Fragmented QRS as a marker of coronary atherosclerosis severity evaluated by the Gensini score.

BACKGROUND: QRS fragmentation (fQRS) represents a marker of local myocardial fibrosis, especially in patients with CAD (coronary artery disease). However, little is known about the association between fQRS and the severity of coronary atherosclerosis as defined by the Gensini score. OBJECTIVE: To identify the angiographic and echocardiographic characteristics of patients with suspected CAD depending on the location and extent of fQRS. METHODS: A total of 178 patients who underwent coronary angiography were included in the study. fQRS was defined as the presence of RSR' and/or notching of the R/S wave (if QRS<120ms) or≥2 notches of the R/S wave (if QRS≥120ms). All patients were divided into three groups: non-fQRS; fQRS in 1-2 and≥3 leads. RESULTS: Statistically significant differences in the LVEF (left ventricular ejection fraction, P=0.009) and the degree of coronary atherosclerosis severity (P=0.008) were found among 3 groups. The median Gensini score was 7 in non-fQRS group (minimal CAD) and >20 in other groups (severe CAD). Both the anterior and lateral fQRS groups had a lower LVEF compared to no fQRS (P=0.039 and P=0.01, respectively). The median Gensini score was significantly higher in case of the lateral fQRS (P=0.037). fQRS in≥1 lead was associated with coronary occlusion (OR 2.1, 95% CI: 1.1-4.1, P=0.038). CONCLUSIONS: The presence of fQRS, particularly in lateral leads, can be a useful noninvasive marker of severe coronary atherosclerosis. Patients with≥1 fragmented lead have a lower LVEF, a higher Gensini score and a two-fold increased risk of occlusion.

[Radical cystectomy: therapeutic aspects of preoperative and early postoperative management].

AIM: to improve the results of radical cystectomy by optimization of patient preparation for surgery and early postoperative care. MATERIALS AND METHODS: A total of 136 patients who underwent radical cystectomy and either orthotopic ileal neobladder or ileal conduit formation were included in the study. Brikkers operation was performed in 92 patients (76% men and 24% women) aged from 39 to 83 years, while in 44 patients (97.7% men, 2.3% women) aged from 32 to 75 years the Studer ileal neobladder was created. All patients underwent preoperative comprehensive examinations in order to determine type and extent of surgical treatment. RESULTS: A complication rate after radical cystectomy with urine derivation using bowel segment was 49.2%. Mortality rate in early postoperative period was 3.9%. CONCLUSION: An algorithm of postoperative care after radical cystectomy with formation of either orthotopic neobladder or ileal conduit and consideration of comorbid status and preparation which we have used in clinical practice was developed. According to the results, after implementation of algorithm of management in preoperative and early postoperative period a decrease in complications and mortality rate has been found.

[Galactin-3: diagnostic and prognostic value in patients with chronic heart failure].

Now there is a relevant development of the new biomarkers capable to serve as the instrument of early diagnostics of a disease for the purpose of selection of a pharmacotherapy and further monitoring of its efficiency. Galektin-3 is the atypical representative of the family of galektin. Its participation in fibrosis, remodeling of heart, the immunologic answer and inflammatory reactions are shown. Prognostic value is discussed and diagnostic opportunities of Galektin-3 at CHF are widely studied and take root into clinical practice. Now a great deal of research devoted to the studying of Galektin-3, possibilities of its use as a biomarker at diagnostics, forecasting of outcomes and the choice of therapeutic strategy at other cardiovascular diseases has been conducted.

[Diagnostic and curative bronchoscopy for purulent-destructive pulmonary diseases]. / Diagnosticheskaia i lechebnaia bronkhoskopiia u patsientov s gnoino-destruktivnymi zabolevaniiami legkikh.

AIM: To assess an efficacy of diagnostic and curative bronchoscopy in patients with purulent-destructive pulmonary diseases. MATERIAL AND METHODS: Diagnosis and treatment of 34 patients with purulent-destructive pulmonary diseases including small-focal destruction (14) and lung abscesses (19) were analyzed. 33 patients underwent diagnostic fibrobronchoscopy (FBS) with brush and transbronchial biopsy. Curative endoscopy included bronchial tree sanation, peribronchial administration of antibiotics (5) and transbronchial drainage of abscess (14). RESULTS: Atrophic bronchitis and cicatricial deformity of the 2-3rd segmental bronchi were revealed in 81.8% and 15.2% respectively. Transbronchial biopsy confirmed malignant neoplasms (15.2%) and pulmonary tuberculosis (6.1%). Peribronchial administration of amikacin in patients with small-focal pulmonary destruction and transbronchial drainage of abscesses accelerated pulmonary tissue repair and complete recovery. CONCLUSION: Transbronchial biopsy in patients with destructive pulmonary diseases verifies pathological process and excludes malignant and specific pulmonary damage. Complex use of endoscopic methods is associated with positive clinical result in all patients with pulmonary destruction.

[Evolution of complex treatment of patients with non-specific pleural empyema]. / Évoliutsiia metodov kompleksnogo lecheniia bol'nykh s nespetsificheskoi émpiemoi plevry.

AIM: To analyze long-term own experience of NPE treatment in view of evolution of surgical sanitation of pleural cavity. MATERIAL AND METHODS: The analysis included 5115 patients with NPE for the last 39 years (1977-2015). Morbidity, features of microflora of purulent exudate, changes in the structure of surgical methods were assessed. The role of computed tomography in the diagnostic algorithm and treatment of NPE was studied. RESULTS: The evolution of NPE surgical management includes introduction of video technologies, thermal surgical instruments and widespread use of computed tomography in the diagnosis of pleural empyema. So, significant reduction of patients who were discharged with residual cavities was observed. Postoperative mortality was 19.5% for the period 1977-1996 when traumatic open surgery was used. At the same time there were no deaths within 1997-2015 due to introduction of VATS pleural drainage. Overall mortality decreased from 4.9% to 3.2% for the same period due to reduced postoperative complications. CONCLUSION: The introduction of minimally invasive technologies, new thermal surgical instruments changed management of NPE patients, reduced the number of traumatic open procedures. So, improved outcomes were achieved.

[Surgical and combined correction of tracheal and laryngotracheal cicatricial stenosis and restenosis]. / Lechenie trakheal'nykh i laringotrakheal'nykh rubtsovykh stenozov i restenozov.

AIM: To improve treatment of patients with cicatricial tracheal stenosis using different methods of recanalization and circular resection. MATERIAL AND METHODS: Analysis involved 57 patients with cicatricial tracheal stenosis including 2 post-traumatic cases, 27 post-intubation cases, 25 cases after tracheostomy and 3 restenoses after previous circular resection. There were 5 cases of tracheal stenosis combined with tracheoesophageal fistula, 1 patient with chest nodular goiter, 8 cases of unclosed tracheostomy and 3 patients with long-existing laryngotracheal fissure. There were 25 women and 32 men aged 15-65 years. Stenosis length ranged from 3.0 to 4.5 cm in 66.6% of patients. There were 13 (22.8%) patients with subcompensated stenosis (d=0.5-0.7 cm) and 44 (77.2%) cases of decompensated stenosis (d<0.5 cm) combined with suppurative tracheobronchitis that required endosurgical recanalization with stenting or balloon dilatation. 45 patients underwent upper tracheal third resection, 9 - middle third resection, 3 - upper third and cricoid cartilage resection. Length of excised segment was 2.5-9.5 cm. Simultaneous suturing of esophageal anterior wall defect was performed in 5 cases. RESULTS: Complete recovery of tracheal lumen was achieved in 54 patients (93%). Restenosis occurred in 4 (7%) cases (3 of them underwent repeated resection with good results and 1 - stenting). CONCLUSION: Circular resection is optimal treatment of cicatricial tracheal stenosis. Endosurgical recanalization is preparatory method prior to radical surgery.

Anti-inflammatory effects of simvastatin in patients with chronic heart failure.

Proinflammatory markers were evaluated in patients with chronic heart failure of ischemic origin and essential hypertension with preserved left-ventricular ejection fraction before and after a 6-month course of simvastatin therapy (20 mg/day). The study was carried out in 125 patients with diastolic dysfunction manifested as impaired relaxation and pseudonormalization. The main group received standard therapy for chronic heart failure and simvastatin, controls received only standard therapy. In addition, the results in the main group were compared in patients with different types of left-ventricular diastolic dysfunction. Simvastatin therapy significantly reduced the levels of C-reactive protein and IL-6.

[The combined endoscopic hemostasis in case of gastroduodenal ulcerative bleeding].

It was done the retrospective analysis of the endoscopic hemostasis effectiveness in 207 patients with gastroduodenal bleeding in the period from November 2011 to April 2013. The differential approach to the choice of hemostasis methods and consistency of their application were developed. It was done the comparative analysis of two- and three-stages combined hemostasis results. The analysis included the infiltration of the submucosal layer by 0.01% solution of adrenaline, argon-plasma coagulation and hemostatic glue applique.

[The effectiveness of the valve bronchial occlusion in case of bronchopleural fistulas].

The experience of endobronchial valve «Medlung" installation in 24 patients with bronchopleural fistula was summarized in the article. In 18 (75%) patients the cause of bronchopleural fistula was purulent - destructive processes in the lungs, including the associated trauma in 4 (22.2%) patients, pneumonia in 14 (77.8%) patients. In 3 (12.5%) cases the cause of the bronchopleural fistula was the lung tumors of different localization and in 3 (12.5%) cases - idiopathic pulmonary fibrosis. Reasonable use of endobronchial valve in patients with bronchopleural fistula provides a persistent separation of the fistula and lets to avoid extensive, traumatic operations.

[Endoscopic diagnosis, treatment and prevention of intubation related injuries of the larynx and trachea in neurosurgical patients].

The goal of the study was to assess of efficacy of endoscopic diagnosis, prevention and treatment of intubation related larynx and tracheal injuries in patients with acute neurosurgical pathology and prolonged mechanical ventilation. 199 patients with different neurosurgical pathology were enrolled in the study group. Mean age was 50 +/- 14. Control group consisted of 399 patient. Mean age was 43 +/- 12. Clinical state of patient from both group were similar. Endoscopic method in the study group included revision of airways via nasal route with tracheostomy tube inserted. Larynx and tracheal injuries by endoscopy were identified in 42 patients (33.6%) in the study group and in 12 patients (7.6) in the control group. Such injuries weren't mentioned in 83 patients in study group and in 146 patients of the control group. Tracheal stenosis was developed in the study group in 0,8% of patients, which is by 7,9 times lower than in the control group (6.3%). We consider that this result was achieved due to our approach to treatment and prevention of tracheal stenosis.

[Emergency fiberoptic bronchoscopy for diagnostics and treatment of lung atelectasis].

The article deals with results of fiberoptic bronchoscopy using during treating of patients suffering atelectasis. According to the research atelectasis is likely to advance in the first three days after serious patients have been admitted to the intensive therapy unit or after operative treatment. Left-sided atelectasis is half as widespread again the right-sided one. The research highlights the effectiveness of atelectasis X-ray diagnosis. Fiberoptic bronchoscopy in almost all the cases allowed diagnosing the degree of tracheobronchial tree obstruction and its causes. Single suction fiberoptic bronchoscopy leads to normalization and encouraged positive dynamics in 76% of all the cases (57 patients). Repeated endoscopic sanation in the first two days was necessary for 25 patients (25.3%) with unresolved or reoccurring atelectasis. The effectiveness of second research was to 84%. It's important to add that mostly patients with serious chest injury were subjected to unresolved or reoccurring atelectasis. And mainly in these cases blood was seen through the tracheobronchial tree lumen.

[Endoscopic treatment of chemical burns to the stomach with mucosa ulceration and necrosis].

The prevalence of acute poisoning with caustic substances in Russia is higher than in other countries and is reported by different authors as accounting for 10-32% cases among the patients admitted to acute poisoning treatment centres. Especially unfavorable prognosis is considered for necrotizing burns to the stomach that increase the risk of severe complications leading to disability of patients. The study aimed at improving the treatment of necrotizing chemical burn to the stomach by the infusion of a 5% Mexidole solution into the edges of a burn lesion at different stages of the treatment course. The paper presents the outcomes of patients who sustained chemical burns to the stomach with mucosa ulceration and necrosis, and provides an assessment of early endoscopic treatment effect.

[The single-stage surgical treatment of the complicated colon cancer].

The results of the single-stage surgical treatment of 54 patients with the complicated forms of colon cancer were analyzed. All patients had radical operations with the formation of primary intestinal anastomosis. For the improvement of the results we have optimized the algorithm of the diagnostics and treatment of such patients, including the endoscopic colon decompression with its recanalization and colic stasis liquidation. The approach to the colon cancer, complicated with the intestinal bleeding was also optimized by the use of intensive hemostatic and substitutional therapy. The optimal use of the described above methods allowed the single-stage radical endosurgical treatment of the patients.

[Endoscopy for gastrointestinal bleeding in patients with pelvic and leg bones trauma].

The results of 36 endoscopic procedures performed because of clinical signs of the gastrointestinal bleeding to the patients, hospitalized with traumatic fractures of pelvis and lower limbs, were analyzed. The acquired data allowed to reveal the terms of bleeding development and the efficacy of the endoscopic hemostasis, as well as substantiate the need of antisecretory treatment for the curtain age category of patients.

[Endoscopic hemostasis in patients with portal hypertension tumor genesis].

AIM OF THE STUDY: to assess the results of using endoscopic techniques to achieve hemostasis for the control of bleeding and the prevention of recurrent bleeding from esophageal and gastric varices in the patients with primary liver cancer and metastatic liver lesions. MATERIALS AND METHODS: in the period of 2009-2011,7 patients with primary liver cancer or metastatic liver lesions complicated by gastro-esophageal bleeding were treated in the Sklifosovsky Clinical and Research Institute for Emergency Medicine. The sources of bleeding were esophageal varices in 6 patients, gastric varices in 1. RESULTS: a diagnostic esophagogastroduodenoscopy (EGDS) revealed, besides the varices, an erosive hemorrhagic gastritis in 4 patients, a ruptured mucosa of cardio-esophageal transition in 1, an erosive hemorrhagic gastritis and a liver tumour invasion in the stomach antrum in 1. The hemostasis achieved by means of paravasal injections with a 20% glucose solution was efficient in 2 of 3 patients. The endoscopic ligations of esophageal varices were performed in 3 patients. Five patients died from the underlying disease progressing. In one of them, the cause of death was a recurrent bleeding from esophageal varices. CONCLUSIONS: in the patients with primary liver cancer and metastatic liver lesions, the use of mini-invasive endoscopic techniques is more appropriate, because the surgical treatment of this patient population carries a very high risk.

[Diagnostics and treatment of pulmonary hemorrhage by the closed thoracic trauma].

Results of diagnostic and treatment of 156 patients with pulmonary hemorrhage, caused by the closed thoracic trauma, were analyzed. All patients had lung bruise, 101 of them had lung rupture. 115 (73.7%) patients demonstrated hemopneumothorax, bleeding was diagnosed in 86 (55.1%) cases and mediastinal emphysema was diagnosed in 52 (33.3%). Pulmonary hemorrhage developed more often by polytrauma of the chest, rather then by solitary lesions. Spiral computed tomography proved to be the best diagnostic means of thoracic trauma. Surgical tactics was defined mainly by the severity of intrapleural or pulmonary bleeding. Conservative treatment allowed successful recovery in the majority of patients. Only 5.1% of patients required surgery. High level of septic complications of pulmonary hemorrhage was registered/ Pneumonia developed in 28.8% and lung abscess was diagnosed in 14.1% of patients. The lethality rate was 9.6%.

[Characteristics of motility function of the esophagus in patients with aphagia].

In article is shown the results of investigation of motility function of esophagus in 18 patients with pharyngoesophageal obstruction. 16 patients were operated. The essence of method was in simultaneous registration of UES intracavitary pressure and impedance. We discovered that all patients have both not opening of for the swallow and disturbances of sphincteral function of LES and contractive activity of thoracic esophagus. Dynamic of this parameters in 7 operated patients was monitored. Obtained data were analyzed according to clinical results of surgery.

[Diagnostics and surgical treatment of pharyngoesophageal impassability].

Data of 29 patients with pharyngoesophageal impassability are analyzed. The condition was a result of a stroke in 89,6% of patients. Radiographic contrast pharyngo- and esophagoscopy (n=29), video X-ray of the swallowing act (n=20), esophagogastroduodenoscopy (n=29) and pharyngoesophagomanometry (n=18) were performed as diagnostic measures. The basal tone of the upper esophageal sphincter was high in 10 patients and decreased in 8. 25 patients were operated on: Chodosh cricopharyngeal myotomy was performed in 7 patients, 18 standed the pharyngoesophageal plasty with inferior constrictor muscle of pharynx's fibers shift after the original method. Follow-up was carried out from 1 month to 2 years. Superb and good results were achieved in 42,7% patients after cricopharyngeal myotomy and in 77,8% patients after the pharyngoesophageal plasty.