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Modern vascular surgery has the data on a substantial role of the endothelium in pathogenesis of vascular diseases. Endothelial dysfunction is associated with a wide range of pathological processes including those in chronic diseases of lower-limb veins. The discovery of the endothelial glycocalyx made it possible to evaluate its role in the development of endothelial dysfunction as a trigger mechanism in impairment of venous blood flow. The understanding of the unifying role of endothelial dysfunction in pathology in various fields of medicine provides a possibility of predicting the development of serious socially significant diseases such as cardiovascular diseases, diabetes mellitus, obstetrical complications, and to correct the conditions associated therewith. The present study was aimed at carrying out a systematic literature review, thus making it possible to evaluate the role of the endothelial glycocalyx in the development of endothelial dysfunction, as well as to determine therapy with sulodexide capable of decreasing the probability of the onset of endothelial dysfunction at the expense of an anti-inflammatory, antithrombotic, and angioprotective effect on the endothelial wall.Современная сосудистая хирургия располагает данными о существенной роли эндотелия в патогенезе сосудистых заболеваний. Нарушение его функции связано с обширным спектром патологических процессов, в том числе и при хронических заболеваниях вен нижних конечностей. Открытие эндотелиального гликокаликса позволило оценить его роль в развитии эндотелиальной дисфункции как пускового механизма в нарушении венозного кровотока. Понимание объединяющей роли эндотелиальной дисфункции в патологии разных областей медицины дает возможность прогнозировать развитие серьезных социально-значимых болезней, таких как сердечно-сосудистые заболевания, сахарный диабет, акушерские осложнения и корректировать состояния, ассоциированные с ними. Целью данной работы явилось проведение систематического обзора литературы, что позволило оценить роль эндотелиального гликокаликса в развитии эндотелиальной дисфункции, а также определить терапию сулодексидом, способную снизить вероятность возникновения эндотелиальной дисфункции за счет противовоспалительного, антитромботического и ангиопротективного действия на эндотелиальную стенку.

Analysed herein is the experience with micronized purified flavonoid fraction (MPFF) in treatment of geriatric patients with decompensated forms of chronic venous diseases. A total of 218 geriatric patients were examined and treated. Of these, 132 patients had trophic disorders (C4-C6 class), including 40 patients found to have venous trophic ulcers (VTU). Therapeutic policy consisted in wound cleansing, application of topical antiseptics, hydroalginate dressing, stimulation of regenerative processes by therapy with MPFF at a dose of 1,000 mg daily. The microcirculatory blood flow was examined by means of laser Doppler flowmetry. By the end of a 4-week course of comprehensive treatment, 31 of 40 patients were found to have elevated microcirculation index to 16.9±2.1 perfusion units, suggesting improved perfusion of the lower-limb skin. Venous trophic ulcers completely epithelialized in 9 patients and decreased by half of their initial area in 22 patients. Repeat assessment of cardiac activity showed a decreased functional class of chronic heart failure in 9 of 17 patients with healed VTU. Assessing safety of phlebotrophic therapy revealed neither adverse reactions nor decompensation of accompanying diseases during the whole follow-up period.Анализируется опыт применения микронизированной очищенной флавоноидной фракции (МОФФ) при лечении геронтологических пациентов с декомпенсированными формами хронических заболеваний вен. Проведено обследование и лечение 218 геронтологических пациентов, из них 132 пациента имели трофические расстройства (класс С4–С6), в т. ч. у 40 больных обнаружены венозные трофические язвы (ВТЯ). Лечебная тактика заключалась в санации язвы, применении топических антисептиков, гидроальгинатных повязок, стимуляции репаративных процессов терапией МОФФ 1000 мг в сутки. Для исследования микроциркуляторного кровотока использовали метод лазерной доплеровской флоуметрии. К окончанию 4-недельного курса комплексного лечения у 31 пациента из 40 отмечено повышение индекса микроциркуляции до 16,9±2,1 перф. ед., свидетельствующее об улучшении перфузии кожи нижних конечностей. Венозные трофические язвы полностью эпителизировались у 9 больных и уменьшились наполовину своей исходной площади у 22 пациентов. При повторной оценке сердечной деятельности у 9 из 17 пациентов с зажившей ВТЯ понижен функциональный класс хронической сердечной недостаточности. При оценке безопасности флеботропной терапии нежелательных реакций, декомпенсации сопутствующих заболеваний за весь период наблюдения отмечено не было.

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.

A relapse of lower-limb varicose disease (LLVD), despite the development of surgical achievements in surgical technologies is currently an important problem of present-day phlebology. A considerable factor of its pathogenesis is endothelial dysfunction (ED). The results of clinical studies of "false" relapses (n=32) and the control group were indicative of pronounced ED. Studying the level of leukocytes confirmed a hypothesis on a "leukocytic" trap at the level of the varicose veins of lower extremities. The authors analysed the dynamics of certain markers of ED (CECs, VCAM-1, P-selectin, E-selectin t-RA, endothelin-1), suggestive of the degree of ED severity, revealing a tendency towards normalization of the ED markers on the background of phlebotrophic therapy (Antistax). The carried out study also makes it possible to conclude that the level of endothelemia and biochemical indices of ED may serve as an evaluating marker of the activity of processes of varicose transformation of veins in patients with a relapse of the disease.

The article deals with the findings obtained by present-day studies in pathophysiology of venous outflow disorders. The authors highlight a considerable role of the endothelium of the vascular wall resulting from its lesion with metabolic products of activated leukocytes in the development of varicose transformation. Also studied was the dynamics of the endothelial dysfunction marker, i.e., the number of the circulating endothelial cells (CECs). In so doing, amongst the patients presenting with segmental subcutaneous varicosity with reflux along the superficial and perforating veins, endothelial dysfunction was revealed most frequently, i.e., in 91% of the cases. It was proved that the CEC index might be used as a marker of endothelial dysfunction in patients presenting with varicose disease. An increase in this parameter above 6 x 10(4) cells per 1 ml of blood should be considered as a reliable manifestation of an endothelial lesion in diseases of the peripheral veins. By the degree of severity of endotheliemia, one may judge of the activity of the process of varicose transformation of veins, which makes it possible to timely take appropriate corrective measures. A priority trend in medical treatment of venous transformation is assigned to diosmine-based phlebotonics.

Symptoms of lower limb chronic venous insufficiency (CVI) are related to hypertension in vena cava inferior system. All changes that take place in macrocirculatory segment of hemodynamics are reflected at microcirculatory level, including metabolic and trophic processes -- the most important function of microcirculation, which is named "transcapillary exchange". Endothelial dysfunction and blood-venous wall interface changes play a crucial role in the development of pathology. Drug therapy remains the main and integral part of CVI treatment. One of its aims is to protect venous wall, normalize permeability and alleviate CVI symptoms at microcirculatory level. Antistax efficiency in patients with CVI was demonstrated in several trials and warranted the inclusion of this drug into complex treatment of lower limb CVI.

Results of treatment of 827 patients with bleedings from chronic gastric and duodenal ulcers are analyzed. Potentialities of various methods of endoscopic hemostasis were studied. Diathermocoagulation was the least effective method of hemostasis (59%). Irrigation of the bleeding source provided hemostasis in 88.7% patients, combined methods - in 94.1%. Methods of irrigation are appropriate in diffuse bleeding from ulcer (Forrest 1B). Stream bleeding (Forrest 1A) is indication for combined methods of hemostasis. It is demonstrated that type of endoscopic procedure does not influence rate of bleeding recurrences. The main element of conservative treatment of gastroduodenal ulcerous bleedings is antisecretory therapy. Proton pump blockers are more effective than H2-blockers; the rate of recurrences was 5.0 and 28.9%, respectively. Prediction of bleeding recurrences and preventive operations are the main way to treatment results improvement.

The paper presents approaches and purposes of conservative treatment of lower limb chronic arterial obliterative lesions. Special attention is given to antiplatelet agents. It is stressed that outpatient management comprises the most important part of this program.

Presented, herein is a review of the paper "Chronic venous insufficiency; effect of public health reforms on the cost of treatment and hospitalization. Italian prospects" by C.Allegra. The paper evaluates the effect of public health reforms carried out in Italy on the cost of the treatment of patients suffering from chronic venous insufficiency of the lower limbs. It is demonstrated that the change over in Italy to the American system of the classification of the diagnoses and discontinuance of donations for phlebotropic drugs has led to a 23.6 million euro rise of the annual expenditures for the treatment of this group patients due to an increase of the expenditures for hospitalization as well as to material redistribution of the financial expenditures from outpatients to inpatients. The review also contains the results of the author's investigations related to the clinical and economic estimation of the treatment of patients with different forms of varicosity using different types of analysis of the financial expenditures.

The examination and treatment of 841 patients with purulent diseases and acute purulent surgical diseases of soft tissues included 486 patients (control group) treated by a traditional (open) method and 355 patients (main group) treated by complex methods using early sutures. The primary suture was used in 124 patients. The average number of bed-days in this group of patients was (11.5 +/- 0.2) days. The primary delayed suture was used in 192 patients--the average number of bed-days was (12.8 +/- 0.1) days. The early secondary suture was used in 27 patients--the average number of bed-days was (17.3 +/- 0.4) days. In 327 (92.1%) cases of the main group patients the healing of the wounds by primary intention was obtained with good functional and cosmetic results which allowed to make the period of hospital treatment at an average 12.2 days shorter.

93 patients aged from 21 to 52 years were examined and operated upon. Endometriosis was diagnosed in 31 patients, carcinoma of the rectum--in 62 patients. Endometriosis had two forms: superficial (noninvasive) and deep (invasive) forms. The necessary components of diagnostics should be rectal and rectovaginal examinations, endoscopy, histological verification. Differential symptoms of endometriosis and rectal carcinoma are described.

Electron microscopy of the venous valves in varicose disease shows that dystrophic changes develop on the external and internal surfaces of the valve cusps. Endotheliocytes on the external surface are located longitudinally in relation to valvular axis and on the internal surface they are perpendicular to it. Fragments of the elastic membrane, collagen fibres and smooth muscle cells are seen under the endothelial lining. Endothelium actively regulates proliferative processes of smooth cells secreting the so-called "growth factor of endothelial origin". The development of venous valve pathological changes in varicose disease is accompanied by endothelial damage, disturbance of morphofunctional state of smooth muscle cells and intercellular substance of the vascular wall.

The article presents an experience with the operative treatment of 476 patients with recurrent dilatation of superficial veins of lower extremities. True and false variants of the recurrences are discussed as well as problems of their diagnosis and treatment. Stress is made on high specific weight (87%) of patients with the development of recurrences due to incomplete examinations and technical defects during the first operation. In 13% of the patients recurrences were caused by progress of the varicose disease and non-eliminated hypertension in profound veins due to their ectasia and incompetence of the valves.

The article analyzes results of different methods of hernioplasty in 964 patients with simple and complicated forms of inguinal hernias. Good results of treatment of complicated forms of inguinal hernias were noted when using methods of deep many-layers hernioplasty after Shuldis and N. I. Kukudzhanov. These methods are based on many-layers strengthening of the posterior wall of the inguinal canal and reconstruction of the internal inguinal ring. Recurrence was 1.1% after using the Shuldis method, and 5.2% after the method of Kukudzhanov. These methods of plasty are most pathologically substantiated and are recommended for practical work of surgeons.

The purpose of the study was to evaluate efficacy of Diosmin (Phlebodia 600, Innothera, France) in treatment of patients presenting with class C0s-C3 chronic venous diseases (CVD) according to the CEAP classification. Presented herein are the results of a prospective observational study aimed at assessing the outcomes of two-month administration of Phlebodia 600 (600 mg diosmin) in patients suffering from class C0s-C3 CVD according to the CEAP classification. The study comprised a total of 868 patients, including 175 (20.2%) men and 693 (79.8%) women. Of these, 866 patients completed the study according to the protocol. Amongst the 868 followed-up patients, 851 (98.0%) subjects strictly adhered to the physician's prescription and stopped taking the drug without violation of the regimen and dosing of diosmin. The main drug dosage regimen of diosmin was 1 tablet once a day in 851/868 (98.04%) patients. Satisfaction with treatment with diosmin was reported as 'excellent' by 46.7 % of patients (95% CI: 43.3-50.0) and by 49.4% of physicians (95%: CI 46.1-52.7), being rated as 'good' by 45.0% of patients (95 % CI: 41.7-48.4) patients and by 43.6% of physicians (95% CI: 40.3-47.0). The score for the quality of life of patients according to the CIVIQ-20 scale at the first follow-up visit amounted to 45.4±15.4 points (median 43.0 points). At the second follow-up visit, this parameter improved dramatically, dropping to the level of 35.6±11.5 points (median 33.0 points). By the third follow-up visit, the positive dynamics of the parameters preserved continued, averagely amounting to 28.9±8.7 points (median 26.0 points). A decrease in the circumference of the left and right crura (by 0.39±0.74 and by 0.36±0.75 cm, respectively) was observed at the second follow-up visit. The difference of the malleolar measurements between the first and third follow-up visits amounted to 7.2±9.4 mm and 6.6±9.7 mm for the right and left crus, respectively (p0.001). The number of patients with a reported feeling of heaviness in the legs statistically significantly decreased from 97.6% at the stage of enrollment into the study to 73.0% after 2 months of therapy, that of those with painful sensations from 84.5 to 55.3%, those with complaints of swelling (oedemas) of the lower limbs from 83.9 to 56.8%, with complaints of convulsions from 71.2 to 35.7%, with complaints of sensation of tingling from 63.4 to 34.1%, respectively. Hence, a statistically significant improvement of the patients' condition was observed as early as 30 days after the beginning of treatment. By day 60, the positive effect of the carried out therapy continued to grow. Safety and good tolerance of the drug were noted, which was confirmed by low incidence of undesirable events and high adherence to treatment.