[Certain molecular effects of physical exercises].

According to the current concept, therapeutic physical exercises provide a simple and efficacious tool for reducing the risk of development of cardiovascular diseases and their complications. The main beneficial effects of regular physical training include positive dynamics of atherogenesis and angiogenesis, improved rheological properties of blood, decreased left ventricular myocardial hypertrophy and re-modeling. The present review is focused on some of the modern views of the molecular mechanisms underlying the influence of therapeutic physical exercises on the above processes with special reference to the activation of nitrous oxide production, regulation of the functions of the progenitor cells, and stimulation of the resident stem cells in the myocardium.

[Surgical treatment of patients with stomach cancer and severe concomitant cardio-vascular pathology].

51 patients with gastric cancer and severe concomitant ischemic heart disease (90.2%), valvular heart disease (5.9%), critical stenosis of the internal carotid artery (2%) or abdominal aortic aneurism (2%) were operated on during 1995-2011yy. Of them men were 41, women - 10; mean age was 65.1 years (51-82). The first stage of gastric cancer was diagnosed in 18 (35.3%) of patients, second, third and fourth in 12 (23.5%), 17 (33.3%) and 4 (7.8%), respectively. Radical tumor resection was achieved in 37 (72.5%), palliative operations were performed in 13 (25.5%) patients. 17.6% of patients were operated on stomach and vessels simultaneously. 82.4% received the stepwise treatment. Intra- and postoperative complications were registered in 47.1% (24 of 51 patients); of whom 5.9% (3 patients) ended lethally. Simultaneous operations showed the 55.6% complications and zero lethality rate, whereas stepwise treatment resulted in 45.2% complications and 7.1% lethality.

[The surgical treatment of patients with lung cancer and severe cardiovascular disorders].

During the period of 1991--2010 yy 51 patients with lung cancrs were operated on the severe cardiovascular diseases (IHD -- 90%; critical carotid stenosis -- 6%; tricuspidal valve failure -- 2% and the combination of the IHD and aortic valve failure -- 2%). Lung cancer steged I in 17 (33.3%) patients, II in 15 (29.4%); III - in 16 (31.4%) and IV in 3 (5.9%) patients. 33 patients of 51 were radically operated on lung cancer, palliative resections were performed in 3; trial thoracotomies were performed in 2 patients. 8 (15.7%) patients were operated on simultaneously. The complicated postoperative period was registered in 22 (57.9%) patients of 38 with exitus lethalis in 2 cases. The complication rate after simultaneous operation was 62.5% with lethality of 12.5%, whereas by the consecutive operations the complication rate was 56.7% with lethality of 3.3%, Nevertheless, surgical correction of the severe concurrent cardiovascular pathology flares the range of operable patients with lung cancer.

[Simultaneous surgery of competing cardio-vascular and malignant diseases of lungs and mediastinum].

36 patients were operated on lung cancer (30), trachea (1), lung colon cancer metastases (1), left atrium paraganglioma, bronchogenic thymic cyst (1) and lung tuberculoma (2). Competing cardio-vascular diseases were as follows: coronary heart disease (30), valve failure (3) and critical stenosis of internal carotid artery (3). Simultaneous operations were performed in 13 (36.1%), consecutive - in 23 patients. Non-complicated postoperative period was registered in 19 patients. 6 of them had simultaneous surgery and 13 were operated on consecutively. Overall mortality rate was 8.3%; among patients operated on simultaneously it was 15.4%, among patients of the second group - 4.3%. There were no postoperative deaths among patients, operated first on cardio-vascular system.

[Surgical treatment of patients with colorectal cancer and severe concurrent cardio-vascular diseases].

The study population comprised 14 patients, operated on account of colon cancer (n=2), sigmoid cancer (n=1), rectal cancer (n=6), synchronous rectal and prostatic cancer (n=1) and lung (n=1) and liver (n=2) colon cancer metastases. The diagnosed concurrent cardiovascular pathology was: coronary heart disease (n=8), valve disease (n=2), aortic aneurism (n=2), coronary heart disease combined with aortic aneurism (n=2). Simultaneous operations were performed in 3 patients, 11 patients were operated on consecutively. No deaths were registered after simultaneous operations. In the group of consecutive operations 2 patients had died of myocardial infarction and cardiac decompensation. 3 (21,4%) patients died of tumor relapse during the follow-up period. The rest 9 patients are under observation for 3 months to 10 years, 2 patients achieved a 5-year cancer-free survival time.

[Risk factors of atrial fibrillation after aortocoronary bypass surgery with extracorporeal blood circulation]. / Faktory riska fibrilliatsii predserdii posle operatsii aortokoronarnogo shuntirovaniia s iskusstvennym krovoobrashcheniem.

Fibrillation of the atriums is registered in 20-40% of cases after the surgery of direct revascularization of the myocardium and runs alongside with impairments that are life-menacing. Seventy-six (76) patients were examined after direct revascularization of the myocardium, including 20 subjects with paroxysms of atrium fibrillation. The arrhythmia-related risk was shown to be increasing in persons (older than 60) with an impaired left column of the left coronary artery, in unstable angina pectoris diagnosed before surgery, malfunction of the left ventricle and in case of a rapid warming-up of a patient after the artificial blood circulation with cold cardioplegia is over.

[Minimally invasive coronary artery bypass surgery]. / Minimal'no invazivnye operatsii koronarnogo shuntirovaniia.

From 19.06.97 to 06.01.2000 36 patients with coronary heart disease underwent direct myocardium revascularization surgery by minimally invasive method (through minithoracotomy, off-pump and on the beating heart), anastomosis between left internal mammaria artery and anterior descending artery (ADA). The majority of the patients (55.6%) had one-vessel damage of ADA coronary bed, in the patients with damage of two and more vessels full revascularization of coronary bed was achieved by two coronary arteries bypass at once or by combination of minimally invasive coronary bypass (MICB) with PTCA. MICB is performed in specially selected patients according to stuct indications. Technique of operation, early postoperative course, possibilities of combination of MICB with other methods of treatment is described. Potential of MICB is discussed.

Cardiopulmonary bypass and cell-saver technique in combined oncologic and cardiovascular surgery.

The purpose of this study was to work out an adequate operative technique for patients with malignant tumors who also need open heart surgery or procedures on major blood vessels. We had 8 such patients. In 6 of them, a tumor (3 cases hypernephroid cancer and 3 cases retroperitoneal sarcoma) had grown through the inferior vena cava (IVC) up to the right atrium. Two patients had lung cancer together with severe coronary artery disease. All of these patients were operated on using a heart-lung machine (HLM) and cell saver (CS). In 6 patients the intravascular portion of the tumor was extracted as much as possible through a right atrium approach (in 3 cases a nephrectomy was performed). Two patients had a one-stage coronary artery bypass graft (CABG) and a lobectomy. All of the patients had uneventful postoperative periods and were alive when checked on 1 year after the procedures. During cytological investigation after each operation, tumor cells were found only on the internal surface of the HLM arterial filters with 20 microns holes. We suggest that special cardiovascular devices such as the HLM and CS might be used in borderline situations in oncology without increasing the risk of hematogenous tumor dissemination.

[Prevention and treatment of infectious complications in myocardial revascularization]. / Profilaktika i lechenie infektsionnykh oslozhnenii pri revaskuliarizatsii miokarda.

The study was conducted in a group of 440 patients who underwent planned operations for ischemic heart disease. Three current methods of preventive antibiotic therapy were compared. The influence of various risk factors on the incidence of infectious complications was analysed. Experience with closed mediastinitis management was also analysed. The effect of a short-term (1-3 days) course of claforan in prevention of infectious complications is the same as that of a 5-7-day course of cefamezin or gentamicin. Postoperative mediastinitis developed in 11 (2.5%) patients. It was managed in all patients by closed irrigation and drainage of the retrosternal space. The average duration of mediastinal irrigation was 7.4 days. Convalescence was attained in all cases.