[Cardioprotective effects of glutamine in patients with ischemic heart disease operated under conditions of extracorporeal blood circulation].

It was conducted a study of glutamine cardioptotective effects during perioperative use in patients with ischemic heart disease, operated under CB. Exclusion criteria were: left ventricular ejection fraction less than 50%, diabetes melitus, myocardial infarction less than 3 months ago, Patients of the study group (n=25) had glutamine (20% solution N(2)-L-alanine-L-glutamine ("Dipeptiven" Fresenius Kabi, Germany); 0.4 g/kg/day. Patients of control group (n=25) received placebo (0.9% NaCl solution). The main indicators were the dynamics of troponin I, as well as central hemodynamics parameters. On the 1-st day after operation the concentration of troponin I was significantly lower in the glutamine-group compared placebo-group (1.280 (0.840-2.230) 2.410 (1.060-6.600) ng/ml; p=0.035). 4 hours after CB in a glutamine-group also had significantly large indicators of cardiac index (2.58 (2.34-2.91) l/min/m2 vs 2.03 (1.76-2.32)) l/min/m2; p=0,002) and stroke index (32.8 (27.8-36.0.) ml/m2 vs 26.1 (22.6-31.8) ml/m2; p=0.023). Systemic vascular resistance index was significantly lower in glutamine-group (1942 (1828-2209) dyn x s/cm(-5)/m2 vs 2456 (2400-3265) dyn x s/cm(-5)/m2; p=0.001). Conclusion. Perioperative use of N(2)-L-alanine-L-glutamine during the first 24 hours ofperioperative period gives cardioprotective effect in patients with ischemic heart disease operated under CB.

[Lipid peroxidation and cytochrome P-450-dependent metabolism of xenobiotics in patients with coronary heart disease and multiple organ failure].

The aim of the investigation was to study oxidative stress and hepatic monooxygenase function (HMF) in coronary heart disease (CHD) patients with multiple organ dysfunction (MOD) after myocardial revascularization. Twenty-seven CHD patients with signs of MOD and 38 patients with an uncomplicated postoperative period were examined. The intensity of MOD was rated by the SOFA scale; oxidative stress was estimated from the values of malondialdehyde, conjugate trienes, ceruplasmin, and catalase, and HMF was evaluated from antipyrine pharmacokinetic data. On postoperative day 1, the study group showed significant signs of MOD, as well as activated lipid peroxidation (LPO) and a 1.5-fold reduction in HMF. The control group displayed an insignificant HMF suppression under less marked oxidative stress. On days 3-4 after surgery, the total MOD index was noticeably lowered. Both groups exhibited a high LPO rate and enhanced HMF. On days 10-12 postoperatively, the severity of MOD corresponded to the previous period. There was a decrease in LPO activity in both groups. HMF was found to substantially reduce in the study group and to be in line with the baseline values in the control one. Correlation analysis revealed direct and inverse relationships of the indices of MOD with LPO rates and HMF. Therefore, MOD in patients with CHD is attended by increased oxidative stress and leads to a more significant HMF reduction as compared with those with an uncomplicated postoperative period. At the same time, LPO activation is one of the cardinal causes of HMF suppression. Reduced HMF may enhance the sensitivity of CHD patients to drug therapy.

[Oxidative stress and hepatic monooxygenase function in patients with coronary heart disease before and after cardiac surgery].

The parameters of lipid peroxidation (LPO) and hepatic monooxygenase function (HMF) were studied in 92 patients with coronary heart disease (CHD). After termination of and within the first 24 hours after myocardial revascularization, the levels of malonic dialdehyde and conjugate trienes were found to show 45.6 and 62.1% increases, respectively. The half-life of antipyrine (AP T(1/2)) increased by 23.5%. Studies on postoperative days 3-4 and 10-12 revealed a reduction in LPO rates and normalized HMF. After off-pump surgery, LPO and HMF significantly unchanged. On the contrary, open heart surgery resulted in a noticeable activation of LPO and an almost 1.5-fold decrease in HMF. The increase in oxidative stress and the deceleration of hepatic microsomal oxidation were ascertained to be directly related to the duration of extracorporeal circulation and the time of myocardial ischemia. After surgery, the rate of LPO and the reduction of HMF were more considerable in patients with multiple organ dysfunctions, as compared with the uncomplicated postoperative period. Within the first 24 hours following surgery, AP T(1/2) increased by 83.4%, but on postoperative days 10 to 14, it remained to be decreased by almost 1.5 times as compared with the baseline. Thus, LPO activation is one of the leading mechanisms of decelerated hepatic xenobiotic biotransformation after myocardial revascularization. Diminished lower HMF enhances the sensitivity of CHD patients to drug therapy and requires a differential approach to its use.

[The effect of hypertonic saline solutions on water-salt metabolism in Brattleboro rats]. / Vliianie gipertonicheskikh solevykh rastvorov na vodno-solevoi obmen u krys linii Brattleboro.

The role of antidiuretic hormone in the organism ability to resist against considerable salt shifts, was studied in Wistar (1st group) and Brattleboro rats--heterozygotes (2nd group). 5% NaCl solution was infused into animals' stomach (30-50-70-100 ml/kg). An increase in diuresis especially at 7-10% load, and a decrease in Na and K excretion occurred in Brattleboro rats. A decrease in tissue cation accumulation was found in Brattleboro rats as compared to Wistar ones. The Brattleboro rats with a partial defect of ADH synthesis revealed a decrease in the reserve possibilities of the system regulating the water-salt metabolism. As a result, 100% of Brattleboro rats died after 100 ml/kg salt load whereas the mortality in Wistar rats was only 22.2%.

[Glomerular filtration rate in distinct nephron populations of rodents with different ecological specializations]. / Raspredelenie klubochkovoi fil'tratsii v otdel'nykh populiatsiiakh nefronov u gryzunov razlichnoi ekologicheskoi spetsializatsii.

14C-ferrocyanide studies of glomerular filtration rate (GFR) distribution among different nephron population has shown that in Arvicola terrestris after dehydration the GFR is increased in juxtamedullar nephron in comparison with superficial ones, while in homozygote rats of Brattleboro line no similar changes of GFR distribution between distinct nephron population took place. In Rhombomis opimus the GFR after dehydration was usually greater in juxtamedullary nephrons. These results indicate the necessity of vasopressin for GFR regulation in distinct nephron populations.

[Thyroid hormones during the correction of acquired mitral defects under perfusion-free hypothermia]. / Tireoidnye gormony pri korrektsii priobretennykh mitral'nykh porokov v usloviiakh besperfuzionnoi gipotermii.

Total triiodothyronine and thyroxine were measured in the blood plasma during different stages of surgery and after it in 26 patients operated on the open heart under conditions of hypothermia without perfusion. Cooling without perfusion did not appreciably affect the levels of thyroid hormones. Only their ratio was evidently changed at cooling below 30 degrees C with the predominant content of thyroxine. After surgery functional hypothyrosis developed. The shifts were the most expressed on day 3 after the operation. Thyroid status normalized by day 10 postoperation.

[Characteristics of carbohydrate metabolism regulation during correction of congenital heart defects and hypothermic protection without perfusion]. / Osobennosti reguliatsii metabolizma uglevodov pri korrektsii vrozhdennykh porokov serdtsa v usloviiakh besperfuzionnoi gipotermicheskoi zashchity.

Carbohydrate metabolism and insulin status have been studied in 89 patients with congenital heart valve defects operated on in conditions of profound perfusion-free hypothermic protection. It has been established that anesthesia, hypothermia, and surgical trauma are accompanied by hyperinsulinemia, which had nothing to do with the introduction of exogenic hormone. Insulin effect is attenuated and insulin resistance develops, which leads to a drop not only in glucose consumption but also in the consumption of glycolysis products. Single insulin injection during induction to anesthesia at a dose of 0.5 U/kg was insufficient for normalization of carbohydrate homeostasis. Glycolysis activation with a considerable increase in blood pyruvate level has been observed, which decreases lactate/pyruvate coefficient informative value at different stages of surgical treatment of heart valve defects.

[The reactions of the sympathoadrenal system during the correction of acquired mitral defects under perfusion-free hypothermia]. / Reaktsii simpatoadrenalovoi sistemy pri korrektsii priobretennykh mitral'nykh porokov v usloviiakh besperfuzionnoi gipotermii.

Blood plasma adrenalin and noradrenaline were measured during correction of acquired mitral defect under conditions of hypothermia without perfusion. Superficial ether anesthesia combined with morphine in a dose of up to 1 mg/kg and droperidol in a dose of up to 0.1 mg/kg did not fully block the sympathoadrenal reaction to cooling. An increase of catecholamines was revealed during cooling, the maximal level being observed in the postocclusion period. Disconnection of the heart from circulation caused an expressed activation of the sympathoadrenal system with the predominance of the adrenomedullary component.

Changes in myocardial metabolism and ultrastructure of myocardial microvessels during pharmacological and cold cardioplegia under hypothermic conditions without perfusion.

A combination of pharmacological and cold cardioplegia in with hypothermia without perfusion in open-heart surgery guarantee the reversible character of shifts in energy and free radical balance in the myocardium. However, this procedure can impair coronary micricirculation due to structural and functional changes in microvessel endothelium. Our results demonstrate that new cytoprotective approaches are extremely needed for cardiac protection during surgery.