[Myocardial infarction in young population].

Description of clinical observation and literature review. Myocardial infarction in patients younger than 45 years is rare, but it is an important clinical, organizational and psychological problem. A case of myocardial infarction in 19-years old patient, who suffered since 6 years from kidney disease, is described. Transmural left-ventricular myocardial infarction has developed on the background of chronic glomerulonephritis, excessive exercise, and traditional risk factors for cardiovascular disease. Coronary venous bypass with the benefit-pleasing outcome is performed. When analysing the literature, the authors emphasize that in comparison with elderly patients, young people have different profiles of risk factors, clinical manfestations and prognosis of myocardial infarction. It is emphasized that kidney chronic disease, regardless the stage, worsen short-term and long-term outcomes of cardiovascular disease. Early stabilization is possible under the condition of risk stratification and-early revascularization, which leads to better clinical outcomes. Particular attention should be given to a comprehensive assessment, it prognostic criteria, risk factor modification, secondary prevention of major and associated diseases, clinical- and -dynamic observation, including patients with asymptomatic course of the disease.

[A case of adenovirus infection complicated by gram-negative polymicrobial sepsis: A clinical and morphological observation].

Among respiratory infections, adenovirus infection (ADVI), in the presence of which there may be severe pneumonia that frequently results in a fatal outcome, occupies particular attention. ADVI in patients without immunodeficiency is usually mild and shows a limited extent of injury. At the same time the disease in immunocompromised individuals may be severe, presenting with viremia, evolving sepsis, and high death rates. The paper gives a characteristic example of severe ADVI and its fatal outcome.

[Bilateral massive pulmonary embolism: clinical observation and literature review].

The description of successful surgical treatment of a patient with bilateral massive pulmonary embolism (with the defeat of the equity and segmental branches), thrombosis of the right atrium and patent foramen ovale is given. The authors emphasize that determining predictors of successful surgical treatment of bilateral pulmonary embolism in a patient with high risk of death are the following: a) operational emergency diagnosis of disease; b) time from the beginning of clinical manifestations till embolectomy (within 1 hour); c) the maximum total removal of blood clots from the pulmonary artery and its branches. Dynamic 12 months observation showed a significant decrease of pulmonary perfusion deficiency, improvement of functional parameters of right heart chambers, absence of thromboembolism relapses.

[Myocardial revasculization in patients with ischemic heart disease and the end-stage of chronic kidney disease].

Chronic kidney disease (CKD) is independent factor of progression of ischemic heart disease (IHD). In that case, it is important to know the peculiarities of diagnosis and treatment of IHD in patients with CKD. The importance of this problem is increasing due to increase of patients with CKD. Cardio-vascular morbidity in patients with CKD is higher than in patients with other diseases. Myocardial revasculization may lead to significant improvement of survivability in patients with CKD. Among the prevention and treatment facilities the Vishnevsky Central Military Clinical Hospital N 3 is a leader in preforming the myocardial revasculization. The authors gave an example of successful coronary artery bypass surgery in patient with IHD and end-stage of CKD. Development of modem medical technologies, systematization of experience and knowledge allow in XXI century to consider CKD as non-absolute contradiction to elective surgery in case of different forms of IHD, including the end-stage of CKD (dialysis treatment). It is advisable to perform the myocardial revasculization in patients with the end-stage of CKD in specialized multi-field hospital, where can provided not only cardiosurgical and cardiological treatment but also specialized treatment for neurological patients, including haemodialysis and hemofiltration.