[Efficacy of using VEGF165 gene in comprehensive treatment of patients with stage 2A-3 lower limb chronic ischaemia]

The authors share their experience in treating a total of 100 patients presenting with stage 2A-3 chronic lower limb ischaemia according to the classification of Pokrovsky-Fontain (the clinical group was composed of 75 patients and the control group comprised 25 subjects), in whom it was impossible to perform surgical revascularization. The clinical group patients received in addition to the conventional vascular therapy local intramuscular injections of Neovasculogen (plasmid genetic construction containing human gene VEGF165) at a course dose of 2.4 mg. The results were assessed after 1 year. It was shown that administration of this gene therapeutic agent is safe with no local or systemic allergic reactions and free form neoplastic processes. Efficacy of treatment was assessed by registering the pain-free walking distance (PFWD), transcutaneous oxygen tension (TCPO2), linear velocity of blood flow, ankle-brachial index (ABI), angiography, and by means of SF-36 questionnaire. It was determined that after 12 months the statistical significance of intergroup and intragroup differences was reached for PFWD (increment 167.2%), TCPO2 (increment 20.4%). The highest clinical response for the PFWD was registered in patients with stage 3 of the disease (547.5%), as well as in those with multi-storey vascular lesions (269.1%). The obtained findings make it possible to consider gene therapy with Neovasculogen as an efficient component of comprehensive treatment of this cohort of patients.

[A lobular version of pathogenesis of vascular-aetiology trophic ulcers]

Presented in the article is an original version of the development of vascular-genesis trophic ulcers. The authors have for the first time come out with a suggestion on the relationship between the lobular structure of tissues and microcirculation. To describe this relationship they introduce the notion of the haemodynamic module (HM). The HM is considered to mean a limited by the fibrous capsule functional tissue fragment including haemic and lymphatic vessels. The HM including only the capillary network belongs to the 1st level, that including arterioles belongs to the 2nd level, and the HM including arteries belongs to the 3rd level. The HMs respond by altering their internal pressure on arterial vasomotion and create a significant addition to the vis a tergo. Impairments of arterial or venous circulation are accompanied and followed by pathological changes in HMs, inducing alterations of the epithelium-matrix communications and the development of trophic ulcers.

[Uninterruptedly relapsing pulmonary artery thromboembolism as a distinct nosological entity]

It is known that the clinical course of thromboembolism may consist of several episodes, the "light" intervals between which may fluctuate from several hours to several days. Owing to these intervals, surgical prevention of recurrent thromboembolisms became possible and available. Based on long-term follow up of clinical patterns of the diseases, we suppose that it is possible to single out yet another special type of the disease's course which we termed uninterruptedly relapsing pulmonary artery thromboembolism. The essence of the process chiefly consists in that these fits appear to occur with very short intervals thus making it possible to suppose a recurring rupture of the embolising materia,from the thrombus with the resulting occlusion of the branches (more often small ones) of the pulmonary artery.

[Antioxidant activity and functional endothelium characteristics before and after the operation in patients with atherosclerosis obliterans]

Data of 410 male patients operated on account of atherosclerosis obliterans of lower limbs vessels. Biochemichal parameters of functional endothelium status of the arteriae after operative treatment are studied. Superoxide dismutase activity and nitric oxide level are registered before and 5 days after the operation. Statistically reliable changes of the biochemical parameters in dependence of methods of the operative treatment are determined.

[Morphologic changes in the arterial wall in restenosis after reconstructive and endovascular interventions]

Morphological changes in the arterial wall after reconstructive and endovascular interventions in patients with lower extremity arterial atherosclerosis obliterans are analyzed. The role of intimal hyperplasia in the development of restenosis as a late complication in reconstructive arterial surgery is shown.

[Hyperplasia of the intima as a cause of restenosis following reconstructive and endovascular operations on lower limb arteries]

The authors herein analyse the role of intimal hyperplasia in the development of restenosis as a late complication in reconstructive surgery of arteries in patients suffering from atherosclerosis obliterans of the arteries of the lower extremities.

[Some aspects of the pathogenesis of trophic venous ulcers]

This paper deals with essentials of trophic venous ulcer pathogenesis, their criticism as well as with the treatment of some phenomena which should be taken into account when creating any new theory of the pathogenesis and essentials of the treatment of trophic ulcers. Basically, this concerns inflammation as a general biological reaction. Chronic venous insufficiency (CVI) changes capillary permeability. The paravasal space is invaded by red blood cells. On break down they secrete hemosiderin, protein molecules and lipid complexes. All this is denatured to form substances liable to resorption. According to the biological laws resorption may be brought about only by means of inflammatory reaction, more exactly, through its cellular phases--acute (leucocytic) and chronic (macrophagal). It is assumed that the main signal for activation of leucocytes is accumulation of the above-indicated decomposition products rather than hypertension which, in non-occlusive CVI forms, cannot be proven numerically. The basic cause of trophic ulcers lies in the permanent cellular phase of the common defence inflammatory reaction because of the presence of the non-transient injurious factor. The permanently repeated cycles of the inflammatory trio (vascular, cellular and reparative phases), being in different correlation, form in the ulcer itself an unusual system which is not governed by the regularities of wound process. Bacterial contamination and colonization of trophic ulcer occur without fail but this process bears secondary character after impairment of barrier skin function and emergence of skin defects. At the same time different processes may take place in trophic ulcer such as exudation in the form of serous and seropurulent discharge, formation of the fibrinonecrotic deposit, formation of granulation tissue, and appearance of islets of unstable epithelialization. From the conceptual viewpoint such a state can be regarded as a system marked by closed pseudochaotic activity. To start up healing, this self-reproducing system must be destroyed while ulcer must transform to a wound with the linear sequence of processes.

[Real embologenicity of thromboses of lower extremity veins]

The aim of the present work was to study real embologenicity of thromboses of lower extremity veins. We carried out a comparative evaluation of the embologenic risk of different thromboses of the superficial and deep veins associated with hospital treatment. The study performed allows the following conclusions to be drawn: venous thromboses in the system of the inferior vena cava are marked by an unpredictable course and require the follow up of the thrombotic process and active conservative treatment within the period not less than 7 days from the time of the first manifestations of thrombosis; thrombosis of the femoral vein as well as thrombosis of the sural veins have the highest embologenic risk (6.45 and 6.25%, respectively). Patients with ascending thrombophlebitis of the greater saphenous vein remain at high risk for embologenic process and require urgent operation.

[The use of magnetics and laser therapy in treating obliterating vascular diseases of the extremities]

The paper presents the results of treatment received by 60 patients suffering from lower limb vascular obliteration stage IIA-III. The treatment involved combined use of magnetic field and laser irradiation. Peripheral circulation and central hemodynamics were evaluated rheographically and using ultrasound Doppler sphygmomanometry. Combined application of the above two modalities produced a greater effect on central hemodynamics compared to them introduced alone.

[Intravenous laser irradiation of the blood in severe forms of chronic venous insufficiency]

Based on an analysis of results of treatment of 86 patients the authors have shown that the intravenous laser irradiation of blood results in hypocoagulation, lower hematocrit index. In 52 patients good results of treatment were obtained, in 26 patients results were satisfactory. No complications were noted.

[Magnetotherapy in obliterating vascular diseases of the lower extremities]

The investigators have developed a polymagnetic system "Avrora-MK-01" employing running impulse magnetic field to treat diseases of the leg vessels by the action on peripheral capillary bed. At a pregangrene stage a positive effect on peripheral capillaries was achieved in 75-82% of the patients treated.

[Arteriovenous anastomoses in the treatment of postphlebitic syndrome of the lower extremities]

The authors describe an original method of putting arteriovenous end-to-end anastomosis between the distal fragment of the artery and central fragment of the vein in postphlebitic + syndrome of lower extremities. Operations were performed on 27 patients with different forms of the syndrome. Clinical improvement was obtained in 22 patients (81%), which was confirmed by findings of functional investigations. This operation was most effective in patients with recanalization or partly recanalized forms of the postphlebitic syndrome.

[Open laser canalization in segmental arteriosclerotic lesions of peripheral arteries]

The article presents results of experimental and clinical applications of argon laser with 514 nm wavelength, output power up to 5w for occlusing injuries of peripheral arteries. The radiation was given through a monofiber quartz light guide with a 400 mu diameter. The laser canalization was performed in the clinic to 16 patients with the 3rd-4th stages of atherosclerotic lesions of the arteries. The indication to operations was considered to be critical stenoses or occlusions of the peripheral arteries of extremities. Good immediate and long-term results were obtained in 8 patients.

[The ALOK-1 laser apparatus for intravenous irradiation of the blood (initial experience with its clinical use)]

Intravenous blood radiation with low-intense laser at a wavelength of 0.63 micron activates energy enzymes of red blood cells, ameliorates the rheological blood properties and normalizes lipid peroxidation processes.

[Quantitative evaluation of arterial insufficiency of the lower extremities]

An original method has been developed for the measurement of arterial blood blow deficit in the lower limbs of patients with obliterating arterial diseases. Quantitative assessment of blood filling deficiency in the lower limbs was made in 58 patients. A relationship was demonstrated between changing parameters of arterial insufficiency of the lower limbs and the stage of the disease. Possible applications of the method for objective assessment of surgical and conservative treatment for obliterating vascular diseases of the the limbs are reviewed.

[Crossed femoro-femoral shunts]

The article analyzes 100 operations of crossed femoro-femoral shunts in patients with atherosclerotic occlusion of iliac arteries. It is concluded that the operation is indicated to patients with high operative risk as well as to patients with acute thrombosis of the iliac artery or a branch of the bifurcation prosthesis in cases with impossible adequate thrombectomy. The syndrome of "overflow" was shown to appear, but it had a subclinical course. Long-term results of the operation show that the operation of crossed femoro-femoral shunt must be given its due place among reconstructive operations.

[Surgical treatment of acute occlusion of the main arteries of the arm]

An experience with the treatment of acute occlusions of the upper limbs vessels in 41 patients is presented. The conservative treatment of 10 patients has brought about poor results (2--gangrene, 5--considerable functional disorders of the limb). 31 patients were subjected to surgical treatment. Complete restoration of the circulation in the limbs occurred in 19 patients, a satisfactory compensation of the circulation occurred in 8 patients. The amputation of fingers was carried out upon 4 patients.

[Problems of the diagnosis and therapeutic procedure in traumatic aneurysms]

Some problems, concerning the diagnosis and treatment of peace-time traumatic aneurysms, are considered here. The authors treated 30 patients, using mostly plastic operations, 28 of them showed excellent and good results. The amputation of the femur was carried out in one case. One patient died from infected arterio-venous aneurysm.

[Femoro-femoral cross shunting in unilateral iliac artery occlusion or thrombosis of the aorto-femoral prosthesis]

The results of the experiment in investigating the hemodynamic changes following femoro-femoral cross shunting are analyzed and the outcome of 13 operations for unilateral occlusion of the iliac artery is discussed. The authors draw the conclusion on minor traumatism and on the effectiveness of such operation; the improvement of the blood circulation in the ischemized extremity is not followed by any circulatory impairment in the donor leg.