Effectiveness of Bokeria-Boldyrev ACH Solution in Surgerical Treatment of Adult Patients with Obstructive Hypertrophic Cardiomyopathy.

The study examined effectiveness of pharmaco-cold cardioplegia employing solutions of enhanced buffer capacity during surgery of obstructive hypertrophic cardiomyopathy in adult patients (N=51) operated during 2013-2018. In group 1 (N=28), the cardioplegia was performed with HTK (Custodiol) solution, whereas in group 2 (N=23), it was carried out with Bokeria-Boldyrev ACH solution. The mean, minimum, and maximum ages in group 1 were 46, 21, and 64 years, respectively; in group 2 - 42, 14, and 70 years, respectively. In both groups, the patients were subjected to myoectomy of exit pathway in the left ventricle according to Bokeria-Morrow operation and annuloplasty of tricuspid valve accompanied by reconstructive surgery (or replacement) of mitral valve. Atrial fibrillation (if any) was suppressed with cryoablation (-60°Ð¡) of the openings of the right and left pulmonary veins. The surgery was carried out in hypothermic mode at 28°C. The significant intergroup differences were observed in the asystole latent period after the onset of antegrade or retrograde injection of cardioplegic solution. In group 1, the asystole latent periods determined after antegrade or retrograde injection were 53±7 or 170±30 sec, respectively; in group 2 - 32±6 and 97±11 sec (p<0.0001), respectively. The mean times of aortic cross-clumping in groups 1 and 2 were 66±8 and 64±6 min, respectively; the electromechanical action of the heart restored after aortic unclamping in 35±7 and 30±6 sec, respectively. The biochemical and clinical data revealed no significant intergroup differences. Overall, novel Bokeria-Boldyrev ACH cardioplegic solution secured effective protection of the myocardium against intraoperative ischemia in adult patients with obstructive hypertrophic cardiomyopathy and significantly decreased the asystole latent period.

Markers of myocardial damage in children of the first year of life with congenital heart disease in the early period after surgery with cardioplegic anoxia.

We measured the level of cardiac markers (high-sensitivity troponin T and MB fraction of creatine kinase) in children of the first year of life with congenital heart disease in the perioperative period. After cardiac surgery, plasma levels of the above markers exceed the reference limits in the examined children. The diagnosis of myocardial ischemia using biochemical markers in the postoperative period is possible only by dynamic monitoring of the cardiac marker level. The preoperative concentration of high-sensitivity troponin T in children of the first year of life with congenital heart disease can be regarded as a predictor of postoperative complications.

[Intravenous immunoglobulins: perspectives in multiple sclerosis (a literature review with own results)]. / Perspektivy primeneniia vnutrivennykh immunoglobulinov pri rasseiannom skleroze.

In this review, we have analyzed a role of intravenous immunoglobulins (IVIGs) in multiple sclerosis (MS) therapy. Main mechanisms of IVIGs are elucidated and the results of the most prominent investigations of IVIGs in MS are reported. Based on these data, we discuss a role of IVIGs as second line therapy in MS. We also present results of our own open observational study of IVIG therapy of 41 patients with relapsing-remitting and secondary progressive with relapses MS, in which a clear decrease of relapse rate (by 2-3 times) and disability (in average by 0.38-0.48 EDSS points) were revealed. We found some differences between complex IVIGs and pure IgG IVIGs clinical efficacy with some prevalence of complex IVIGs that were discussed. High IVIGs safety and tolerability (only slight transitory side effects in up to 14% of patients) were found.

[Analysis of the short-term and long-term results in surgical treatment of the chronic cystic pancreatitis].

INTRODUCTION: In recent years, the practice of abdominal surgery marked increase in the number of patients with pancreatic cysts. Tactics of treatment of this disease is still disputable. MATERIAL AND METHODS: The article analyzes the treatment of 128 patients with formed pancreatic cysts. They were divided into three groups: 1) external drainage - 44 (34.4%); 2) internal drainage - 41 (32.0%); 3) resection surgery - 43 (33.6%). RESULTS: The duodenum resections were introduced for the treatment of the pancreatic head cysts - 21 (48.8%). Resection methods in the number of postoperative complications (23.3%) could be compared with the operations of the internal drainage of pancreatic cysts (19.5%), although the resection methods are technically more difficult and traumatic. 66 (51.6%) patients were observed in the long-term period. The number of postoperated disease recurrences was more in group 1 (28.6%). Quality of life indicators (SF-36) were higher in group 3. We marked the best results after resection operations. CONCLUSION: So this type of operation can be recommended for the treatment of patients with formed pancreatic cysts as the most radical method.

Experimental study of the effects of sodium ion concentrations on the function of the myocardium exposed to cardioplegic ischemia.

A new cardioplegic solution based on three natural dipeptides was developed and introduced at the Laboratory of Cardioplegia, A. N. Bakulev Research Center of Cardiovascular Surgery. The electrolyte composition of the solution corresponded to the category of intracellular cardioplegic solutions. The results of 60 experiments on isolated rat hearts were analyzed for choosing the optimal concentration of sodium ions (35, 60, or 80 mmol/liter). The composition of the studied cardioplegic solutions was selected by ion concentrations in the intra- and extracellular fluid. Earlier and most effective recovery of cardiac function with minimum rhythm and conductivity disorders was observed in the group treated with cardioplegic solution with sodium ion concentration of 60 mmol/liter.

[The 1st native department of nervous and mental diseases].

In 1860 year in Medical-surgical academy in St. Petersburg was found the first department of nervous and mental diseases. With this department are aligned names of the greatest native neurologists and psychiatrists (Merzheevsky I.P., Bekhterev V.M., Blumenau L.V., Astvatsarov M.I., Dojnikov B.S., Triumfov A.V., Razdolsky I.Ya., Panov A.G. and etc.) who took the glory of Russian neurology. For 150 years the department was the base of neurological specialists for all medical institutes of the state. The department keeps the single educational and scientific institute, supplying systematic and high-qualified preparedness of military neurologists.

[Mechanical work of the left ventricle of the human heart]. / Mekhanicheskaia rabota levogo zheludochka serdtsa cheloveka.

By means of the echocardiographic techniques, morphometric and functional parameters of the heart left ventricle (HLV) were studied in male humans aged 20 to 23, in resting and under the effect of a physical load. The total ventricle work was found to be about 1 J, the relative one (per 100 g of the LV mass)--0.6 J. The total working power was found to be about 70 Watt, the relative one--about 40 Watt. The physical load resulted in increase of the LV mechanical work parameters due to the heart rate and systolic arterial pressure.

[Feasibility of chronic pulmonary heart diagnosis by ECG criteria]. / Vozmozhnost' diagnostiki khronicheskogo legochnogo serdtsa po élektrokardiograficheskim kriteriiam.

AIM: To determine diagnostic value of the method of ECG in 12 conventional leads for diagnosis of pulmonary heart. MATERIALS AND METHODS: The ECG data for 41 patients with clinical diagnosis "pulmonary heart", a risk group of 59 patients with suspected diagnosis "pulmonary heart" and healthy residents of the Komi Republic (n = 968) and Arkhangelsk region (n = 62) have been analysed. The ECGs were recorded using standard electrocardiographs with manual measurement of the amplitude and temporal parameters. RESULTS: We have analysed 215 diagnostic ECG criteria of "pulmonary heart" used in practice, selected 19 informative indices and developed 19 new ones. On the basis of 17 most significant criteria a short algorithm and a program of diagnosis of "pulmonary heart" for IBM PC have been elaborated. The test of the algorithm efficiency by a blind method confirmed the clinical diagnosis in 81.3% of cases, hypodiagnosis and hyperdiagnosis in 6.2 and 12.5%, respectively. CONCLUSION: A widespread and noninvasive ECG method proved promising in diagnosis of pulmonary heart.

[Determining the volume of solution necessary for intraoperative disinfection lavage of the abdominal cavity in diffuse suppurative peritonitis]. / Opredelenie ob"ema rastvora, neobkhodimogo dlia intra-operatsionnoi sanatsii briushnoi polosti pri rasprostranennom gnoinom peritonite.

The advantages of lavage of the abdominal cavity in diffuse purulent peritonitis by means of a developed device "Geyser" are shown. Changes in the bacterial contamination, toxicity and metabolite contents in the lavage solution and peritoneum depended on a volume of the fluid used.

[Use of membrane drainage in treating suppurative peritonitis]. / Primenenie membrannykh drenazhei pri lechenii gnoinogo peritonita.

The use of 70 patients of functionally active drainage in combination with the developed method for sanation of the abdominal cavity permitted to decrease lethality in diffuse peritonitis by 10% when compared with the existing methods for drainage of the abdominal cavity, to shorten the duration of treatment of the patients.

Shuttlebox self-stimulation in the rat: an anatomical analysis and the effect of morphine with two current levels.

A shuttlebox paradigm was used to train rats to turn electrical stimulation ON and OFF by crossing back and forth in a stabilimeter cage. Two experiments are presented. In the first experiment a threshold current level was used in testing four electrode sites: the lateral hypothalamic area (LHA), lateral septal nucleus (LSN), periaqueductal grey (PAG), and the mesencephalic reticular formation (MRF). In the second experiment, a suprathreshold current level was used to explore two electrode sites: the PAG and the MRF. Stimulation with electrodes in the MRF produced an aversive behavioral response; animals shuttled mainly to turn electrical stimulation OFF. At the other electrode sites, both rewarding and aversive properties were apparent: animals shuttled to turn the stimulation ON as well as OFF. Systemic morphine (10 mg/kg) injections nonselectively increased both average ON and OFF times for the three rewarding sites (minimum p less than 0.05) at the threshold current level. Systemic morphine injections (10 mg/kg) in animals stimulated at a suprathreshold current level in the PAG selectively increased time spent with stimulation ON (p less than 0.05) as opposed to time spent with stimulation OFF. No significant behavioral change due to morphine was seen in the aversive MRF at either current level. Animal behavior also was found to vary as a function of site of stimulation (p less than 0.05). The use of suprathreshold currents appears necessary to produce selective reward facilitation effects of morphine such as those found in the PAG or LHA.