Search

Objective: To assess the main performance indicators of neurosurgical departments in surgical treatment of cerebral aneurysms in the Russian Federation., Material and Methods: We analyzed 22 neurosurgical departments (19 regional and 3 federal hospitals) in 2017 and 2021. The study enrolled 6.135 patients including 3.160 ones in 2017 and 2.975 ones in 2021. We studied the features of surgical treatment of cerebral aneurysms in different volume hospitals and factors influencing postoperative outcomes., Results: The number of surgeries for cerebral aneurysms decreased from 2.950 in 2017 to 2.711 in 2021. Postoperative mortality rate was 6.3% and 5.6%, respectively. The number of microsurgical interventions decreased from 60% in 2017 to 48% in 2021. The share of endovascular interventions increased from 40% to 52%, respectively. Endovascular embolization was accompanied by stenting in 55% of cases. Simultaneous revascularization was carried out in 2% of cases. In 2021, the number of patients undergoing surgery in acute period of hemorrhage increased to 70% (in 2017 - 61%). The number of hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased from 14 in 2017 to 17 in 2021., Conclusion: Certain changes in neurosurgical service occurred in 2021 compared to 2017. Lower number of surgical interventions for cerebral aneurysms, most likely caused by the COVID-19 pandemic, is accompanied by lower postoperative mortality. Endovascular interventions and revascularization techniques became more common. The number of surgeries in acute period after aneurysm rupture and hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased.

Objective: The objective of this study was to evaluate the results of surgical treatment of cerebral aneurysms in the Russian Federation., Material and Methods: We analyzed performance indicators in neurosurgical departments of regional and federal health institutions of the Russian Federation for 2017. The results of surgical treatment of cerebral aneurysms (CAs) were analyzed in 19 regional vascular centers (RVCs) in several federal districts and in 3 federal centers (FCs) with the most dynamically developing vascular neurosurgery and smoothly running system of statistical data processing., Results: The study included 3160 patients hospitalized to 22 medical institutions in 2017. Of these, 1808 patients were treated in RVCs, and 1352 patients were treated in FCs. We analyzed factors affecting the treatment outcome in CA patients. We identified features of CA treatment in clinics with a different amount of surgical intervention., Conclusion: An increase in the surgical activity in centers and simultaneous development of microsurgical and endovascular treatments for cerebral aneurysms reduce postoperative mortality. Due to the presence of a RVC network in the Russian Federation, many patients could receive necessary specialized treatment. The number of operations for cerebral aneurysms has increased 6-fold for the past 10 years.

Presented in the article are the results of studying antiaggregate activity of acetylsalicylic acid and clopidogrel in a total of 36 patients suffering from various-severity chronic arterial insufficiency of lower limbs on the background of atherosclerosis obliterans. The study was conducted prior to treatment for correct selection of a particular antiplatelet agent. The obtained results showed that clopidogrel was not always more efficient than acetylsalicylic acid, since there is individual sensitivity of each patients to a particular antiplatelet agent. Therefore, an individual approach is necessary to conservative therapy of arterial insufficiency of lower limbs. For some patients it is preferable to administer clopidogrel, for others - acetylsalicylic acid. In a series of cases combined treatment is justified, while some patients having low sensitivity to both acetylsalicylic acid and clopidogrel require careful selection of alternative agents influencing other thrombocyte receptors.

Presented herein are the results of treating a total of sixty patients suffering from atherosclerosis obliterans of the lower limbs with degree IV chronic ischaemia according to the Fontain-Pokrovsky classification and accompanied by pyonecrotic alterations. The patients were subdivided into two clinically matching groups, each comprising 30 subjects. All patients after two-week conservative preparation underwent various reconstructive surgical operations performed on major arteries of the lower limbs. The local preoperative treatment was of two different types, i. e. consisting of Levomecol ointment used in the control group patients and Metrogyl 1% topical gel applied in the study group patients. Sampled before treatment, inoculations of the wound discharge demonstrated predominantly anaerobic flora in all patients, with the number of bacterial strains having dramatically decreased once Metrogyl gel 1% had been used, whereas application of Levomecol did not significantly influence the structure of the microbial profile. Following surgical treatment we had to perform high amputation of the lower limb in 5 patients of the control group, whereas in the study group patients only one patient required amputation at the foot level. Hence, prior to carrying out reconstructive vascular interventions in patients presenting with pyonecrotic lesions of lower extremities it is preferable to perform debridement of the necrotic foci using topical antibacterial agents, one of which may be Metrogyl 1% gel.

The study comprised a total of 107 patients (all men) after endured femoropopliteal bypass grafting above the genicular fissure with a synthetic stent graft manufactured by the Gore Company for stage IIB and III chronic arterial insufficiency of the lower extremities according to the Fontain-Pokrovsky classification. Group One I (control group) was composed of fifty-four patients permanently taking in the postoperative period at the out-patient stage pentoxiphylline (trental 400 mg 1 tablet 3 times daily) and xantinol nicotinate at a dose of 150 mg one tablet thrice daily. Group Two (Study Group) consisted of fifty-three patients taking after reconstructive vascular surgery at the out-patient stage in addition to pentoxiphylline and xantinol nicotinate acetylsalicylic acid (cardiomagnil 75 mg 1 tablet once daily). The Control Group patients within 3 to 6 months of follow up were found to have a considerable progressing improvement of the functional abilities of the microcirculatory bed requiring in 44 (81.5%) cases hospitalization to the Surgical Department for intensive vascular therapy. Despite this fact four (7.4%) patients within the time frame from 6 to 9 months after surgery developed thrombosis of the vascular implant requiring a repeat surgical intervention. In the Study Group patients, the degree of functional capabilities of the microcirculatory bed in the postoperative period was less considerable, reaching the maximum after 10-12 months of follow up, with eighteen (34.0%) patients requiring hospitalization for additional vascular therapy to perform. There were no cases of implants' thrombosis in the Study Group patients. Pathological alterations in the functional state of the peripheral vascular bed correlated with viscosimetric indices and activity of blood platelet aggregation. The addition of antithrombocytic agents to conservative postoperative therapy considerably improved the outcomes of surgical treatment.

Forecasting the development of implants' narrowing appears to be one of the most important problems encountered in vascular surgery today. The present study was therefore undertaken to work out a comprehensive diagnostic methodology making it possible to reliably predict the development of stenosis of vascular anastomoses during the postoperative period in patients presenting with atherosclerosis obliterans. The work was based upon the findings obtained by examining a total of seventy-nine patients diagnosed with atherosclerosis obliterans of the lower-limbs arteries, also including assessment of a large number of haemodynamic and immunological parameters both before and after reconstructive vascular interventions. The study showed substantial dynamics of a series of immunological and haemodynamic indices on the background of the operation and during the postoperative period. Based on the mathematical processing of the obtained data, the authors managed to reveal the factors playing a leading role in the development of stenosis, having also worked out a prognostic algorithm making it possible with high reliability to predict the development of stenosis of arterial anastomoses.

The work was based on the findings of the examination and surgical management of 69 patients with obliterating atherosclerosis of the lower limbs with various degree of chronic arterial insufficiency. The authors analyzed the main causes promoting development of early reocclusion of the bypasses and prostheses following reconstructive surgical operations. They also proved the role of high peripheral vascular resistance and, in particular, diminished functional possibilities of the microcirculatory-bed vessels in the genesis of early reocclusions in patients with chronic arterial insufficiency of the lower limbs. They also suggested a new technique of determining the carrying capacity of the microcirculatory channel, the use of which in the preoperative period makes it possible to predict development of early thrombotic complications, and in some cases to wisely abstain from carrying out a reconstructive vascular intervention due to high risk of its poor outcomes. It is preferable for such patients to undergo conservative pathogenetic preoperative therapy aimed at improving the functional possibilities of the microcirculatory vessels.

The paper analyses diagnosis and treatment outcomes for 20 men aged from 55 to 76 with lower limb arteriosclerosis obliterans. Based on exhaustive laboratory and instrumental diagnostic data the authors conclude that 10-days course of Vazaprostan (20 mkg per day) for patients with IIb stage of chronic lower limb arterial insufficiency yields not only improvement in tissue metabolism, but a reduction of peripheral vascular resistance as well. Thus such therapy can be used for preoperative care before reconstructive vascular interventions in order to reduce the risk of implant thrombosis in early postoperative period.

Saturated vapor pressures for a number of parabens (methyl- (MePB); ethyl- (EtPB), n-propyl- (PrPB) and n-butyl- (BuPB)) were obtained and from their respective temperature dependences the sublimation enthalpy, DeltaH(sub)( degrees ), and sublimation entropy, DeltaS(sub)(degrees), as well as their respective relative fractions in the process calculated. The sublimation enthalpies are: DeltaH(sub)(degrees)(MePB)=98.8+/-0.8; DeltaH(sub)(degrees)(EtPB)=100.9+/-0.7; DeltaH(sub)(degrees)(PrPB)=123.7+/-0.6; DeltaH(sub)(degrees)(BuPB)=108.4+/-0.8 kJmol(-1). The obtained values are discussed with regard to X-ray data from the literature. Theoretical calculations of the respective crystal lattice energies were carried out and compared to the experimental data. The following parameters were analyzed: (a) energetic contribution of van der Waals forces and hydrogen bonding to the total packing energy of the crystals; (b) contributions of the different fragments of the paraben molecules to the packing energy; (c) influence of bias of the supposed C-H distances on the result of the calculation procedure. Enthalpies of evaporation were estimated from the measured enthalpies of sublimation and enthalpies of fusion, and compared with literature data. Moreover, the thermodynamic functions of solvation of the molecules in water and in a number of n-alcohols were evaluated. The thermodynamic terms (Gibbs energy, enthalpy and entropy) of the solvation process were split up in their respective specific and nonspecific fraction, and these values compared for all combinations of parabens and solvents. The influence of mutual saturation of the phases in the water-octanol system on the partitioning process of the molecules is also discussed.

It is known that functional activity of macrophages (Mph), adhesion and phagocytosis, depends on the local concentration of Fc receptors (Fc gamma R) on the cell surface. Fc gamma R may have a random distribution on cell membrane or form clusters of different sizes. This process depends on the local activity of microfilaments that, in its turn, reflects peculiarities of macrophage microenvironments. One may conceive that the number of opsonized erythrocytes (OE) subject to adhesion (engulfing) to separate Mph depends on the amount of active centres on the cell surface and their activity. The structures, such as Fc gamma R clusters, phagosomes and others, in whose formation numerous components of Mph (cell skeleton, microvesicles, signal receptive system and others) are involved, are arbitrarily called the structural functional units (SFU). Thus, we used two parameters: the average number of SFU per Mph in population, and the average activity of SFU instead of a generally accepted number of OE per Mph. The number of SFU per Mph can be 0, 1, 2 etc., and one SFU may bind (engulf) 0, 1, 2 etc. EA. For the assessment of the parameters, the approximation of experimental histograms by type-A Neyman's distribution was used. To verify the adequacy of the model, observations of OE adhesion and phagocytosis in different conditions were made. The results show that the parameters of the model fit well the biological processes in this system.

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).

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.

A favorable effect of combined pathogenetic treatment for acute arterial obstruction on systemic microcirculation has been demonstrated in 40 experimental animals and 40 patients operated on for embolism in the aortic bifurcation and main arteries of the limbs.

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.

Three hours after the administration of sodium nucleinate the activation of glycolysis, the hexosomonophosphate shunt, the urea cycle (determined by the analysis of key enzymes), the expression of FC gamma-receptors and the decrease of oxidizing phosphorylation were noted in the peritoneal macrophages of mice. By 36 hours the gradual decrease of these characteristics occurred. After three oral administrations of the preparation immature macrophages with lower metabolic activity and increased oxidizing phosphorylation appeared in the exudate, while resident and activated cells practically disappeared. The immaturity of the cells was confirmed by their incubation in vitro. The changes in the cells, revealed in this investigation, are supposed to occur due to the redistribution of activated and intact macrophage populations in situ.

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.

Good results were obtained in the treatment of 10 patients with massive embolism of the pulmonary artery by regional infusions of small doses of streptase and heparin. The efficiency of the method was dependent on duration of the disease and character of the embolic occlusion of branches of the pulmonary artery, a prolonged activation of the patient's fibrinolysis contributing to lysis of emboli and to recovery of pulmonary blood flow in late follow-up terms.

The immunological action of RNA mononucleotides was studied in animal experiments. The most pronounced activation of macrophagal glycolysis urea cycle, oxidative phosphorylation, lysosomal hydrolases was induced by uridine 5'-monophosphate (5'-UMP) and guanosine 5'-monophosphate (5'-GMP); 5'-GMP also induced the maximum increase of the expression of FC gamma receptors. 5'-UMP ensured cell activation comparable with the total action of all mononucleotides. 5'-UMP and 5'-GMP, used in combination, produced the highest stimulating effect on macrophages, and the addition of low-active adenosine 5'-monophosphate (5'-AMP) to active 5'-UMP did not decrease the stimulating potency of the latter. The stimulating activity of sodium nucleinate exceeded that of all mononucleotides and their combinations. 5'-GMP and 5'-AMP induced the maximum activation of oxygen metabolism, evaluated by chemiluminescence, while 5'-UMP and cytidine 5'-monophosphate (5'CMP) proved to be inactive. The shift of the phosphate group to the third carbon atom or the production of the oligonucleotide 5'-UMP consisting of 5-15 nucleotides resulted in the appearance of the capacity for stimulating oxygen metabolism in macrophages. Their in vitro cultivation with 5'-GMP and 5'-AMP induced the maximum increase of cell spreading in comparison with other mononucleotides, while the maximum increase of phagocytosis was ensured only by 5'-UMP and 5'-GMP.2+ 5'-UMP and 5'-GMP enhanced nonospecific resistance to Salmonella typhi infection, and sodium nucleinate, to Pseudomonas pseudomallei and Pseudomonas mallei infections.

Heterogeneity of resident peritoneal macrophages was studied as revealed by their phagocytosis and binding of sheep erythrocytes opsonized by specific rabbit IgG. It has been shown that the macrophage heterogeneity is due to the presence of active and inactive cellular subpopulations. A mathematical model, based on the Poisson fitting of experimental histograms, was elaborated for the analysis of subpopulation composition of macrophage pool in the test of rosette formation and phagocytosis. The validity of the model was supported by physicochemical isolation of the macrophage subpopulation which was inactive in erythrocyte binding. The macrophage pool was separated into fractions by absorption--elution at different temperatures. Active and inactive macrophage subpopulations were found in all the fractions but in different ratios.

The heterogeneity of resident peritoneal macrophages and peritoneal macrophages was studied in different periods following oral administration of sodium nucleinate according to their ability to bind and phagocytize sheep erythrocytes opsonized by means of specific rabbit IgG. Using a mathematical method developed earlier, it has been possible to demonstrate that resident peritoneal macrophages can be divided into two subpopulations--actively and poorly binding macrophages but, after activation by sodium nucleinate--into three subpopulations. Fractionation of the macrophages according to their ability to adhesion within a temperature gradient has shown that the same peaks are traced in the fractions as in the overall pool of cells, but in different quantitative ratios. It has also been demonstrated that phagocytic activity is reduced in macrophages capable of adhesion to plastic at lower temperatures.

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.