[Treatment of colorectal cancer complicated by intestinal bleeding in a patient with multivessel coronary artery disease and degenerative aortic valve disease]. / Lechenie kolorektal'nogo raka, oslozhnennogo kishechnym krovotecheniem u bol'nogo IBS i aortal'nym porokom serdtsa.

The aim of the presented clinical observation is to demonstrate a multidisciplinary approach in the treatment of a comorbid patient with complicated colorectal cancer, multivessel coronary artery disease, degenerative aortic valve disease and chronic heart failure. The authors presented a clinical case of treatment of a patient with ischemic heart disease, postinfarction cardiosclerosis (acute myocardial infarction from 1990), hemodynamically significant intestinal bleeding, the source of which was cancer of the descending colon. Comprehensive examination revealed moderately differentiated (G2) adenocarcinoma of the descending colon cT3N1M0, stage IIIB, in combination with multivessel coronary artery disease and degenerative aortic heart disease with a predominance of stenosis (pressure gradient: Pg max - 94 mm Hg, Pg mean - 68 mm Hg) and the development of aortic valve insufficiency. Taking into account the results of the examinations, the patient is indicated for myocardial revascularization and aortic valve replacement, which implied the subsequent long-term use of anticoagulants, but this increased the risk of recurrence of fatal colonic bleeding. At the same time, performing the operation to remove the source of recurrent bleeding according to all oncological principles had high risks of cardiovascular complications intraoperatively and in the immediate postoperative period. In this regard, after an objective assessment of all perioperative risks, it was decided to simultaneously perform direct myocardial revascularization, aortic valve replacement and extended left-sided hemicolectomy with extended lymphadenectomy. The patient is monitored at the Moscow State Clinical Hospital named after S.S. Yudin after the operation for 2 years, there is no data for the progression of the oncological process. Thus, a favorable outcome in this patient was determined by a multidisciplinary approach - performing a simultaneous operation on a comorbid patient.

Predictors of Chronic Thromboembolic Pulmonary Hypertension.

PURPOSE: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). MATERIAL AND METHODS: We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning.   Examination also included echocardiography. RESULTS: In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, post-infarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

Nausea and vomiting after fast-track cardiac anaesthesia.

BACKGROUND: The aim of this study was to determine the prevalence of postoperative nausea and vomiting (PONV) after fast-track cardiac anaesthesia, risk factors for PONV and its influence on the length of stay in the intensive care unit (ICU). METHODS: A prospective study was performed in the cardiothoracic ICU (CTICU) of a university hospital; 1221 consecutive patients undergoing fast-track anaesthesia (FTCA) in cardiac surgery were enrolled in the study. Severity of PONV was assessed immediately after extubation and then every hour until discharge from the CTICU. Metoclopramide 10 mg i.v. was used as a first-line rescue medication and ondansetron 4 mg i.v. as second-line rescue medication for PONV. RESULTS: Nausea was reported in 240 (19.7%) patients, and vomiting in 53 (4.3%). A total of 269 (22%) patients were treated with metoclopramide and 38 (3.1%) with metoclopramide and ondansetron. The latter was effective in all cases. Risk factors for PONV were age less than 60 yr, female gender and previous history of PONV. Discharge from the CTICU was delayed for a few hours because of PONV in eight patients, all of whom were discharged the same day. CONCLUSIONS: The incidence of PONV is relatively low after FTCA and does not prolong ICU stay. Prophylactic administration of anti-emetic drugs before FTCA is not necessary.

[Evaluation of the effectiveness of various protocols of antibiotic prophylaxis and therapy in pancreatic necrosis]. / Otsenka éffektivnosti razlichnykh rezhimov antibakterial'noi profilaktiki i terapii pri pankreonekkroze.

The efficiency of various protocols of antibiotic prophylaxis and therapy (APT) used in 63 patients with pancreonecrosis is analyzed. Early treatment with carbapenemes is the most effective in disseminated infectious pancreonecrosis requiring obligatory surgical treatment. Drug efficiency is the key factor in choosing APT for intensive care of patients with destructive pancreatitis.

The calcium-phosphate-induced fusion of human erythrocytes.

The calcium-phosphate-induced fusion of normal human erythrocytes with those having increased (above physiological) levels of intracellular ATP was studied. Fusion of erythrocytes was markedly enhanced in the case of increased content of intracellular ATP. Fusion of such erythrocytes results in formation of giant cells up to 130 microm in diameter. Dithiothreitol practically completely inhibited fusion of erythrocytes with normal ATP content and markedly lowered it between those with increased ATP content.

[A new Soviet allergen made from bee venom for the specific diagnosis of allergic reactions to bee stings]. / Novyi otechestvennyi allergen iz iada pchel dlia spetsificheskoi diagnostiki allergicheskikh reaktsii na uzhaleniia pchelami.

Overall 46 patients with allergic reactions to bee stings were examined. As a result of making skin prick, scarification and intracutaneous tests with an allergen from bee venom, allergy to bee stings was revealed in all the 46 patients, whereas only 37 patients responded to an allergen from the bee body. Specific IgE-antibodies using RAST were detected in 29 out of 31 patients. All the 29 patients had positive skin tests with an allergen from bee venom and only 22 with an allergen from the bee body. Specific histamine release was detected in all 13 patients examined by means of the indicated test. 100% coincidence was recorded with the results of intracutaneous tests with an allergen from bee venom. Only 11 out of the 13 patients had positive intracutaneous tests with an allergen from the bee body. Thus, the new Soviet allergen obtained from bee venom is effective in the diagnosis of allergy in response to bee stings.

[Effect of the neurotoxin apamin on ion currents in membranes of heart fibers]. / Vliianie neirotoksina apamina na ionnye toki membran serdechnykh volokon.

It has been shown on auricle fibres of the frog that neurotoxin apamin in extremely low concentrations (10(-10)-10(-9) M) suppresses the current entering in the cell through calcium channels of the membrane, but it increases tonic contraction related to Na/Ca exchange. No significant effects on fast sodium and potassium channels were observed. The results show that the mechanism of apamin effect on the heart is to a large extent conditioned by specific influence on Ca transport through the cell membranes.

[Effect of melittin on ion currents in heart cell membranes]. / Deistvie melittina na ionnye toki membran kletok serdtsa.

It has been shown on auricle fibres of the frog that neurotoxin from bee poison melittin suppresses the ionic currents entering the cell through calcium and sodium channels of the membrane, increases the background potassium current, suppresses phasic and tonic contraction of the fibres. Toxin modifies the kinetics of calcium channels, but does not affect activation and desensitization of beta adrenoreceptors. Effects of melittin are not decreased when adding the inhibitor of phospholipase A2 indomethacin. The results show that melittin directly affects the protein components of the membrane-ionic channels, probably binding with them.

[Rheological properties of the blood and erythrocyte suspension after exposure to zootoxins]. / Reologicheskie svoistva krovi i éritrotsitarnykh suspenzii v usloviiakh vozdeistviia zootoksinov.

The rheological properties of blood (viscosity, suspension stability and deformation of red blood cells) have been studied under the influence of zootoxins. It has been shown that the toxins Apis mellifera, Mesobuthus eupeus, Agkistrodon blomhoffii in vitro exert essential effect on haemorheological indexes.

[Effect of the venom of the toad Bufo viridis Laur. on cardiac hemodynamics in dogs]. / Vliianie iada zhaby Bufo viridis Laur. na kardiogemodinamiku sobak.

The cardiotonic effect of the secretion of the toads Bufo viridis Laur. skin glands and discharged bufadienolidines has been studied in the experiments on dogs under anaesthesia. It has been shown that the toad poison and bufadienolidines administered intravenously produce a marked cardiotonic and vasotonic effect, increasing the intraventricular and aortal pressure, the rate of pressure growth in the ventricles and the contraction index of the myocardium. The cardiotonic effect of poisons has also been noted in the model study of cardiac insufficiency caused by the bandaging of the coronary artery, it has greater effect than that of the cardiac glycoside corglycon.

[Reparative regeneration of rat liver after treatment with bee venom]. / Reparativnaia regeneratsiia pecheni krys pri deistvii pchelinogo iada.

After 70% of the rat liver volume has been resected, certain stimulating effect of a single administration of bee venom (1 mg/kg) on hepatocyte proliferation is revealed. In 4 hours the amount of binuclear hepatocytes increases, and in 22-24 hours increases their mitotic activity. The effect of bee venom is explained as activation of the adenilate cyclase system by means of prostaglandins and adrenal hormones.

[Disorders of neurohumoral regulation in rats exposed to the poison of the scorpion Buthus eupeus]. / Narusheniia neirogumoral'noi reguliatsii u krys pri vozdeistvii iada skorpiona Buthus eupeus.

The intraperitoneal injection of Buthus eupeus to rats (2,5 mg/kg) results in increasing of catecholamines and cyclic nucleotides content in blood. The hyperinsulinemia is observed simultaneously with the development of hyperglycaemia. It is believed that the activation of the cyclic system is a key mechanism of the neuro-humoral disturbances of homeostasis in case of scorpion venom influence.