[Surgical decision-making in management of patients with lower limb critical ischaemia using radioisotope scintigraphy].

Presented herein is a new technique of studying the competence of the microcirculatory bed and viability of appendicular tissues in patients suffering from lower limb critical ischaemia. The competence of the resistive link of microcirculation was determined by means of dynamic scintigraphy based on studying the primary passage of an internally administered radiopharmaceutical along the microcirculatory system. Accumulation of the radiopharmaceutical with an affinity for the sites of necrosis and inflammation was recorded by means of stationary scintigraphy. Based on the findings obtained in studying the outcomes of surgical management of 105 of the 123 examined patients presenting with lower limb critical ischaemia, criteria for microcirculatory competence and viability of the lower extremities were worked out. Reliable significance of these two criteria in assessing the efficacy of the outcomes of various types of revascularizations and amputations was determined.

[Clinical-and-pathophysiological prerequisites of impaired breathing and ensuring of safety in drug-induced depression of consciousness]. / Kliniko-patofiziologicheskie predposylki dlia narusheniia vneshnego dykhaniia i vozmozhnye puti dostizheniia bezopasnosti pri medikamentoznoi depressii soznaniia.

Seventy-three patients operated on under anesthesia based on regional blocks were examined. Thiopental-sodium (T; n = 29), myadozalam (M; n = 10) and propofol (P; n = 24) were used for sedation. The conditions of breathing and of gas exchange were evaluated by the findings of pneumotachography: V(peak insp), P(peak insp), P(100) Raw, breathing pattern, SpO2, PEtCO2 and EMG from mouth-diagram muscles. The obtained results were made use of to draw up a rating scale for impaired breathing, which is based on the respiratory volume and respiration rate of gas exchange as well as on different variations of respiratory support. Irrespective of a sedation type and of a degree of consciousness suppression, the impaired breathing was registered in 90-100% of cases: obstruction of the respiratory tracts was predominant in T (higher Raw); in M--depression of the respiratory center (lower P(100); in P--a pronouncedly lower of EMG, and, respectively, a weakened contraction of diaphragm (lower P(peak insp)). Depression of the respiratory center was found to occur irrespectively of a drug used in sedation, however, the mechanisms of obstruction were different: in T--impaired breathing; in M--impaired phase muscle activity. Sedation by P was not accompanied by any clinically valuable obstructive signs.

[A new method of monitoring the psycho-emotional condition in patients during balanced anesthesia based on regional blockades]. / Novyi metod monitoringa psikhoémotsional'nogo sostoianiia patsientov vo vremia sbalansirovannoi anestezii na osnove regionarnykh blokad.

The potentialities of a skin-galvanic reaction (SGR) were studied, to evaluate the psycho-emotional status, in 9 sedated (midazole, thiopental-sodium, propofol) classes I and II ASA patients operated (10 interventions) under regional block. An original software was designed to analyze the SGR; it detects the signs of psycho-emotional discomfort (including positional discomfort) in drug-induced depression of consciousness as well as the uncontrollable moments of falling-asleep and awakening.

[Use of plasmapheresis in the treatment of drug-resistant cardiac arrhythmias]. / Ispol'zovanie plazmafereza pri lechenii narushenii ritma serdtsa, rezistentnykh k lekarstvennoi terapii.

AIM: To study the therapeutical efficiency of plasmapheresis (PA) in patients with drug-resistant cardiac arrhythmias (CA) and its mechanisms. MATERIALS AND METHODS: Discrete PA sessions were carried out in 56 patients with drug-resistant CA: paroxysmal atrial arrhythmia (AA), ventricular and supraventricular premature contractions, supraventricular tachycardia of various etiology. Biochemical blood values, coagulographic parameters, lipid peroxidation (LPO), the spectrum of nonesterified fatty acids (NEFA), the level of medium-sized molecules were determined, ECG monitoring, EchoCG, and left ventricular radioisotope computed tomography were performed before and after a PA session. RESULTS: PA was effective in 50% of cases. The duration of its effect averaged 3.0 (1.25-5.0) months. PA was more beneficial for patients with IHD, AA with normal left atrial dimensions, and hyperlipidemia. The duration of the effect was significantly higher when antiarrhythmic drug therapy was continued after PA. Due to PA, there were significant decreases in the blood concentrations of cholesterol, medium-sized molecules, malonic dialdehyde (MDA) and in the proportion of polyunsaturated NEFA. The antiarrhythmic effect was associated with the decreases in MDA and NEFA, with a tendency for a reduction in the rate of chemiluminescence. CONCLUSION: PA may be used in the treatment of drug-resistant CA. The most significant mechanism of its antiarrhythmic activity is to recover sensitivity to antiarrhythmics. The intrinsic antiarrhythmic activity may be associated with its effect on NEFA metabolism and LPO; however, its mechanisms await further studies.

[Role of osteoscintigraphy in postoperative monitoring of bone graft survival]. / Znachenie osteostsintigrafii v posleoperatsionnom kontrole za zhiznesposobnostíu kostnogo allobrefotransplantata.

Osteoscintigraphy was conducted in three patients in the immediate and late-term period after transplantation of allobrephobone with revascularization in the recipient zone. The method is compared with the results of immunological monitoring and histological control. Radionuclide study in combination with other methods allowed judgement of the adequacy of blood circulation in the bone allobrephotransplant and its viability. It is suggested that osteoscintigraphy of the transplant in comparison with the corresponding intact segments of the skeleton may serves as a criterion for this transplant in various postoperative periods.

[Current methods of assessing hemodynamics in the intensive care unit (comparative aspects)]. / Sovremennye metody otsenki gemodinamiki v usloviiakh otdeleniia intensivnoi terapii (sravnitel'nyi aspekt).

The paper deals with comparative characterization of validity shown by current techniques for assessing hemodynamic parameters such as radiocardiography, echocardiography, Doppler cardiography, electroimpedance indicator separation, alveolar gas carbon dioxide concentration change technique, tetrapolar chest rheography and their potential role in the practice of intensive care and resuscitation units.

[Cardiac insufficiency and mortality after correction of the mitral valve defect, depending on the degree of cardiac output before the operation]. / Serdechnaia nedostatochnost' i letal'nost' ot nee posle korrektsii mitral'nogo poroka v zavisimosti ot velichiny serdechnogo vybrosa do operatsii.

The course of the postoperative period was studied in 107 patients subjected to adequate correction of mitral valvular disease; 88 of them underwent open heart surgery. The cardiac output was measured by radiocardiography. Total postoperative mortality was 13%, cardiac insufficiency mortality 8.4%. Cardiac insufficiency was encountered in 42% of patients who had been operated on. Significant increase in the rate of cardiac insufficiency with the diminution of the cardiac index with "critical" value of 21/min/m2 was established: cardiac insufficiency was found in 76.3% of patients subjected to operation with cardiac index below 21/min/m2 and in 23.2% among those with cardiac index equal to or more than 21/min/m2. A similar regularity was revealed in analysis of cardiac insufficiency mortality:with cardiac index below 21/min/m2 it was 18.4%, with cardiac index of 21/min/m2 or more, it was 2.9%. No interrelationship was revealed between cardiac insufficiency incidence and mortality and the type of mitral valve lesion, extent of surgical intervention, and duration of extracorporeal circulation.

[Radioisotope studies in the practice of an intensive therapy department]. / Radioizotopnye issledovaniia v praktike otdeleniia intensivnoi terapii.

The article discusses the 10-year experience in the use of radioisotop diagnosis in the practice of an intensive therapy department. The results of the examination of over 300 patients who had been operated on under conditions of extracorporeal circulation are analyzed. With the use of radioactive indicators some new aspects of the pathophysiology of acute circulatory disorders were revealed, among others those related to the problem of blood deposition, the correlation between the functioning of the right and left parts of the heart; the diagnostic possibilities in appraising the causes of the disorders of circulation, functioning of the parenchymatous organs, and tissue blood flow were widened; the therapeutic tactics in the development of hypovolemia, acute cardiac failure, and disturbances in tissue perfusion could be elaborated.

[Effect of hyperbaric oxygenation on the circulatory function in rheumatic mitral valve disease]. / Vliianie giperbaricheskoi oksigenatsii na funktsiiu krovoobrashcheniia u bol'nykh revmaticheskim mitral'nym porokom.

The effect of a hyperbaric oxygenation course (10-14 exposures, one exposure daily at 0.7-1.0 ATA) upon the circulation function was studied in 61 patients with rheumatic mitral valve disease combined with systemic circulation insufficiency. The obtained results (reduction of the heart volume, acceleration of the blood stream within the heart and the body, increase of the stroke index, of the blood flow in the muscles of the extremities, reduction of the arterial and central venous pressure) demonstrate that the contractility of the myocardium and redistribution of the cardiac output between separate vascular regions is improved under the effect of hyperbaric oxygenation. The authors suggest that the increase of contractility in the right or left heart predominantly depends on the prevalence of mitral stenosis or circulatory insufficiency.

[Changes in the coronary blood flow rate during selective coronary angiography and nitroglycerin administration]. / Izmeneniia skorosti koronarnogo krovotoka pod vliianiem selektivnoi koronarografii i priema nitroglitserina

The effect of selective coronary angiography on the amount of the coronary blood flow is discussed. The effect of sublingual nitroglycerin administration on the level of the coronary flow was also studied. The coronary flow was measured with the aid of intracoronary injection of Xe133 prior to selective coronary angiography, and on the 3rd, 6th and 10th minutes following the termination of the radiocontrast examination. The coronary blood flow was shown either to remain unchanged, or to decrease slightly on the 3rd minute after the termination of angiography, as compared with the value of this parameter prior to the examination. On the 6th minute some increase of the coronary flow is observed, on the average 12%, which subsequently returns to the initial level. Sublingual intake of nitroglycerin results in an increase of the coronary flow, both prior to and following coronary angiography.

[Postoperative period and principles of intensive therapy after surgery of ischemic heart disease]. / Posleoperatsionnyi period i printsipy intensivnoi terapii u bol'nykh, operirovannykh po povodu ishemicheskoi bolezni serdtsa

The early postoperative course (within 10 days after surgery) is analysed in 218 patients operated upon for the ischaemic heart disease. Resection and plastic repair of the postinfarction aneurysm was undertaken in 132 of them, aortocoronary bypass procedures--in 86. The peculiarities of an uneventful postoperative course are presented, the diagnosis and therapy of the complications are discussed, and the mortality is analysed.