Influence of cardiopulmonary bypass on the state of cognitive functions in patients with ischemic heart disease.

Forty patients with ischemic heart disease and undergoing aortocoronary shunting surgery with cardiopulmonary bypass were studied. All patients were subjected to neuropsychological assessment and immunochemical analysis of the production of chemokines (IL-8, IP-10, MCP-1, MCP-3, MIP-1 beta, SDF-1 alpha) and cytokines (TNF-alpha and IL-10). The aims of the study were to assess the presence and severity of cognitive deficit developing after surgery with cardiopulmonary bypass and to assess the effects of intraoperative Trasylol on its severity. Cognitive deficit on day 9 after coronary shunting with cardiopulmonary bypass was seen as impairments of attention, hearing-speech memory, visual memory, and dynamic praxis. Trasylol had a marked neuroprotective effect and suppressed the systemic inflammatory response. Patients given intraoperative Trasylol had no clinically significant cognitive deficit in the early post-operative period.

Use of p300 cognitive evoked potentials in the diagnosis of impairments of higher mental functions after cardiac surgery in conditions of cardiopulmonary bypass.

A total of 40 patients with ischemic heart disease undergoing aortocoronary shunting surgery in conditions of cardiopulmonary bypass were studied. Parameters of the P300 cognitive evoked potentials were studied before surgery and 7-9 days after surgery. Neurological and neuropsychological assessments were also performed. The most significant parameters of the P300 potential were found to be the latencies of the P3 and N2 components, increases in which showed positive correlations with the extent of the developing cognitive deficit. Evidence supporting the neuroprotective effects of Trasylol given during surgery was obtained. Patients given Trasylol showed less marked cognitive deficit and smaller changes in P300 parameters. Analysis of the P300 cognitive evoked potential can be recommended for detecting early cognitive dysfunction and assessing the efficacy of neuroprotective therapy in patients undergoing surgery with cardiopulmonary bypass.

[Use of cognitive evoked potentials P300 in diagnosis of affection of the higher mental functions after surgery on the heart in conditions of cardiopulmonary bypass].

Parameters of cognitive evoked potentials P300 were studied in 40 patients with ischemic heart disease subjected to coronary artery bypass graft surgery in conditions of cardiopulmonary bypass before and 7-9 days after operation. Patients underwent also neurological and neuropsychological examination. The most significant P300 parameters proved to be P3 and N2 latency, an increase of which correlated with the level of developing cognitive deficiency. A neuroprotective effect of Tracilol during the surgery was confirmed. In patients receiving this drug, cognitive deficiency and changes of P300 parameters were less pronounced. A study of cognitive evoked potentials P300 may be recommended for detecting early cognitive dysfunction and estimation of neuroprotective therapy in patients operated on in conditions of cardiopulmonary bypass.

[Influence of cardiopulmonary bypass on cognitive functions in patients with ischemic heart disease].

Forty patients with ischemic heart disease subjected to coronary artery bypass graft surgery (CABGS) have been studied in conditions of cardiopulmonary bypass. All the patients underwent neuropsychological testing and enzyme immunoassay of chemokines (IL-8, IP-10, MCP-1, MCP-3, MIP-1, SDF-1alpha) and cytokines (TNF-alpha and IL-10). The study aimed at evaluation of the presence and severity of cognitive deficit developing after the surgery in conditions of cardiopulmonary bypass as well as of intrasurgery effect of tracilol on its expression. On day 9 after CABGS, there was an impairment of attention, audio-speech and memory and dynamic praxis. Tracilol exerted a pronounced neuroprotective action by inhibiting systemic inflammation response. Patients on intrasurgery treatment with tracilol did not demonstrate clinically significant cognitive deficit in the early postoperative period.

[Immunological disorders of homeostasis and the methods of their correction for the programmed and preoperative treatment of patients with nonspecific aorto-arteritis]. / Immunologicheskie narusheniia gomeostaza i metody ikh korrektsii dlia programmnogo i predoperatsionnogo lecheniia bol'nylh nespestsificheskim aorto-arteriitom.

The authors examined 29 patients with aorto-arteritis of unspecific origin of different duration and variants of affections of the major vessels. The patients were divided into groups with active and inactive course of the inflammatory process. The changes of immunological values and the phagocytosis data were more marked in the group with the active phase of the disease. These changes correlated with the data on unspecific inflammation and the clinical picture. Twenty-two patients were treated by hemosorption and immunocorrective measures. The fibrinogen concentration reduced, the ESR was normalized, and C-reactive protein became negative. The concentration of circulating immune complex and immunoglobulins diminished, the phagocytosis values became close to normal. It is concluded that hemosorption is an effective method of correction of immunological disorders in unspecific aorto-arteritis, both as an independent therapeutic method and as a measure of preoperative management.

[Surgical treatment of nonspecific aorto-arteritis]. / Khirurgicheskoe lechenie nespetsificheskogo aorto-arterita.

The authors analyse experience with 273 operations carried out in 273 patients; 107 operations were conducted on the branches of the aortic arch, 136 were performed for the "middle aorta syndrome", and 30 operations were performed in affections of the terminal aorta and the iliac arteries. Experience is also shown in operative treatment of 32 patients with coexistent affections of the "middle aorta" and the branches of the aortic arch, the surgical tactics and the sequence of operations in this type of pathology are discussed. Problems dealing with the classification of nonspecific aorto-aortitis (NAA) are discussed, and the authors' classification of the variants of the vascular manifestations of the process is suggested. The authors draw attention to the need for preoperative management of patients with UAA for correcting the activity of the inflammatory process. Hemosorption and immunocorrective therapy are suggested for this purpose. Means for improving the results of surgical treatment of patients with UAA are suggested. The total mortality was 13%.