[Diagnostic possibilities of multilayer computer tomography in blunt abdominal trauma].

The purpose of our study was to determine MDCT diagnostic possibility in blunt abdominal trauma. Our work was based on MDCT results of 84 blunt abdominal trauma patients with stable hemodynamic status (28 (33.3%) female and 56 (66.6%) male). Age ranges from 17 up to 64 years. The CT scan showed obvious organ and system injuries in 82 poly-trauma patients. Injuries of craniocerebral region, also of facial bones, chest and spine were determined in two patients; in one of which, however, it was not possible to differentiate subcapsular spleen hematoma accurately because of left upper joint metallic holder artifacts. In second patient the liver injury was accurately diagnosed, but there were visualization problems caused by the massive retroperitoneal hematoma from right adrenal gland injury. The investigation showed that sensitivity of CT scan data was 98%, specificity-97% and accuracy rate-98%. All above mentioned clearly states the importance of MDCT in the emergency department. MDCT ensures precise diagnosis in maximally short period of time and thereby helps to choose proper treatment and decreases post-traumatic complications.

[Profiles of genotypes of familial hypertrophic cardiomyopathy according to data of clinical studies].

With the aim of studying clinical profiles of hereditary cases of hypertrophic cardiomyopathy (HCMP) we examined 64 patients with HCMP of both sexes (mean age 43.8+/-11.7 years). Genealogy of 40 patients (62.5%) revealed no cases of the disease among first degree relatives. They were defined as sporadic forms of HCMP. Genealogical screening revealed 22 patients (37.5%) with familial forms of HCMP. In 8 cases study of genealogy of probands detected 16 more patients. Results of assessment of familial history, ECG and echocardiographic investigations reflected degree of thickening of interventricular septum, asymmetric character of distribution of hypertrophy in the myocardium, and cases of sudden deaths in first degree relatives as possible hereditary signs in familial HCMP determining variations of clinical phenotype of the disease through interrelated disturbances of contractile and electrical myocardial functions.

[The role and place of helical ct for preporative diagnosis of acute appendicitis].

The goal of our study was to ascertain the role and place of helical CT for preoperative diagnosis of acute appendicitis. Our study relied upon the results of helical CT scans of 60 patients, which were diagnosed probable acute appendicitis based upon clinical signs. Of these 60 patients 49 (81,6%) were female, 11 (18,4%) male. For all patients laboratory studies of blood were made, 31 patients were examined by ultrasonography. Among this group the diagnosis of acute appendicitis was verified by CT scan in 41 patients. In the case of 5 patients the scan was equivocal because of smaller amount of omentum; in this subgroup of 5 patients (5% overall) three were given radiocontrast dye, and two (3,3% overall) were not. In 11 (18,3%) cases the diagnosis of acute appendicitis was not verified, and in three cases the diagnosis was incorrect. According to data of our study and intraoperative data analysis, sensitivity of this method approaches 93% and the specificity - 92%, and overall diagnostic accuracy 93%. Helical CT may be stated as diagnostic method of choice in the diagnosis of acute appendicitis. It is helpful in clinical decision making, and reducing the amount of false appendectomies.

Endovascular treatment of stenosis of autogenous arteriovenous access for hemodialysis.

Retrospectively review of long-term outcome of balloon angioplasty (TBA) in the treatment of native dialysis A-V fistulae stenosis was conducted. From February 2008 to January 2009, seven hemodialysis patients (5 women and 2 men; mean age 46.4 years) were treated for stenosis of the A-V fistula at the venous outflow tract. Angioplasty was performed with the use of high-pressure balloons. Percutaneous transluminal angioplasty was used. There were no any complications during and after procedure. In 4 cases residual stenosis did not exceed 10% and in 3 cases 30%. After 3 month the improvement rate was 85%. Two patients required surgical treatment. None of the patients displayed any major complications from the procedure. This study confirms the efficacy of PTA in the treatment of vascular access stenosis. Elevated dialysis blood line pressure can be the first sign of fistula stenosis. Although our series is small, we have nevertheless demonstrated that the concerted efforts of nephrologists, interventional radiologists, and surgeons are the key to maintaining and prolonging vascular access survival in this group of patients.

[Isolated systolic arterial hypertension in elderly and senile patients].

Systolic arterial pressure rises uninterruptedly with age and it appears as a strong independent risk-factor of cardiovascular, cerebral and renal complications. A combined using Norvasc and Egilok gives stable hypotensive effect, provides regression of left ventricular hyper-trophy with improvement parameters of systolic and diastolic function, which is vitally important for researched contingent of patients. A combined using small therapy doses of drugs protects geriatric patients against side effects.

[Prevention of paroxysms of atrial fibrillation in old and senile patients].

It is known that the atrial fibrillation is a sorrow "privilege" of the senile groups of people. The aim of the given paper was to study the reasons of atrial fibrillation arising in old (60-74 years) and senile (75-89 years) patients and possibility of prevention paroxysms of atrial fibrillation and its complications with help of prolonged selective beta-blocker egilok retard pro daily doses 50-100 mg. The results which were received after the examination and treatment of 147 patients who were under stationary and dispensary treatment at the Research Institute of Experimental and Clinical therapy for 12 months. We have achieved full absence of paroxysmal atrial fibrillation in 89.8% patients (132 patients). The use of egilok retard gives stable hypotensive effect in old and senile patients, provides the regression of the left ventricular hypertrophy with improvement of its parameters and diastolic function, which is especially important for the studied contingent of the patients.

[Effect of the metabolic syndrome on the electrophysiological parameters of the heart].

The goal of this research was to study influence of the MS on the electrophysiological parameters of the heart conduction system. The research involved 32 patients suffering from heart arrhythmias (18 females and 14 males, average age 52,8-/+12,9). The patients were categorized into 2 groups. Group I included 15 patients (9 females and 6 males, average age 47,5-/+8,9) suffering from heart arrhythmias and with signs of MS. Group I was subdivided into 2 subgroups: I subgroup--10 patients without diabetes, and II subgroup 5 patients with type II diabetes. Group II comprised of 17 patients (8 females and 9 males, average age 57,4-/+11,9) with arrhythmias without any signs of MS. The refractoriness dispersion between the right atrium (RA) and the left atrium (LA) caused by the MS, directly provokes development of atrial fibrillation and type II (atypical) atrial flutter. In cases of metabolic syndrome and "slow-fast" type of PRAVNT caused by the metabolic failures, the prolongation of the antegrade effective refractory period (ERP) of the slow AV nodal pathways and the retrograde ERP of the fast AV nodal pathways provoked prolongation of the tachycardia cycle and, consequently, reduction of the heart rate during paroxysms of tachycardia. Metabolic failures produce direct effect upon the sinus node function, causing suppression of its function as the SNSS develops, which requires implantation of pacemaker. The research results for metabolic syndrome and AV blockage cases demonstrated that the latter was always of a distal type, which was caused by a direct effect of metabolic failures upon the electrophysiology of the atrioventricular junction.

["Hypertensive heart" symptoms in the elderly]. / Simptomatika "gipertonocheskogo" serdtsa v pozhilom i starcheskom vozraste.

Arterial hypertension is a leading pathology in the elderly. This pathology become extremely important in a spread atherosclerotic process commonly observed in the geriatric patients. While the aspects of left ventricle in arterial hypertensive patients are rather well known, this pathology needs further investigations connected with the studies on age-related changes in cardiovascular system. Particular attention should be paid to a symptomatic of "hypertensive heart" in the elderly patients.

Therapeutic angiogenesis for patients with limb ischemia by utilization of fibrin meshwork. Pilot randomized controlled study.

AIM: The aim of this paper is to assess the feasibility and efficacy of fibrin in inducing neovascularization as an angiogenic substance and/or carrier for vascular endothelial growth factor (VEGF) in patients with limb ischemia. METHODS: Twenty-three patients with limb ischemia and referred for below the knee amputations were randomized for treatment: group 1, 7 patients received only a saline injection; group 2, 9 received intramuscular injection of fibrin and group 3, 7 received the fibrin composition with deferoxamine and added VEGF(165). The fibrin meshwork was introduced into the popliteal area of the diseased limbs using a dual syringe system (1 contained thrombin solution [1 mg, 5000 U] and 1 contained fibrinogen [1 mg, Baxter Hyland Immuno] solution). In group 3, Deferoxamine (100 microg) and 500 microg of VEGF(165) were added to the fibrinogen solution. RESULTS: In the control group 5 patients had undergone below the knee amputation at the 3-6 month follow-up. Only 1 patient from Group 2 had below the knee amputation 5 months following Fibrin only administration. Clinical improvement was noted in all 8 patients following fibrin administration and in all 7 patients injected with the fibrin meshwork, deferoxamine and VEGF combination. CONCLUSION: IM injection of fibrin is safe and appears to be an efficient method to treat limb ischemia. These findings indicate that use of fibrin may be a novel and simple method for inducing therapeutic angiogenesis.

Intravascular low-power laser irradiation after coronary stenting: long-term follow-up.

BACKGROUND AND OBJECTIVE: A high restenosis rate remains a limiting factor for percutaneous transluminal coronary angioplasty and stenting. The objective of this study was to evaluate the effect of intravascular red laser therapy (IRLT) on restenosis after stenting procedures in de novo lesions. STUDY DESIGN/MATERIALS AND METHODS: A total of 68 consecutive patients were treated with IRLT in conjunction with coronary stenting procedures. Mean lesion length was 16.5 +/- 2.4 mm. Reference vessel diameter (RVD) and pre-minimal lumen diameter (MLD) were 2.90 +/- 0.15 mm and 1.12 +/- 0.26 mm, respectively. RESULTS: After treatment, MLD was 2.76 +/- 0.32 mm with no procedural complications or in-hospital adverse events. Angiographic follow-up (n = 61) revealed restenosis in nine patients (14.7%) with rate by artery size of > 3 mm (n = 21) 0%; 2.5--3.0 mm (n = 28) 14.2%; and < 2.5 mm (n = 12) 41.6%. CONCLUSION: Intravascular red light therapy is safe, feasible, and reduces expected restenosis rate after coronary stenting.

[The action of a number of cardiac glycosides on an isolated system of myocardial contractile proteins in heart failure due to toxic-allergic myocarditis. The molecular mechanism]. / Deistvie riada serdechnykh glikozidov na izolirovannuiu sistemu kontraktil'nykh belkov miokarda pri nedostatochnosti serdtsa, obuslovlennoi toksiko-allergicheskim miokarditom. Molekuliarnyi mekhanizm.

Experiments conducted on an isolated contractile apparatus, myocardial fibers (MF) in cardiac insufficiency (CI) caused by toxico-allergic myocarditis of 10 days duration (TAM10dd) showed that cardiac glycosides (CG), beta-acetyldigoxin (beta AD), beta-methyldigoxin, and strophanthin K (SK) increase the capacity of the actomyosin ensemble (AME) for generation of force, hydrolization, and economic use of the free energy of ATP hydrolysis. The mechanism of the effect of these CG in the phase of contraction differs from that of their effect on the AE of a normal myocardium. For instance, in severe CI induced by TAM10dd beta AD, in distinction from its action on the AME of a normal myocardium, can increase contractility economy, particularly in the phase of highest energy capacity, the phase of force generation, and exceed the level encountered in normal conditions, it also increases significantly the rate and reduces the time of MF relaxation as in the case of MF of a normal heart.

Prevalence of cardiovascular risk factors in the Republic of Georgia.

BACKGROUND: Eastern Europe is experiencing an epidemic of deaths from cardiovascular diseases with an increase since the early 1990s approaching 50%. The ability to survey the risk factors associated with this striking rise is severely hampered by the current disarray of the area's public health system. We used a rapid survey method to describe the epidemiology of cardiovascular risk in the capital of the Republic of Georgia, Tbilisi. METHODS: A two-stage cluster design, 'rapid survey method' developed by the Chronic Disease Center was used to estimate the frequency of hypertension, a major cardiovascular risk factor. Local personnel were trained and certified in blood pressure measurement and rapid survey techniques. The training and survey were conducted over a period of 14 days at which time a preliminary report of the survey was presented to the Ministry of Health. RESULTS: A total of 321 subjects were surveyed. The frequency of high blood pressure (>140/>90 mm Hg) at the time of the examination was 58% in men and 56% in women. The major correlates for blood pressure were gender and age. In addition we found that 31% of the population had a total cholesterol > or =220 mg% and a similar number had a low high density lipoprotein < or =35 mg%. Smoking was present in 60% of men and none were taking aspirin daily to prevent premature coronary artery disease. CONCLUSIONS: The rapid survey method is feasible in the former Soviet Union and can quickly provide estimates of the risk factors associated with the epidemic of cardiovascular disease in this area.

[The comparative efficacy and differences in the molecular mechanism of the inotropic action of cardiac glycosides and nonglycoside cardiotropic agents on the contractile protein system of the myocardium]. / Sravnitel'naia éffektivnost' i razlichiia v molekuliarnom mekhanizme inotropnogo deistviia nekotorykh serdechnykh glikozidov i neglikozidnykh kardiotropnykh sredstv na sistemu kontraktil'nykh belkov miokarda.

The in vitro study on an isolated system of myocardial contractile proteins determined optimal concentrations of the positive inotropic action and biological activity ranges of beta-methyldigoxin (beta-MD), strophanthin K, K-strophantozide, beta-acetyldigoxin (beta-AD), milrinone, and amrinone. Optimal concentrations of the beta-MD and strophanthin K (10(-2) and 10(-6) M, respectively) significantly increased qualitatively and quantitatively the economy and thermodynamic efficiency, altered the energy transformation in the contractile protein system under the isometric contraction, whereas the beta-AD produced only the quantitative effect. However, the beta-MD and strophanthin K at concentrations exceeding the optimal one by one order lost the ability to produce the qualitative effect, retaining only the quantitative one in the actomyosin ensemble. The strophanthin K significantly increased the economy of a single actomyosin ensemble in the force generation phase and the beta-MD in the tension maintenance phase. Unlike the strophanthin K, the beta-MD did not slow down (did not worsen) the relaxation process. This provides grounds to conclude that the beta-MD produces most favorable effect on the energy transformation by myocardial contractile proteins.

[Lectin-induced chemiluminescence of peripheral blood neutrophils in patients with ischemic heart disease before and after blood irradiation with helium-neon laser]. / Lektinindutsirovannaia khemiliuminestsentsiia neitrofil'nykhgranu- lotsitov perifericheskoi krovi bol'nykh ishemicheskoi bolezn'iu serdtsa do i posle oblucheniia krovi gelii-neonovym lazerom.

The blood taken from 35 patients with coronary heart disease and 30 healthy donors was irradiated with He-Ne laser, which resulted in a decrease in its count of segmented neutrophilic granulocytes. Lectins bound to various carbohydrate determinants onto the neutrophil surface were shown to affect changes occurring after luminol-depended chemiluminescence irradiation in patients and healthy persons in different ways. The patients' neutrophils contained lower levels of radiommunologically detectable leukotriene B4. Thromboxane B2 levels also dropped following the irradiation. The laser irradiation induced elimination of some less resistant cells from blood flow, i.e. "rejuvenation" of a cell population of neutrophilic granulocytes. The remaining cells differed in the composition and reactivity of surface lectin receptors and in the content of biologically active substances, which is likely to play the key role in the mechanism responsible for the therapeutical effect of He-Ne laser.

[Changes in lectin-induced chemiluminescence of neutrophilic granulocytes after irradiation of blood with helium-neon lasers]. / Izmenenie lektinindutsirovannoi khemiliuminestsentsii neitrofil'nykh granulotsitov posle oblucheniia krovi svetom gelii-neonovogo lazera.

Blood obtained from 33 healthy donors was irradiated with He-Ne laser. During this process the count of segmented neutrophils decreased, while the content of radioimmunologically determined leukotriene B4 and thromboxane B2 increased in the other neutrophils. Application of mannose-specific lectins (Con A, PSL) as inductors caused the increase, while application of other carbohydrate-specific lectins caused the decrease of luminol-dependent chemiluminescence in neutrophilic granulocyte suspension after the irradiation. As a result of direct laser effect on the blood cells some portion of the less resistant cells were eliminated from the blood flow, i.e. "rejuvenation" of the neutrophilic granulocyte population in the cells takes place.

[Risk factors and methods of prevention of complications in digestive organs after myocardial revascularization in patients with generalized atherosclerosis]. / Faktory riska i metody profilaktiki oslozhnenii so storony organov pishchevareniia pri revaskuliarizatsii miokarda u bol'nykh generalizovannoi formoi ateroskleroza.

The clinico-hemodynamic and angiographic findings in 66 patients with ischemic heart disease were analysed to identify the risk factors of complications in the digestive system and to determine the methods for their prevention after myocardial revascularization. It was found that complications in the gastrointestinal tract develop after extracorporeal circulation more often in patients with lesions of the visceral branches of the abdominal aorta than in those without them. With purposeful preventive therapy and observance of definite precautions before, during, and after the operation, the incidence of complications in abdominal organs and the organs of the retroperitoneal space reduced to one fourth while the nature of these complications was less aggressive. This was confirmed by no postoperative deaths in the group of patients who had undergone preventive treatment.

[Morphological study of the myocardium of mice infected with Coxsackie B1 virus during the treatment with an immunomodulating drug T-activin]. / Morfologicheskoe izuchenie miokarda myshei, infitsirovannykh virusom Koksaki B1, na fone lecheniia immunomoduliruiushchim preparatom T-aktivinom.

The study was undertaken to examine myocardial morphological alterations in mice treated with T-activin in different periods of viral myocarditis. Two-month BALB/C mice of both sexes were used in the experiments, which were intraperitoneally given 0.2 ml Coxsackie B1 virus in a titer of 10(-3)-10(-7) D50 ml. The material was taken 3, 5, 7, 9, 15, and 30 days following infection. Intact mice and animals given culture fluid were applied as controls. T-activin was subcutaneously injected in a dose of 0.2 ml at the rate of 0.01 mg per kg body weight on day 5 after virus infection for 5 days. The predominance of an alterative component of inflammation (dystrophic, necrobiotic and necrotic changes) over proliferative processes was ascertained to be common to all periods of infection. T-activin administration attenuated myocardial damage.