[Comparison of the clinical and hemodynamic effects of nitroglycerin, isosorbide dinitrate and isosorbide-5-mononitrate in acute myocardial infarction]

One hundred and eighty patients with acute myocardial infarction (MI) were followed up. The patients were divided into 3 groups: (1) those receiving glyceryl trinitrate (GTN) (n = 43); (2) those on isosorbide dinitrate (ISDN) (n = 66); (3) those on isosorbide-5-mononitrate (IS-5-MN) (n = 71). In all the groups, the drugs were given by long-term continuous oligovolumic infusion. Following 24 hours of administration, 66.7, 47.3, and 17.1% increases in infusion rates were required in 74.4, 72.7, and 26.8% of the patients from Groups 1, 2, and 3, respectively. All the agents produced a pronounced antianginal effect and resulted in alleviated acute left ventricular failure. The in-hospital mortality rates were 16.2, 16.7, and 12.7% in Groups 1, 2, and 3, respectively. GTN, ISDN, and IS-5-MN caused adverse effects in 4.7, 18.2, and 2.8% of the patients from Groups 1, 2, and 3, respectively.

[Principles of early postoperative management of patients after open-heart surgery]

Proceeding from their personal 5-years experience comprising over 1500 operations with extracorporeal circulation the authors formulate their tactics of the early postoperative therapy. The attention is mainly paid to the maintenance of the optimum pulmonary gas exchange, adequate haemodynamics and stable homeostasis. An important role belongs to prolonged artificial pulmonary ventilation that was used for therapeutic purposed in 324 cases of cardiac and respiratory insufficiency and for preventive purposes--in 908 patients. The therapeutic tactics for various forms of respiratory and cardiac insufficiency and multiform cardiac rhythm disorders is presented in detail. On the example of 149 patients shows that a moderately incomplete blood replacement in the postoperative period does not result in clearsut anaemia. The authors recommend donor blood transfusions when the hemoglobin level is below 10 Gm%.