[Surgical treatment of patients with stomach cancer and severe concomitant cardio-vascular pathology].

51 patients with gastric cancer and severe concomitant ischemic heart disease (90.2%), valvular heart disease (5.9%), critical stenosis of the internal carotid artery (2%) or abdominal aortic aneurism (2%) were operated on during 1995-2011yy. Of them men were 41, women - 10; mean age was 65.1 years (51-82). The first stage of gastric cancer was diagnosed in 18 (35.3%) of patients, second, third and fourth in 12 (23.5%), 17 (33.3%) and 4 (7.8%), respectively. Radical tumor resection was achieved in 37 (72.5%), palliative operations were performed in 13 (25.5%) patients. 17.6% of patients were operated on stomach and vessels simultaneously. 82.4% received the stepwise treatment. Intra- and postoperative complications were registered in 47.1% (24 of 51 patients); of whom 5.9% (3 patients) ended lethally. Simultaneous operations showed the 55.6% complications and zero lethality rate, whereas stepwise treatment resulted in 45.2% complications and 7.1% lethality.

[The surgical treatment of patients with lung cancer and severe cardiovascular disorders].

During the period of 1991--2010 yy 51 patients with lung cancrs were operated on the severe cardiovascular diseases (IHD -- 90%; critical carotid stenosis -- 6%; tricuspidal valve failure -- 2% and the combination of the IHD and aortic valve failure -- 2%). Lung cancer steged I in 17 (33.3%) patients, II in 15 (29.4%); III - in 16 (31.4%) and IV in 3 (5.9%) patients. 33 patients of 51 were radically operated on lung cancer, palliative resections were performed in 3; trial thoracotomies were performed in 2 patients. 8 (15.7%) patients were operated on simultaneously. The complicated postoperative period was registered in 22 (57.9%) patients of 38 with exitus lethalis in 2 cases. The complication rate after simultaneous operation was 62.5% with lethality of 12.5%, whereas by the consecutive operations the complication rate was 56.7% with lethality of 3.3%, Nevertheless, surgical correction of the severe concurrent cardiovascular pathology flares the range of operable patients with lung cancer.

[Surgical treatment of patients with colorectal cancer and severe concurrent cardio-vascular diseases].

The study population comprised 14 patients, operated on account of colon cancer (n=2), sigmoid cancer (n=1), rectal cancer (n=6), synchronous rectal and prostatic cancer (n=1) and lung (n=1) and liver (n=2) colon cancer metastases. The diagnosed concurrent cardiovascular pathology was: coronary heart disease (n=8), valve disease (n=2), aortic aneurism (n=2), coronary heart disease combined with aortic aneurism (n=2). Simultaneous operations were performed in 3 patients, 11 patients were operated on consecutively. No deaths were registered after simultaneous operations. In the group of consecutive operations 2 patients had died of myocardial infarction and cardiac decompensation. 3 (21,4%) patients died of tumor relapse during the follow-up period. The rest 9 patients are under observation for 3 months to 10 years, 2 patients achieved a 5-year cancer-free survival time.

[Effects of anesthetics on oxidative stress changes in patients with high anesthetic risk in the perioperative period of coronary bypass surgery].

The study included 44 patients who were divided into 3 groups according to the type of anesthesia. In group 1 patients (n = 15), initial anesthesia was accomplished by inhaled sevoflurane and intravenous fentanyl (2.5-3.5 microg/kg); basal anesthesia was performed with sevoflurane. In Group 2, midazolam, 0.1-0.15 mg/kg, fentanyl, 5.2 +/- 0.01 vg/kg, and ketamine, 0.85 +/- 0.13 mg/kg were given for induction. Basic anesthesia was carried out, by administering fentanyl in a dose of 4.71 +/- 0.4 microg/kg/hour, halothane, 0.5-1.5 ob %. In Group 3, midazolam, 1.2 +/- 0.01 mg/kg) and fentanyl, 7.8 +/- 0.6 microg/kg) were used to induce anesthesia. Basic anesthesia was effected with fentanyl, 5.31 +/- 0.5 microg/kg/hour, ketamine, and diprivan. Anesthetic management using halogen-containing inhalational anesthetics at coronary bypass surgery in patients at high anesthetic risk was ascertained to cause a significant reduction in the degree of manifestations of oxidative stress and facilitated a better intraoperative period. Sevorane was found to have the most significant effect on oxidative stress.

[The influence of halogenated anesthetic agents on the hemodynamics and myocardial metabolism in ischemic heart disease].

The authors studied the effects of anesthesia with equipotential concentrations of halothane, enflurane, and isoflurane plus 33% O2 on central hemodynamics, coronary flow, and myocardial metabolism in 60 patients undergoing myocardial revascularization surgery. The study found that halothane and isoflurane with 33% O2 caused dose-dependent and well-controlled arterial hypotension and decreased left ventricular (LV) stroke work index, myocardial consumption of O2 MCO2), total peripheral vascular resistance, and coronary vascular resistance (CVR), which increased coronary volume flow. Monoanesthesia with enflurane lowered myocardial contractility and did not change LV work; MCO2 decreased, while coronary sinus flow increased due to a decrease in CVR. Thus, the comparison of hemodynamic and myocardial effects of the three potent inhaled anesthetics--halothane, enflurane, and isoflurane - demonstrated their positive effects on myocardial oxygen balance in a form of dosed and controlled decrease in its work in cardiological patients with preserved LV contractility. The imported anesthetics enflurane and isoflurane do not have any significant advantage over the Russian-made halothane in this category of patients. At the same time, halothane vs. enflurane has a more noticeable "unloading" effect on afterload and does not cause convulsive episodes and periods of cerebral activity depression; in contrast to isoflurane, halothane dose not cause metabolic disturbances in a compromised myocardium; halothane is used in lower inhaled concentrations to achieve the same degree of myocardial work decrease without a substantial decrease in cardiac efficiency. These facts suggest that halothane has a practical advantage over the other anesthetics.

[Assessment of efficacy of endarterectomy of coronary arteries]. / Otsenka éffektivnosti éndarteréktomii iz koronarnykh arterii.

Results of coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) are analyzed. The study group consisted of 97 patients who has undergone ACB with CE, control group--102 patients after ACB without CE. There were no differences in clinical state of the patients early (30 days) and late (1-2 years) after surgery. Computed tomography was used for detection of coronary bypass patency. In long-term period of follow-up (60 patients) autoarterial shunts were occluded in 3% cases in the study group and in 5% cases in the control one. Autovenous shunts were occluded in 36 and 27% cases respectively. These results demonstrate necessity of CE in CABG.

[Transplantation of the heart-lung complex (the first clinical experience)]. / Transplantatsiia kompleksa serdtse-legkie(pervyi klinicheskii opyt).

The article deals with experience in the first transplantation of a heart-lung complex in the USSR. The recipient was a 34-year-old male with dilation cardiomyopathy. It was decided to perform the transplantation because the terminal stage of cardiac failure and secondary pulmonary hypertension developed (cardiac index 1.3 l/m, pressure in pulmonary artery 80/50 mm Hg, resistance of pulmonary vessels 10.4 units after Wood). The heart and lung were transplanted from a 19-year-old male who died from a craniocerebral injury. Cyclosporine, metipred , imuran, dopamine in small doses, cardiotonics, and antibiotics were given in the postoperative period; the patient was kept on artificial respiration for 48 hours. For up to 10 days the patient's condition was relatively stable and his consciousness was clear. Bilateral pneumonia developed, however, from which he died on the 12th postoperative day. The article discusses organizational problems and some questions of immunosuppressive therapy, immunological monitoring, and the management of patients after transplantation of a heart-lung complex.

[Risk factors of atrial fibrillation after aortocoronary bypass surgery with extracorporeal blood circulation]. / Faktory riska fibrilliatsii predserdii posle operatsii aortokoronarnogo shuntirovaniia s iskusstvennym krovoobrashcheniem.

Fibrillation of the atriums is registered in 20-40% of cases after the surgery of direct revascularization of the myocardium and runs alongside with impairments that are life-menacing. Seventy-six (76) patients were examined after direct revascularization of the myocardium, including 20 subjects with paroxysms of atrium fibrillation. The arrhythmia-related risk was shown to be increasing in persons (older than 60) with an impaired left column of the left coronary artery, in unstable angina pectoris diagnosed before surgery, malfunction of the left ventricle and in case of a rapid warming-up of a patient after the artificial blood circulation with cold cardioplegia is over.

[Use of microsurgery in the treatment of ischemic heart disease]. / Primenenie mikrokhirurgii dlia lecheniia ishemicheskoi bolezni serdtsa.

Coronary artery bypass operations with the use of microsurgery were performed in 60 patients with diffuse forms and distal levels of coronary artery lesions. In 55 patients aortocoronary bypass operations, and in 5 patients mammary-coronary bypass operations were performed (total of 213 distal anastomoses). During the operation and in immediate postoperative period 3 patients (5%) died, 3 patients developed the intraoperational myocardial infarction. Microsurgery has good prospects in operations of coronary arteries.