This multicenter study investigated the possibility of reducing mortality rate by administering natural lung surfactant additional to standard therapy to treat patients after cardiac surgery who developed an acute respiratory failure (ARDS/ALI).A total of 78 patients (1998)(1999)(2000)(2001)(2002)
<p>This review investigates the various methods used for carotid endarterectomy (CEE). These methods are presented, and allow us to analyse effective revascularisation with extended damage to the internal carotid artery. The data of studies comparing the results of eversion and classical carotid endarterectomy with plasty of the reconstruction zone with a patch made of diepoxy-treated pericardium are presented. Special attention is paid to emergency carotid endarterectomy and carotid endarterectomy in the acute period of ischemic stroke. The important and main aspects of the glomus-saving species of CEE are also demonstrated. The main complications behind operations, and causes of restenosis in long-term follow-up periods are also duly noted. Similarly, suggestions to eliminate these issues are also proposed. This review comprehensively covers the state of the art of carotid endarterectomy and dissects current techniques and methods in the area.</p><p>Received 16 July 2020. Revised 24 August 2020. Accepted 25 August 2020.</p><p><strong>Conflict of interest:</strong> Authors declare no conflicts of interest.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Author contributions</strong><br />Conception and study design: G.G. Khubulava<br />Drafting the article: A.N. Kazantsev<br />Critical revision of the article: A.A. Erofeev, V.N. Kravchuk, K.P. Chernykh<br />Final approval of the version to be published: G.G. Khubulava, A.N. Kazantsev, A.A. Erofeev, V.N. Kravchuk, K.P. Chernykh</p>
Резюме. Не вызывает сомнений, что предпосылкой успехов реконструктивной ангиохирургии было внедрение в сосудистую хирургию синтетических материалов. Биологическая инертность, прочность, простота стерилизации и легкость моделирования синтетических протезов сосудов способствовали их широкому применению, как при протезировании аорты, так и магистральных сосудов. однако анализ накопленного клинического опыта использования синтетических протезов показал, что увлечение ими постепенно сменилось сдержанным отношением, а порой и отказом, ибо синтетические сосудистые протезы, при наличии известных достоинств, склонны к тромбообразованию, развитию инфекции [15]. в этой связи ведется поиск схем антикоагулянтной, антибактериальной терапии и путей создания протезов, минимизирующих риск тромбообразования и развития инфекционных осложнений. К одному из таких путей не без основания относят тканевую инженерию, позволяющую на основе применения принципов и методов инженерии и биологии создавать биологические заместители тканей и органов. тканеинженерные сосудистые трансплантаты (тИст), созданные на основе естественного бесклеточного аллогенного или ксеногенного сосудистого каркаса, заселенного клетками пациента, то есть персонифицированные, будут биосовместимы, атромбогенны, лишены иных недостатков синтетических протезов [1, 29]. Как биосовместимые продукты, они будут способны к росту и пригодны не только для взрослых, но и для детей с сердечно-сосудистыми дефектами. однако ряд вопросов, связанных с поиском оптимальных условий получения тИст, остается открытым.Ключевые слова: тканевая инженерия; сосуд; децеллюляризация; внеклеточный матрикс; механические свойства. Abstract. There is no doubt that the introduction of synthetic materials was the prerequisite for success of vascular surgery. Biological inertness, durability, eases of sterilization and modeling of synthetic vascular grafts contributed to their widespread use as in aortic and great vessels. However, analysis of the accumulated clinical experience in using of synthetic grafts showed that fascination with them was gradually replaced by cautious attitude, and sometimes by refusing, because in the presence of well-known advantages, synthetic grafts are prone to thrombosis and the development of infection. Thereby, it takes place searching of anticoagulant and antibiotic therapy schemes, and the ways of creation of such grafts which will minimize the risk of thrombus formation and the development of infectious complications. Not without reason one of such ways includes tissue engineering, which allows to create substitute for biological tissues and organs using the principles and methods of engineering and biology. Tissue engineering vascular grafts (TIVG), created on the basis of natural acellular allogeneic or xenogeneic vascular matrices and populated with patient cells, so personalized, are thought to be biocompatible, athrombogenic, and deprived of any deficiencies of synthetic grafts. Being biocompatible products, they will be able to grow and will be suitable not only...
Aim. To analyze inhospital outcomes of carotid endarterectomy (CE) in the acute period (within 3 days from the onset) of ischemic stroke.Material and methods. This retrospective multicenter study for the period from January 2008 to August 2020 included 357 patients who underwent CE in the acute period of stroke. An interdisciplinary commission defined the revascularization timing. There were following inclusion criteria: 1. Mild neurological disorders: NIHSS stroke of 3-8; modified Rankin Scale score <2; Bartel index >61; 2. Indications for CE according to the current national guidelines; 3. Brain ischemic focus <2,5 cm in diameter. There were following exclusion criteria: 1. Presence of contraindications to CE. The endpoints were such unfavorable cardiovascular events as death, myocardial infarction (MI), stroke/transient ischemic attack (TIA), silent stroke, silent hemorrhagic transformations, Bleeding Academic Research Consortium (BARC) type >3b bleeding, internal carotid artery thrombosis, composite endpoint (death + all strokes/TIA + MI). Silent strokes were those strokes, established according to control multi-slice computed tomography angiography, without symptoms.Results. During the in-hospital follow-up period, 8 deaths (2,24%), 5 MIs (1,4%), 6 strokes/TIAs (1,7%), 15 silent ischemic strokes (4,2%), 13 hemorrhagic transformations (3,6%), 26 silent hemorrhagic transformations (7,3%), and 6 BARC type >3b bleeding (1,7%) were recorded. Thus, the combined endpoint was 20,4% (n=73).Conclusion. Due to the high incidence of cardiovascular events, CE is not a safe operation for patients in the acute period of ischemic stroke. The stroke + mortality rate exceeding 3% demonstrates the ineffectiveness of this method of treatment.
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