Objective: to assess the results of the treatment and prevention of hemorrhage from the esophageal varices (EV) in patients on the waiting list (WL) for liver transplantation (LT).

Subjects and methods. Twenty-seven patients with portal hypertension-complicated hepatic cirrhosis of various etiologies were treated at the N.V. Sklifosovsky Research Institute of Emergency Care in 2005 to 2010. All the patients were placed on the LT WL on the basis of clinical and instrumental studies. In addition to esophagogastroduodenoscopy (EGD), a set of instrumental studies comprised abdominal ultrasonography and dynamic and static liver scintigraphy.

Results and discussion. Diagnostic EGD revealed grade 3 EV in all the 27 patients. There was a rather high rate of not only erosive gastroduodenitis, but also duodenal ulcer (22.2%).

Conclusion. Diagnostic and therapeutic EGD in patients with severe portal hypertension can diagnose esophageal varix and a number of concomitant abnormal changes and apply a set of mini-invasive methods to arrest and prevent esophagogastrointestinal hemorrhage.

Objective: to study the role of echographic techniques in the evaluation of hemodynamic and structural changes in a liver transplant (LT) in ischemia-reperfusion injuries (IRI).

Materials and methods. The results of an echographic follow-up were analyzed in 122 patients who had undergone orthotopic liver transplantation in 2005 to 2010.

Results. A high-resistance flow pattern was more frequently recorded in the arterial bed of LT within the first 24 postoperative hours. On day 3, there were negative changes as an increased resistance index at the level of the hepatic artery or its branches in 35% of the patients. Transient postischemic structural changes in the grafted organ were diagnosed in 42.3% of all the examinees; formation of large focal necroses was found in 28%. Mortality in patients with transient edema of the hepatic parenchyma was 4.5%. In the group of recipients who had been diagnosed as having large focal hepatic parenchymal necroses, mortality was 29.6%. Liver retransplantation was carried out in 10% of the patients because of graft dysfunction.

Conclusion. According to the echographic findings, LT hemodynamic and structural changes as a sequel of prior IRI were revealed in the overwhelming majority of recipients. Ultrasound follow-up monitoring is a reliable tool for assessing the severity of LT injuries and risk factors for poor outcome.

Objective: to develop rational modes of nutritional status correction in patients with diffuse liver diseases on the liver transplantation (LT) waiting list (WL).

Subjects and methods. A comprehensive examination was made in 82 patients with hepatic cirrhosis who were included into the LT WL and allocated to 3 groups. The patients were matched for age, gender, and the severity of their condition. Nutritional status parameters and energy expenditures were studied in all the groups. Complex methods to calculate nutritional status parameters, energy expenditures, and nutrient needs were used to evaluate malnutrition.

Results and discussion. Assessment of nutritional status, metabolism, and nutritional therapy revealed disorders in 64 (78%) patients on the LT WL. Normal nutritional status was found in 18 (22%) patients; mild, moderate, and severe protein-energy malnutrition was detectable in 18 (22%), 40 (48.8%), and 6 (7.3%) patients, respectively. The patients with moderate and severe malnutrition were given oral balanced feeding formulas in addition to diet therapy. To correct imbalance of blood amino acid composition, 10 patients were given hepamin in combination therapy for hepatic encephalopathy. During the performed therapy, there was a significant reduction in serum ammonia levels and improved psychometric testing results.

Conclusion and practical guidelines. When HC patients are referred to the LT WL and admitted to hospital for surgery, it is necessary to make an integrated assessment of nutritional status and to define the degree of malnutrition. An individual nutritional support plan must be complied for patients with moderate and severe malnutrition and for those with postoperative complications.

To study efficiency of molgramostim as an adjuvant in HBV vaccination we randomized 18 pts after OLT due to non-HBV causes. Nine pts received GM-CSF (150 mcg of sc 24 h before 1st dose of vaccine). Other 9 pts received only vaccine. Both groups of pts did not differ in sex, age, immunosuppression and received vaccine in double doses (40 mcg im) by similar way (0, 1 and 2 Mo). Anti-HBs titers were estimated in 3 Mo after the last dose of vaccine. High anti-HBs titer (>200 mME/ml) achieved 4 pts (44%) from the GM-CSF group and nobody from the control group (p=0.037) No serious adverse effects occurred. Conclusion: GM-CSF may be useful as an adjuvant in HBV vaccination after OLT.

Background. There is now only one method for replacement of virtually any integumentary defects differing in extent, which satisfies all the requirements of primary plastic repair – microsurgical autotransplantation of tissue units on a vascular pedicle. Primary plastic repair by microsurgical autotransplantation makes it possible not only to perform adequate reconstructive manipulations of an injured limb, but also to create the optimal conditions for delayed surgical interventions.

Materials and methods. Since 2000, the N.V. Sklifosovsky Research Institute of Emergency Care has been performing autotransplantation of vascularized tissue units to cover soft tissue defects. For this time, 57 flaps have been grafted in 57 patients with open limb bone fractures. For closure of soft tissue defects, the authors have successfully applied free autografts comprising the muscles and skin.

Results and discussion. Out of the 57 primary microsurgical autotransplantations of tissue flaps, only 4 cases required emergency intervention; the others needed delayed one. To close soft tissue defects, the authors successfully applied free autografts comprising the muscles and skin. All the transplanted autografts got implanted completely.

Conclusion. The used procedure furnishes a means of minimizing donor site damage and ultimately improves both functional and aesthetic surgical results. The authors’ experience permits one to recommend a more active introduction of microsurgical plastic methods into clinical practice.

Objective: to evaluate the efficiency of endoscopic transpapillary interventions in the diagnosis and treatment of biliary complications in patients after orthotopic liver transplantation (OLT).

Materials and methods. One hundred and seventy-one OLTs were carried out at the N.V. Sklifosovsky Research Institute of Emergency Care in January to October 2010. Of them, endoscopic transpapillary interventions into the bile ducts for biliary complications were undertaken in 13 (7.6%) patients. These patients underwent a total of 33 endoscopic retrograde cholangiographies (ERCG), 13 endoscopic papillosphincterotomies, 5 bouginages, and 22 stentings.

Results. There were no fatal outcomes associated with endoscopic interventions. By and large, the immediate result of endoscopic treatment was positive in 10 (77.0%) patients. Our results of endoscopic treatment were comparable with the data available in the literature.

Conclusion. ERCG can reveal post-OLT bile-biliary anastomostic strictures and failure, which serve as an indication for endoscopic bilioduodenal stenting with stepwise restenting.

Objective: to evaluate the effects of pre-existing HLA antibodies on the posttransplantation period and to study changes in the generation of donor-specific antibodies in recipients after allogeneic cadaveric kidney transplantation.

Materials and methods. One hundred and ten serum samples from patients on the kidney transplantation waiting list (WL) were tested for pre-existing HLA antibodies. To evaluate the effect of preantibodies, the investigators examined 55 patients (32 males and 23 females, whose age was 28 to 63 years) who had undergone kidney transplantation at the N.V. Sklifosovsky Research Institute of Emergency Care in October 2009 to September 2010. In the second part of the investigation, HLA antibody levels were monitored in the posttransplantation period. A total of 27 patients (15 males and 12 females aged 26 to 61 years) were examined after kidney transplantations made at the N.V. Sklifosovsky Research Institute of Emergency Care in March to September 2010.

Results and discussion. Since November 2009, the serum level of pre-existing HLA antibodies had been measured in all the patients registered on the kidney transplantation WL at the N.V. Sklifosovsky Research Institute of Emergency Care. One hundred and ten patients have been examined today; of them 69 males and 41 females are waiting for kidney transplantation.

Conclusion. The level of pre-existing HLA antibodies must be estimated in the recipients to be prepared for kidney transplantation since this makes it possible to identify in practice a group of patients requiring a more thorough selection of donor organs and preoperative preparation that involves the methods of extracorporeal blood correction and medical therapy.

We analyzed natural history of recurrent HCV-infection after cadaveric liver transplantation (LTx) in 38 cases. The mean follow-up time was 23.8 (95% CI, 18.4; 29.2) mo after LTx. There were latent course in 19 pts, and active hepatitis in another 19 pts in the 1st post-LTx year. Active hepatitis has been associated with CMV-infection, acute cellular rejection and methylprednisolon pulse-therapy. Liver biopsy had shown advanced fibrosis or cirrhosis in 19% cases independently on latent or active course. In 5 out 8 pts with latent course of HCV-infection in the 1st y., the active hepatitis developed up to the end of the 2nd y. FU. Two cases of fibrosing cholestatic hepatitis resulted in the death or retransplantation. Two cases of unusual course of recurrent HCV-infection described (i.e. fulminant liver failure without cholestasis).

The paper gives a clinical example of successful therapy for severe sepsis, the cause of which was methicillin-resistant Staphylococcus aureus infection in a patient undergoing liver transplantation and splenectomy.

The paper analyzes current approaches to selecting heart transplantation (HT) recipients, namely, approaches to assessing the severity of heart failure since the latter is the most common indication for HT. The approaches to selecting patients will be refined as the availability of new types of therapy increases and the implantation of mechanical extracorporeal circulation devices is ranked as a more standard intervention. With allowance made for the shortage of donor organs, it is anticipated that the trend in the performance of HT will persist in the most critically ill patients who need long-term parenteral use of positive inotropic drugs and mechanical circulation support.

Objective: to conduct a morphological (histological) study of the effect of a designed collagen bandage on grade IIIa burn wound healing.

Materials and methods. Wound biopsy specimens taken from 19 patients (mean age 50 years) with grade IIIa burns (10 to 60% of the body surface) were examined. A type I collagen-based biological bandage was used for their treatment. The wounds of the patients who were treated with a levomecol ointment-containing bandage served as a control. The healing of Grade IIIa burn wounds, by applying a type I collagenbased platelet-derived growth factor BB (PDGF-BB)-enriched biological bandage, was histologically studied.

Results. Burn wound epitheliazation was observed on days 7 to 9 when the collagen-based bandage was applied. It was seen in the controls on days 20-22 if the course of the wound process was favorable.

Conclusion. The application of the type 1 collagen-type PDGF-BB biological bandage on days 1-2 after injury considerably accelerated grade IIIa burn wound healing processes. The stimulating effect of the bandage is likely to be associated mainly with the fact that in the early stage of the wound healing process, exogenous collagen of the bandage creates the conditions that are necessary for the fixation and movement of cells (both keratinocytes and fibroblasts).

Objective: to evaluate the efficiency of follicular microautotransplantation in the treatment of scarring alopecia.

Subjects and methods. The results of surgical treatment were analyzed in 62 patients with scalp scars at various sites after injuries, burns, and surgery. Surgical treatment was performed using follicular microautotransplantation. The surgery was made as an outpatient procedure (the patients did not need hospitalization) and it involved 4 basic stages. The efficiency of the surgical treatment for scarring alopecia was evaluated, by analyzing its early and late results. Gender, age, etiology, and scar time did not affect the results of the treatment.

Results. The early surgical results were assessed from indicators, such as the proportion of surviving grafts and the quality of restored hair. The late results were followed up for at least 9 months. The maximum follow-up was 2.8 years. The engraftment rate of transplanted follicles averaged 93.8%; it was 96.6% for a normotrophic scar.

Conclusion. Transfer of own hair by follicular microautotransplantation is an effective surgical treatment in patients with scalp scarring defects; it yields a good cosmetic effect and substantially improves quality of life in patients with scarring alopecia.