[Surgical treatment of patients with abdominal aortic aneurysm and ischaemic heart disease]

Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. In patients with haemodynamically significant lesions of the coronary bed and positive non-invasive tests, the first stage consisted in coronary artery bypass grafting or stenting of coronary arteries taking into account the risk of cardiac complications according to the SYNTAX Score. The second stage consisted in prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. The terms of the second stage differed and were determined by the course of abdominal aortic aneurysms. In symptomatic large aneurysms (more than 8 cm), prosthetic repair of the abdominal aorta was carried out within 2 weeks after previous stenting of coronary arteries. Simultaneous myocardial revascularization and abdominal aortic reconstruction were performed only in patients with severe angina pectoris, lesions of the trunk of the left coronary artery, three-vessel lesions of the coronary bed, high risk of cardiac complications according to the SYNTAX Score and a complicated or symptomatic course of an infrarenal aortic aneurysm. During implantation of stent grafts into the abdominal aorta there were neither lethal outcomes nor cardiac complications. In open operations, the 30-day mortality rate amounted to 2.2%, with the 5-year survival rate of 92%.

[Threatened paradoxical embolism, massive occlusion of pulmonary artery: risk stratification, treatment policy]

Described in the article is a clinical case report regarding a male patient presenting with pulmonary thromboembolism, with a floating thrombus in the common femoral vein, in the right atrium, prolapsing into the right ventricle and propagating through a patent foramen ovale to the left atrium, thus being a threat of paradoxical embolism. The echocardiography findings demonstrated the following: mean pressure in the pulmonary artery amounting to 56 mm Hg, dilatation of the right atrium and right ventricle. The patient was subjected to simultaneous thrombectomy from the common femoral artery, from the right, left atria and pulmonary artery in conditions of cardioplegia, as well as ligation of the superficial femoral artery. The postoperative period proved uneventful. The patient was discharged on postoperative day 15, with pressure in the pulmonary artery amounting to 38 mm Hg. Besides, analysed herein are the contemporary literature data, clinical guidelines, and opinions of experts concerning treatment policy in this complex pathology.

[Individual resistance card in health care for patients with urogenital diseases]

Currently, practical health care does not have a means to transfer patients health data when they change the place of residence and employment. In this regard, there was a need to develop a health-related instrument to accompany an individual when he/she changes the place of residence and work. The aim of the study was to develop an "individual resistance card" to use in health care for patients with diseases of the genitourinary system.

MATERIALS AND METHODS

We developed an "individual resistance card" proposed to implement in the practice of health care, as an information document on the state of reactivity and resistance (health) of the organism in terms of urologic diseases.

RESULTS

The degree (index) of relative organism resistance is calculated based on impaired individual reactivity and power (intensity) of the environmental pathogenic factors. Its application allows for significant improvement in the effectiveness of periodic health checks, primary and secondary prevention of diseases, because it takes into account both a primary (genotypic) and secondary (acquired) reactivity.

CONCLUSION

The developed Card can be used to record the state of the organism reactivity and resistance regarding urologic diseases and monitor these indicators when the patients change the place of residence and employment. This e-card (in encrypted form) and paper versions may accompany the individuals throughout their lives and will be used for to effectively organize primary and secondary disease prevention by a general practitioner and an urologist.

[Neurosis and genetic theory of etiology and pathogenesis of ulcer disease]

Based on the analysis of literature data and our own research, we have developed the original concept of etiology and pathogenesis of peptic ulcer disease. An analysis of the literature shows that none of the theories of pathogenesis of peptic ulcer disease does not cover the full diversity of the involved functions and their shifts, which lead to the development of ulcers in the stomach and the duodenum. Our neurogenic-genetic theory of etiology and pathogenesis of gastric ulcer and duodenal ulcer very best explains the cause-and-effect relationships in the patient peptic ulcer, allowing options for predominance in one or the other case factors of neurosis or genetic factors. However, it is clear that the only other: combination of neurogenic factor with genetically modified reactivity of gastroduodenal system (the presence of the target organ) cause the chronicity of the sores. The theory of peptic ulcer disease related to psychosomatic pathologies allows us to develop effective schema therapy, including drugs with psychocorrective action. On the basis of our theory of the role of Helicobacter pylori infection is treated as a pathogenetic factor in the development of peptic ulcer disease.

[Revascularization of the myocardium and kidneys in patients with combined atherosclerotic lesions of coronary and renal arteries]

The study included a total of 109 patients presenting with combined atherosclerotic lesions of coronary and renal arteries. Depending on severity of angina pectoris, the patients were subdivided into two groups. Group One consisted of patients subjected to revascularization of the myocardium and kidneys, and Group Two comprised those with a dominating clinical picture of vasorenal hypertension syndrome and undergoing surgery on renal arteries alone. Combined revascularizations were carried out in 31 patients. Of these, five underwent single-stage endovascular interventions on coronary and renal arteries. Isolated interventions were performed in 78 patients. Selectivity of revascularisations of vascular basins was determined first of all by the degree of coronary impairments, arterial hypertension, and the presence of chronic renal failure. No cases of hospital lethality were registered. The 10-year survival rate after renal revascularization amounted to 80.1%, after combined operations to 90.9%. In the immediate postoperative period improvement following isolated renal revascularization was achieved in 62 (86.1%) patients, after isolated coronary artery bypass grafting and combined operation - in all patients. The long-term outcomes turned out to be better after combined operations (80.0%) as compared to those after isolated operations on renal arteries (70.3%).

Surgical management of acute pulmonary artery thromboembolism

We operated on a total of twenty-seven patients presenting with acute massive thromboembolism of pulmonary arteries. The patients' mean age amounted to 38.6 ± 9.17 years. The estimated pressure in the pulmonary artery averaged 54.2 ± 7.15 mm Hg. A total of twenty- two thromboembolectomic procedures were performed in the setting of assisted circulation. In five patients embolectomy was carried out from a thoracotomic approach without artificial circulation. The remote period was marked by a relapse of thromboembolism, with the female patient having completely refused to undergo treatment. All the patients remain in a satisfactory condition, with the estimated pressure in the pulmonary artery maintaining at an average level of 27.05 ± 3.11 mm Hg.

[A favourable outcome of combined treatment in a patient with renal artery embolism and atrial fibrillation]

Presented herein is a clinical case report regarding a patient who was found to have embolism of the right renal artery with accompanying atrial fibrillation. Open surgery is viewed as a method of choice amongst a variety of the available treatment modalities aimed at re-establishing renal blood supply impaired due to embolism of the renal artery trunk. This clinical example demonstrates a possibility of successful renal revascularization undertaken 72 hours after renal artery embolism. The decision to simultaneously perform a combined surgical intervention consisting of embolectomy from the bifurcation of the renal artery, thrombectomy from it branches, and finally followed by radiofrequency ablation of the cava-tricuspidal isthmus, turned out an appropriate therapeutic policy which yielded a patient-friendly immediate outcome as well as favourable remote results persisting over time.

[Successful endovascular treatment for a false aneurysm of the hepatic artery using a stent-graft (a remote follow-up case report)]

Presented herein is a clinical case report concerning a female patient diagnosed with a pseudoaneurysm of the hepatic artery, chronic panel eatitis, and a pancreatic cyst. The woman was subjected to intravascular treatment consisting in reconstruction of the hepatic artery at the site of the origin of the aneurysmal neck with a stent graft.

[Zeolite-containing tripoli powder in experimental hepatology]

Biological activity of zeolite-containing tripoli powder was studied in rats. Biochemical, enzymatic and lipid peroxidation indices were assessed. The results of the study confirm enterosorption and detoxication activity of the powder.

[Effect of magnetolaser therapy on dynamics of bioamines, heparin in injured peritoneum and healing of this injury]

An experimental study on 62 guinea pigs was made to examine a magnetic-laser effect on the levels of histamin, serotonin, catecholamine, heparin and pathomorphology of wound healing after operations in the abdominal cavity. Magnetolaser therapy promotes fast normalization of the above levels, suppression of inflammatory-necrotic processes and stimulation of reparative and regenerative processes.

[Work capacity of patients after resection of post-infarction heart aneurysm]

The paper provides data of a ten-year follow-up of 51 patients who underwent postinfarction left ventricular aneurysmectomy in the All-Union Surgery Research Center with a view to verifying the degree of working capacity loss. In the long-term period, out of them 37 persons (72.5%) had Group II disability, 10 (19.6%) had easier managerial jobs (4 persons (7.8%) had not worked before surgery) and 3 (5.9%) retired on their old-age pension. The surgical therapy for postinfarction cardiac aneurysm significantly improves the functional status and physical working capacity in 72.5% of the patients.

[Ways of improving the diagnosis and prognosis in vasorenal hypertension]

Atherosclerosis, aorto-arteritis and fibromuscular dysplasia are the most common causes of vasorenal hypertension. Determination of plasma renin activity is a valuable diagnostic test at early stages of vasorenal hypertension. HLA studies demonstrated significantly elevated antigens B8 and B12 in patients with essential hypertension, and antigen A9 in patients with affected renal arteries. These findings may expand the possibilities of differential diagnosis for the selection of patients, eligible for angiographic investigation. A less than three-years duration of the disease in the presence of high plasma renin activity is a favorable prognostic criterion.

[Species and interspecies antigenic specificity of house dust mites (genus Dermatophagoides)]

Among 800 neonates screened for cerebral bleeding, perinatal sonography indentified 35 preterm neonates with intraparenchymal hemorrhage (IPH). The observed IPHs were categorized in five general groups: classical grade-IV hemorrhage (16 patients), grade-IV hemorrhage with coexisting but anatomically separate hemorrhages (four patients), grade-IV hemorrhage with later development of secondary parenchymal hemorrhages at distant sites (five patients), hemorrhagic periventricular leukomalacia (four patients), and parenchymal hemorrhage unrelated to grade-IV hemorrhages (six patients). Thirty IPHs had concurrent germinal matrix hemorrhages, but in only 16 patients did the IPH represent an extension of the subependymal hematoma and therefore qualify as pure grade-IV hemorrhage according to the most popular classification.

The high concurrence of periventricular leukomalacia (80–100% in most groups) and germinal-matrix-remote IPHs supports the concept that most IPHs in preterm neonates represent secondary hemorrhages into ischemic brain tissue.

[Gel filtration analysis of the protein antigens of Dermatophagoides pteronyssinus ticks]

Gel filtration analysis was used to study the antigenous composition and molecular weight of the culture extract from the ticks D. pteronyssinus. The highest allergenic and immunochemical activity was shown by elution fractions I and II taken together. Their activity exceeded that of the whole extract by 69%. The molecular weight of antigens entering elution fractions I and II is about 49000--28000. Fraction III is immunochemically inert and exhibits little allergenic activity.

[Role of alpha- and beta-adrenoreceptors in isolated guinea pig trachea anaphylaxis to aerosol tick (D. pteronyssinus) allergy]

Experiments were performed on inhalation-sensitized guinea-pigs, with the use of immunoallergic neurohistochemical techniques. Anaphylactic tracheobronchial spasm was shown to be related not only to the degree of sensitization but also to the state of alpha- and beta-adrenoreceptors. Sensitization, in its turn, changed the function of adrenoreceptors. It increased histamine sensitivity and decreased catecholamine sensitivity of an isolated organ.

[Adrenergic and cholinergic structures of guinea pig lungs under normal conditions and in experimental bronchial asthma]

Fluorescent and histochemical methods were applied to the study of the morpho-functional condition of the adrenergic and cholinergic nervous system of the bronchopumonary apparatus in guinea pigs under normal conditions and during sensitization (subcutaneous and inhalant) with tick Dermatophagoides pteronyssinus ticks. There was revealed a marked excitation of the adrenergic nervous system, and a reduction of the acetylcholine esterase activity in the bronchopulmonary tissue during the animal sensitization.

[Experimental sensitization with an extract of Dermatophagoides pteronyssinus ticks]

Immunogenic properties of Dermatophagoides pteronyssinus ticks were studied in subcutaneous injection of the antigen to guinea pigs and rabbits. Marked changes in the immunological reactivity of the animal organism were revealed; these changes were accompanied by production of agglutinating, sensitizing the mast cells and precipitating (in rabbits) antibodies, and by the development of hypersensitivity of the immediate and delayed type.