[Atrial fibrillation registered for the first time: characteristics of clinical course, treatment, prognosis].

To study the clinical presentation of the first episode of atrial fibrillation (AF), treatment tactics and its compliance with current recommendations, features of the further clinical course and prognosis in patients with AF we performed a retrospective study on data of Polyclinic No 1 of the General Management Department of the President of RF . We analyzed data from 58 patients (36 men, 22 women) from January 2009 to September 2011 inclusive. The first episode of AF was recorded in the age from 48 to 90 years (in 39.7% of patients - aged 80 to 90 years old), mostly had paroxysmal character (84.5%), in 82.1% of cases was accompanied by marked clinical symptoms: sense of disruption of the heart (50%), feeling short of breath (28.6%), weakness (17.9%). In 87% of cases clinical symptomatology required calls for medical emergencies. In 42.9% of cases uncontrolled hypertension was possible predisposing factor for developing AF. Paroxysmal AF moved to constant in 38.8% of patients during the period from 1 year to 18 years. Due to the high risk of thromboembolic complications (2 to 5 on a scale of CHADS2), after the detection AF warfarin was shown to 96.6% of patients, because of the high risk of bleeding in practice was appointed only 37.9%. Complications of therapy in the form of bleeding were 9.1%. Tactics of rhythm control by antiarrhythmic drugs I and III classes has remained in 36.7% of patients with paroxysmal AF. -adrenoblockers were constantly taken by 63.3% of the patients using antiarrhythmic drugs I and III classes for relief of arrhythmia during her recurrence (the strategy of "pill in pocket").

[Clinico-economical aspects of cardioversion of paroxysmal atrial fibrillation at phehospital stage and during hospitalization].

We carried out clinico-economical analysis of 2 tactics of rhythm restoration in patients with paroxysmal atrial fibrillation (AF) lasting less than 48 hours: cardioversion at prehospital stage with intravenous procainamide and inhospital cardioversion with any method. This retrospective study was based on the data from department of urgent aid of an outpatient clinic. The results showed that within 48 hours inhospital was a was more effective, safe, and more economically profitable compared with administration of procainamide at prehospital stage. Intravenous procainamide resulted in effective cardioversion in 70.6% of patients. It was associated with arterial hypotension and proarrhythmogenic action in 14,7% of cases. Patients with effective cardioversion with procainamide had lesser mean values of left ventricular anterior-posterior dimension (echocardiography) and shorter duration of arrhythmia.

[Analysis of causes of pulmonary artery embolism hypodiagnostics at prehospital stage].

Aim of the study was to analyze causes of pulmonary artery thromboembolism (PATE) hypodiagnostics at prehospital stage. We compared clinical and electrocardiographic picture of acute period of the disease in groups of patients with diagnosed (n=61) and undiagnosed (n=22) PATE at prehospital stage. We also assessed retrospectively probability of PATE according to Revised Geneva Score. In 49 cases we analyzed dynamics of the acute period of PATE. The analysis showed that in more than 50% of cases hypodiagnostics of PATE was caused by similarity of observed clinical and electrocardiographical picture and that of acute coronary syndrome. There were no differences between groups in Revised Geneva Score.

[Newly developed atrial fibrillation among patients under active observation by an outpatient clinic].

We carried out prospective cohort study of incidence of new cases of atrial fibrillation (AF) in a sample of Moscow population (patients under observation in our policlinic). Total incidence of AF between 2003 and 2009 was 7.7 per 1000 patient/years, it was higher among men than among women. Incidence of AF progressively increased with age reaching maximum in age group more or equal 85 years. Most frequent baseline disease in patients with first appearance of AF was hypertensive disease (71%). Ischemic heart disease diagnosed according to strict criteria (postinfarction cardiosclerosis, revascularization procedures) was registered in 20.1%, diabetes - in 15.7%, chronic heart failure - in 13%, valvular heart disease - in 5.6%, and history of acute ischemic stroke - in 2.5% of patients.

[Prevalence of atrial fibrillation among patients under observation by an outpatient clinic].

Prevalence of atrial fibrillation among patients attending our policlinic (2.44 and 3.78% in 2002 and 2009, respectively) was higher among men than among women and progressively increased with age achieving maximum in the group of patients aged more or equal 85 years. Paroxysmal and persistent forms were more frequent than permanent AF. Thromboembolic complications, heart failure and valvular heart disease were to a greater degree characteristic of permanent AF.

[Better quality of medical care in patients with trauma before hospitalization]. / O povyshenii kachestva meditsinskogo obespecheniia postradavshikh s travmoi na dogospital'nom étape.

The psychological stability of traveling emergency care teams was under consideration. Reasons affecting, essentially, the human factor under the conditions of time deficit are presented on the basis of an analysis of the experience of the Research Center for Emergency Medical Care as well as on the basis of published data. The acting model of the dispatcher's service, whose activity is targeted at implementing a set of appropriate measures ensuring an optimal decision in a complicated professional situation, is described. It is concluded that a higher quality of medical care before hospitalization demands a balanced approach towards the discussed issue, which should be based on a comprehensive analysis of the positive experience accumulated in other countries and on searching for the mechanisms of adaptation of such experience to the principles existing in Russia.

[Economic efficiency of computer monitoring of health]. / Ekonomicheskaia éffektivnost' komp'iuternogo monitoringa zdorov'ia.

Presents the method of computer monitoring of health, based on utilization of modern information technologies in public health. The method helps organize preventive activities of an outpatient clinic at a high level and essentially decrease the time and money loss. Efficiency of such preventive measures, increased number of computer and Internet users suggests that such methods are promising and further studies in this field are needed.

[The treatment and prevention of ischemic heart disease in stress states by using laser radiation and transcutaneous electric nerve stimulation]. / Lechenie i profilaktika ishemicheskoi bolezni serdtsa v stressovykh sostoianiiakh s pomoshch'iu lazernogo izlucheniia i chreskozhnoi élektroneirostimuliatsii.

An effectiveness of treatment and prevention of ischemic heart disease (IHD) using laser rays and transcutaneous electroneurostimulation (TENS) in 144 patients who underwent myocardial infarction and in whose clinical characteristics of a disease there prevailed chronic painful syndrome, was studied. An analgesic effect of TENS was achieved by an application of TENS to cardiac area and Zakharin-Head's zones. Low-intensity laser rays were applied for both irradiating projections of the heart and the large vessels and irradiating the biologically active points using unique procedure. All patients had a positive clinical effect resulted from applying laser and TENS which appeared as a decreased number of stenocardia attacks, an increased tolerance to exercise and as positive ECG dynamics. Duration of remission in the main group of patients exceeded the remission length in the control group in 2.7 times which is indicative of the effectiveness of using laser therapy and TENS as a tool of urgent medical aid under stresses induced by the development of life-threatening states. Small-size laser and TENS apparatuses are proposed for use as an onboard medical equipment.

[Rationale for using helium-neon laser in medical rehabilitation of patients with atrophy]. / Obosnovanie primeneniia gelii- neonovogo lazera v meditsinskoi reabilitatsii bolnykh s atrofiiami.

High resolution measurements of helium-neon laser spectra have been conducted about 0.64 mm wavelength. The singlet oxygen photo-generation was demonstrated to be responsible for the bioeffects of this spectral interval. Helium-neon radiation with 0.633 mm wavelength was used for medical rehabilitation of 15 patients with muscular atrophy as a result of wearing immobilizing plaster arm-bends on lower extremity fractures. 50-day hypokinesia of a damaged extremity induced differences in functional indices between damaged and healthy extremities in the same patient. This difference was diminishing more rapidly after laser therapy than in the control group though all patients had adequate rehabilitative treatment. Due to the likelihood of hypokinesia- and weightlessness-induced atrophies, helium-neon laser may be recommended for atrophy prophylaxis and treatment in both cases.

[S. S. Iudin's views on the problems of anesthesia]. / Vzgliady S. S. Iudina na voprosy obezbolivaniia.

The article expounds S. S. Yudin's views on problems of anesthesia in various periods of his surgical activity: ideas on the necessity of introducing modern multicomponent endotracheal anesthesia were expressed before the mid-forties. S. S. Yudin's experience in applying spinal anesthesia gave rise today to the wide use of epidural anesthesia.

[Use of fibrinolysis blood in patients with acute surgical diseases and injuries]. / Primenenie fibrinoliznoi krovi u bol'nykh s ostrymi khirurgicheskimi zabolevaniiami i travmami.

S. S. Yudin paid much attention to the use of cadaveric blood in urgent medicine. While transfusing large amounts of blood (2-3 1) for pre- and intraoperative correction of hypovolemia, the danger of isoimmune reaction is reduced. Blood circulation measurement fluctuations while using both cadaveric and donor's blood are similar. However, the use of cadaveric blood helps correct hypercoagulation caused by some anesthetics. Cadaveric blood can be substituted for donor's blood. Besides, large amounts of cadaveric blood can be used from the same donor, which provides economic effectiveness.

[The effect of hypothermia and oxygenation on the cardiorespiratory system in man exposed to experimental weightlessness]. / Vliianie okhlazhdeniia i oksigenatsii na kardiorespiratornuiu sistemu cheloveka, nakhodiashchegosia v usloviiakh vozdeistviia faktorov modelirovannoi nevesomosti.

It has been established that hypothermia in experimental weightlessness, as compared to normal conditions, was characterized by a considerably smaller deficit of erythrocytes in the energy balance and reduced gas exchange level, despite unidirectional changes in hemodynamic parameters. Unlike in hypothermia, an increase in oxygen concentration in the inhaled gas mixture had no noticeable effect on the parameters of the cardiorespiratory system studied.

[Metabolic changes in simulated weightlessness]. / Izmeneniia metabolizma pri modelirovannoi nevesomosti.

8 healthy subjects participated in 2 series of experiments on the comparative studies of two techniques of respiratory therapy employing multicomponent anesthesia during controlled lung ventilation in normal conditions and in experimental weightlessness. It has been established that experimental weightlessness, as compared to normal conditions of controlled lung ventilation, was more favourable for the maintenance of effective energy exchange in erythrocytes and tissue O2 consumption. Both techniques of respiratory therapy during controlled lung ventilation are recommended in these conditions.