[POSSIBILITIES OF THE FORCED INTRAARTERIAL INJECTION OF MEDICINAL PREPARATIONS IN A COMPLEX OF TREATMENT FOR THE LOWER EXTREMITIES CHRONIC ISCHEMIA]

The efficacy and prognostic significance of the forced intraarterial injection of medicinal preparations in complex of treatment in patients, suffering chronic ischemia of the lower extremities tissues, was studied. In experimental conditions of the main blood flow blockade the forced intraarterial injection of medicinal preparations have promoted the release of vessels from cellular aggregates and the blood clots; and in the ischemia of degree ІІ - ІІІа – has determined more pronounced clinical improvement. Appearance of reactive hyperemia of the foot in terms more than 2 min have witnessed the hopelessness of the extremity saving.

Brucella arteritis: clinical manifestations, treatment, and prognosis

Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.

Femoral artery infections associated with percutaneous arterial closure devices

Hemostasis obtained by manual compression after femoral artery catheterization results in consistently low rates of major complications. A rare complication of femoral artery catheterization is arterial infection. Its occurrence after diagnostic angiography using manual compression has not been reported. We report two cases of femoral arterial infection after uneventful diagnostic catheterization in nonimmunocompromised patients using the Perclose percutaneous arterial closure device. Our cases are representative of Perclose associated infections, with delayed presentation of a staphylococcal arterial infection requiring arterial debridement and reconstruction. This article indicates that Perclose use carries a risk of severe arterial infection. Surgeons should be aware of the potential infectious complications associated with Perclose use and the need for aggressive treatment.

[Outpatient electromagnetic therapy combined with hyperbaric oxygenation in arterial occlusive diseases]

The authors first applied hyperbaric oxygenation (HBO) in the outpatient clinic in 1968. Barotherapy was conducted in 107 outpatients whose ages ranged from 27 to 80 years; they had various stages of the disease of 5- to 20-year history. In 70 patients treated for obliterating diseases of the vessels by HBO in a complex with magnetotherapy by means of magnetophors, the remission lasted 1-2 years; patients treated by HBO alone had a 3-8 month remission. A prolonged positive effect was produced in 64 patients. The suggested effective and safe method is an additional one to the existing means of treating this serious and progressive disease, which can be applied successfully in outpatient clinics.

[Plasmapheresis in the treatment of patients with vascular diseases]

The mechanisms of positive effects of plasmapheresis were studied in 52 patients with angiological pathology who were given 135 sessions of plasmapheresis. Most of the patients had obliterating atherosclerosis (28) and endarteritis (16). The clinical effect obtained in 80.7% of the patients with a severe regional ischemia was associated with the improved hemorheology (lower blood viscosity, lower fibrinogen level, higher deformability of erythrocytes), with hypocoagulation and normalization of the correlation of high and low density lipoproteins in atherosclerotic patients. These effects are of relatively long durations, the repeated courses of plasmapheresis within 6-8 months being, as a rule, successful.

[Autologous transfusion of UV-irradiated blood in occlusive vascular diseases of the legs]

Under analysis were observations of 34 patients with obliterating diseases of the lower extremity vessels. All of them were treated by autotransfusion of ultraviolet irradiated blood. It was noted that the patients' state improved, pains subsided and the ulcers were epithelized. Control examinations have revealed better blood filling of the tissues and increased oxygen saturation of blood.

[Plasmosorption in the complex treatment of endarteritis obliterans]

Plasmosorption was included in the complex of measures in 20 patients with obliterating endarteritis with different degrees of ischemia of lower extremities. Plasmosorption has been found to improve hemodynamics and microcirculation of diseased extremities, and to facilitate the reestablishment of the immune status, hemostasis and protein metabolism.

[Comparative evaluation of the effectiveness of hemosorption in the treatment of patients with various forms of chronic arterial insufficiency of lower limbs]

A comparative effectiveness of hemosorption in relation to atherosclerotic or autoimmune genesis of the disease is presented by results of the treatment of 41 patients with chronic arterial insufficiency of the extremities. The effectiveness of hemosorption is shown to be significantly higher in patients with autoimmune genesis of the disease than with atherosclerosis.

[Regional oxygenation in the treatment of severe destructive forms of occlusive arterial diseases of the limbs]

Femoral regional perfusions and continuous intraarterial infusions were used for the treatment of 84 patients. The 0,15-0,25% solution of H2O2 was used as the oxygenator. The methods used when combined with sympathectomy allowed to restrict the operation by a parcimonious amputation of the extremity and to retain the knee joint in most of the patients.

[Correction of the regional blood flow in obliterating vascular lesions of the legs]

Results of different methods of treatment of 712 patients with obliterating injuries of the lower extremity vessels were followed for the period from 1974 to 1980. Complex conservative therapy was used in 225 patients. Good results were observed in 1/3 of the patients. Operations were fulfilled in 487 patients: 273 lumbar sympathectomies (bilateral in 28%) and 214 reconstruction operation on the arteries. The prognosing of effects of sympathectomies gave positive results in 84.3% of patients. Good remote results after reconstructive operations were observed in 72,5% of patients. The authors emphasize a short-term effect of reconstructive operations below the inguinal ligament.

Septic endarteritis due to intra-arterial catheters for cancer chemotherapy. I. Evaluation of an outbreak. II. Risk factors, clinical features and management, III. Guidelines for prevention

A cluster of three cases of staphylococcal septic endarteritis originating from percutaneously inserted brachial artery catheters for regional cancer chemotherapy prompted an epidemiologic and clinical study of bacteremic infections associated with this therapeutic modality. Nine cases were identified over a 3 1/2-year period (1.6% of all catheterizations), all caused by Staphylococcus aureus. The cluster followed discontinuation of hexachlorophene for scrub of the extremity prior to cannulation; phage-typing suggested the three cases were caused by the patients' own strains of Staphylococcus. These infections produced a distinctive clinical syndrome which facilitates implicating the catheter in the genesis of fever occurring in a patient receiving intra-arterial chemotherapy: early localized pain (89%) and hemorrhage (78%), and Osler's nodes distally (44%), later followed by local inflammation (78%), purulence (56%) and signs of systemic sepsis (100%) (each factor, p less than or equal to .005). Duration of cannulation did not influence susceptibility to infection. However, difficult cannulations or need for repositioning the catheter (p = .0096), prior radiation therapy (p = .033), leukopenia (p less than .05) and hypoalbuminemia (p less than .05) were all associated with septicemia. In the 25 months since implementation of specific control measures, there have been no further catheter-related septicemia in 310 catheterization (p less than .001). Guide-lines for prevention and management of these infections are provided.

[Prognostic importance of lymphocytosis in obliterating endarteritis]

Based on observations of 317 patients with obliterating endarteritis, the most persistant effect following the complex therapy was noted in patients showing lymphocytosis after the treatment. The overwhelming majority of patients with unfavourable issues of the therapy showed lymphopenia. So, of 67 patients showing lymphocytosis after 2--3 courses of the therapy 48 patients proved to be practically recovered. But there was no recovery among 30 lymphopenic patients, and in 13 cases the extremity had to be amputated. Among 220 patients showing the normal amount of lymphocytes the repeat course of the therapy resulted in a complete recovery in 19, in 2 cases the extremity was amputated.