The articles published under CC BY NC-ND license В.И. РУСИН, В.В. КОРСАК, В.В. РУСИН, Ф.В. ГОРЛЕНКО, В.М. ДОБОШ АНГИОАРХИТЕКТОНИКА И МОРФОМЕТРИЯ ГЛУБОКОЙ АРТЕРИИ БЕДРА Ужгородский национальный университет, г. Ужгород, Украина Цель. Изучить хирургическую анатомию глубокой артерии бедра. Материал и методы. Проведено изучение ангиоархитектоники глубокой артерии бедра на 20 трупах. На одной стороне нижней конечности выделяли глубокую артерию бедра на протяжении 17 см, все ветки глубокой артерии брали на держалки, фиксировали их количество, диаметр на уровне основного ствола и дистальнее 17 см, варианты отхождения медиальной и латеральной огибающих ветвей, варианты анатомического строения глубокой артерии бедра и места расположения устья по отношению к общей бедренной артерии. После чего поверхностную бедренную артерию на уровне устья перевязывали и выполняли пункционно-катетерную ангиографию ГАБ на передвижном аппарате PXP-40HF (52-58 kV, 1.8-3.2 mas) при фокусном расстоянии 1 м. Для ангиографического исследования использовали 20 мл 76% раствора триомбраста. Результаты. На основании данных ревизии было определено три основных варианта строения ствола глубокой бедренной артерии. Первый вариант встречается в 11 (55%) случаях, где в наличии был единственный ствол глубокой артерии бедра, от которого четко отходили латеральная и медиальная огибающие ветви. При втором варианте латеральная и медиальная огибающие ветви и глубокая артерия бедра отходили раздельно от общей бедренной артерии. Особенностью анатомического строения глубокой артерии бедра для третьего варианта являлось отсутствие четкого различия между основным стволом последней и его ветвями. Заключение. Глубокая артерия бедра имеет три основных варианта формирования и отхождения от общей бедренной артерии. По отхождению глубокой бедренной артерии от общей бедренной артерии установлено, что в 50% наблюдений устье глубокой бедренной артерии располагается по латеральной полуокружности, в 25% наблюдениях-по заднелатеральной полуокружности, в 15%-по задней полуокружности и в 10%-по заднемедиальной полуокружности. Ключевые слова: хроническая ишемия нижних конечностей, диаметр глубокой артерии бедра, анатомия глубокой артерии бедра, бедренная артерия/хирургия, окклюзивные артериальные заболевания Objective. To study the surgical anatomy of the deep femoral artery. Methods. The study of angioarchitectonics of the deep femoral artery was carried out on 20 cadavers. On one side of the lower extremity, the deep femoral artery was isolated over 17 cm, all branches of the deep artery were taken on handles, their number was fixed as well as the diameter at the level of the main trunk and distal to 17 cm, variants of the union of the medial and lateral enveloping branches, variants of the anatomical structure of the deep femoral artery and the location of the orifice relatively to the common femoral artery. After that, the superficial femoral artery at the level of the orifice was ligated and puncture-catheter angiography of the deep femoral artery was performed on a PXP-40HF m...
Objective. To propose and introduce a diagnostic-treatment algorithm for the inferior vena cava (IVC) leiomyosarcoma into clinical practice. Materials and methods. During last 30 years in Zakarpattya Regional Clinical Hospital Named After Andriy Novak and Zakarpattya Antitumoral Centre were operated 8 patients, suffering the IVC leiomyosarcoma - 7 (87.5%) women and 1 (12.5%) man. Median of the patients' age have constituted 57 yrs old. For characterization of the affection localization in accordance to own views on the subject the classification of the IVC division into 7 segments was applied: infrarenal, іnterrenal, suprarenal, retrohepatic, іnfradiaphragmatic, supradiaphragmatic,іntracardial. Іntravasal localization of the tumor was observed in 3 (37.5%), extravasal - in 1 (12.5%), mixed - in 4 (50%) patients. In all the patients the open laparotomy approach was applied: in 1 (12.5%) patient median laparotomy was performed, and in 7 (87.5%) - bilateral subcostal laparotomy of a «Chevron» type. For the IVC alloprosthesis in 6 (75%) patients a politetrafluoroethylene prosthesis was applied, while in 2 (25%) - Gore-tex prosthesis of 18-22 mm in diameter. In 5 (62.5%) patients circular resection with the IVC alloprosthesis was done, in 2 (25%) - circular resection, the IVC alloprosthesis and іmplantation of right and left renal veins into the prosthesis, and in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of left renal vein into prosthesis. Results. The operation median duration have constituted 215 (160 - 320) min, while the average volume of the blood loss - 305 (250 - 500) ml. The Degree II postoperative complications in accordance to classification of Clavien-Dindo were registered in 2 (25%) patients. Pulmonary thromboembolism, venous thrombosis, thrombosis of prosthesis, as well as intraoperative or immediate postoperative lethality were not observed. In 7 (87.5%) patients a radical intervention was performed. In 3 (37.5%) patients a remote hepatic and pulmonary metastases have been developed, leading to their death in terms from 10 to 34 mo. General one-, two- and a three-ear survival have constituted 87.5, 75 and 62.5%, accordingly. Conclusion. Surgical approach of a «Chevron» type and the staged dissection of IVC guarantees an adequate visualization of its іnfra-, іnter- and suprarenal segments. The «piggyback» procedure of hepatic mobilization and Pringle maneuver constitute necessary parts on the stage of dissection in retrohepatic, infradiaphragmatic and supradiaphragmatic segments of IVC. Radical tumoral excision with the IVC prosthesis and implantation, when needed, of renal or hepatic veins - is the only one possibility for improvement of the patients' quality of life in the IVC leiomyosarcoma.
Background and aims Endothelial dysfunction (DE)-a state of the vascular endothelium, which is accompanied by vazotonic, remodelic, anti-inflammatory and anticoagulant functions. The range of these disorders, the severity of each, and chronology of occurrence, the dynamic progression vary depending on the nosology pathology. Methods The investigated group included of 36 children (age -13,98 ± 0,16) with diagnosed primary arterial hypertension assotiated with DE. The scientific study was conducted in the Transcarpathian region of Ukraine. Results There were a significant difference in the levels of HDL (1,2 ± 0,31 mmmol/l to 69 ± 0,01 mmol/l, p < 0,001). In these children were indicated increase level of total cholesterol by LDL fraction to 2,35 ± 0,18 mmol/l. IA was in 2.97times higher in patients with mountainous region to according the control group (2.67 and 0.90). Changes in hemostasiogramme were identificated in 54% children (an increase of activated recalcification time (74,76 ± 5,06 s and 64,76 ± 2,04 s, p < 0.05), an increase of concentration of fibrinogen (17,53 ± 1,63 s and 11,32 ± 0,77 s, p < 0.001). According to our research were higher levels of Antiphospholipid IgM, than IgG (2,73 ± 0,34 to 2,03 ± 0,24, U/ml, p < 0.02), which varies within the reference values, but have different signs with dates of the control group. Conclusion These dates presented the risk of thrombogenesis, but non significant. The levels of IL-1 and IL -6 were in the range of control values, but have a tendency to decline, according to our data. This fact indicated about the decrease in production of interleukins of child’s organism in the mountains region.
The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) – circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.
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