METABOLIC, ENZYMATIC AND MINERAL MAINTENANCE OFREPARATIVE OSTEOGENESIS OF FACIAL CRANIUM INJURIES.

Aim - study of marker enzymes, hormonal and carbohydrate-protein indicators of the state of reparative osteogenesis in patients with complicated and uncomplicated course of injuries of facial cranium. The study included 81 patients with injuries of facial cranium, which were divided into 2 groups, depending on the presence of complications. The following enzyme indicators were studied: the level of excretion of hydroxyproline in daily urine; alkaline and acid phosphatase activity; the percentage of bone isoenzymes of alkaline phosphatase. To assess the mineral metabolism, the level of total and ionized calcium and inorganic phosphorus in the blood serum, as well as their excretion in the urine, were determined. To assess the state of metabolism, the concentration of glycosaminoglycans and their fractions in the blood serum were studied. To study the structural and functional state of the bone tissue the densitometry was performed. In patients with complicated course of injuries of facial cranium assosiated with traumatic brain injury there was revealed the increase (р<0,05) of: excretion of phosphorus, uronic acids and oxyproline, while the excretion of calcium was not disturbed (р>0,05), and excretion of magnesium was decreased (р<0,05). It was found out that the level of calcium of blood serum in patients with complicated course is significantly (р<0,05) lower than in the control group and does not depend on the presence of craniocerebral injury (р>0,05). The decrease of the level of ionized calcium content in blood serum can be the confirmation of lower metabolic activity of reparative osteogenesis processes, first of all at the expense of damage of central mechanisms. When studying the content of carbohydrate-protein metabolites by complicated course of injuries of facial cranium, the absolute increase (р<0,05) of concentration of chondroitin-6-sulfates was revealed, and during the analysis of results it was found out that in absolute values, as well as in structural indexes, the specific weight of various fractions changes, that can be the evidence of instability of mechanisms of osteogenesis and of damage of physiological mechanisms of reparative osteogenesis. Densitometric equivalents of forming of complicated course of injuries of facial cranium are the increase of broadband ultrasonic attenuation and the decrease of its spreading speed on the background of low levels of chondroitin-6-sulfates.

[Use of the electric stimulation of the heart in sick sinus syndrome (achievements and disputable problems)]. / Primenenie élektricheskoi stimuliatsii serdtsa pri sindrome slabosti sinusovogo uzla (dostizheniia i diskutabel'nye voprosy).

Experience with cardiac electrostimulation for the weak sinus node syndrome is presented. Between 1982 and 1985, 296 primary pacemaker implantations were performed, or 21.44% of all primary implantations performed over that period. The weak sinus node syndrome was diagnosed on the basis of ECG, Holter's monitoring and the atrial stimulation test. Initial atrioventricular conductivity disorders were recorded in 22.1%. Atrioventricular conductivity deteriorated in 16.1% of patients after 2 to 8 years of follow-up. The right ventricle was the principal stimulus application site in 267 patients, right-atrial stimulation was performed in 9, and double stimulation (radio-frequency right-atrial stimulation plus right-ventricular or right-atrial stimulation on demand), in 20. Permanent atrial fibrillation developed in 25% of 144 patients, followed up for 2 to 8 years, and the implant was removed in 5 (14%) patients.

[Clinical use of transvenous electrodestruction of the atrioventricular junction in patients with supraventricular tachyarrhythmia]. / Klinicheskoe primenenie transvenoznoi élektrodestruktsii atrioventrikuliarnogo soedineniia u bol'nykh s supraventrikuliarnymi takhiaritmiiami.

The authors described 51 patients with different types of supraventricular tachyarrhythmias and ciliary arrhythmia paroxysms who showed resistance to drug therapy. All the patients were treated by the closed transvenous electrodestruction of the atrioventricular junction by producing a series of discharges with a defibrillator to the area of His' bundle, the power being 280-400 J. A stable and complete transversal blockade was obtained in 45 patients, in 6 patients the restoration of permeability in the atrioventricular system with frequent ventricular responses was observed, being the reason for repeated electrodestructions. No complications were observed. In the patients with blockade of the I-II degree tachycardia paroxysms either stopped or were milder and subjected to drug therapy. Biologically controlled electrocardiostimulators of the "demand" type were implanted to all patients after electrodestruction of the atrioventricular junction. Proceeding from the above the authors made a conclusion that the closed transvenous electrodestruction was a method of choice in the treatment of supraventricular tachyarrhythmias and ciliary arrhythmia paroxysms who showed resistance to drug therapy. It can be effectively used for seriously ill patients and elderly persons.

[Determination of the life expectancy of patients undergoing continuous endocardial stimulation]. / Opredelenie sroka zhizni bol'nykh s postoiannoi éndokardial'noi stimuliatsiei.

Using an actuarial analysis, the authors studied the time of survival in 120 patients with continuous endocardiac electrostimulation. There were 37 lethal outcomes by the end of the fourth year of the follow-up, with 31 of these patients aging from 65 to 100 years. The study of the survival rate in different age groups showed that the highest survival rate was in the group below 55 years and the lowest in the group of patients aged 75 to 100 years. The study of survival in different age groups is important for the prognosis of the necessary amount of cardiostimulators with energy sources varying in relation to their operational life time.

[Programmed transesophageal electrostimulation of the left atrium]. / Programmirovannaia chrespishchevodnaia élektrostimuliatsiia levogo predserdiia.

In 34 patients with complex arrhythmias and conduction disturbances, programmed transesophageal electric stimulation of the left atrium was performed to determine the sinoatrial conduction time, relative refractory period of the atrioventricular conducting system, effective refractory period of the atrioventricular conducting system, that of the atria, that of an accessory tract in the Wolff-Parkinson--White syndrome, and stimulation parameters to trigger and reverse supraventricular tachicardia in order to define its mechanism. Potentials of a new noninvasive method of study are discussed.

[Electric stimulation of the heart in ventricular tachycardia: achievements and prospects]. / Elektricheskaia stimuliatsiia serdtsa pri zheludochkovoi takhikardii: dostizheniia i perspektivy.

Cardiac electrostimulation was conducted in 19 patients to prevent and control paroxysmal ventricular tachycardia. In 8 of those, an attempt was made to prevent tachycardia by continuous endocardial ventricular stimulation in the demand regimen. In 11 patients, a radio-frequency stimulator was implanted, its electrode positioned in the right ventricle to control current tachycardiac attacks. A 3-5-second stimulation at frequencies of 180-220 impulses per minute was sufficient to control the attack in 8 of the patients, while programmed ventricular stimulation only was needed to produce the effect in 3 patients.

[Electrical stimulation of the heart in the sick sinus syndrome]. / Elektricheskaia stimuliatsiia serdtsa pri sindrome slabosti sinusovogo uzla.

The results of electrical stimulation of the heart in 49 patients with the sick sinus syndrome are discussed. Continuous endocardial stimulation of the ventricle was applied in 30 patients. Implantation of two cardiac stimulators was performed on 5 patients, one for frequent stimulation of the atrium (switched on outside) and the other (biocontrolled) for stimulation of the ventricle. Fourteen patients who had no episodes of loss of consciousness and no signs of circulatory insufficiency did not undergo operation. There were two fatal outcomes in the postoperative period, which were not linked directly with the use of electrostimulation. No complications of a thromboembolic character were encountered.