INTRODUCTION: Among the European population of 715 million people, 1.4 million cases of strokes are recorded annually. Of them, approximately 87% are ischemic strokes, and approximately 20% were accounted for by atherosclerosis of the carotid arteries. To prevent an ischemic cerebral event associated with atherosclerosis of brachiocephalic arteries, different surgical techniques have been developed including carotid endarterectomy (CEAE) and carotid artery stenting (CAS). CEAE and CAS reliably reduce the risk of recurrent stroke associated with atherothrombosis, but with this, the level of alterations of cognitive functions and the restoration of cerebral functional deficit have not been widely studied. At present, no randomized studies and meta-analyses have met all the standards of conducting research concerning alterations in cognitive functions in patients with past interventions on carotid arteries. Some medical centers have performed such interventions, but data are not unambiguous: some authors describe the improvement of cognitive functions, whereas others do not note any differences or even see signs of impairment.
CONCLUSION: This literature review highlights an issue concerning the assessment of the alteration of postoperative cognitive deficit in patients with past CEAE or CAS. Comparisons in the context of cognitive cerebral functions in the postoperative period of endarterectomy or stenting and assessment of neurological status in patients with or without a history of acute cerebrovascular accident, different variants of anesthesia, and CEAE techniques are considered.
At present, in emergency surgery, great importance is attached to reliable intraoperative hemostasis, for the achievement of which local hemostatic agents are used. The use of these funds tends to increase. The hemostatic agents are divided on 3 main groups. In turn, each group has its own physical and chemical characteristics and different ways of application. The surgeon have task of choosing and correctly using a specific hemostatic agent in a specific clinical situation, especially an emergency one.
The combination of peripheral atherosclerosis and diabetes mellitus is a severe pathology, characterized by a high rate, mortality and social significance. The results of limb salvage and distant survival in this pathology in a remote period are unsatisfactory in spite of all existing treatment methods. Clinical trials in previous years have shown efficacy and safety of the medication, which is a plasmid construct with the gene encoding vascular endothelial growth factor - kambiogenplasmid, in patients with disease stage IIa-III according to the A.V. Pokrovsky and Fontaine classification, who were not indicated for surgical treatment. The article presents the clinical cases of successful use of this drug for therapeutic angiogenesis in patients with critical limb ischemia and severe type 2 diabetes mellitus. The inclusion of therapeutic angiogenesis in the conservative treatment algorithms is promising for the treatment of this group of patients. There is a need for further research on the efficacy and safety of the medication in patients with peripheral atherosclerosis and diabetes mellitus in a remote period.
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