[Comparative assessment of variants of potassium crystalloid cardioplegia]. / Sravnitel'naia otsenka variantov kalievoi kristalloidnoi kardioplegii.

Sixty eight patients operated on for valvular abnormalities were examined. In Group 1 (n = 34) myocardial protection was made by potassium solutions containing different potassium concentrations: 30 mM and 5 mM for induction and reinfusion, respectively. In Group 2 (n = 34) a hyperosmolar oxygenized cardioplegic solution containing K+, 15 mM, and Mg2+, 16 mM was administered under the same conditions. In the early postoperative period, no differences were found in the frequency and size of inotropic support, as evidenced by central hemodynamic parameters. ECG showed that in Group 2 there was a reduction in the frequency of changes of S-T segment, indicating the presence of myocardial ischemic changes. A 24-hour Holter monitoring demonstrated that life-threatening ventricular arrhythmias occurred significantly more infrequently in Group 2. The ultrastructural study of intraoperative biopsy specimens of the myocardium, including their treatment with colloid lanthanum showed that the tracer had penetrated virtually into all cardiomyocytes at the peak of ischemia and reperfusion in Group 1. In Group 2, ultrastructural changes were less profound and the particles of the tracer lanthanum had penetrated into the sarcoplasm of 15% of cells. Inadequate myocardial protection cannot be regarded as a cause of one of three deaths from acute heart failure. The studies demonstrated that crystalloid potassium cardioplegia was highly effective. However, the possibility of additionally affecting the permeability of a cell membrane by changing the solution composition (elevating magnesium concentrations) and the reduction of frequency of cardiac arrhythmias suggest that each components of the cardioplegic solution should be studied.

[Immunopathologic study of the myocardium in dilated cardiomyopathy]. / Immunopatologicheskoe issledovanie miokarda pri diliatatsionnoi kardiomiopatii.

Myocardial tissues of patients with dilated cardiomyopathy were studied by immunofluorescence. While immunoglobulin A fixation was observed in myocardial capillary wall and cardiomyocyte sarcolemma in the majority of patients (11 of 12), immunoglobulin G and C3 complement component were a rare finding. In the vessel wall of heart allografts immunoglobulin A fixation occurred 3-6 days after transplantation. As a result of the intensive immunosuppressive therapy which was used after the operation immunoglobulin A disappeared from heart allografts within 4-5 weeks. Immunoglobulin A fixation in the heart of patients with dilated cardiomyopathy is attributed to the anti-tissue or antivirus antibodies and probably is involved in the development of this disease.

[Infectious complications following heart transplantation]. / Infektsionnye oslozhneniia posle transplantatsii serdtsa.

The work analyses infectious complications after 35 orthotopic transplantations of the heart. The infectious complications are divided into 2 groups. Group 1 consisted of 6 patients with local complications. Group 2 was made up of 8 patients who died from bacterial infectious complications (mediastinitis 3, sepsis 2), from miliary tuberculosis of the lungs 1, cytomegaloviral infection 1, and systemic candidiasis 1.

[Chronic rejection of a transplanted heart]. / Khronicheskoe ottorzhenie peresazhennogo serdtsa.

Three cases of chronic rejection occurring 7.5, 10, and 24 months after transplantation of the heart are analysed. The clinical features of chronic rejection in the late-term periods after transplantation of the heart are discussed. The problems of clinical diagnosis of chronic rejection, the role of endomyocardial biopsy and disorders of lipid metabolism are dealt with. Tactics of saving the patient are recommended. The authors substantiate the necessity for heart retransplantation and, in the absence of a donor's heart, for two-stage transplantation of the heart through an artificial heart or a biventricular approach by means of artificial heart ventricles.

[Diagnosis of transplanted heart acute rejection on the basis of endomyocardial biopsy morphologic examination]. / Diagnostika ostroi reaktsii ottorzheniia transplantirovannogo serdtsa po dannym morfologicheskogo issledovaniia éndomiokardial'nykh bioptatov.

Results of morphological diagnosis of acute rejection on the material of 265 endomyocardial biopsies from 26 patients after an orthotopic donor heart transplantation are presented. The structural characteristics of different stages of acute rejection are given which is revealed in 85.7% observations. Ultrastructural myocardial changes in the early postoperative period not connected with the acute rejection crisis but resulting from a reperfusion cardiomyocytes damage are described. Results of electron microscopic examination of myocardium in rejection crisis are also given.

[Aggregates of islet cells, their structure and insulin-producing activity during cultivation in vitro]. / Agregaty ostrovkovykh kletok, ikh struktura i insulinprodutsiruiushchaia aktivnost' v usloviiakh kul'tivirovaniia in vitro.

Purified rat islets were dissociated into single-cell suspension with an EDTA-Trypsin treatment. During a stationary culture in vitro the islet cells reassociated forming aggregates (neoislets). Electron microscopy revealed that the aggregates consisted mostly of beta-cells and not numerous alpha-cells. They showed a good insulin-secreting capacity and were able to increase insulin release in response to glucose plus theophylline. The lack of passenger leukocytes makes the neoislets particularly suited for experimental and clinical transplantation.

[Immunosuppressive therapy and the reaction of the minor salivary glands in the oral mucosa]. / Immunosupressivnaia terapiia i reaktsiia malykh sliunnykh zhelez slizistoi obolochki polosti rta.

Clinical changes in oral mucosa minor salivary glands were examined in 30 patients with grave diabetes mellitus treated by transplantation of pancreatic islet cells without immunosuppressant therapy and in 35 patients suffering from chronic renal failure 18 of these operated on for transplantation of an allogenic kidney with immunosuppressant therapy. Clinical condition and function of the minor salivary glands were assessed according to a scheme developed by the authors with consideration for clinical signs: edemas, hyperemia, hyperplasia, retention, and destruction. Morphologic examinations were carried out in various periods after transplantation.

[Ultrastructural characteristics of anti-ischemia protection of intact and hypertrophic myocardium with phosphocreatinine]. / Ul'trastrukturnaia kharakteristika protivoishemicheskoi zashchity neizmenennogo i gipertrofirovannogo miokarda fosfokreatininom.

Ultrastructural changes in normal and hypertrophied dog hearts under conditions of total ischemia were studied by electron microscope method. In the control group sings of irreversible damage appeared in 90 min, in the presence of phosphocreatine, 10 mM, these changes became apparent in 120 min. In the hypertrophied hearts signs of the irreversible damages became evident in 60 and 90 min in the absence and presence of phosphocreatine, respectively. Ability of phosphocreatine to protect both normal and hypertrophied myocardium allows to use it safely.

[Retrograde cardioplegia through the right atrium]. / Retrogradnaia kardioplegiia cherez pravoe predserdie.

The results of retrograde cardioplegia through the right atrium in 50 patients are analysed. The uniform cooling of the myocardium, frequent restoration of the sinus rhythm, and the low hospital mortality rate are evidence of the high efficacy of this method of myocardial protection. Electronmicroscopy showed marked intactness of the myocardial ultrastructure and moderately manifested and reparable reperfusion changes. It is concluded that the method must be employed in coronary disease, combination of ischemic heart disease with heart valvular disease, as well as in mild forms of aortic insufficiency which cannot be corrected.

[Ultrastructural diagnosis of changes in the human myocardium during protection of the heart with cardioplegic solutions]. / Ul'trastrukturnaia diagnostika izmenenii miokarda cheloveka pri zashchite serdtsa kardioplegicheskimi rastvorami.

Results of qualitative and quantitative assessment of myocardial changes are presented based on examinations of 180 cardiobiopsy specimens taken from 58 patients with acquired heart diseases during open-heart surgery. For quantitative assessment of intracellular organelle changes a 6-score scale has been developed by means of which the time course of injury to the major cellular components was studied: before aortal clamping, at the height of ischemia, and during reperfusion. Basing on the integral assessment of structural changes it is possible to assess the severity of myocardial damage; such approach is valuable in the assessment of the efficacy of cardioplegic solutions in the clinical practice.

[Ultrastructure of calcium-induced myocardial necrosis]. / Ul'trastruktura kal'tsievykh nekrozov miokarda.

The authors present for the first time a complete picture of ultrastructural changes of contractile cardiomyocytes in myocardial calcium necroses in the time course from reversible to irreversible stages. Three types of calcium cell lesions are singled out: rigor, lytic, and vacuolar.

[Structural and biochemical characteristics of the effectiveness of intraoperative protection of the myocardium]. / Strukturno-biokhimicheskaia kharakteristika éffektivnosti intraoperatsionnoi zashchity miokarda.

Results of morphological and biochemical examination of 153 myocardium biopsies from 42 patients with the intraoperational heart ischemia that developed during the correction of cardiac valves disturbances under the condition of artificial circulation and cardioplegia with the blood based solution are given. Phosphocreatin ("neoton" produced by Schiapparelli Company, Italy) was added as a cardioprotector to the cardioplegic solution in 24 patients. The high efficiency of the drugs for the cardiomyocytes sarcolemma is shown by means of colloidal lanthanum. A full retention of the macroergic phosphates is also shown biochemically when the standard solution was modified for the heart protection.

[Information retrieval system of the pathoanatomical department]. / Informatsionno-poiskovaia sistema patologoanatomicheskogo arkhiva.

An information search system (ISS) of pathological archive was developed and introduced into practice in the Department of Pathomorphology of the N. V. Sklifosovsky Research Institute of Emergency. A bank of data for 1977-1979 consisting of 8400 perforated cards corresponding to 4200 autopsies has been accumulated. A computer-oriented card has been developed for recording of preadmission, clinical, and anatomical diagnosis. Treatment of the materials in a ES-1020-1022 computer permitted to reduce the labour consumption in the analysis of clinico-anatomic diagnoses, to improve the quality of documentation, and to create the bank of data based on the archives of the Pathomorphology Department. To increase the volume and value of the input information dictionaries-codifiers of various operative interventions, kinds of anesthesia, histological types of neoplasias, etc. have been created in addition to the "International Statistical Classification of Diseases, Traumas, and Causes of Death". The results obtained with the employment of the "Archive" ISS open broad prospects for creation of an automatized system of pathological archives.