[Comparative assessment of risk factors and hospital results in male and female patients underwent to coronary artery bypass surgery].

There are controversial data on relatively unfavorable effect of female gender on postoperative mortality of patients underwent to coronary artery bypass grafting (CABG). In order to assess risk factors and hospital outcomes after elective CABG we studied retrospectively data on patients who had undergone CABG in Sani Konuogly medical center (Gasiatep, Turkey) during the period from March 2002 to March 2010. For elimination of unfavorable effect of old age we included into analysis data from patients younger than 65 years. In accordance with study aim all patients (n=2692) were divided into two gender groups 1966 men (mean age 54,01 years) and 726 women (mean age 54.35 years). Diabetes (48.3 and 26.9%; p=0.0001), arterial hypertension (76.6 and 28.4%; p=0.00001), and obesity (50 42%; p=0.03) were more frequent among women while smoking (44.5 and 10.3%; p=0.0001), hyperlipidemia (37.6 and 21.5%; p=0.0002), and history of myocardial infarction (31.3 and 17.3%; p=0.06) were more often registered among men. Mortality was insignificantly higher in women (1.6 and 0.9%; p=0.06). Perioperative Q-wave myocardial infarction was more frequent among men than among women (1.5 and 0.4% respectively; p=0.04). It is necessary to conduct prospective well controlled study for exclusion of gender influences on perioperative outcomes in patients subjected to CABG .

[Clinical and economical effectiveness of outpatient diagnostic coronary angiography].

Introduction into clinical practice of transradial coronary angiography (CA) made it possible to conduct the procedure in outpatients and thus increase number of CA and diminish its cost. Aim of the study was to assess possibility, safety and economical efficacy of outpatient CA. Between April 2004 and August 2007 CA was carried out in 133 outpatients without overt heart failure, unstable angina, complex disturbances of cardiac rhythm or conduction. Comparison group comprised 187 patients subjected to CA within framework of short term hospitalization program. There were no complications associated with the use of either transradial or transfemoral approach. Total average cost of outpatient CA was 19% less than that of inhospital CA. Thus outpatient CA with transradial approach appears to be safe and effective procedure with low risk of complications in patients with stable ischemic heart disease.

[Possibility of coronary angiography without hospitalization].

Coronary angiography is the necessary investigation in the diagnostic complex of patients with ischemic heart disease (IHD). The use of trans-radial access makes it possible to do the angiography without hospitalization. The algorithm of coronary angiography in day-time clinic was proposed. Non-hospital angiography in 15 patients was successful. It is the first time this method has been used in this country.

[Experimental and clinical assessment of antioxidant efficacy of multicomponent antioxidant medication]. / Eksperimental'naia i klinicheskaia otsenka antiokislitel'noi éffektivnosti mnogokomponentnogo antioksidantnogo preparata.

AIM: To study an antioxidant action of antioxidant vitamins (vitamins C, E and provitamin A) in vitro and in vivo. MATERIAL AND METHODS: The study was made of kinetic parameters of copper-initiated free radical oxidation (FRO) of low density lipoproteins (HDLP) in human blood plasm, antioxidant potential of rat liver and myocardium, the level of FRO products in HDLP and activity of glutathione peroxidase in erythrocytes of 31 males aged 40-64 years with coronary heart disease (CHD). RESULTS: An antioxidant action of the combinations alpha-tocopherol+ascorbic acid and alpha-tocopherol+beta-carotin was much more potent than that of each of the component alone. The whole complex of the antioxidants completely suppressed FRO of HDLP in the model system. Feeding rats for 30 days with a complex of antioxidant vitamins and selenium produced a sharp enhancement of the antioxidant potential of the liver and a complete suppression of free radical processes in the myocardium. If this complex was given to CHD patients for 2 months, it sharply reduced the amount of FRO primary and secondary products in blood plasm LDLP in growing activity of erythrocytic selenium-containing glutathione peroxidase. CONCLUSION: The scheme is proposed for objective experimental assessment of antioxidant efficacy of multicomponent antioxidant medication in laboratory and clinical trials.

[The results of catheterization and the x-ray angiographic assessment of cardiac contractility and volume in primary pulmonary hypertension]. / Rezul'taty kateterizatsii i rentgenoangiograficheskaia otsenka sokratimosti i ob''emov serdtsa pri pervichnoi legochnoi gipertonii.

To ascertain the role of invasive investigations in the diagnosis of primary pulmonary hypertension (PPH), 12 PPH patients underwent catheterization of the left and right heart compartments, contrast right and left ventriculography and oximetry. Compared to control values, the patients had high pressure in the pulmonary artery and right ventricle. Some of them exhibited elevated pressure in the right atrium. Pulmonary artery wedge pressure, left ventricular end-diastolic and systolic, diastolic pressure in the aorta did not differ significantly from those in the controls. Right and left ventriculography revealed an increase in the end-systolic and end-diastolic volumes of the right ventricle which diminished its stroke index and ejection fraction. The latter two were reduced in the left ventricle also. Because the procedure was well tolerated by the patients, it is recommended for PPH diagnosis and follow-up.

[The risk assessment for a fatal outcome in patients with stable angina based on the data from a long-term prospective observation (a comparison of the 5-year survival prognosis with the data at the 6th to 12th years of the observation)]. / Otsenka riska letal'nogo iskhoda u bol'nykh so stabil'noi stenokardiei po dannym dlitel'nogo prospektivnogo nabliudeniia (sopostavlenie 5-letnego prognoza vyzhivaemosti s dannymi na 6--12-m godu nabliudeniia).

A rule has been developed to predict coronary death in 377 patients with coronary heart disease and stable angina due to coronary stenotic atherosclerosis. Gravimetric values of various clinical signs, resting ECG changes, and bicycle ergometric testing have been obtained by a computer. A decisive rule has been also derived. According to the values of prognostic indices I1 and I2, groups of low, moderate, and high risks for fatal outcomes for 5 years have been identified and the patient's survival during a subsequent follow-up of 6 to 12 years has been assessed. The developed scheme of prognosis permits its use in practice.

[Clinical use of magnetic resonance tomography in the assessment of vital organs in malignant arterial hypertension]. / Klinicheskoe primenenie magnitno-rezonansnoi tomografii v otsenke sostoianiia zhiznenno vazhnykh organov pri zlokachestvennom techenii arterial'noi gipertonii.

Magnetic resonance tomography was performed to examine the kidneys, brain, adrenals, vessels, and heart in 110 patients with malignant arterial hypertension (MAH). The findings were compared with those of the examination of healthy subjects and patients with benign hypertensive disease (BHD). As compared to the controls, all the MAH patients had changes in the target organs, however, their nature and magnitude varied with under underlying MAH disease. Renal alterations were most profound in chronic glomerulonephritis. All the patients displayed signs of concentrated cardiac hypertrophy: its maximum degree being noted in renovascular hypertension, the least, in MAH of adrenal genesis. Examination of the central nervous system in MAH patients revealed that the ventricular system and subdural space were dilated. It was shown that it was feasible to diagnose hypertrophic encephalopathy in the prehospital period by employing magnetic resonance tomography.

[Comparative assessment of data of echocardiography and phonocardiography in the diagnosis of heart diseases]. / Sravnitel'niia otsenka dannykh ekho- i fonokardiografii v diagnostike porokov serdtsa

A comparison was made between the echo- and phonocardiographic examinations and the final clinical diagnosis of 85 patients with various cardiac pathology. Echo- and phonocardiography were found to be not alternative, and the less -- contradictory, but mutually supplementing methods. Echocardiography has certain advantages over phonocardiography in the diagnosis of mitral valve defects -- in evaluating the degree of its stenosis and in characterizing the morphological changes of the valve, but it is somewhat inferior in diagnosing mitral insufficiency. In the diagnosis of aortic valve defects phonocardiography appears to be more informative since echocardiography does not always permit to record the state of the aortic valve. Indisputable advantages of echocardiography in the diagnosis of the tricuspid valve defects were revealed. The comparison of the data of echocardiography and phonocardiography permitted to decypher the syndrome of "a late systolic click with a late systolic murmur" that was previously interpreted as a pericardium sound. Besides, the echocardiographic data on the changes in the left ventricular outflow tract help to explain the origin of the spindle-form systolic murmur. So far their interpretation was rather complicated, although they are often seen on phonocardiograms of normal individuals and patients with heart diseases.