[Discrete plasmapheresis for coronary heart disease].

AIM: To provide a rationale for the expediency and efficiency of discrete plasmapheresis (PA) in the package of therapeutic measures for coronary heart disease (CHD). SUBJECTS AND METHODS: 585 sessions or 120 cycles of low-volume therapeutic PA were performed in 91 patients with CHD. The parameters of blood lipid composition, hemocoagulation, rheology, and endotoxicosis were studied. RESULTS: Removal of 100% circulating plasma volume per treatment cycle could achieve a significant positive result of abnormally higher homeostatic parameters. The levels of high-density lipoprotein cholesterol, antithrombin III, and albumin did not decrease significantly. CONCLUSION: Low-volume discrete PA is a pathogenetically sound and effective method to affect homeostasis in CHD.

[The role of magnesium in the implementation of vascular reactions during anesthesia in cardiac surgery patients].

UNLABELLED: The purpose of the study is to examine the relationship between the concentration of magnesium in plasma and vascular reactions during cardiac surgery. MATERIALS AND METHODS: The study included 77 patients with coronary artery disease who underwent myocardial revascularization surgery. In the first group (n = 44) during the entire operation infusion solution "potassium and magnesium asparginate" (Berlin-Chemie) was carried out at a rate of 1.5-2 ml/kg/h, in the second group (n = 33) patients were injected magnesium free crystalloid solutions. An analysis of central hemodynamics (PiCCO Plus) and microcirculation (laser Doppler flowmetry LASMA) was carried out. CONCLUSION: Maintenance of normal concentrations of magnesium in blood plasma reduces the incidence of episodes of intraoperative hypertension and improves peripheral microcirculation.

[Use of a potassium and magnesium asparaginate solution to maintain the balance of potassium and magnesium during cardiosurgical interventions under extracorporeal circulation].

The study included 42 patients with coronary heart disease operated on the coronary arteries. A potassium and magnesium asparaginate (PMA) solution, 450-1000 ml, was injected in 30 patients for 5-7 hours; other crystalloid solutions was used in a control group (n = 12). The concentrations of potassium and magnesium were measured prior to surgery, following initial anesthesia, before and after extracorporeal circulation (EC). The measurements suggested a significant potassium and magnesium intake at surgery under EC. The use of PMA solution showed its advantage in stabilizing the study electrolytes at the main surgical stages. Inclusion of PMA into infusion therapy considerably reduced a need for an additional use of concentrated KCl solution to maintain potassium at the preoperative level. Of particular importance was the use of PMA to maintain magnesium that was held in the upper normal range throughout the operation, as shown by both the median values and an individual analysis. When PLA was not administered, the mean concentration of magnesium was consistent with that in the lower normal electrolyte range and 50% patients developed hypomagnesemia. The comparative analysis of the clinical course after EC in both groups of patients with different levels of magnesium was indicative of the better status of some hemostatic parameters with the level of magnesium being maintained in the upper normal range.

[Dialysis-Control apparatus for optimization of hemodialysis procedure].

Dialysis-Control apparatus for noninvasive monitoring of hemodialysis parameters is described. The monitoring procedure is based on electrochemical measurement of the content of organic substances in salt-containing liquid. The Dialysis-Control apparatus provides timely assessment and correction of hemodialysis procedure and ensures adequacy of the delivered treatment, which leads to improvement of dialysis treatment quality.

[Comparative evaluation of clinical use of cardioplegic solutions custodiol and konsol in the correction of cardiac valvular diseases].

The efficiency of myocardial protection with cold crystalloid cardioplegia (CC) during operations on the heart under total ischemia and extracorporeal circulation was studied. Two hundred and fifty patients who underwent prosthetic or plastic repair of the aortic and mitral valves or plastic repair of the tricuspid valve were examined. Group 1 comprised 218 patients in whom the myocardium was protected with Konsol solution ("Biofarm "research-and-production enterprise, Russia); Group 2 included 32 patients in whom Custodiol solution ("Dr Franz Kohler Chemia GMBH", Germany). The volume of the Konsol solution required for CC was 400-2000 ml, with the duration of myocardial ischemia (MI) being 75 +/- 33 min; that of the Custodiol was 2000-4000 ml, with the duration of MI being 80 +/- 22 min. The used algorithm of administration of the solutions provided a persistent cardioplegic effect in both groups. After aortic declamping, there was a spontaneous recovery of cardiac performance in 84 and 40% in Groups 1 and 2, respectively. In the reperfusion period (RP), no significant differences were found in the basic hemodynamic parameters (heart rate, blood pressure, and central venous pressure) in both groups. After defect correction, cardiac output equally increased in both groups. The groups did not differ in the rate of inotropic support either. In RP, transient cardiac rhythm and conduction disturbances occurred in 19 and 28% in Groups 1 and 2, respectively.

[Use of information properties of biological liquids for correction of development of living organisms].

Liquids (in particular, water) can receive, store, and transmit different kinds of information. In our experiments, transmission of "youth and health" information from younger to older rats led to restoration of the reproductive function and improvement of health.

[Hemodialysis with biological object].

The essence of the method of biodialysis (hemodialysis with biological object) developed and suggested by the authors for clinical use consists in that the healthy organism exerts, through a system of mass transfer, a therapeutic action on the sick organism. Blood from the affected and healthy organisms is perfused through individual mass exchangers (dialyzers, hemodiafilters and hemofilters), which are hydraulically connected by a circulating transport medium. Metabolites that accumulate in blood of the affected organism diffuse into the transport medium and, from there, into blood of the healthy organism, which metabolizes them. The reverse process occurs simultaneously: substances, whose concentration in blood of the sick organism is less versus the healthy organism, diffuse from blood of the healthy organism to blood of patient. The method suggested by us can be used in clinical practice for normalizing a variety of parameters in patients with hepatic and renal insufficiency. Besides, a number of substances can be transferred from the healthy donor to patient in the process of biodialysis, which opens promising potentialities for the treatment of many diseases.

[Monitoring urea content during hemodialysis]. / Monitoring mocheviny pri gemodialize.

The urea content monitoring during hemodialysis enables the feed-back within the system "patient--artificial kidney--patient". The existing methods of determining the concentration of urea in the dialyzing solution require an expendable reagent, i.e. urease, they are discrete and need often a calibration. The electrochemical urea analyzer, worked out by the authors, is easy in use, it provides a continues information about the urea concentration and does not virtually need any calibration. Besides, the plotter, belonging to the set, provides the graphic information about the dynamic changes of urea content.

[Metabolic aspects of reperfusion syndrome in patients with chronic ischemia of the lower limbs after surgical revascularization]. / Metabolicheskie aspekty reperfuzionnogo sindroma u bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei posle khirurgicheskoi revaskuliarizatsii.

24 patients with chronic lower limb ischemia were examined during arterial reconstructive surgery and on the first postoperative day. The parameters of acid-base balance, lipid peroxidation and antioxidant system were measured in arterial and venous blood to determine laboratory criteria of the reperfusion syndrome. The arteriovenous oxygen difference decreased after revascularization while chemiluminescence emission, malonic dialdehyde concentration, antioxidant activity coefficient and medium-weight molecules elevated. On the first postoperative day all these parameters recovered but remained higher than their baseline values. These data illustrate excessive production of free oxygen radicals after limb revascularization, which contributes to reperfusion syndrome. Since determination of lipid peroxidation and antioxidant activity is a time-consuming work, levels of medium-weight molecules content in plasma may indicate reperfusion damage to the limb.

[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.

[Free radical damage in the transplanted liver]. / Nekotorye aspekty svobodnoradikal'nogo povrezhdeniia transplantirovannoi pecheni.

The activity of lipid peroxidation (LPO), antiradical characteristics, content of sodium, potassium, magnesium, total and ionized calcium, copper, zink and iron in blood were studied in 12 patients in the course of ortotopic transplantation of the liver. The duration of the operation was on the average 11.5 +/- 1.5 hours, liver-free period 16.4 +/- 52 minutes, blood loss 7.2 +/- 2.5 l. It was discovered that in the liver-free period and in liver reperfusion there was a prominent shift of free radical and antioxidant properties, content of macro- and trace elements of blood. Because the studied parameters returned to the baseline level to the end of the operation the metabolic shifts are thought reversible.

[Water purification for hemodialysis]. / Ochistka vody dlia gemodializa.

An electrodialysis system has been designed to purify water. It comprises two units: a preliminary preparation unit and an electrodialysis one. The system consists of columns containing zeolite, activated carbon, and ion-exchange resins. Zeolite makes water free from mechanical impurities and iron, activated carbon adsorbs organic matter and chlorine ions, ion-exchange resins soften water. The electrodialysis unit is noted for its original design. Mathematical simulation has allowed the authors to optimize the design and to make a block that makes the process continuous without repolarization, which can decant the minimum levels of salt concentrates, thus decreasing energy supply to 2 W per liter. The unit is made as a pressure filter design having the platinum-titanium electrodes and membranes MK-40 and MK-45 made in Russia. The system operates automatically. Its all components are made in Russia.

[Detoxication and disinfection by sodium hypochlorite]. / Detoksikatsiia i dezinfektsiia gipokhloritom natriia.

Sodium hypochlorite electrochemically derived from aqueous sodium chloride solutions is the most convenient and physiological source of active oxygen. It is not toxic, easily excreted, has low molecular weight, small sizes, which allows it to readily penetrate through the cellular membranes and hence can oxidize toxins that are present not only in blood, but also in tissues, which is of great clinical practical value. The high reactivity and nonspecificity of sodium hypochlorite open ample scope for its wide medical applications.

[Electrochemical regeneration of the dialyzing solution]. / Elektrokhimicheskaia regeneratsiia dializiruiushchego rastvora.

The system with electrochemical regeneration (ER) of the dialyzing solution functions as effectively as a conventional hemodialysis system: ER eliminates creatinine and potassium ions, is inferior in eliminating urea and non-organic phosphorus but superior to hemodialysis in elimination of middle-size molecular toxins. ER enables continuous purification of dialyzing solution, electrolyzer is a constant element of the regeneration system, produced by electrolyzer sodium hypochlorite warrants the system self-sterilization. ER works without systems of water purification, water communications and dialyzer concentrate that is why the procedure of detoxication can be performed outside specially equipped laboratories.

[Myocardial metabolism and functional capacity in various types of cardiac reperfusion]. / Metabolizm i funktsional'naia sposobnost' miokarda pri razlichnykh vidakh reperfuzii serdtsa.

Myocardial metabolism and function were studied in 128 patients operated on under extracorporeal circulation for acquired heart diseases. Three groups of patients with different types of cardiac reperfusion were analyzed. Controlled (one- and two-stage) reperfusion was carried out with hyperosmotic unified solution 7 minutes before the beginning of blood recirculation and with perfusate after restoration of blood circulation. Reperfusion was spontaneous with perfusate alone in the control group. It was shown that the use of controlled reperfusion permit the negative action of oxygen and thermal shocks on the cold anoxed myocardium to be largely overcome. This is manifested by rather rapid reorganization of myocardial cells to the aerobic pathway, by inhibited activation of free oxygen radicals, by normalization of fluid-and-electrolyte balance, etc. Two-stage reperfusion was most effective in preventing myocardial metabolic disorders, as evidenced by more rare defibrillation to restore cardiac rhythm and less catecholamine uptake than those with one-stage and especially spontaneous reperfusion. With the latter, myocardial metabolic and functional disturbances were more severe and could be corrected only by the end of an operation.

[Hemodialysis with electrochemical regeneration of dialysis solution]. / Gemodializ s élektrokhimicheskoi regeneratsiei dializnogo rastvora.

The method of electrochemical regeneration of dialysis solution is virtually as effective as the traditional hemoperfusion system in removing creatinine and potassium ions from the body, but inferior to it as regards urea and inorganic phosphorus and superior in removal of medium-weight toxins. A more smooth reduction of urea level in the blood provides relatively stable hemodynamics in patients liable to hypotension. Electrochemical regeneration permits a continuous purification of dialysis solution, the regeneration block may be used many times, and sodium hypochlorite produced during electrolysis operation maintains the sterility of the system. Electrochemical regeneration does not require water purification systems, water communication, and dialysis concentrate, this permitting the performance of detoxication in rooms without special equipment.