[Management of patients with isolated aortic stenosis considering negative prognostic factors].

BACKGROUND: Aortic stenosis (AS) is the most common valve defect in developed countries; its prevalence increases with age of the population. The most frequent cause for isolated AS in adults is calcification of normal tricuspid or congenital bicuspid aortic valve (AV). The only effective treatment of AS is aortic valve replacement (AVR). Major negative prognostic factors include low LV ejection fraction (EF), age older than 70, female gender, and comorbidities such as renal dysfunction, chronic obstructive pulmonary disease, and neural disorders. AIM: To study negative prognostic factors influencing outcomes of treatment for AS and to determine possibilities for managing AS patients taking into account these factors. MATERIALS AND METHODS: 120 medical records of patients who had undergone AVR for isolated AS (76 women and 44 men aged 45 to 81) were studied retrospectively, and 50 patients were examined in a late post-AV period (26 women aged 67.5 (65.0-72.0) at the time of surgery, 24 men aged 63.0 (57.0-68.0) at the time of surgery), and 84 unoperated patients (51 women and 33 men). RESULTS: Perioperative death rate was 8.76 %, 11 of 120 patients, 3 men (6.8 % of operated men) and 8 women (10.5 % of all operated women). The deceased patients aged 70 or older whereas perioperative death rate of patients younger than 70 was zero (Pχ 2 =0.004). Despite a relatively high perioperative risk, late survival of patients older than 70 who had undergone AVR was substantially and statistically significantly higher than that of unoperated AS patients. In elderly patients who died during the perioperative period of AVR, the history of valve defect was longer, and a part of the patients who did not survive AVR could have been operated at age younger than 70. Unoperated AS patients with a small LV cavity, severe LV hypertrophy, and LV EF >70 % were suggested to be isolated into a special group of risk with a special strategy for cardiosurgical treatment.

[Problems of chronic fatigue]. / Problema khronicheskogo utomleniia.

The review covers some human pathologic conditions defined as chronic fatigue syndrome, caroshi, burnout. Concerning nonspecific manifestations, one could characterize these conditions as general overfatigue of human. The authors attempt to consider these conditions from the viewpoint of occupationally induced disorders.