Volodymir N. Substantiation of small invasive desympatization method under obliterated diseases of extremity vessels

The thesis encompasses selection and introduction of small invasive paravertebral chemical desympatization, controlled by computer tomography, into clinical practice in treatment patients with obliterated disease of extremity vessels. In this study four groups of research were used: In the first group different small invasive desympatization methods were used experimentally in dogs in vivo; In the second group histological and morphological characteristics of sympathetic ganglions after different kinds of small invasive desympatization in dogs were studied; In the third group sympatheticolitics distribution in paravertebral area were studied in corpse materials; In the fourth group the results of small invasive chemical desympatization in patients with obliterated disease of extremity vessels in clinical conditions were studied. The research encompasses 3 experimental stages: Stage 1 - in aseptic and antiseptic conditions under general intravenous thiopental anesthetic the following operations were done: · Lumbar bilateral desympatization by crystal phenol; · Lumbar chemical desympatization by 10% phenol water solution ; · Lumbar bilateral desympatization by 70% ethyl spirit solution; · Lumbar chemical desympatization by 10% benzyl spirit; · Lumbar bilateral thermal coagulation of sympathetic ganglions; · Destruction of sympathetic ganglions by radio frequent coagulant; · Lumbar bilateral desympatization by hot water (85-90 C). Stage 2 - an hour later after the first experimental stage, under general intravenous thiopental anesthetic, material was collected (sympathetic ganglions, which had been replaced and contiguous tissue). Stage 3 - 24 hours later after the first experimental stage, materials were collected from the opposite side to compare the morphological changes in dynamics and for the further histological study. The clinical examination of patients consisted of two parts: subjective - finding out patient's complaints and anamnesis of disease, speed of its development, etiological factors, which launched obliterated disease of extremity vessels and promoted its development; objective - defining local status, doplerauscultation of vessels, comparative thermometry of skin in distal extremity areas and ankle-humeral dopler-pressure and dopler-index, finding tactile and pain sensibility in extremities, defining scale and value of active movements. Among functional methods the following ones were used: Opel's test; Samuel's test; finger pressing test - a white spot symptom. Information on periphery blood circulation of extremities was obtained by functional instrumental ways of examining. The selection of small invasive desympatization is substantiated by morphological comparison of the changes in removed paravertebral sympathetic ganglions under the effect of different destructive factors. The required minimal number of sypatheticolitic was defined by experimental modeling method. Clinical results of small invasive paravertebral desympatization, controlled by computer tomography with 70% ethyl spirithave been compared with open operative sympathectomy after Lariche in treatment of obliterated diseases of extremity vessels. Small invasive desympatization method with 70% ethyl spirit, using stereotaxis is proposed