[The significance of increased sensitivity of the carotid sinus in some surgical diseases].
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The results of 295 reconstructive operations on the major vessels of lower extremities were analyzed. The patients were divided into 4 groups depending on the scheme of anticoagulation therapy in the postoperative period. Under investigation was the state of hemostasis and hemorheology. The frequency of thrombohemorrhagic complications was assessed. It was found that the regimen based on the administration of low molecular weight heparins during the nearest 5 days after the intervention was the most rational regimen of anticoagulation therapy after reconstructive operations on the major arteries of lower extremities.
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Based upon the investigation of the hemogram, biochemical indices of blood and certain instrumental methods of research in patients with a critical form of obliterating diseases of lower extremity vessels, whose treatment included UVI of auto-blood, the authors have shown pronounced clinical efficiency of the method of treatment resulting in the improvement of theological properties of blood, microcirculation in tissues, less pain syndrome and rapid healing of trophic ulcers against the background of better condition of the patient. The method allowed the time of staying at the hospital to be substantially shortened.
A 44-year-old female with Sneddon's syndrome, i.e. generalized racemose livedo and recurrent cerebrovascular disease, is presented. Significant levels of IgG anticardiolipin antibodies were found in her serum.
Discussed are circulatory disorders as well as pathologico-anatomic findings recordable from fetal vessels of the placenta. Thorough reference is first made to obliterative endoarteritis of the greater arteries. Its forms are described, with formal and causative pathogenesis being discussed. Conclusive coverage of causative pathogenesis has proved to be possible only for unambiguously determined inflammatory manifestations (rubella, lues). The second major complex covers alterations to greater and minor fetal vessels which are characterized by central parietal thrombosis (possibly associated with fetal asphyxia) and peripherally disseminated intravasal coagulation (associated with peripartal shock or other conditions). Included in the latter group of alterations are congenital pulmonary hyaline membranes (perhaps also some membranes of postnatal origin) which are, as well, considered as shock equivalent.
The methods of direct revascularization of the lower extremities in occlusive-stenotic lesion at the stage of severe ischemia were used in 144 patients. Of them in 35, simultaneously or with a several day interval, the ++roentgeno-endovascular dilatation (RED) in the several segments of the arterial bed was carried out, in 36--RED was performed in combination with 2-3 procedures of plasmapheresis, in 16 patients in occlusion to a large extent, the isolated balloon profundoplasty was performed, in 46 patients with total lesion of the vessels--isolated RED of the aorto-iliac segment. This contributed to increase in the effectiveness of the collateral blood flow in the vessels of the lower extremities. A high effectiveness of the methods employed was noted in follow-up of from 1 to 5 years. The indications for the use of RED and causes of failures are presented.
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The method of treatment after Ilizarov was used in 28 patients with occlusion of lower extremity arteries, mainly of distal localization, with the III and IV degrees of ischemia. Osteotomy of mainly the tibial bone and distraction of the free osseous split was performed during 31-36 days. Two patients had fractures of the bone during operative interventions, after operation four patients had purulent complications or necrosis of the skin around the wire. The immediate positive result was noted in 20 patients. Their fate was followed-up in remote periods from 2 to 19 months, good results were observed in 18 patients. The use of the Ilizarov method was most justified in patients with the III and IV degrees of ischemia when other methods of treatment failed to give any effect and surgical reconstruction of the vessels is impossible. When treating patients with the IV degree, it is necessary to take into consideration the late appearance of revascularization and possibility of temporary deterioration. The use of the Ilizarov method foresees provision of the joint work of an angiosurgeon and a traumatologist-orthopedist.