Subcutaneous Veins Research Articles

Case report of varicose veins treatment in patient with a prosthetic mitral valve

This clinical case may be of interest in situations where a patient with varicose veins of the lower limbs and concomitant heart disease, who is on long-term anticoagulant therapy and is scheduled to undergo minor surgery, may present the possibility of endovenous laser ablation (EVLA) against the background of warfarin use. Patient, G., 68 years old, with rheumatic combined mitral valve disease (mitral valve replacement in 2019, permanent atrial fibrillation), also had varicose vein disease of the lower limbs. History included acute cerebrovascular accident (19.01.2023). Duplex Ultrasonography Screening (DUS) showed failure of the left great saphenous vein valve. Hypocoagulation was also observed in coagulogram and the risk of bleeding on HAS-BLED score was average. On Caprini score, the risk was very high. Endovenous laser ablation of the large saphenous vein on the left side was performed. During follow-up examinations, there were no signs of bleeding from puncture sites. The target trunk was obliterated in dynamics at DUS. Therefore, it is possible to carry out EVLA of a large subcutaneous vein while taking therapeutic doses of warfarin without switching to bridge therapy. Endovascular laser ablation allowed it to be done with less risk of bleeding and, against the background of taking warfarin, reduced the risk of thrombosis.

Total Stripping of the Great Saphenous Vein in Varicose Vein Patients with Thrombophlebitis

Introduction. Patients with varicose disease of the lower extremities may suffer from subcutaneous vein thrombophlebitis with an incidence of more than 50%. However, saphenous vein thrombophlebitis occurs against the background of varicose veins in 80% of patients. Aim. To improve the efficacy of phlebectomy in patients with varicose veins complicated by saphenous vein thrombophlebitis. A modified method of total stripping of the great saphenous vein was developed and introduced into clinical practice in City Clinical Hospital No. 21 (Ufa, Russia). The modified surgical technique is aimed at reducing the severity of postoperative hematomas, increasing the cosmetic effect and reducing the incidence of damage to the cutaneous nerve located near the large saphenous vein. The surgery technique was patented (Patent No. RU2812293C1). Materials and methods. From 2022 to 2023, total stripping of the great saphenous vein was performed in 26 patients with varicose veins of the lower extremities and thrombophlebitis of the great saphenous vein in Cardiac Surgery Department of City Clinical Hospital No. 21. The examined patients were divided into a control group (18 patients) and a comparison group (8 patients). The quality of life of all patients was assessed before and after surgical intervention using the Visual Analog Scale (VAS). Results and discussion. All patients underwent total stripping of the great saphenous vein. Prior to surgery, no statistically significant difference was reported in the assessment of quality of life between the groups. The group of the modified stripping technique demonstrated positive clinical and aesthetic results after surgery. Performing total stripping of the great saphenous vein using the modified technique statistically significantly improved the quality of life in the postoperative period. Control points of examinations were on days 1, 7, 30, 90 after surgery. Conclusion. The comparative analysis of the treatment results proved the efficacy of the modified technique of total stripping in varicose vein patients with thrombophlebitis, including a higher level of quality of life, better clinical and aesthetic result of surgical treatment.

Arteriovenous Shunts: Their Location and Role in Physiology, Pathology, and Tissue Transfer. A Preliminary Report in the Upper Limb.

Tiny arteriovenous (AV) shunts of 10-150 µm (0.01-0.15 mm) are documented in the hands and feet. Larger shunts up to 0.5 mm (500 µm) have been discovered by the authors in the inner canthus and the human eye. This study seeks their possible existence in the upper limb. Radiographic lead oxide cadaver injection and dissection studies of 14 archival and six new upper limbs were examined. AV shunts of 0.1-0.5 mm were discovered between the brachial, ulnar, and radial arteries and their venae comitantes and between their arterial perforators and the subcutaneous veins. This pilot study provides insight into the possible function of these large AV shunts associated with blood flow variation in temperature, blood pressure, tissue transfer, flap prefabrication, and flap necrosis.

Mechanism of Paeoniae Radix Rubra and Aconiti Lateralis Radix Praeparata herbal pair in promoting hepatocellular regeneration in chronic acute liver failure based on HGF/PI3K/Akt signaling axis

Based on the hepatocyte growth factor(HGF)/phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt) signaling axis, this study investigated the therapeutic effect of Paeoniae Radix Rubra and Aconiti Lateralis Radix Praeparata(PRR-ALRP) her-bal pair on acute-on-chronic liver failure(ACLF) rats and its impact on hepatocellular regeneration. The rat model of ACLF was constructed by subcutaneous and tail vein injection of bovine serum albumin combined with intraperitoneal injection of lipopolysaccharides(LPS)+D-galactosamine(D-GalN). The rats were divided into normal control(NC) group, model(vehicle) group, PRR-ALRP(5.85 g·kg~(-1)) group, and hepatocyte growth factor granules(HGFG, 4.05 g·kg~(-1)) group. Hematoxylin-eosin(HE) staining was used to observe pathological changes in rat liver tissues. Serum alanine aminotransferase(ALT), aspartate transaminase(AST), and total bilirubin(TBIL) were detected using an automatic biochemical analyzer. The levels of interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) inflammatory factors were detected by ELISA. Immunofluorescence staining was used to detect the positive expression of proliferating cell nuclear antigen(PCNA), antigen identified by monoclonal antibody(Ki67), and cell cycle protein B1(CyclinB1). Real-time fluorescence-based quantitative polymerase chain reaction(RT-qPCR) and Western blot were used to detect the mRNA and protein expression levels of HGF, growth factor receptor-bound protein 1(Gab1), PI3K, Akt, phosphorylated PI3K(p-PI3K), and phosphorylated Akt(p-Akt). The results showed that compared with the vehicle group, the PRR-ALRP group had reduced liver tissue pathological scores, improved liver function, and reduced inflammatory response, with enhanced PCNA, Ki67, and CyclinB1 fluorescence expression. Furthermore, compared with the model group, the PRR-ALRP group showed upregulated expression of HGF and Gab1 proteins, as well as activation of PI3K and Akt phosphorylation. These findings suggest that PRR-ALRP herbal pair exerts anti-liver failure effects by alleviating hepatocyte inflammatory damage and promoting hepatocellular regeneration, and its specific regulatory mechanism may be related to the activation of the HGF/PI3K/Akt signaling pathway.

Quantitative evaluation of lower limb varicose veins using photoacoustic imaging

PurposeVaricose veins in the lower extremities are dilated subcutaneous varicose veins with a diameter of ≥ 3 mm, caused by increased venous pressure resulting from backflow of blood due to venous valve insufficiency (Gloviczki in Handbook of venous disorders: guidelines of the American venous forum, Hodder Arnold, London, 2009). When diagnosing varicose veins, the shape and thickness of the blood vessels should be accurately visualized in three dimensions. In this study, we investigated a new method for numerical evaluation of vascular morphology related to varicose veins in the lower extremities, using a photoacoustic imaging (PAI) system, which can acquire high-resolution and three-dimensional images noninvasively.MethodsNine patients with varicose veins participated in the study, and their images were captured using an optical camera and PAI system. We visualized the vascular structure, created a blood presence density (BPD) heat map, and examined the correlation between BPD and location of varicose veins.ResultsThe obtained photoacoustic (PA) images demonstrated the ability of this method to visualize vessels ranging from as small as 0.2 mm in diameter to large, dilated vessels in three dimensions. Furthermore, the study revealed a correlation between the high-density part of the BPD heat map generated from the PAI images and the presence of varicose veins.ConclusionPAI is a promising technique for noninvasive and accurate diagnosis of varicose veins in the lower extremities. By providing valuable information on the morphology and hemodynamics of the varicose veins, PAI may facilitate their early detection and treatment.

Dual-mode optical projection mapping system: integration of laser speckle contrast and subcutaneous vein imaging

Dual-mode optical imaging can simultaneously provide morphological and functional information. Furthermore, it can be integrated with projection mapping method to directly observe the images in the region of interest. This study was aimed to develop a dual-mode optical projection mapping system (DOPMS) that obtains laser speckle contrast image (LSCI) and subcutaneous vein image (SVI) and projects onto the region of interest, minimizing the spatial misalignment between the regions captured by the camera and projected by a projector. In in vitro and in vivo studies, LSCI and SVI were obtained and projected under single-mode illumination, where either the laser or light-emitting diode (LED) was activated, and under dual-mode illumination, where the laser and LED were activated simultaneously. In addition, fusion image (FI) of LSCI and SVI was implemented to selectively observe blood perfusion in the vein. DOPMS successfully obtained LSCI, SVI, and FI and projected them onto the identical region of interest, minimizing spatial misalignment. Single-mode illumination resulted in relatively clearer and noise-free images. Dual-mode illumination introduced speckle noise to SVI and FI but enabled real-time imaging by simultaneously employing LSCI, SVI, and FI. FI may be more effective for quasi-static evaluations before and after treatment under single-mode illumination and for real-time evaluation during treatment under dual-mode illumination owing to its faster image processing, albeit with a potential tradeoff in image quality.

Primary disease of adipose tissue: When to think about and how to evaluate it in clinical practice?

Primary diseases of adipose tissue are rare disorders resulting from impairments in the physiological functions of adipose tissue (lipid stockage and endocrine function). It mainly refers to lipodystrophy syndromes with subcutaneous adipose tissue atrophy and/or altered body distribution of adipose tissue leading to insulin resistance, diabetes, hepatic steatosis, dyslipidemia, cardiovascular complications and polycystic ovary syndrome in women. Those syndromes are congenital or acquired, and lipoatrophy is partial or generalized. The diagnosis of lipodystrophy syndromes is often unrecognized, delayed and/or inaccurate, while it is of major importance to adapt investigations to search for specific comorbidities, in particular cardiovascular involvement, and set up multidisciplinary care, and in some cases specific treatment. Physicians have to recognize the clinical and biological elements allowing to establish the diagnosis. Lipodystrophic syndromes should be considered, notably, in patients with diabetes at a young age, with a normal or low BMI, negative pancreatic autoantibodies, presenting clinical signs of lipodystrophy and insulin resistance (acanthosis nigricans, hyperandrogenism, hepatic steatosis, high insulin doses). The association of diabetes and a family history of severe and/or early cardiovascular disease (coronary atherosclerosis, cardiomyopathy with rhythm and/or conduction disorders) may reveal Dunnigan syndrome, the most frequent form of familial lipodystrophy, due to LMNA pathogenic variants. Clinical assessment is primarily done through clinical examination: acanthosis nigricans, abnormal adipose tissue distribution, lipoatrophy, muscular hypertrophy, acromegaloid or Cushingoid features, lipomas, highly visible subcutaneous veins, may be revealing signs. The amount of circulating adipokines may reflect of adipose dysfunction with low leptinemia and adiponectinemia. Other biological metabolic parameters (hypertriglyceridemia, hyperinsulinemia, increased glycemia and hepatic enzymes) may also represent markers of insulin resistance. Quantification of total body fat by impedancemetry or dual-photon X-ray absorptiometry (DEXA) reveals decreased total body mass, in correlation with adipose tissue atrophy; metabolic magnetic resonance imaging can also quantify intraperitoneal and abdominal fat and the degree of hepatic steatosis. Histological analysis of adipose tissue showing structural abnormalities should be reserved for clinical research. Acquired lipodystrophic syndromes most often lead to similar clinical phenotype as congenital syndromes with generalized or partial lipoatrophy. The most frequent causes are old anti-HIV therapy or glucocorticoid treatments. Family history, history of treatments and clinical examination, including a careful physical examination, are keys for diagnosis.

Multifocal superficial thrombophlebitis of the extremities in HIV infection

Long-term observations indicate an increased risk of developing venous thromboembolic conditions in people with the human immunodeficiency virus, their tendency to relapse or a widespread nature. In addition, the incidence of thrombosis increases several times in HIV-infected people compared to the average rates characteristic of people of the same age. A clinical case of multiple bilateral lesions of the subcutaneous veins of the upper and lower extremities in a young patient with HIV infection is presented. Ineffective outpatient treatment and ascending superficial thrombophlebitis of the lower extremities required emergency hospitalization and surgical treatment of the patient to prevent thromboembolic complications. In the postoperative period, in order to prevent the progression of the thrombotic process, as well as to relieve the symptoms of an acute inflammatory reaction of the venous wall and paravasal tissues, a complex application of compression therapy, modern oral anticoagulant drugs, phlebotropic drugs with proven efficacy was carried out. The postoperative period proceeded without complications. In the next few days, the patient’s condition improved, there was a clear regression of thrombotic limb damage. Conclusion: In case of multiple thrombotic lesions of the subcutaneous veins of the upper and lower extremities on the background of HIV infection, the combination of timely surgical intervention with systemic anticoagulant therapy and phlebotropic agents of general and topical use has significant effectiveness in the medical rehabilitation of the patient.

Localized mammary gland changes in milk composition and venous blood metabolite concentrations result from sterile subclinical mastitis

Subclinical mastitis reduces milk yield and elicits undesirable changes in milk composition, but the mechanisms resulting in reduced milk production in affected mammary glands are incompletely understood. This study investigated the effects of sterile inflammation on mammary gland metabolism by assessing changes in milk and venous blood composition. Mid-lactation primiparous Holstein cows (n = 4) had udder halves randomly allocated to treatments; quarters of 1 udder half were infused with 2 billion cfu of formalin fixed Staphylococcus aureus (FX-STAPH) and quarters of the opposite udder half infused with saline (SAL). Blood samples were collected from the right and left subcutaneous abdominal veins in 2.6 h intervals until 40 h post challenge and analyzed for blood gas and metabolite concentrations. Milk from FX-STAPH udder halves had significantly increased SCS by first milking at 8 h post-challenge. By 16 h post-challenge, FX-STAPH udder halves had increased concentrations of protein and lactate and lower lactose concentrations than SAL udder halves. Milk fat concentrations, milk yields, energy corrected milk yields, and the ferric reducing antioxidant power of milk were not significantly different between SAL and FX-STAPH udder halves. Venous blood of FX-STAPH halves had marginally greater concentrations of saturated O2, partial pressures of O2, and glucose concentrations than SAL halves. Conversely, total and partial pressures of CO2 did not differ between udder half treatments suggesting a shift in local metabolite utilization in FX-STAPH udder halves. These results indicate that changes in milk composition resulting from mastitis are accompanied by changes in some key blood metabolite concentrations. The shift in venous blood metabolite concentrations, along with the marked increase in milk lactate, suggests that local mammary tissue and/or recruited and immune cells alters metabolite usage in mammary tissues. Future studies are needed to quantify the uptake of key milk precursors during mastitis.

EFFECTIVENESS OF A BIOLOGICAL PROSTHESIS IN THE TREATMENT OF TRAUMATIC FEMORAL ARTERY INJURIES

HighlightsThe prevalence of vascular injuries during military engagements can reach 20%. In the thigh, vascular injuries are the second most frequent type of injury. Vascular replacement using a graft is required in case of a femoral artery injury with length of more than 10 cm. If autologous blood vessels are not available for replacement, specialists resort to using a synthetic prosthesis. Selection of an appropriate prosthesis remains a priority for vascular surgeons. Aim. To evaluate the outcome of vascular replacement using a biological prosthesis derived from bovine internal thoracic arteries for the treatment of femoral artery injuries.Material and methods. The study involved 30 patients with femoral artery injuries. The analysis focused on the indicators of comprehensive examination and treatment of these patients, who were divided into 2 statistically homogeneous groups of 15 people each. In the first group, a biological prosthesis derived from bovine internal thoracic artery was used to replace the artery, and in the second group, a large subcutaneous vein was used. The results of treatment were evaluated by the number of postoperative complications, the durability of grafts and the quality of life of patients.Results. There were no fatal cases. In the first group, 6 (40%) patients suffered postoperative complications, and in the second group – in 5 (33.3%) patients. After 5 years, 12 (80%) grafts remained functioning in the first group, and 13 (86.7%) grafts in the second group. The physical component of the health of patients in the first group was equal to 60.6 ± 3.2, in the second group – 62.5 ± 3.4, and the psychological component of health 58.7 ± 2.8, and 59.5 ± 3.1, respectively. There was no statistical reliability between the indicators of the groups (p > 0.05).Conclusion. Biological prosthesis derived from bovine internal thoracic arteries for the treatment of femoral artery injuries is quite effective.

Necessity and possible promising directions for creating artificial choledoch duct (literature review)

This review is devoted to the prospect of creating an artificial choledoch duct in case of its intraoperative injuries. Currently, there is no consensus on the optimal tactics of reconstructive surgical interventions, determining indications for the formation of biliodigestive anastomoses and transhepatic drainage of the biliary tract. The quality patients’ life after reconstruction in low mortality rate in this type of surgery decreases due to recurrent cholangitis, which in the future leads to liver abscesses and cirrhosis. The first attempts of prosthetics of the common bile duct were associated with the first use of stents in surgical practice. The second stage in the study of the reconstruction of the common bile duct were attempts to use stents and patches from transplants of subcutaneous veins, urethra, vagina of the rectus abdominis, and small intestine. The third stage in the development of this direction is using stents made with fibers of biodegradable polymer compounds. There several advantages of using biodegradable stents. Firstly, they are completely metabolized in the body and perform a skeleton function. Secondly, it is possible to use multilayer structures by means of cellular technologies that ensure the conformitythis of the model with the structures of the common bile duct. A stent from biodegradable material can be used with radiopaque dye and medications, for example, antibiotics to prevent cholangitis, or drugs supressing enhanced formation of fibrous tissue to prevent strictures.

Abstract 5373: Decoding the role of intrinsic pancreatic cellular signaling in shaping the immunosuppressive tumor microenvironment

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) has the highest mortality rate among major cancers, with over 50% of patients having liver metastases at diagnosis. Conventional T-cell-based immunotherapies are ineffective against PDAC liver metastases due to the intricate hepatic tumor microenvironment (TME) that hinders effective immune responses. Thus, it is vital to promote the influx of cytotoxic lymphocytes and prime antitumor immunity. PDAC cells exhibit plasticity and intrinsic cellular heterogeneity, leading to varying immune cell infiltrates and immune responses. Concurrently, early metastases to the liver create an immunosuppressive environment. Our study employs multiple PDAC models, originating from a congenic array of distinct PDAC cell clone tumors with varying degrees of T cell infiltration to delineate the signaling pathways that lead to immunosuppression in the pancreas and liver. Methods: The compendium of congenic PDAC murine cell clones mirrors immune heterogeneity observed in tumors, spanning from low to high T cell infiltration. To overcome a scarcity of tumor-specific neoepitopes in PDAC, we engineered PDAC cell clones expressing chicken ovalbumin (OVA) for antigen-specific T and B cell responses. By subcutaneous and intraportal vein injection of PDAC cell clones into mice, we induce primary pancreatic and metastatic liver tumors to explore immune phenotypes and assess anti-tumor adaptive immune responses, including myeloid and lymphoid cell subsets. Results: In vivo engraftment of PDAC clones showed varied CD4+/CD8+ T cells and polymorphonuclear myeloid-derived suppressor cells, accentuated with immunogenic OVA antigen expression. While all OVA+ PDAC lines elicited antigen-specific immune responses, only ‘TIL high’ tumors were eradicated, while ‘TIL low’ clones persisted in vivo. Additionally, ‘TIL low’ clones formed liver metastases upon intraportal injection, despite OVA expression. RNAseq unveiled differential expression in IL-1 family cytokines and receptors, chemokine-like factor gene superfamily, parathyroid hormone relevant function and metabolism. Current investigations include altering these pathways to re-program the tumor microenvironment and induce local immune suppression. Conclusion: Using diverse PDAC models, we created tumors with immune heterogeneity and altered transcriptional profiles. We identified validated differentially expressed immune altering cytokines, such as CXCL1 and CSF3, and potential novel IL-1 family genes and parathyroid signaling genes. The altered TME conferred protection against tumor antigen-specific immunity in certain clones, both in subcutaneous and liver metastasis models. Ongoing studies will assess the impact of these genes in the distinct environments, offering avenues for immunotherapeutic strategies targeting pancreatic cancer liver metastasis. Citation Format: Bushangqing Liu, Ethan Agritelley, Daniel Nussbaum, Junping Wei, Gangjun Lei, Melissa Gajda, Zachary Hartman. Decoding the role of intrinsic pancreatic cellular signaling in shaping the immunosuppressive tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5373.

Results of mechano-chemical obliteration of the trunk of the great saphenous vein in varicose vein disease

Aim: To evaluate the effectiveness of mechano-chemical obliteration in the treatment of varicose enlargement of the great saphenous vein.Material and Methods: The results of mechano-chemical obliteration of 57 patients (49 (85.9%) women, 8 (14.1%) men; average age 27.2±4.1 years) with varicose disease were analyzed. In 39 patients (36 women and 3 men), the second, and in 18 (13 women and 5 men) – the third class of varicose transformation of subcutaneous veins was observed. The average body mass index of patients was 28.2±2.4 kg/m2, and the average duration of varicose disease was 7.6±1.8 years.Results and Discussion: The average diameter of the great saphenous vein was 10.4±2.1 mm. Insufficiency of perforating veins with an average diameter of 3.2±0.8 mm was detected in 31 (54.4%) cases. The technical success of the procedure was 100%. No intraoperative complications occurred in any patient. The average duration of mechanochemical obliteration was 24.2±4.8 minutes, and the entire operation – crossectomy, mechano-chemical obliteration, and excision of dilated tributary veins – lasted 98.5±25.5 minutes. The average length of the great saphenous vein subjected to mechano-chemical obliteration was 94.2±6.1 cm. The level of pain on the first day after surgery was 3.8±0.6 points, decreasing to 0.9±0.1 points before discharge. Only on the day after the intervention, patients required narcotic analgesics (average volume of used anesthetics – 1.5±0.5 ml); on other days, patients received non-steroidal anti-inflammatory drugs (average duration 3.5±0.5 days, volume – 10.5±1.5 ml).Conclusion: Mechano-chemical scleroobliteration is one of the effective methods for eliminating pathological vertical reflux, with its effectiveness observed in the vast majority of patients in the long term.Moreover, due to its minimal invasiveness and capability for repeated application, it can be recommended for widespread clinical use. To improve the results of mechano-chemical obliteration and reduce the frequency of recanalization of the great saphenous vein, it is necessary to supplement the procedure with crossectomy and miniphlebectomy.

PRDX2 regulates stemness contributing to cisplatin resistance and metastasis in bladder cancer.

Cisplatin (CDDP)-based chemotherapy has emerged as the primary treatment for muscle-invasive bladder cancer and metastatic bladder cancer. Nevertheless, a significant proportion of patients experience rapidly developed chemoresistance, leading to treatment ineffectiveness. Existing evidence suggests that chemoresistance is governed by various factors, including tumor stem cells, epithelial mesenchymal transition, and reactive oxygen species (ROS). However, limited research has been conducted on the role of PRDX2, a crucial ROS scavenger, in the modulation of chemoresistance in bladder cancer. Cisplatin-resistant cell lines were established using the concentration gradient overlay method, and differentially expressed genes in resistant cells were screened through RNA sequencing. The expression of PRDX2 in cells and tissues was assessed using RT-qPCR, Western Blot, and immunohistochemistry. The expression of PRDX2 in bladder cancer and adjacent tissues was evaluated using a bladder cancer tissue microarray. Furthermore, the impact of PRDX2 knockdown on tumor formation and metastasis was investigated in vivo by applying subcutaneous tumor xenografts tail vein metastasis assays. We demonstrated that PRDX2 is significantly upregulated in bladder tumors and cisplatin-resistant bladder tumor cell lines. Overexpression of PRDX2 can promote tumor proliferation, migration, and invasion both in vitro and in vivo. We have found that knockdown of PRDX2 expression can effectively reverse cell resistance to cisplatin. Mechanistically, our findings suggest that PRDX2 is involved in regulating tumor stemness and epithelial-mesenchymal transition (EMT). Knockdown of PRDX2 affects the PI3K-AKT and mTOR signaling pathways, thereby influencing tumor stemness and EMT, ultimately impacting the chemotherapy resistance of the tumor. This study provides a new insight into the regulation of chemotherapy resistance in bladder cancer by PRDX2. Targeting PRDX2 can serve as a potent therapeutic target for chemotherapy resistance.

Risk Factors Of Lower Extremities Varicose Vein At Mohammad Hoesin Hospital

Backgrounds: Varicose veins are defined as subcutaneous veins in the lower extremities that are dilated to ≥3 mm in diameter. There are several risk factors that can cause varicose veins. These factors are divided based on lifestyle such as prolonged standing or sitting position, hormonal such as estrogen levels in women, familial such as family history, height, and age, and acquired such as obesity and pregnancy. The disease can then weigh on economies globally. In Palembang, there has been no research that discusses the risk factors for varicose veins in the lower legs. Methods: This study is a descriptive study of medical records with a cross-sectional design. The aim of this study was to determine the distribution of risk factors that cause leg vein disease in inpatients who were treated at RSMH Palembang in the period January 2019-December 2019. Results: In the study, there were 28 research subjects, of whom had jobs (85.7%) consisting of 95% male and 62.5% female. The age groups most affected by various ages were under the age of 16-24 and 55-64 years (28.6%). Most patients have a normal body mass index (45%) than male subjects and 75% in the female population. The majority of patients were male (71.4%). Most of the population denied the existence of varicose veins of the lower leg in the family (96.4%). Conclusion: Appropriate education for risk factors of varicose vein and early detection is a key for management of lower extremities varicose vein.

History of surgical treatment of lymphatic drainage at the Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital in Brno.

The Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital in Brno, and Faculty of Medicine of Masaryk University, Brno, has a long history of surgical treatment of lymphedema and elephantiasis, which started in 1970s. There were many types of surgeries described and performed at our department - starting with prof. Bařinka's radical operation of elephantiasis, then lower limb end-to-side lymphovenous anastomosis pulled through the wall to the great saphenous vein, and genital lymphedema reduction. We call this era "the first period" of surgical lymphedema treatment. "The second period" started in 2016 by using free flaps with lymph nodes or vascularized lymph nodes and using microsurgical techniques of end-to-end, end-to-side and side-to-end lymphovenous anastomoses to the subcutaneous veins of a small calibre, which then drain the lymph into the blood stream. "The third period" started 2 years ago after the visit of prof. Yang from Taiwan - we started to use the method of single stitch end-to-side anastomosis to big subcutaneous veins like the great saphenous vein or the cephalic vein.

Comparative assessment of surgical myocardial revascularization using autoarterial and autove-nous conduits in patients with coronary artery disease: In-hospital results

Objective: to evaluate the hospital results of coronary artery bypass grafting using autoarterial and au-tovenous conduits. Material and methods. A randomized clinical trial was conducted. The internal thoracic artery on the left was used in both groups (for shunting the anterior interventricular branch), the remaining conduits, depending on the distribution into groups, were either only the radial artery or the radial artery and the large subcutaneous vein (the study group) or only the large subcutaneous vein (the control group). The outcomes studied were: hospital mortality, myocardial infarction (type 5), cerebrovascular events, respiratory failure, bleeding, cardiac arrhythmias, acute kidney injury, etc. Results. 27 patients were randomized: 12 of whom were included in the study group, and 15 were included in the control group. According to operational and early postoperative data, there were no statistically significant differences between the groups, except for the duration of stay on a ventilator in the ICU: in the study group, the duration of a ventilator was longer than in the control group: 14 (12; 18) hours versus 9.3 (5.8; 13) hours, p=0.034. The most frequent complications were cardiac arrhythmias, as well as AKI. There were no statistically significant differences between the groups according to the outcomes studied. The bed-day after surgery also did not differ statistically significantly between the groups. Conclusion. According to the data obtained, it can be concluded that the first days after surgery, the use of the radial artery does not provide significant advantages compared to the use of a large saphenous vein.

Вариабельность биохимических показателей крови и установление референтных интервалов в доклинических исследованиях. Сообщение 11: собаки

Dogs are a common in vivo test system in preclinical studies due to the relatively large body size sufficient for surgical manipulations, as well as the pathophysiology of various diseases similar to humans. A separate point of application of the animal species in question in preclinical studies is the study and therapy of oncological diseases. The aim of the work was to create its own database of reference intervals of biochemical blood parameters of Beagle dogs. These norms are necessary in preclinical studies when asses­sing the state of animal health, monitoring the formed pathological model, as well as checking the safety of the studied drugs. Biological samples used for the formation of reference intervals were obtained from intact animals in research and manufacturing company “Home оf Pharmacy”. All manipulations and experiments carried out were approved by the bioethical commission. The study included 56 males and 48 females. The age of the animals corresponded to the range of 10–18 months, the body weight of females was 7–11 kg, and males 8–14 kg. In order to implement a uniform approach when creating reference intervals, all manipulations were carried out under the same conditions. For the study, blood was used, which was taken from the lateral subcutaneous vein of the leg of the studied animals on an empty stomach, without sedation and anesthesia. The following parameters were recorded in the blood serum of animals: creatinine, urea, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, cholesterol, triglycerides, total protein, albumin, glucose, creatine kinase, lactate dehydrogenase and total bilirubin, the albumin-globulin coefficient was calculated. Statistical outliers were estimated using the Tukey method, the type of distribution was determined using the Shapiro—Wilk criterion, paired comparisons between animals of different sexes were carried out using the Mann—Whitney U-test and the Student t-test. The obtained ranges of values of males and females correlated with each other for all the considered indicators, no statistical difference was revealed. When comparing the obtained intervals with the reference ranges of dogs from other literature sources, it was shown that, in general, the ranges of the considered indicators are similar, but there are also differences that can be explained by a wide list of factors. These include the image of keeping animals, as well as the preanalytical and analytical stages of the study. A comparative analysis of the interindividual variability of the biochemical parameters of the blood of dogs and humans showed the presence of some species differences that need to be taken into account in experimental activities.

Experience in the lower extremities trophic ulcers treatment in patient with combined pathologies: varicose veins and rheumatoid arthritis

Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body. Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations. Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.

Atypical Forms of Lower Limb Varicose Vein Disease: Features of Diagnosis and Surgical Treatment

INTRODUCTION: Lower limb varicose vein disease (LLVVD) is the most common vascular disease with a predominant lesion of the main trunks of saphenous veins. At the same time, there exist atypical variants of lesion of the venous system in LLVVD, which cause difficulties in diagnosis and treatment.
 AIM: To study the incidence rate, anatomical bases of the varicose transformation, the features of reflux formation and the results of surgical treatment in atypical forms of LLVVD.
 MATERIALS AND METHODS: The study involved 600 patients with LLVVD, C2-C3 class of clinical manifestations in CEAP classification; 82 of them had atypical forms. The mean age of patients was 40.2 ± 9.2 years, duration of disease 15.0 ± 5.6 years. Duplex scanning of the lower limb venous system was conducted according to Russian recommendations for the diagnosis and treatment of chronic venous disorders of lower limbs of 2018. Patients with atypical forms of LLVVD additionally underwent computed tomography of the venous system with contrast. Surgical treatment of 50 patients with atypical forms of LLVVD included separation of the site of opening of a tributary in the area of saphenofemoral junction after preliminary marking and isolated elimination of varicose tributaries using Muller hooks; incompetent perforating veins were ligated at the epi- or subfascial levels depending on the location. The results were considered in the periods for up to two years.
 RESULTS: According to our data, the incidence of atypical forms of LLVVD was 13.7%. Lesion of the large tributaries of the main saphenous veins accounted for the highest proportion of atypical forms of LLVVD — 68.3%. Of these, varicose transformation of the anterolateral tributary made 98.2%, and of the superficial iliac circumflex vein — 1.8%. Isolated varicose transformation of perforating veins occurred in 31.7% of cases, where transformation of perforating veins of the gluteal area made 7.7%, of perforating veins of the posterolateral surface of the thigh — 46.2%, and of perforating veins of the patella region — 46.2%. The technical success in the postoperative period in the form of elimination of varicose saphenous veins and of the source of their incompetence was achieved in 100% of cases.
 CONCLUSIONS: The incidence of atypical forms of LLVVD is 13.7%, with the main trunks of saphenous veins remaining competent. The anatomical and hemodynamic basis for such forms of LLVVD is incompetence of the deep vein valves, from where the reflux is transmitted to tributaries of the saphenofemoral junction and/or perforating veins of the gluteal region, femoral region or popliteal fossa. Precise separation of varicose tributaries and perforating veins with preservation of the main trunks of subcutaneous veins is an organ-saving method of LLVVD treatment with a good effect in the follow-up period of up to two years.