[Prevention and treatment of anemia during endoprosthetic replacement of large joints].

Endoprosthetic replacement of large joints is frequently followed by great blood loss and evolving postoperative anemia. Three hundred and thirty-seven cases of endoprosthetic hip joint replacement were retrospectively analyzed. The total frequency of allogenic hemotransfusion was 16.9%. The data of the analysis made and the review of literature support that preoperative anemia and revising intervention are the leading risk factors of allogenic hemotransfusion. Allogenic packed red blood cell transfusion is associated with the higher frequency of postoperative complications and longer hospitalization. The routine use of intraoperative autohemotransfusion has shown its low efficiency while drainage blood reinfusion can reduce the need for donor blood preparations. At present there is a great variety of effective agents whose introduction into clinical practice makes it possible to considerably reduce the need for allogenic hemotransfusion during endoprosthetic replacement of large joints and to improve the results of treatment.

[Prevalence and clinical features of atrial fibrillation in the north-west of the Russian Federation].

Incidence and prevalence of atrial fibrillation (AF) are analysed for the period from 1980 to 2004. They are shown to increase 5 and 6-fold respectively in the north-western region of Russia. Prevalence of AF in men increased 10-fold and in women 4-fold. Different incidence of AF among men and women was documented for the first time. Percentage of arterial hypertension, idiopathic AF, and diabetes mellitus increased among patients with newly diagnosed AF.

[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Genetic polymorphism and risk of arterial thrombosis in patients with atrial fibrillation].

This study revealed the importance of 6 genetic determinants (accounting for predisposition to thrombophilia) as risk factors of thromboembolic stroke in patients with atrial fibrillation (AF). The occurrence of A-allele of FGB gene of patients with complicated form of AF was shown to be significantly higher compared with controls. Carriage of FGB-455A, grade II mitral regurgitation, and AF longer than 48 hours are assumed to be independent predictors of thromboembolic stroke.

[Maritime medical service as a means to preserve health in water transport workers].

The authors justify new views of maritime medical service as a science of work ecology for individuals engaged into high risk occupations. The article describes unfavorable factors experienced by seamen during long voyages, presents analysis of maritime medicine state in Russia and outlines prospects for development of such medical branch.

[Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia)].

AIM: To assess efficacy of early and long-term exercise in patients with ischemic heart disease (IHD) after acute coronary events (acute myocardial infarction--AMI, unstable angina--UA, coronary artery bypass grafting--CABG) in wide outpatient medical practice of Russia. MATERIAL AND METHODS: Three to eight weeks after the acute coronary event (ACE) 373 patients from different clinics of RF regions were randomized into two groups: the study group (n = 188) and a control one (n = 185). Both groups received standard therapy, the study group performed also a special exercise program (moderate exercise for maximum 1 hour 3 times a week for a year). The efficacy of the treatment was assessed by clinical, device and biochemical findings during 6-month follow-up. RESULTS: Physical work capacity, total amount of performed work (PW) in stress test rose in the study group by 26.5% (p < 0.01) and 59.4% (p < 0.01), respectively; HRmax and BPSmax x HRmax increased by 6.4 and 9.8%, respectively, p < 0.01); PW/Hrpeak rose by 48.6% (p < 0.01), PW/DP peak--by 45.9% (p < 0.01). Left ventricular ejection fraction increased by 5.6% (p < 0.05), LV stroke volume--by 3.4% (p < 0.05). In 6 months, controls demonstrated a 4.7% (p < 0.05) rise in HDLP cholesterol, total cholesterol lowered in the study group by 6.4% (p < 0.01), body mass index--by 1.9%, number of anginal attacks--by 0.9%. CONCLUSION: The proposed exercise program is effective and can be applied in outpatients after acute coronary events. The program can be also used as a method of secondary prophylaxis as it lowers total cholesterol, atherogenic index and body mass index.

[Psychosomatic correlations and autonomic regulation of systemic hemodynamics in peptic ulcer in people of the European North of the Russian Federation]. / Psikhosomaticheskie sootnosheniia i vegetativnaia reguliatsiia sistemnoi gemodinamiki pri iazvennoi bolezni u zhitelei Evropeiskogo Severa.

The examination of 71 patients with ulcer has established correlations between psychological status of the patients (personality and reactive anxiety, neurotism, type of personality response to the disease) and numerous clinical characteristics of the diseases. Features of vegetative regulation of systemic hemodynamics in ulcer northerners and correlations between vegetative tonicity and psychological status of the patients are characterized.

[Psychosomatic correlations and autonomic regulation of functions in peptic ulcer in inhabitants of the European North of the Russian Federation]. / Psikhosomaticheskie sootnosheniia i vegetativnaia reguliatsiia funktsii pri iazvennoi bolezni u zhitelei Evropeiskogo Severa.

The study of 71 patients with ulcer disease has found correlations between psychological status (personality and reactive anxiety, neurotism, type of personality response to the disease) and many clinical symptoms of the disease. Autonomic regulation features in ulcer citizens of the European North, correlations between vegetative tone and psychological status of the patients are characterized.

[Specific features of ulcer disease in sailors of the North Sea basin]. / Osobennosti techeniia iazvennoi bolezni u moriakov i rybakov Severnogo basseina.

The course of ulcer disease (UD) in sailors of the North seas was analysed and compared to that in non-sailors. UD in sailors runs with less pronounced subjective symptoms, manifests at younger age, is frequently accompanied by duodenal mucosa erosions and duodenogastric reflux. The greatest number of UD exacerbations was observed in the first month in sea and two months after getting home. Because of the fear to lose the job the sailors often do not seek medical assistance in spite of ulcer symptoms and this results in many cases of late diagnosis.

[Myocardial infarction and sudden cardiac death in seamen of the north ship line]. / Infarkt miokarda i vnezapnaia koronarnaia smert' u moriakov severnogo basse'na.

Ischemic heart disease (IHD) is the leading cause of mortality, disability and posting from a ship among seamen. As shown by analysis of case records of 124 seamen who died suddenly of myocardial infarction, IHD lethality on board the ship is much higher than on land. The greatest number of myocardial infarctions and IHD deaths occur on sailing month 3 and 4, within month 1 after returning home. Specific features of myocardial infarction in seamen are the following: absence of typical history, high incidence of painless forms and postmortem diagnosis, rare hospitalization, relationship with low exercise tolerance and inability to reach submaximal heart rate at bicycle exercise. Coronaroangiography performed after myocardial infarction detected stenosing atherosclerosis of the coronary arteries in 95% of cases.