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Presented herein is a case report dealing with successive combined treatment for arteriovenous malformation of the left part of the chest, macrofistular form complicated by necroses of the left thoracic portion with arrosive haemorrhage from the area of necrosis. The authors describe diagnosis of this disease, technical peculiarities of performing transcatheter endovascular occlusion and topical treatment of wounds, underlining difficulties of verifying the pathology concerned at the prehospital stage and prevention of complications. Particular emphasis in management of these patients is placed upon therapeutic decision-making. Radical excision of tissue practically completely consisting of dilated thin-walled vessels may result in massive perfuse haemorrhage and is often impossible. Selective exclusion of feeding arteries by endovascular methods frequently leads to formation of necroses, does not differ in radical nature because of the presence of multiple arteriovenous fistulas and requires regular follow up of the patient due to a possibility of relapse. The final therapeutic decision should be made in the context of a particular patient, since there are no versatile approaches to management of the pathology concerned.Представлен случай успешного комбинированного лечения артериовенозной мальформации левой половины грудной клетки, макрофистулезная форма, осложненной некрозами левой половины грудной клетки и аррозивным кровотечением. Описаны диагностика данного заболевания, технические особенности выполнения транскатетерной эндоваскулярной окклюзии, местного лечения ран. Отмечены трудности верифицирования данной патологии на догоспитальном этапе, профилактики осложнений. Представлен выбор тактики лечения. Радикальное иссечение ткани, практически полностью состоящей из расширенных тонкостенных сосудов, может привести к массивному профузному кровотечению и зачастую невозможно. Селективное выключение питающих артерий эндоваскулярными методами часто приводит к формированию некрозов, не отличается радикальностью в связи с наличием множественных артериовенозных фистул и требует регулярного наблюдения за пациентом в связи с возможностью развития рецидива. Окончательный выбор лечения должен рассматриваться в контексте определенного больного, ввиду отсутствия универсальных подходов к ведению данной патологии.

Factor XIII (FXIII) plays an important role in formation and stabilization of the fibrin clot. It is known that FXIII-A gene G163T (Val34Leu) polymorphism leads to increased activation of this factor, however participation of the 34Leu variant in thrombogenesis remains disputable. The present work was aimed at studying peculiarities of distribution of variants of FXIII-A polymorphisms in patients with early onset of venous thromboembolism (VTE), as well as revealing associative links between the carrier state of this mutation and the character of clinical course of the disease. We examined a total of 250 patients with VTE. Of these, there were 119 (47.6%) men and 131 (52.4%) women, mean age 37.42 years (range 10-45 years). In the group of patients with VTE, the proportion of homozygous carriers of allele 163T (Leu34) turned out to be more than 1.5-fold higher as compared with the corresponding parameter in the control group (OR=1.8, 95% CI: 0.9-4.0; p=0.14). Analysing FXIII-A G163T polymorphism depending on gender revealed a considerable increase in the incidence rate (IR) of 163TT genotype in women with VTE as compared to male patients (13.0% versus 5.1 %, respectively, OR=2.8, 95% CI: 1.1-7.4; p=0.047) and to the control group (OR=2.7; 95% CI: 1.2-6.1; p=0.023). Analysing gene FXIII-A polymorphism in the groups of patients with various clinical manifestations of VTE revealed a decrease in the proportion of heterozygotes in the group of deep vein thrombosis + pulmonary artery thromboembolism (PATE) and, vice versa, an increase in the proportion of homozygotes by the Leu34 variant in patients with signs of PATE. The obtained findings make it possible to consider the genotype 163TT of FXIII-A gene as a new independent risk factor for the development of VTE in young women living in the North-West region of Russia, which is observed for the first time. Additional studies are necessary.

The article contains a review of the literature dedicated to a rare complication of an abdominal aortic aneurysm, i.e., an aortic-intestinal fistula, and a report of two clinical cases illustrating different tactical approaches to management of this pathology in the settings of a referral department.

Creating hybrid operating rooms (OR) is a new stage of the development of present-day cardiovascular surgery, with the need for these operating suites having evolved resulting from rapid implementation of novel techniques of treating cardiovascular diseases, combining elements of «open» and endovascular surgery. Despite widespread interest in this problem, there are virtually no systematized works properly describing the specificity of designing and organization of the hybrid OR's work. The present work was aimed at compiling the literature data and sharing own experience gained in organization of the hybrid OR, designation of indispensable technical and organizational requirements for performing hybrid interventions, studying the basic problems related to designing and building such operating rooms, as well as organization and management of the personnel.

The authors analyzed results of treatment of 127 patients. A new direction in the endovascular treatment of critical ischemia of the lower extremities is substantiated on the basis of a combination of methods of subintimal and intraluminal angioplasty. For the first time all the patients with critical ischemia of lower extremities, and having no irreversible changes of the extremity requiring amputation at the level of the low leg or femur, must be considered as good candidates for translumbar balloon angioplasty.

To evaluate efficiency of transluminal balloon angioplasty (TLBAP) in treatment of lower limb critical ischaemia (LLCI).Over the period from November 2004 to April 2008, we performed a total of 89 TLBAPs in eighty-two patients presenting with LLCI. The patients' age averagely amounted to 67.8 +/- 9.8 years. Fifty (61%) patients had an ischaemic ulcer on the foot, seventeen (20.7%) had gangrene, and fifteen (18.3%) patients suffered from ischaemic pain at rest. Forty-five (54.9%) patients suffered from diabetes mellitus, including thirty-three (40.2%) subjects with insulin dependent DM. Sixty (73.2%) patients were diagnosed as having coronary heart disease (CHD), sixty-five (79.3%) had arterial hypertension, twenty-five (30.5%) - cerebrovascular disease, and thirteen (15.9%) - chronic renal insufficiency. Six (7.3%) patients were on chronic haemodialysis. The distribution of the patients by the level of the lesion were as follows: iliac 4 (3.6%), femoropopliteal 55 (49.5%), crural artery 52 (46.8%) Type-C and type-D lesions (TASC) were encountered in 89.2% of cases. Occlusions were observed in 82% of all lesions of the crural artery. 42.2% of the patients were treated by means of subintimal angioplasty. Stenting was used in fourteen (7.3%) cases.The angiographic and clinical success of the procedure was achieved in seventy-five (91.5%) patients. No LLCI was observed either after one or three years in 79.4 and 52.9% of the patients, respectively.

The aim of the study was to examine the potential of perftoran for the treatment of patients with critical lower limb ischemia, in whom surgical revascularization appeared not feasible in view of the type of lesion or severity of concomitant pathology. The study accrued 85 patients distributed into the basic and control groups. The control group patients (n=40) received the basic conservative therapy including rheological, vasoactive drugs, anticoagulants and aggregation inhibitors. Patients entering the basic group (n=45) were administered perftoran infusions together with the basic therapy protocol. We examined the time course of changes in the painful syndrome, ascertained the degree of ischemia, the extent of trophic disorders, the parameters of the peripheral flow in the pedal arteries by ultrasound Doppler (USD), and the intensity of the manifestations of the systemic inflammatory response. It has been proven that the use of perftoran is justified and that the preparation may be recommended for use in multimodality treatment of the patient group under consideration.

The authors propose a system of assessment of the state of blood circulation in lower extremities which allows planning a more effective method of treatment of patients with obliterating diseases in the stage of critical ischemia.

During an open-heart surgery, right atrium myocytes were obtained from 5 patients (aged from 40 to 54 years) with ischemic hearts. The DNA and total protein contents were measured in isolated cells using two-wavelength scanning cytophotometry after the double staining: the Feulgen nuclear reaction followed by naphthol yellow S staining. The degree of ploidy in the investigated myocytes appeared not high. The number of 2c, 4c and 8c cells varied, respectively, from 35 to 55%, from 39 to 55%, and from 5 to 15%. The share of 2-nuclear cells varied from 0 to 6%. The average square of tetraploid cells is more than that of diploid cells. In cells of a given size the protein content is higher in cells with higher ploidy, but the difference is not of 2-fold value. Larger 2c and 4c cells had more protein. In all the patients examined, along with myocytes with normal ultrastructure, some myocytes with different degree of organelle damage were observed, whose share varied in different patients. Myocytes with moderately to heavily damaged organelles are of more frequent occurrence in patients who displayed as well the highest myocyte hypertrophy and the largest share of polyploid cells.

Biopsies of right auricle of human heart have been obtained during open heart surgery from 6 patients aged 23 to 49. The DNA and total protein content have been determined in isolated myocytes by two-wavelength scanning cytophotometry after double staining: Feulgen and naphthol yellow S. In all the biopsies predominant are polyploid hypertrophied myocytes. Both hypertrophied non-degenerating cells and cells with different extent of degenerative changes, primarily of myofibrils and membranes, are present. The highest extent of cell ploidy is in patients belonging to functional class IV according to the classification of New York Heart Association (NYHA); in these cases 72 to 98% of cells have nuclei with 8 c and more DNA content. With an increase in ploidy level, cells grow in size and in protein content, however the rate of this growth is much lower than that of DNA content in cells. There is no direct relation between ploidy and cell degeneration extent and no inverse relation between degeneration extent and ejection fraction.

Biopsies from human right auricles were obtained during open heart surgery, prior to valve replacement, from six patients (aged from 20 to 49 years) with rheumatic heart disease. DNA and the total protein contents were measured in isolated myocytes by means of the two wave-length scanning cytophotometry after the double Feulgen and Naphthol yellow S staining procedure. In all the biopsies polyploid hypertrophied myocytes predominate. The hypertrophic, nondegenerated cells and the cells with degenerative changes of varying severity (in the first place, changes of contractile apparatus and membranes) are present. The highest degree of cell ploidy occurs in patients of functional class IV according to the New York Heart Association classification, 72 to 98% of cells displaying octaploid and higher DNA values. With the increase in ploidy of myocytes in series 2c----4c----8c----16c----32c----64c the protein content increases only as 2.0----3.0----5.8----7.8----13.0----16.8. Neither direct correlation between the ploidy level and the degree of cell degeneration, no inverse correlation between the degree of degeneration and the value of ejection fraction was observed.

Prolonged regional anesthesia used for relieving pain was given to 65 patients with closed traumas of the chest complicated by fractures of the ribs. The method was shown to be effective, simple and safe. It may be used both at the hospital and at prehospital stage. The prolonged regional anesthesia allowed reducing the amount of pulmonary complications from 4.5% to 1.7%.