Coronary endarterectomy during off-pump coronary artery bypass surgery.

Coronary endarterectomy (CEA) is often combined with coronary artery bypass grafting (CABG), which is performed on cardiopulmonary bypass (CPB). Recent advances in off-pump surgical technique and cardioanesthesiology, along with the increasing number of patients with high risk of CPB complications made it possible and desirable to execute CEA on a beating heart. Russian scientific literature lacks reports on these interventions. The study was aimed at evaluation of off-pump CEA feasibility and early outcomes. From 59 patients with ischemic heart disease (IHD), who underwent combined CABG and CEA, off-pump technique was used for 16 (27.1%) patients, including 12 men and 4 women, mean age 55.3 +/- 6.4. All of them had long-lasting history of IHD; 2 patients had angina CCS class II, 12--class III and 2 patents--class IV. Total number of anastomoses was 51 for 16 patients or 3.18 per patient. Open endarterectomy was used in 7 (9%) CEAs, semi-closed--in 9 (11.5%) CEAs. The technique of atherosclerotic plaque extraction, coronary artery reconstruction and bypass was similar in both groups. Complete revascularization was achieved for all patients. At discharge clinical improvement was evident in patients with functional classes 0-1. Diffuse involvement of coronary arteries is not considered to be contraindication for CABG. Simultaneous CEA with off-pump technique helps to achieve complete myocardial revascularization and good early outcomes, comparable with the results of conventional CPB-assisted procedures.

Species, population and age diversity in cell resistance to adhesion of Neisseria meningitidis serogroups A, B and C.

The variation of cell adherence of meningococci serogroups A, B and C and influenza viruses was investigated in 11 animal species and in humans of different age groups (1st, 2nd, 3rd and 4th weeks; 2nd-3rd months; 4th-12th months, 2nd-3rd years; and 18th-60th years of life) as well as in women during pregnancy (17th-36th weeks) and childbirth. Red blood cells of all animals tested as well as of human newborns were absolutely resistant to attachment of meningococci. In neonatal and the later periods the human cells become far differently sensitive individually to meningococcal adhesion. In contrast, the viral adhesion was characterized by different individual cell sensitivity in all age groups tested. Pregnancy and childbirth did not influence the women's cell sensitivity to adhesion of Neisseria meningitidis. Different receptors are involved in interactions of human cells with influenza viruses and meningococci. The function of meningococcal receptors on human cells develops during postnatal ontogenesis. The variations express both specific (genetic) and ontogenetic (individual) differences in natural resistance to meningococcal infection.

[The ontogeny of the cell receptors of the adhesion of meningococci and influenza viruses]. / Ontogenez kletochnykh retseptorov adgezii meningokokkov i virusov grippa.

Specific age and individual features of the adhesion of Neisseria meningitidis, groups A, B and C, and influenza viruses, types A and B, to red blood cells of humans aged 0-60 years were studied. The study revealed that the red blood cells of newborns, in contrast to those of persons of older age groups, are highly resistant to N. meningitidis adhesion, but highly sensitive to the adhesion of influenza viruses, though to a varying degree. The postnatal period of ontogenesis is characterized first by a sharp rise (up to 1 month) and then by a slower increase of the individual sensitivity of red blood cells to N.meningitidis adhesion without essential changes in the sensitivity of the same cells to the adhesion of influenza viruses.

[The range of individual sensitivity to adhesion by Neisseria meningitidis serogroup B in young men]. / Diapazon individual'noi chuvstvitel'nosti k adgezii Neisseria meningitidis serogruppy B u molodykh muzhchin.

5,340 young adult males, including 5,149 healthy persons, 141 N. meningitidis carriers, 25 patients with generalized meningococcal infection and 6 patients with nasopharyngitis of meningococcal etiology, were examined. The study revealed that red blood cells of 17.4% of healthy persons were highly sensitive to N.meningitidis adhesion (adhesion indices equal to 0.25 and less), red blood cells of 20.4% of persons had low sensitivity to N.meningitidis adhesion (adhesion indices equal to 2 and greater). All other persons with high sensitivity of their red blood cells proved to be patients with meningococcal infection or carriers of N.meningitidis of the same group.

[The adhesive properties of meningococci from serogroups A, B and C]. / Adgezivnye svoistva meningokokkov serogrupp A, B i C.

The adhesive properties of 261 meningococcal strains have been studied by the methods of the hemagglutination test, the test of adhesion on buccal epithelial cells and electron microscopy. The study has revealed that adhesive properties can be observed in the strains of all groups under study (A, B and C) isolated from patients and carriers, including those isolated from the nasopharynx, blood and liquor, adhesive properties occurring in newly isolated strains with greater frequency than in museum ones. The simultaneous use of all three above-mentioned methods increases the possibility of the detection of meningococcal strains with adhesive activity.