[Nonimmunogenic staphylokinase in the treatment of acute ischemic stroke (FRIDA trial results)]. / Neimmunogennaya stafilokinaza ­ novyi tromboliticheskii preparat v lechenii ishemicheskogo insul'ta (rezul'taty issledovaniya FRIDA).

AIM OF THE STUDY: To investigate the efficacy and safety of non-immunogenic staphylokinase (NS) compared with alteplase (A) in patients with acute ischemic stroke (AIS) within 4.5 h after symptom onset. MATERIAL AND METHODS: 336 patients with IS within 4.5 h after symptom onset were included in a randomized, open-label, multicenter, parallel-group, non-inferiority comparative trial of NS vs A (168 patients in each group). NS was administered as an intravenous bolus in a dose of 10 mg, regardless of body weight, over 10 s, A was administered as a bolus infusion in a dose of 0.9 mg/kg, maximum 90 mg over 1 hour. The primary efficacy endpoint was a favorable outcome, defined as a modified Rankin scale (mRS) score of 0-1 on day 90. Safety endpoints included all-cause mortality on day 90, symptomatic intracranial haemorrhage, and other serious adverse events (SAEs). RESULTS: At day 90, 84 (50%) patients reached the primary endpoint (mRS 0-1) in the NS group, 68 (41%) patients - in the A group (p=0.10, OR=1.47, 95% CI=0.93-2.32). The difference between groups NS and A was 9.5% (95% CI= -1.7-20.7) and the lower limit of the 95% CI did not cross the margin of non-inferiority (pnon-inferiority<0.0001). There were no significant differences in the frequency of deaths between the groups: on day 90, 17 (10%) patients in the NS group and 24 (14%) in the A group had died (p=0.32). There was a trend towards significant differences in the frequency of symptomatic intracranial haemorrhage: NS group - 5 (3%) patients, A group - 13 (8%) patients (p=0.087, OR=0.37, 95% CI=0.1-1.13). There were significant differences in the number of patients with SAEs: in the NS group - 22 (13%) patients, in the A group - 37 (22%) patients (p=0.044, OR=0.53, 95% CI=0.28-0.98). CONCLUSION: The presented results of the FRIDA trial are the first in the world to use a drug based on NS in patients with IS. It has been shown that a single bolus (within 10 s) administration of NS at a standard dose of 10 mg, regardless of body weight, allows to conduct fast, effective and safe thrombolytic therapy in patients with IS within 4.5 h after symptom onset. In further clinical tials of NS, it is planned to expand the therapeutic window beyond 4.5 h after symptom onset in patients with IS.

[Indications to the formation of arteriovenous fistulas in performing reconstructive operations in patients with atherosclerotic lesions of the main arteries of the femur and shin at the stage of critical ischemia].

Causes of early shunt thromboses were studied retrospectively in 35 patients with occlusion of the femoro-popliteal segment and critical ischemia, in whom the operation of distal femoro-tibial shunt with the autovein had been performed by the method in situ without an application of the arteio-venous fistula (AVF). Early thromboses of the shunts took place in 8 patients (22.9%). The main cause of the early thromboses of the femorotibial shunts was shown to be a critical occlusive-stenotic lesion of the main arteries of the shin and foot with dysfunction of the plantar arch as well as decompensation of the microcirculation system. Objective criteria of the formation of AVF were worked out. The application of the criteria in operative treatment of 25 patients allowed the number of early thromboses to be reduced to 4%.

[Choice of optimal surgical reconstruction at patients with critical limb ischemia due to infrainguinal atherosclerotic arterial occlusive disease].

One hundred and four patients with atherosclerotic lesion of femoro-popliteal segment and III-IV stage of ischemia underwent vascular surgical procedures. Results of these operations were analyzed depending on state of distal arterial bed. Autovenous femoro-popliteal bypass (FPB) with reversed autovein was performed at 49 (47.1%) patients, femoro-tibial bypass (FTB) with autovein in situ - at 55 (52.9%). Clinical and angiographic variants of favorable and unfavorable prognosis of FBP and FTB are described. It is demonstrated that severe lesion of outflow distal arteries is the main cause of bypasses thrombosis. Protective arteriovenous fistula in the region of FTB distal anastomosis improves significantly short-term results of operation.

[Assessment of central hemodynamics by pump function and sizes of heart chambers in cardiac surgery patients]. / Otsenka tsentral'noi gemodinamiki po nasosnoi funktsii i razmeram polostei serdtsa u kardiokhirurgicheskikh bol'nykh.

In 198 cardiosurgical patients the treadmill test was performed with the noninvasive evaluation of the pump function of the heart and anaerobic threshold. The results were compared with echocardiographic sizes of the left atrium (LA), systolic and diastolic sizes of the left ventricle (CLV and DLV). It was shown that in patients with mitral stenosis the pump function of the heart reliably corresponded to the size of the LA, in mitral regurgitation--O of the DLV, in aortal defects--that of the CLV and DLV. After isolated prosthezing of the heart valves the correlation found was not retained. It was proved that the maximum consumption of O2 did not reliably correlate with LA, CLV and DLV.

[Ultrasonic diagnosis of congenital membraneous subvalvular aortic stenosis]. / Ul'trazvukovaia diagnostika vrozhdennogo membranoznogo podklapannogo stenoza ust'ia aorty.

The paper reviews a 10-year experience with complex ultrasonic diagnosis of membraneous subvalvular aortic stenosis, a rare congenital defect. Fifteen subjects operated on for this abnormality were examined. Profound systolic closure of the aortic cusps, concentrated left ventricular myocardial hypertrophy, linear-shaped echo signals generated by the membrane in the subaortic area, turbulent systolic blood flow in the ascending aorta are the most significant signs for the diagnosis of the membraneous subvalvular aortic stenosis.

[Atrioplasty in surgical correction of mitral valve defect complicated by left-sided atriomegaly]. / Atrioplastika pri khirurgicheskoi korrektsii mitral'nogo poroka, oslozhnennogo levoi atriomegaliei.

Surgical treatment of 40 patients with mitral valvular diseases and left atriomegaly is analysed. The dimensions of the giant left atrium in this group of patients must be reduced because it causes compression of the posterobasal part of the left ventricle, constriction of the lumen of the left main bronchus or compression of the inferior and middle lobes of the right lung. Left atrioplasty has a favorable effect on the course of the immediate postoperative period and reduces significantly hospital mortality among this grave contingent of patients.

[Ultrasonic diagnosis of aneurysmal rupture of the sinus of Valsalva]. / Ul'trazvukovaia diagnostika razryva anevrizmy sinusa Val'salvy.

Echocardiographic findings in 8 patients operated on for Valsalva's sinus aneurysm rupture are summed up: aneurysm and the site of its rupture shown on two-dimensional echocardiogram, abnormal diastolic blood flow through the aneurysm, evidenced by Doppler cardiography, and dilatation of cardiac chambers, dependent on the direction of blood discharge through the aorto-cardiac fistula.

[Echocardiography in the diagnosis of paravalvular fistulae in mitral prosthesis]. / Ekhokardiografiia v diagnostike paraval'vuliarnykh fistul pri mitral'nom protezirovanii.

Echocardiographic findings were analysed in 25 patients after surgical application of biological mitral valve prosthesis BAKS-M and 10 patients with paravalvular fistulas developing after similar operations employing different types of prosthesis. A tendency to increased postoperative size of the heart, left-atrial systolic turbulent flow, normalized ventricular septal movement and high-frequency oscillations of the aortic valve cusps are characteristic echocardiographic signs of paravalvular fistula.

[Status of the contractile function of the myocardium in patients with a mild form of infectious-allergic myocarditis]. / Sostoianie sokratitel'noi funktsii miokarda u bol'nykh s netiazheloi formoi infektsionno-allergicheskogo miokardita.

The authors analysed the results of echocardiography of patients with a mild ("ambulatory") form of infectious allergic myocarditis (the 1st group). Enhanced myocardial contractility was revealed in the 1st group as compared to the group of healthy persons (controls), decreased left ventricular contractility was noted in patients of the 2nd group (with dilated cardiomyopathy). A conclusion was made that a mild form of infectious allergic myocarditis was characterized by enhanced left ventricular contractility as a sign of its compensatory hyperfunction in response to myocardial damage.

[Echocardiographic determination of the degree of valvular regurgitation in isolated acquired heart defects]. / Ekhokardiograficheskoe opredelenie ob'ema klapannoi regurgitatsii pri izolirovannykh priobretennykh porokakh serdtsa.

A simple echocardiographic method for the assessment of the valve regurgitation volume in patients with isolated acquired heart diseases is described. It can be widely used in the routine clinical practice due to its relative simplicity.

[Diagnosis of dissecting aneurysms of the thoracic aorta]. / Diagnostika rasslaivaiushchikh anevrizm grudnoi aorty.

A study of the clinical pattern and findings of auxiliary investigation in 27 patients with dissecting aneurysms of the thoracic aorta showed that early diagnosis was necessary to improve the results of the treatment. A new non-invasive diagnostic method, computerized tomography, was employed for the first time in domestic clinical practice. The diagnostic value of various instrumental investigation techniques was demonstrated with respect to research and clinical work.

[Diagnosis of subvalvular adhesions in mitral stenosis by 2--dimensional echocardiography]. / O diagnostike podklapannykh srashchenii pri mitral'nom stenoze metodom dvukhmernoi ékhokardiografii.

Echocardiographic signs of subvalvular fusions are discussed, as they frequently complicate the course of mitral stenosis. The diagnostic value of two-dimensional echo-cardiography is established for this abnormality. Subvalvular fusions of the chordal apparatus are shown to be associated with certain signs on the two-dimensional echocardiogram, such as additional echoes under mitral valve cusps in short-axis heart section (sensitivity 67.2%, specificity 90.7%), and mitral orifice drawn towards the interventricular septum (sensitivity 35.7%, specificity 93.5%), thickened subvalvular structures in the long-axis section of the heart's left compartments (sensitivity 40.7%, specificity 82.9%), and fissural or "coma-like" shape of the mitral orifice.