[Structural changes in metabolism in the early postoperative period and the methods for their correction]. / Strukturnye izmeneniia metabolizma v rannem posleoperatsionnom periode i metody ikh korrektsii.

Surgery and general anesthesia involve changes in adaptive compensatory mechanisms manifesting by homeostasis disturbances, specifically metabolic disorders. This report describes the dynamic characteristics of structural metabolic disorders and the external respiratory function during the immediate and early postoperative period after surgery of different duration under different anesthesias and metabolic infusions. The results indicate that general anesthesia and any surgery involve structural disorders in energy expenditures during the early postoperative period. The duration of anesthesia and surgery and methods of anesthesia determine the metabolic disturbances and external respiratory changes during the postoperative period. Addition of opioids and hypertensive glucose infusions to general anesthesia and postoperative period decreases the severity of structural metabolic disorders and external respiratory function during the early postoperative period.

[Laser therapy and death caused by arrhythmia in ischemic heart disease]. / Lazeroterapiia i aritmicheskaia smert' pri ishemicheskoi bolezni serdtsa.

The paper presents a new treatment of myocardial infarction which proved its high antiarrhythmic effectiveness in 300 MI patients followed up for 2 years. The method implies endogenous radiation of blood by He-Ne laser. Holter monitoring revealed that such radiation in the acute MI period promoted the arrest of high-grade ventricular arrhythmia more efficiency than lidocaine++ and prevented primary ventricular fibrillation. The 2-year follow-up provides evidence for a significant reduction in the occurrence of high-grade and lethal outcomes which decreased by half. In view of high occurrence of high-grade extrasystole in most decreased control subjects, this may be attributed to less frequent arrhythmic deaths. Lethal outcomes in laser therapy were reported in persistent cardiac failure, repeat myocardial damage and in presenile and senile patients.

Intravascular laser therapy of acute myocardial infarction.

The efficacy of a new method of treatment, endovascular blood irradiation with He-Ne laser, developed by the authors, was studied in 295 patients with primary acute transmural myocardial infarction (MI). Twenty-four-hour Holter monitoring findings before and after laser irradiation suggested the possibility of preventing sudden death in the acute period of MI owing to the high anti-arrhythmic efficacy of the method with respect to high-grade ventricular arrhythmias. Precodial ECG mapping and serial determination of blood enzyme activities (CPK and MB-CPK) showed that irradiation performed within the first hours of MI development contributed to effective limitation of the infarction area and restricted the spread of the area of myocardial ischemic damage.

[Effect of intravascular irradiation of blood by helium-neon laser on the markers of the area of ischemic myocardial damage in patients with acute myocardial infarction]. / Vliianie vnutrisosudistogo oblucheniia krovi gelii-neonovym lazerom na markery zony ishemicheskogo povrezhdeniia serdechnoi myshtsy u bol'nykh ostrym infarktom miokarda.

In 80 patients with acute transmural myocardial infarction (30 patients with anterior infarction and 50 with posterior infarction), endovascular irradiation of blood with helium-neon laser was studied for effects on the time-course of the processes of ischemic lesion and myocardial necrotization from the data on precordial mapping of 35 leads ECG (epsilon ST, nST, nQS) and serum creatinine phosphokinase and its MB fraction (maximal activity peak attainment time, level normalization, summary Q ejection and activity increase rate, delta E/delta t) were measured. The irradiation initiated no later than 4 hours after the development of anginal pains was found to contribute to a more rapid formation of a necrotic zone and to a decrease in extension and relapses of myocardial infarction.

[Effectiveness of blood irradiation using a helium-neon laser in the acute period of myocardial infarction]. / Effektivnost' gemooblucheniia gelii-neonovym lazerom v ostrom periode infarkta miokarda.

The efficacy of endovascular irradiation of the blood with He-Ne laser by the method developed by the authors was examined in 295 patients with primary acute transmural myocardial infarction. Laser therapy was conducive to effective alleviation of the pain syndrome and prevention of anginous status. Twenty-four-hour Holter monitoring, carried out before and after irradiation, has detected high antiarrhythmic activity in respect of complex ventricular arrhythmias and a preventive possibility of fibrillations. Studies of precardial ECG parameters and measurements of the blood enzymic activities (creatine phosphokinase and MB creatine phosphokinase) have shown that irradiation carried out within the first hours of myocardial infarction is conducive to limitation of the infarction area, i.e. that endovascular laser therapy is a highly effective and pathogenetic method for acute myocardial infarction treatment.

[Evaluation of the anti-arrhythmic effect of intracardiac laser therapy by 24-hour electrocardiographic monitoring of patients with acute myocardial infarction]. / Otsenka antiaritmicheskogo éffekta vnutriserdechnoi lazeroterapii metodom kruglosutochnogo monitorirovaniia EKG u bol'nykh ostrym infarktom miokarda.

Ventricular arrhythmias were studied by Holter's 24-hour ECG monitoring in 215 acute myocardial infarction patients within the first day of the disease. Twenty-five minutes sessions of blood irradiation by a 2-4 mW helium-neon laser (HNL) through a light guide, introduced into the right atrium via the subclavian vein, were conducted for 3-5 days in 180 patients. The HNL therapy showed a marked antiarrhythimic effect in acute myocardial infarction, significant for the prevention and treatment of ventricular arrhythmias. High antiarrhythmic activity was noted in patients with frequent ventricular extrasystoles and high-grade arrhythmias. Control patients showed no significant spontaneous reduction of the rate of ventricular arrhythmias over a comparable period of time.

[Use of paired impulses and automatic depressing stimulation during sinus tachycardia systole in experimental acute myocardial ischemia]. / Ispol'zovanie parnykh impul'sov i avtomatizirovannoi urezhaiushchei stimuliatsii pri sinusovoi takhisistolii v usloviiakh ostroi ishemii miokarda v éksperimente.

In 102 dog experiments, the effect of a twin stimulator and a device of original design, providing automated pace rarefication, on the heart's contractility and hemodynamics, coronary flow and myocardial electric activity was examined in conditions of acute ischemia. Rarefying stimulation was found to have the best effect in cases of basic tachycardia and accompanying heart failure, which is related to the postextrasystolic potentiation effect. The stimulation in the presence of myocardial hyperfunction or an excessive induced rarefication of heart rhythm may result in negative electrographic and hemodynamic changes, the latter being systemic as well as intracardiac. The advantages of automated stimulation are in that it provides stability of rhythm rarefication rate so that continuous control of the pace-making is rendered unnecessary, and rules out the possibility of an impulse falling to the vulnerable period.

[Effectiveness of various dopamine doses in acute myocardial ischemia complicated by cardiogenic shock (an experimental study)]. / Effektivnost' razlichnykh doz dopamina pri ostroi ishemii miokarda, oslozhnennoi kardiogennym shokom (éksperimental'noe issledovanie).

The effect of various doses of dopamine on the values of cardiac contractile and hemodynamic function under conditions of acute two-hour ischemia complicated by cardiogenic shock was studied in 27 experiments on dogs. In a dose of 5 microgram/kg/min dopamine caused an optimum increase in cardiac productive capacity, reduction of peripheral resistance, adequate increase in coronary circulation and decrease in ST segment depression on the ECG. Infusion of 10 microgram/kg/min dopamine usually caused myocardial hyperfunction with an increase in total peripheral resistance and cardiac performance. Maximum dopamine doses (10 microgram/kg/min and more) were effective in the areactive form of cardiogenic shock. In longterm dopamine infusion it is necessary to establish continuous control over the hemodynamic parameters and the ECG to prevent aggravation of ischemia and for stage-by-stage reduction of the drug concentration and determination of the minimum maintenance dose.