[Comparative assessment of methods for prevention of microvascular anastomotic thrombosis at reparative plastic surgery for cancer].

Four therapeutic-and-prophylactic drug complexes aimed at preventing microvascular anastomotic thrombosis and used as a part of anesthesiological appliance and intensive care were studied in 83 cancer patients who underwent planned extensive reparative plastic operations with microsurgical autoplasty. The drug complexes included pathogenetically substantiated special agents, such as low molecular-weight heparin (nadroparin), the gas-transport blood substitute perfluorane, the kininogenesis inhibitor (aprotinine), the nonsteroidal anti-inflammatory drug ketoprofen, the disaggregant pentoxifylline (trental), which were given in various combinations. The study of hemostatic parameters and the analysis of postoperative (hemorrhagic, necrotic) complications have demonstrated that fraxiparin-perfluorane-contrycal and fraxiparin-trental-contrycal are the most optimal therapeutic-and-prophylactic complexes to preserve the viability of autografts during oncological operations with microsurgical autoplasty.

[Special aspects of anesthesiology and intensive care in oncological operations with microsurgical autoplasty]. / Spetsial'nye aspekty anesteziologicheskogo posobiia i intensivnoi terapii pri onkologicheskikh operatsiiakh s mikrokhirurgicheskoi autoplastikoi.

The efficiency of the most rational antithrombotic, rheological, and antiischemic agents was evaluated: low-molecular heparin fraxiparin, nonsteroid antiinflammatory drug ketoprofene (ketonal), perfluorane, and antikininogen contrycal. Twenty-eight patients divided into 3 groups were examined before, during, and after extensive interventions with simultaneous microsurgical plastic repair by complex autotissue grafts. Results of treatment of 17 patients, in whom therapeutic and prophylactic complex including fraxiparin, perfluorane, and contrycal was used, deserve special attention. Use of this drug complex according to the proposed protocol creates optimal conditions for maintaining blood supply and oxygenation of the transplant at the expense of deceleration of blood clotting, decrease of blood viscosity, and decrease of erythrocyte and platelet aggregation. Complete healing of transplants was attained in all patients, who were discharged with good plastic results.

[The effect of anaprilin on the reaction of the sympathetic-adrenal system to graded physical loading in healthy subjects and patients with ischemic heart disease]. / Vliianie anaprilina na reaktsiiu simpatiko-adrenalovoi sistemy pri dozirovannoi fizicheskoi nagruzke u zdorovoykh liudei i bol'nykh ishemicheskoi bolezn'iu serdtsa.

The specific features of responses of the sympathoadrenal system during its activation by graded exercise (E), including that along with anaprilin induced blockade of beta-adrenoceptors, were determined from the urinary excretion of norepinephrine, epinephrine, dopamine, and dioxyphenylalanine in 54 healthy males and 22 patients with postinfarction cardiosclerosis concurrent with Functional Class I-II angina pectoris on effort. E caused hyperreactivity of the sympathoadrenal system, as appeared as significantly greater increases in the levels of catecholamines and their precursors in the patients than in the healthy persons. A single anaprilin dose of 40 mg abolished the responsiveness to exercise and improved its tolerance. The revealed features of sympathoadrenal responsiveness to exercise with and without anaprilin suggest that the patients with coronary heart disease have sympathoadrenal dysfunction, which shows one of the possible mechanisms responsible for the cardioprotective effect of beta-adrenoblockers in this disease.

[Study of the status of energy metabolism in thyrotoxicosis by the insulin test]. / Sostoianie énergeticheskogo obmena pri tireotoksikoze po dannym insulinovoi proby.

The insulin test was carried out in 68 healthy subjects and 20 patients with moderate thyrotoxicosis at the stage of compensation. Blood levels of pyruvate and lactate, plasma and erythrocytic glucose, urinary catecholamines and gas exchange were measured before, 30 and 120 min after intravenous administration of insulin (0.15 U/kg). All the measurements evidenced hypermetabolism: oxygen consumption, carbonic acid production, pulmonary ventilation were enhanced; lactate-pyruvate index and urine catecholamines were lower versus those of healthy subjects. Correlation analysis demonstrated disturbed regulation of hyperventilation by the sympathetic-adrenal system in thyrotoxicosis.

[Study of metabolic characteristics in patients with ischemic heart disease based on the insulin test]. / Osobennosti metabolizma u bol'nykh ishemicheskoi bolezn'iu serdtsa po dannym insulinovoi proby.

The study was undertaken to examine 68 healthy males and 34 patients with Functional Class I coronary heart disease. The insulin test (fasting intravenous simple insulin, 0.15 U/kg body weight, was given in the morning) was performed. The study was conducted in 3 stages: 1) before, 2) 30 min, and 3) 2 hr after insulin administration. Examination of glycemia and gas exchange revealed changes resulting in impaired energy supply of the body in CHD. In CHD patients, the enhanced glucose uptake after insulin was followed by abnormalities both in aerobic and anaerobic glucose oxidation. The insulin test detected the signs of excessive overtension and diminished reserve potentialities of the sympathetic adrenal system early in CHD.

[Hemodynamics and its control in patients with thyrotoxicosis and in healthy persons according to the data of anapriline and graded exercise tests]. / Gemodinamika i ee reguliatsiia u bol'nykh tireotoksikozom i zdorovykh lits po dannym prob s anaprilinom i dozirovannoi fizicheskoi nagruzkoi.

The study was undertaken to examine effects of anapriline on bicycle ergometric and echocardiographic parameters and catecholamine excretion in 17 patients with thyrotoxicosis and 21 healthy subjects. A single dose of anapriline contributed to transition of hyperkinetic central hemodynamics to eukinetic one and a more saving regimen of heart performance at rest and submaximal exercise levels in the healthy subjects. In contrast, the patients maintained hyperkinetic hemodynamics and had a high energy demand during exercise and showed a reduction in left ventricular systolic and diastolic function and a significant decrease in catecholamine excretion. Disintegration of regulatory mechanisms in thyrotoxicosis was found to be due to the function interrelationship between thyroid hormones and catecholamines.

[Functional state of the vascular wall in patients with coronary arteriosclerosis and different types of reactions to psycho- emotional stress]. / Funktsional'noe sostoianie stenki sosudov u bol'nykh koronarnym aterosklerozom s razlichnymi tipami reagirovaniia na psikho- emotsional'nuiu nagruzku.

With changes in psychoemotional stress, antithrombogenic properties of the vascular wall and hemostatic parameters were evaluated in 25 healthy subjects and 46 patients with coronary heart disease (CHD) who differently performed a leader function when intrapersonal interaction was simulated by using a bioengineering "Gomeostat" device. There was a significant increase in the functional activity of the hemostatic system involving enhanced platelet functional activity and diminished blood procoagulative fibrinolytic activity and decreased antithrombogenic activity of the vascular wall in patients with CHD who showed a managerial tactics during simulated intrapersonal interaction in a minor group as compared to a group of followers among CHD patients.

[The rehabilitation of patients with diabetes mellitus and ischemic heart disease]. / O reabilitatsii bol'nykh sakharnym diabetom i ishemicheskoi bolezn'iu serdtsa.

The results of bicycle ergometry testing were studied in 20 patients with diabetes mellitus of type II without clinical signs of circulatory insufficiency, 21 patients with postinfarction cardiosclerosis with undisturbed carbohydrate tolerance, and in 18 healthy persons. The blood level of glucose in patients with diabetes mellitus was investigated on an empty stomach and 30, 60 and 120 min. after physical exercising. Similar changes of bicycle ergometry results were found in diabetic and CHD patients. In compensation of diabetes in response to graded physical exercise glycemic changes were absent, in decompensation glycemia increased in 30 and 60 min. and returned to the basal level 120 min. after testing. Since the results of bicycle exercises in diabetic (compensated) and CHD patients were the same, the principles of their physical rehabilitation must be identical. In patients with decompensated diabetes mellitus a hyperglycemic reaction to graded physical exercise serves the basis for reduction of motor activity in patients with decompensated diabetes mellitus.

[Characteristics of hormonal regulation in patients with ischemic heart disease after the insulin test combined with physical load]. / Osobennosti gormonal'noi reguliatsii u bol'nykh ishemicheskoi bolezn'iu serdtsa pri sochetannom vozdeistvii insulinovoi proby i fizicheskoi nagruzki.

Nine normal subjects and 6 coronary patients (aged 26 to 53 years) who had survived myocardial infarction more than 3 years before and showed no clinical signs of heart failure, obesity, hypertension and diabetes mellitus, while having normal glucose tolerance test values, were exposed to the insulin test in combination with physical stress in the presence of clinically manifest hypoglycemia. Plasma and erythrocyte glucose and immunoreactive insulin, and urinary excretion of catecholamines were measured. Coronary patients showed considerably increased erythrocyte immunoreactive insulin levels, recorded immediately upon discontinuation of exercise, while their sympathoadrenal hormonal activation was less significant, as compared to normal subjects. The combination of the insulin test and exercise in coronary patients with normal glucose tolerance values helps to detect disturbances of regulatory mechanisms at the erythrocyte level and can be used as an adjuvant method for the assessment of latent carbohydrate metabolic disorders.

[Disorders in the status of the vessel-thrombocyte and plasma links of the hemostatic system in the pathogenesis of disseminated intravascular coagulation in ischemic heart disease]. / Znachenie narusheniia sostoianiia sosudisto-trombotsitarnogo i plazmennogo zven'ev sistemy gemostaza v patogeneze disseminirovannogo vnutrisosudistogo svertyvaniia krovi pri ishemicheskoi bolenzni serdtsa.

Platelet/vascular and plasma elements of hemostasis were investigated in normal subjects and coronary patients under stimulated emotional stress, following the assessment of vascular wall antithrombogenic properties on the basis of evidence from short-term local vascular ischemia (the cuff test). In normal subjects, vascular wall antithrombotic properties remained unchanged, providing a sufficient anticoagulant and thrombolytic support under emotional stress and thereby protecting the body against thrombosis. Coronary patients showed depressed vascular-wall antiaggregant, anticoagulant and fibrinolytic activity and latent disseminated intravascular microcoagulation that tended to progress under mental stress, creating a risk of intravascular thrombosis.

[Dynamics of cyclase systems and hormonal indices in patients with ischemic heart disease in a state of emotional stress]. / Dinamika tsiklaznykh sistem i gormonal'nykh pokazatelei u bol'nykh ischemicheskoi bolezn'iu serdtsa v sostoianii émotsional'nogo napriazheniia.

A total of 64 male patients with varying forms of coronary heart disease (CHD), aged 43 to 65 years, and free of diabetes mellitus, obesity and arterial hypertension symptoms, were studied in conditions of emotional stress simulated, using the method of mental calculations with shifts of attention under time shortage. Pre- and post-exercise blood levels of cyclic nucleotides (cAMP and cGMP), the somatotropic hormone and immunoreactive insulin were measured. Stress-induced decrease in platelet cAMP/cGMP ratios, indicative of further increase in the functional activity of platelets, was demonstrated in coronary patients with marked coronary atherosclerosis, as contrasted to normal subjects and patients with milder disease. They also showed a more considerable (sixfold) increase in the somatotropic hormone levels and a tendency to decreased levels of immunoreactive insulin under stress, apparently as a consequence of the prevailing activation of alpha-adrenoreceptor pathways.

[Interaction of adrenocorticotropic hormone, cortisol and insulin during emotional tension among ischemic heart disease patients]. / Vzaimodeistvie adrenokortikotropnogo gormona, kortizola i insulina pri émotsional'nom napriazhenii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Blood levels of the adenocorticotrophic hormone (ACTH), cortisol and insulin were measured in normal subjects and patients with different forms of coronary heart disease (CHD), aged 35 to 60 years and showing no signs of diabetes mellitus, obesity and arterial hypertension, under simulated emotional stress. The majority of the patients, particularly those with unfavorable course of the CHD, showed stress-induced disturbances of hormonal control due to depressed insulin levels in the presence of an insignificant ACTH increment and high cortisolemia. Hormonal rations were shown to be of predictive value in stress-exposed normal subjects and coronary patients alike.

[Hormonal regulation of the hemostasis system in patients with ischemic heart disease during emotional stress]. / O gormonal'noi reguliatsii sistemy gemostaza u bol'nykh ishemicheskoi bolezn'iu serdtsa v usloviiakh emotsional'nogo napriazheniia.

A total of 75 patients were examined, suffering from various forms of coronary heart disease (CHD) in conditions of emotional stress (ES). It was found that, as the blood anticoagulant activity and fibrinolysis are intensified in CHD patients in response to ES, the catecholamone effect on the blood coagulation inhibitors is decreased, the correlation between these parameters remaining high. In some patients decrease of the blood anticoagulant activity and fibrinolysis depression are observed in response to ES; decreased blood catecholamine concentrations were detected in the presence of high hydrocortisonemia, weakened hormonal effects, and emergence of negative correlation between these effects and the hemostatic system anticoagulant parameters, that evidences exhausted capacity of the anticoagulant system to defense activation.

[Effect of emotional tension on intravascular coagulation in patients with angiographically established ischemic heart disease]. / Vliianie émotsional'nogo napriazheniia ba vnutrisosudistuiu koaguliatsiiu u bol'nykh s angigraficheski podtverzhdennoi ishemicheskoi bolezn'iu serdtsa.

The effect of simulated emotional stress (ES) on the platelet/vascular and plasma components of the hemostatic system was examined in normal subjects and coronary patients. In coronary patients, prestress hemostatic platelet/vascular and plasma factors were disturbed, their blood showing a tendency to activated intravascular coagulation. Stress further increased the blood thrombogenic potential of coronary patients, causing intravascular coagulation as evidenced by declining cAMP/cHMP ratio, enhanced release of soluble fibrin and fibrinogen-fibrin degradation products (FDPs), and reduced antithrombin III.

[Changes in the hemostatic system and the progression of arteriosclerosis in ischemic heart disease patients]. / Izmeneniia sistemy gemostaza i progressirovanie ateroskleroza u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The effect of standardized mental stress on the hemostatic system was studied in 160 patients with coronary heart disease. The diagnosis of coronary atherosclerosis was documented by selective coronary angiographic findings. Emotional tension was modelled using the method of counting with interswitching in conditions of time deficit, irritating light and sound signals, as well as critical remarks about the work performed. According to the protective-adaptive activation of the anti-clotting system, the patients were divided into two groups: 1 with activation of heparin activity of the blood and fibrinolysis, 2 with depressed fibrinolysis and lowered blood heparin. Prior to the onset of the study the patients of both groups exhibited hypercoagulation as compared with the control group. The maximum degree of hypercoagulation was observed in the second group patients. Hypercoagulative changes both at rest and under stress were shown to depend on the degree of coronary artery damage.