[In-hospital outcomes of endarterectomy and coronary artery bypass grafting in multiple diffuse lesions of coronary arteries]. / Gospital'nye rezul'taty éndarteréktomii i koronarnogo shuntirovaniia pri mnozhestvennom diffuznom porazhenii koronarnykh arterii.

BACKGROUND: According to a series of studies, performing coronary endarterectomy in direct myocardial revascularization increases the risk of myocardial infarction and in-hospital mortality. There are no commonly accepted indications for carrying out endarterectomy, and in clinical practice this technique is used in severe diffuse lesions of coronary arteries. AIM: The study was aimed at assessing in-hospital clinical outcomes of coronary artery bypass grafting (CABG) with the use of endarterectomy in patients with severe multiple diffuse lesions of coronary arteries. PATIENTS AND METHODS: This was a single-centre retrospective study enrolling a total of 205 patients presenting with multiple diffuse lesions and subjected to CABG procedures. Of these, after excluding those with severe concomitant pathology (n=28), 177 were enrolled and divided into 2 groups: 76 patients during formation of a coronary anastomosis were subjected to forced endarterectomy from the native channel (Group 1, n=76) and the remaining patients to prolonged anastomosis and/or bypass grafting of distal branches of the diffusely damaged artery (Group 2, n=101). In-hospital outcomes were analysed in both groups. RESULTS: The demographic and clinical characteristics were comparable by all parameters except for age: Group 1 patients were older (66.3±8.4 vs 63.0±8.5, p<0.05). The groups were comparable by severity of coronary lesions by both the SYNTAX Score and diffuse lesion index. The incidence of perioperative myocardial infarction during coronary endarterectomy (Group 1) amounted to 9.2% (7/71) and in the group without endarterectomy (Group 2) to 0. There were no cases of in-hospital mortality in either group. CONCLUSION: In severe diffuse coronary lesions, endarterectomy combined with CABG makes it possible to perform adequate myocardial revascularization. Performing endarterectomy from coronary arteries is associated with an increased risk for the development of myocardial infarction, but its use is justified if it is impossible to create an anastomosis by means of other techniques.

[Left main coronary artery stenosis and progression of coronary artery atherosclerosis after angioplasty and stenting in patients directed to coronary artery bypass surgery].

Recent investigations demonstrated appearance of left main coronary artery stenosis after PTCA. We performed a retrospective study of specific characteristics of development of coronary lesions after percutaneous coronary interventions (PCI) in patients subjected to coronary artery bypass grafting (CABG) because of angina recurrence after PCI. Data of 150 patients operated because of angina recurrence after PCI were analyzed. The recurrence of angina in 93% of cases was associated with development of significant stenoses in previously intact segments of coronary arteries, but not with restenosis or occlusion of the stented segment. The recurrence of symptoms occurred in 1 year after coronary stenting in 54% of patients. In 19 patients rapid development of a novel left main coronary artery stenosis was observed. Some characteristics of this group (the use of Back-up, XB, AL-catheters, repetitive PCI, manipulations in more than 2 coronary segments, stenting of bifurcations with 2 stents, use of kissing-balloons, small diameter of left coronary artery, and concomitant diabetes) significantly differed from those of the main group. In all patients CABG was successful.

Experience in early rehabilitation of patients after coronary artery bypass graft surgery.

UNLABELLED: A strategy of rapid in-hospital postoperative rehabilitation is currently a priority trend in managing the patients after coronary artery bypass graft (CABG) surgery. OBJECTIVE: To investigate the baseline characteristics and peculiarities of perioperative treatment of patients with a short period ofin-hospital rehabilitation. MATERIALS AND METHODS: We studied a total of 690 patients who had endured CABG operations according to the conventional technique performed over the period from January 2007 to August 2008. The procedures of preoperative preparation, surgical intervention and postoperative management both at the stage of the intensive care unit (ICU) and at the Cardiosurgical Department in all the patients were carried out in accordance with the accepted protocol. RESULTS: The Study Group (Group 1) comprised a total of eighty-three 39-to-79-year-old (average age 55.7 +/- 7.9 years) patients whose postoperative hospital stay amounted to 8.1 +/- 1.3 days. Of these, there were 76 men and 7 women. The Comparison Group (Group 2) was composed of one hundred 39-to-76-year-old (mean age 56.2 +/- 8.3 years) patients, with 89 men and 11 women enrolled. The duration of the postoperative hospital stay in the Comparison Group amounted to 12 +/- 1.4 days (p < 0.05). All the operated patients according to the findings of coronary angiography (CAG) had had haemodynamically significant atherosclerotic lesions of three and more coronary arteries. The patients in both Groups were comparable by the main clinical characteristics. There were no patients with recently sustained myocardial infarction, unstable angina, or left-ventricular aneurysms in either of the groups studied. CONCLUSIONS: Employing the protocol we devised makes it possible to reduce the postoperative hospital stay to 7 days in electively operated patients presenting with a stable course of coronary artery disease (CAD), without pronounced co-existing pathology, with a satisfactory left-ventricular systolic function, with preoperatively compensated diabetes mellitus (DM) and adequately controlled arterial hypertension (AH).

[Utilization of cluster analysis in evaluation of weather and geliophysical effects on patients with bronchial asthma].

Cluster analysis was used to grade the weather and solar activity factors by contribution to bronchial asthma exacerbation in patients. The analysis showed up clusters associating acute episodes of the disease of varying intensity with weather factors.

[Comparative assessment of DNA extraction methods for identification of glanders and melioidosis etiological agents by PCR].

Pathogenic Burkholderia are considered as a cause of dangerous infections and potential agents of bioterrorism. Comparative assessment of different methods of extraction and purification of DNA for PCR analysis of pure cultures and samples contaminated by etiological agents of glanders and melioidosis was performed. Samples of soil and food artificially contaminated by pathogenic Burkholderia as well as organs of infected animals were tested. DNA was extracted by methods of boiling, nucleosorption with presence of guanidine thiocyanate, guanidine thiocyanatephenol extraction, guanidine thiocyanate-phenol extraction with additional purification of DNA by nucleosorption. Amplification was performed by "Flash" technique and detector of fluorescence was used for analysis of PCR products. Utilization of the recommended methods of preparation depending on the nature of sample let to detect by the "Flash" technique the etiological agents of glanders and melioidosis in concentration =10(3) microbial cells per ml. Choice of DNA extraction and purification methods is determined by type of a sample and presence in it of admixtures inhibiting PCR.

[Immunomorphological study of angiotensin-converting enzyme in coronary shunts].

Coronary bypass surgery is the operation of choice in patients with coronary atherosclerosis. However, some time later, venous shunts frequently stop functioning after successful surgery. The reasons for this include intimal hyperplasia occurring in response to release of cytokines, angiotensin II in particular. In man, the latter is formed by angiotensin-converting enzyme or chimase. The findings show that elevated ATF concentrations are found in some cells in the area of intimal hyperplasia, in macrophages and smooth muscle cells of the shunt hyperplastic intima. The increased ATF concentration in the aorto-coronary shunt cells results in the elevated levels of angiotensin II, the migration of smooth muscle cells, their hypertrophy and hyperplasia, the formation of atherosclerotic plaques, thrombosis, and circulatory disorders.

[Adequate selection of antigens for serologic diagnostics of experimental melioidosis].

Sera of Burkholderia pseudomallei-infected golden hamsters, white mice, guinea pigs and white rats were studied. Immunochemical analysis revealed presence of antibodies against antigens 2, 3, 6, d, and g with significant predominance of antibodies to antigens 6 and d. Antigen d was detected irrespectively to strain used for experimental infection and experimental animal species. Antibodies to antigen 6 were detected only when strains belonging to Asian serovar, but not to Australian serovar, were used. On the basis of antigens 6 and d following methods of serologic diagnostics were developed: reaction of indirect hemagglutination, reaction of latex agglutination, and radioimmunological assay. Their sensitivity and specificity reached 100% during experimental melioidosis in golden hamsters, guinea pigs and white rats.

[Immunomorphological study of coronary grafts].

Most patients subjected to coronary artery bypass grafting develop graft occlusions in some time after successful coronary surgery. Causes of graft occlusions comprise hyperplasia of intima occurring as a response to release of cytokines and angiotensin II. Angiotensin II is formed in human body with participation of angiotensin converting enzyme (ACE) or chymase. We found high concentrations of ACE in some smooth muscle cells in hyperplasia zone. Proliferation of smooth muscle cells, their hypertrophy and increased synthesis of intercellular space proteins facilitate graft occlusion. Moreover ACE was found in cytoplasm of macrophages infiltrating graft's intima. Thus ACE can be an important contributor to the process of coronary artery bypass graft obstruction.

[Role of electron-beam tomography in diagnosing patency of aortocoronary and mammary-coronary shunts (from data from a 3-year study)]. / Rol' élektronno-luchevoi tomografii v diagnostike prokodimosti aortokoronarnykh i mammarokoronarnykh shuntov (po dannym 3-letnego nabliudeniia).

AIM: To assess informative value of electron-beam tomography (EBT) and to compare dynamics of occlusive defects of autovenous and autoarterial shunts. MATERIAL AND METHODS: 36 patients with coronary heart disease entered the study. All the patients have undergone coronary artery bypass operation and/or mammarocoronary bypass operation (CABO and MCBO, respectively). For three years after the surgery the patients were annually examined with EBT-shuntography. The contrast agent was injected intravenously in a dose 135-140 ml with the injection rate 3.5-4.0 ml/s. In addition to EBT-shuntography, selective x-ray contrast shuntography was conducted one year after CABO. RESULTS: By a comparative analysis, EBT sensitivity and specificity in examination of autovenous shunts patency is 100%, in assessment of patency of mammary shunts is 93 and 100%, respectively. The 3-year retrospective analysis has revealed occlusions in 17.1% venous shunts and 2.7% arterial ones in the first year after CABO and MCBO, 5.2 and 2.8% in the second year, respectively, and in 1.8% venous shunts in the third year. CONCLUSION: EBT-shuntography is a highly informative non-invasive method of diagnosis of aortocoronary shunts patency.

[The effect of the acid exopolysaccharide produced by the causative agent of melioidosis on macrophage function]. / Vliianie kislogo ékzopolisakharida, produtsiruemogo vozbuditelem melioidoza, na funktsional'nuiu aktivnost' makrofagov.

Acid exopolysaccharide of the melioidosis agent, isolated from the slime of alysogenic strain of Pseudomonas pseudomallei SVBDO-141 inhibits the capture of sheep erythrocytes--55Fe by mouse peritoneal macrophages. Administration of the sheep erythrocytes--55Fe, sensibilized by acid exopolysaccharide was proved not to have an antiphagocytic effect. Inhibition of phagocytic macrophagal activity depends on the conditions of isolation of acid exopolysaccharide.

[The isolation and characteristics of antibiotic-containing liposomes]. / Poluchenie i kharakteristika liposom, soderzhashchikh antibiotiki.

The results of studies on the incorporation of a number of antibiotics into liposomes and the use of gamma irradiation for sterilization of phospholipid vesicles are presented. The toxicity of hydrochloride tetracyclin in free and liposomal forms is estimated for golden hamster with different methods of administration.