[Modulation of cardiac contractility in patients with chronic heart failure and atrial fibrillation].

AIM: to evaluate the effectiveness of cardiac contractility modulation (MSS) in patients with chronic heart failure (CHF) and atrial fibrillation (AF). MATERIALS AND METHODS: The following studies were performed in 40 patients with CHF and AF before implantation of the MSS device and after 2 and 6 months of follow-up: 12-channel ECG, transthoracic EchoCG, 6-minute walk test, determination of the level of Pro-natriuretic N-terminal peptide (NT-proBNP), daily ECG monitoring, and a questionnaire based on the Minnesota quality of life questionnaire for patients with CHF (MHFLQ). All patients received long-term optimal drug therapy for CHF before surgery. RESULTS: The results obtained indicate a statistically significant positive effect of the use of MSS in patients with CHF and AF on LV FV, the functional class of CHF, and levels of NT-proBNP regardless of the etiology of CHF. CONCLUSION: The use of MSS may be promising for the treatment of heart failure in patients with CHF and AF.

[Interrelationship between polymorphic markers of methylenetetrahydrofolate reductase gene and development of acute disturbance of brain circulation in families of patients with atrial fibrillation].

In the present work we for the first time on the clinic-genetic material revealed genetic predictors of development of acute disturbance of brain circulation (ADBC) in families of patients with atrial fibrillation (AF) namely polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene. Genotype CC was significantly more often found among patients with AF and ADBC compared with controls (58.1 and 35.2%, respectively, p=0.02) as well as in relatives of probands compared with the control group (59.3 and 35.2%, respectively, p=0.008). With this in relatives with revealed paroxysmal AF and ADBC we also noted presence of CC genotype. Taking into consideration the relationship obtained between polymorphysms of MTHFR gene and AF it was possible to assume that polymorphic marker CC appeared to be a predictor of ADBC in these families.

[Surgical strategies in perforated of gastroduodenal ulcers combined with penetration and stenosis].

One hundred and twenty-six patients aged 14 to 88 years underwent surgery concerning perforative ulcer os stomach and duodenum. Forty-seven patients had symptoms of stenosis including 23 patients with penetration. It is demonstrated that vagotomy, incision of ulcer with duodenoplasty or pyloro-duodenoplasty permit to treat successfully perforative ulcers and to achieve good functional results in long-term period.

[Use of the solutions of hydroxyethyl starch and reamberin in the combined treatment of severe gestosis]. / Primenenie rastvorov gidroksiétilkrakhmala i reamberina v komleksnom lechenii tiazhelogo gestoza.

The effects of the solutions of hydroethyl starch (HES) and reamberin on hemodynamics, metabolism, and water-sector disorders were studied in patients with severe gestosis. The study covered 42 puerperas who were divided into 3 groups: 1) 10 patients with severe gestosis and normal acid-alkali balance (AAB); 2) 10 with severe gestosis and metabolic acidosis; 3) 22 pueperas with physiological single pregnancy (a control group). Group 1 patients were given infusions of 6% HES solution, 5-6 ml/kg; Group 2 received in addition to 6% HES solution in the above dose infusions of 1.5% reamberin solution, 5 ml/kg. In patients with severe gestosis, hemodynamic, water-sector, and metabolic monitoring on puerperal days 1-5 were found to identify changes in oxygen supply and consumption, water balance, and AAB. In Group 1 patients, HES infusion on days 1-2 after delivery decreased the content of systemic water, extracellular and interstitial fluid, increased oxygen supply; in Group 2, combined infusion therapy with GES and reamberin on puerperal days 1-2 led to an increase in oxygen supply and consumption and a reduction in interstitial hyperhydration and to normalization of AAB.

[Postpartum emergencies: some aspects]. / Nekotorye aspekty kriticheskikh sostoianii v poslerodovom periode.

The critical states occurring during pregnancy, labor, and early puerperium were analyzed. Seventy puerperas treated at intensive care units (ICU) were examined. The patients were divided into 5 groups: 1) those with preeclampsia (n = 15); 2) eclampsia (n = 22); 3) massive blood loss (n = 17); 4) pyoseptic complications (n = 10); 5) acute respiratory failure (n = 6). The APACHE II scale severity was 22 +/- 5.3 scores. The mean age of puerperas is 29.2 +/- 7.2 years. Total mortality was 14.3%. Parametric and non-parametric statistic methods were used to analyze the reasons for referral of the patients to ICU, their age composition, the association of an outcome to the time of their referral to ICU, the duration of stay there and at hospital, mortality, the time of controlled ventilation, the incidence of multiorgan failure. The common reasons for referral of the puerperas from maternity homes to ICU were eclampsia, preeclampsia, and massive blood loss. Acute respiratory distress syndrome (52.9%), encephalopathy (44.3%), coma (47.1%), and intestinal insufficiency (38.6%) were predominant in the pattern of multiorgan failure in intensive care obstetric patients. When emergencies occurred in puerperas, earlier referral from maternal homes to ICU caused a reduction in mortality from 33.% at referral on day 3 after their occurrence to 23.5% at referral on day 2, and to 11.5 at referral on day 1.

[Assessment of unbalance in water compartments of patients with gestosis]. / Otsenka disbalansa vodnykh sektorov u bol'nykh s gestozami.

The water-sector misbalance was studied in 53 puerperants. The method of bio-impedance spectrometry was made use of to determine the total body water, extra-cellular- cellular- and interstitial water as well as the circulating blood volume. The levels of extra-cellular and interstitial water were found to be reliably higher in patients with moderate gestosis on day 1 after delivery versus healthy subjects. Stable trends towards normalizing the volumes of extra-cellular and interstitial water were registered by day 5. As for patients with sever gestosis, a reliably increasing total body water as well as extra-cellular and interstitial water persisted in them by day 5 after delivery versus the controls.

[Lipid peroxidation processes in the blood of patients during thoracic surgery]. / Sostoianie protsessov perekisnogo okisleniia lipidov v krovi bol'nykh pri torakal'nykh operatsiiakh.

Lipid peroxidation processes (malonic dialdehyde, parameters of induced Fe(2+)-chemiluminescence) have been studied in 22 patients operated on for diseases of the lungs and mediastinum and 15 patients subjected to heart surgery for ischemic disease. It has been shown that the severity of the disease depends on the activity of lipid peroxidation and the presence of a toxic product, malonic dialdehyde, in the blood plasma. The incidence and severity of postoperative complications were also higher in patients with intensive lipid peroxidation. The necessity of preventive therapy with antioxidants both in the pre- and postoperative periods has been substantiated.

[Assessment of fluid balance and several hemodynamic parameters in lung surgery using the method of impedance plethysmography]. / Izuchenie balansa zhidkosti i nekotorykh pokazatelei gemodinamiki pri operatsiiakh na legkikh s ispol'zovaniem metoda razvedeniia élektroimpedansnykh indikatorov.

The hemodynamic effects of different modes of controlled ventilation (CV) were studied by means of impedance plethysmography in 52 anesthetized patients during surgery on the lungs, trachea, and bronchi. To adapt this investigation technique to the conditions of the operating room, a specially designed device was applied for extracorporeal measurement of electric resistance of the blood flow. It was found that impaired transcapillary exchange of fluid in the lungs and its accumulation in the interstitial spaces were secondary to the operated lung collapse irrespective of the composition of the inhaled gas mixture used for the controlled ventilation of the contralateral lung. A differential approach to the ventilation of the dependent and independent lungs using the conventional and high-frequency CV modifications allows for an optimal compensation for the damaged transcapillary exchange of fluids in the lungs, is most physiological, sparing, and organ-saving.

[Functional state of the sinoatrial node in patients with intraventricular block]. / Funktsiona'lnoe sostoianie sinusovogo uzla u bo'lnykh s vnutrizheludochkovymi blokadami.

The function of sinus node (SN) was studied in 101 subjects with intraventricular blocks (IVB) and 30 controls. The patients with IVB showed a significant increase in the corrected time of SN function recovery and that of sinoatrial conduction both before and after medicamentous++ autonomic block, as compared to the controls. In general, signs of SN dysfunction were detected in 47 (46.5%) subjects with IVB. In 18.8% of the examinees, SN dysfunction was due to abnormal autonomic exposures, 27.7% had abnormalities in SN proper or perinodal tissue. ++Tachy-bradycardia was found in 53.5% patients with the sick sinus syndrome and IVB, 25% had concurrent atrioventricular conduction disturbances. A concomitant SN lesion was common in patients with IVB. One should take into account a type of this syndrome and the status of atrioventricular conduction when the optimal conditions of continuous electrical cardiostimulation are applied to patients with IVB and clinical signs of the sick sinus syndrome.

[Use of transesophageal stimulation of the left atrium in the diagnosis of ischemia and cicatricial myocardial changes in patients with complete block of the left fascicle of the bundle of His]. / Primenenie chrespishchevodnoi stimuliatsii levogo predserdiia dlia diagnostiki ishemii i rubtsovykh izmenenii miokarda u bo'lnykh s polnoi blokadoi levoi nozhki puchka Gisa.

Transesophageal stimulation of the left atrium was performed in 52 patients who had signs of complete left bundle branch block as evidenced by ECG, 48 patients having sustained block, 4, intermittent one. In 42 (80.8%) patients, the block was temporarily arrested during and/or after discontinuation of the electric stimulation, in 28 of them, the block was stopped during the stimulation without any drugs, in 1, only after obsidan, and in 13, following obsidan and atropine. When the block was being arrested, 13 patients showed ECG ischemic changes, 7 exhibited myocardial scarring alterations, 8 had nonspecific T wave alterations, 8 displayed signs of left ventricular hypertrophy with impaired repolarization. No ECG changes were found in 7 patients. The use of transesophageal electrical stimulation of the left atrium to temporarily abolish complete left bundle branch block may contribute to elucidation of the etiology of the block and choice of the most adequate therapy.

[Clinico-electrocardiographic variants of combined lesions of the sinoatrial and atrioventricular nodes]. / Kliniko-elektrokardiograficheskie varianty pri sochetannom porazhenii sinusovogo i atrioventrikuliarnogo uzlov.

A study of 71 patients with atrioventricular blocks and 57 patients with the sick-sinus syndrome (SSS) revealed electrophysiologic evidence of sinus dysfunction in 38 (53.5%) patients with atrioventricular blocks. Sinus dysfunction was due to pathologic vegetative effects in 15 (21.1%) patients with AV blocks, and a pathology of the sinus node itself in 23 (32.4%). Impaired atrioventricular conductivity, was registered in 29 (38.7%) patients with the SSS. A disorder of atrioventricular automatism was detected in 38 patients, and was combined with impaired AV conductivity in 19 of those. Five clinico-electrocardiographic variants of binodal heart disease have been identified, and possible therapies are discussed for each of those.

[Intraventricular blocks in myocardial infarct]. / Vnutrizheludochkovye blokady pri infarkte miokarda

The examination was carried out in 787 patients with macrofocal myocardial infarction. The most frequently encountered variant of intraventricular block in males was the right bundle branch block, in females--the left bundle branch block. The rarest variant of intraventricular conductivity disorders in myocardial infarction was the left-posterior hemiblock. The prognostically severest variant of bilateral block consists in a combination of the right bundle branch block with the left-posterior hemiblock. The leading causes of death among the patients with myocardial infarction and intraventricular blocks were acute (cardiogenic shock, pulmonary oedema) and chronic cardiac insufficiency. In patients with bilateral blocks the frequent causes of death were, along with cardiac insufficiency, also arrhythmias (ventricular fibrillation, asystole).