[Analysis of immediate and mid-term outcomes of surgical and endoscopic treatment of patients with coronary heart disease and multiple lesions of coronary arteries].

The study included retrospective analysis of the results of treatment in 529 patients with CHD and multiple coronary lesions divided into 2 groups. Group 1 included 280 patients who underwent surgical myocardial revascularization, group 2 comprised 249 patients after coronary stenting. The groups did not significantly differ in the occurrence of serious clinical complications (death, acute myocardial infarction) in both early and mid-late postoperative periods. Patients in group 2 more frequently suffered anginal attacks and required repeat myocardial revascularization. The main factor limiting clinical efficiency of endovascular procedures was coronary restenosis in roughly 34% of the patients.

[Surgical treatment of a subclavian artery aneurysm].

The article describes a rare clinical case of an atherosclerotic (poststenotic) aneurysm of the second segment of the subclavian artery, also involving the opening of the internal thoracic artery (ITA) in a male patient with CAD. The authors showed a possibility of preserving the ITA during resection of the aneurysm, in order to use it later on for surgical revascularization of the myocardium.

Aneurysms of the extracranial internal carotid artery.

Aneurysm of the carotid artery is a rare pathology. According to the modern concepts, aneurysm of the artery is classified as a local enlargement of its diameter, namely by over than 50% as compared to the adjacent unchanged segment. In addition to the establishment as to whether aneurysm is present, the aims of examination consist in specification of the site, size, presence and extent of the interluminal thrombus. Duplex scanning is highly effective in so-called <> aneurysms, whereas in distal lesions its potential is insufficient. Today the greatest information content may be attained due to the application of spiral computed tomography (CT) by means of three-dimensional reconstruction or MRT but CT is more preferable. It is necessary to carefully visualize the intracranial bed.

Y configuration of the internal thoracic arteries in myocardial revascularization.

This paper describes the short-term results of surgical myocardial revascularization in 35 patients. Y configuration from one or two internal thoracic arteries was applied for bypass grafting of the left coronary artery. In 4 patients with truncal stenosis of the left coronary artery (LCA) or proximal stenoses of the anterior interventricular artery (AIVA) and circumflex artery, the length of the left internal thoracic artery (LITA) appeared adequate for creation of Y bypass and revascularization of the entire LCA pool. In most cases (28), Y bypass was formed from both ITA, which made it possible to revascularise more distant arteries of the posterolateral wall of the left ventricle. Analysis of bypass-graphies performed in 10 patients after 7 months on the average has demonstrated that occlusion (2) and stenosis of one of the branches (2) of Y bypass were most probably caused by underestimation of the degree of stenosis of the target coronary arteries.

[The results of direct myocardial revascularization in patients with various forms of coronary heart disease].

The authors analyzed the results of aortocoronary bypass surgery in correlation with the condition of the shunts and the native blood vessels. According to this analysis, 92.9% of the shunts were passable within 7.2 +/- 0.8 months of the surgery. Twelve shunts (four arterial and eight venous ones) had been occluded by the time of the control examination. Another ten shunts (five arterial and five venous ones) had hemodynamically significant stenoses. Concurrent blood flow was revealed in eight patients. According to comparative analysis, in cases of arterial shunting a good condition of the shunts was found in 95.6% of cases, while in patients with venous shunts the shunts were in a good condition in 88.1% of cases. Depending on the type of connection, the passability was satisfactory in 91.2% of straight shunts, in 94.5% of sequential shunts, and in 71.4% of Y-shaped ones. Analysis of changes in the native coronary arteries revealed progression of atherosclerosis in the bypassed arteries proximally to the site of anastomosis in 27 (25.5%) patients. An increase in the degree of stenosis distally of the site of anastomosis was found in 8 (7.5%) of patients; in another 7 (6.6%) patients similar changes were revealed in non-bypassed arteries. The surgery led to the disappearance of anginous manifestations and a negative result of a physical load test in most patients.

[Methods of plastic surgery of the renal arteries in children with vasorenal hypertension]. / Metody plastiki pochechnykh arterii u detei s vazorenal'noi gipertenziei.

The work deals with the management of vasorenal hypertension in children and adolescents. The Bakulev Institute of Cardiovascular Surgery had 185 children with arterial hypertension from 1965 to 1990. Their ages ranged from 12 months to 17 years. The vasorenal genesis of hypertension was caused by fibromuscular dysplasia (FMD) of the renal arteries in 61 patients, unspecific aortoarteritis (UAA) in 39, hypoplasia of the abdominal aorta, kidneys, and renal arteries in 22 patients, supernumerary renal arteries were found in 7 patients. A total of 119 operations were carried out on 106 patients. Operations and one-stage revascularization of the kidneys and alimentary organs were performed on 22 patients, isolated reconstruction of the renal arteries on 51 patients. Among 99 patients with stenoses and aneurysms of the renal arteries 13 were treated by nephrectomy (11.3%). The postoperative mortality was 0.9%. A hypotensive effect was not produced in the immediate postoperative period in 5 patients with UAA (4.6%) and in one patient with, FMD (0.9%). Six operations were performed in late-term periods after the first operative interventions: 2 for aneurysm of autovenous grafts, 2 for restenosis of the renal arteries, and 2 for stenosis of the aorta distal to the primary site of reconstruction in UAA. Three patients died in the late-term periods. The stability of good operative results was highest in congenital hypoplasia of the aorta--100%. A favorable effect of the operation persists in 89.6% of patients with FMD of the renal arteries. The stability of the effect is lowest (75%) in UAA.

[Acetylation of sulfadimezine and ethazole in rats]. / Atsetilirovanie sul'fadimezina i étazola u krys.

The paper is concerned with studies into acetylation of sulfadimezine (S) in Wistar, August and random-bred rats and into that of ethazole in Wistar rats. Age-associated differences in S acetylation were examined in random-bred animals and the effect of phenobarbital on S acetylation was investigated in Wistar and August rats. Interlinear differences as regards S acetylation were found to be absent in the presence of sexual dimorphism as to the sign under study: the females were disclosed to be rapid while males to be slow S acetylators. Administration of phenobarbital did not lead to appreciable changes in the rat acetylator phenotypes. However there was tendency towards retardation of S acetylation in both the strains and both sexes. No sexual dimorphism as regards S acetylation was found in sexually immature random-bred rats whose acetylator phenotypes do not differ from those of adult females, or the development of sexual dimorphism in sexually mature animals. No sexual dimorphism as regards ethazole acetylation was shown in Wistar rats.