic prophylaxis depends on the presence and character of hemodynamic disorders in the involved extremity. It is established that general fractional heparinization is not suitable for antithrombotic prophylaxis due to low efficacy and high rate of hemorrhagic complications. Continuous regional infusion of rheopolyglucin-heparin mixture with nicotinic acid and Trental ensures in most cases correction of the thrombotic condition of hemostasis and effective prevention of rethrombosis of the major veins with minimum hazard of hemorrhagic complications.

The main principle of the antithrombotic therapy in acute thrombosis of major veins is to eliminate the thrombotic state of the homeostasis system by means of a simultaneous correction of pathological changes in all the three main links of this system. The authors believe the joint application of anticoagulants, antiaggregants and fibrinolysis activators to be necessary for the elimination of the state mentioned. The doses should be chosen in order to normalize the parameters of hemocoagulation, fibrinolysis and aggregation of thrombocytes.

Prior to the treatment 39 patients with osteogenic sarcoma were examined for some cell immunity indices by the skin-allergic reaction of delayed hypersensitivity (RDH) and the reaction of suppression of leucocytes migration (RSLM). As an antigen a polysaccharide fraction of osteogenic sarcoma was employed, for the control--normal bone polysaccharide fraction. In 25 patients the course of the disease was followed up for 8--14 months after the primary examination. Both RDH and RSLM were found to show no essential difference in the reactions for polysaccharide antigens isolated from osteogenic sarcoma and normal bone. In patients with a rapid growth of the primary tumor negative RSLM was noted, while RDH indices failed to show such differences. In patients without any signs of the progressing disease during 8--14 months since the moment of the examination, as a rule, positive RSLM and RDH are noted. In patients with a precipitous course of the disease 1--8 months prior to the treatment negative RSLM and RDH are more frequently observed.

The material of 117 hemosorptions has shown different efficiency of hemosorptions in patients with chronic arterial insufficiency to be dependent on genesis and stage of the disease. Hemosorption as an independent method may be used at early stages of obliterating endarteritis.