[The complicated intestinal amebiasis in emergency surgery].

18 patients with complicated forms of intestinal amebiasis were operated on acute appendicitis, liver abscess or total necrotic colitis. Appendectomy, abscess drainage and colon resection were performed respectively. There were no postoperative deaths. Features of amebic appendicitis and total necrotic amebic colitis are described using clinical cases demonstrations. Recommendations for the treatment of these forms of amebiasis are given.

[Thrombogenic properties of the inner vascular surface following laser exposure]. / Trombogennye svoistva vnutrennei poverkhnosti sosuda posle lazernogovozdeistviia.

Laser angioplasty, using YAG-neodymium laser and a balloon catheter with monofiber quartz light guide (400 micron), introduced into its central canal, was performed in 8 dogs with thromboses of 11 femoral or carotid arteries. Average energy expenditure for recanalization was 26 +/- 4 J, with 4.9 +/- 0.3 W and exposure time of 5.1 +/- 0.7 s. Re-thrombosis developed after 5 to 10 days in all arteries, left in the circulation network after laser angioplasty. The latter part of the study is dealing with the assessment of the surface of femoral or carotid arteries of the dogs after laser exposure. This was done by quantitation of the adhered platelets after platelet-enriched plasma was circulated through vessels, whose inner surface was 1) intact, 2) de-endothelized, or 3) laser-damaged, using a scanning electron microscope. The thrombogenic index was 65-96, 85 and 66%, respectively, for the YAG-neodymium, argon and eximeric (XeCl) lasers.

Value of electrocardiography and echocardiography for diagnosing ventricular enlargement in dilated cardiomyopathy.

A comparison is made of the informative value of ECG voltage criteria, echocardiographic signs (90 cases) and autopsy findings (38 cases) for diagnosing heart enlargement in dilated cardiomyopathy. Besides enlargement of both ventricles there can also occur predominant enlargement of the left or right ventricle. Echocardiographic signs of the ventricular dimensions correlate closely with the ventricular mass established by separate weighing at autopsy. 65.5% of the patients presented one or several ECG voltage signs of myocardial hypertrophy. Comparison of the results of instrumental examination with autopsy findings showed that EchoCG and ECG have a sufficiently high informative value in assessing the degree of left ventricular enlargement; however, their sensitivity is smaller in enlargement of the right ventricle.

[Congestive cardiomyopathy (pathologo-anatomic study of the heart)]. / Zastoinaia kardiomiopatiia (patologoanatomicheskoe issledovanie serdtsa).

A pathomorphologic study of 40 cases of congestive cardiomyopathy (CCMP) demonstrated that circulatory insufficiency was the cause of death in 70% of cases, while sudden death occurred in 25%. Morphometric investigation identified 3 CCMP patterns: cardiosclerosis-free and accompanied with small-focal (diffuse) and large-focal cardiosclerosis. The mean duration of the disease and the mean age at death were the smallest in the cardiosclerosis-free group where the dilatation of heart cavities was found to be the greatest. A direct relationship was demonstrated between the duration of the disease and the myocardial fibrous tissue content. Blood flow deceleration due to circulatory insufficiency in CCMP cases was shown to be conducive to thrombogenesis both in heart cavities, and in minor pulmonary arteries and myocardial veins.

[Atherosclerotic stenosis of the coronary arteries and contraction lesions of the myocardium in sudden coronary death]. / Ateroskleroticheskii stenoz koronarnykh arterii i kontrakturnye povrezhdeniia miokarda pri vnezapnoi koronarnoi smerti.

Hearts of 50 patients (males of 30 to 54 years) after sudden cardiac death (SCD) without myocardial infarction, acute or recorded in the past, were studied. Heart slides were stained with an iron hematoxylin; polarizing microscopy was also used. The surface of cardiomyocytes diffusely stained with an iron hematoxylin was determined in histological slides by means of a 100-points ocular mesh. Essential differences in the spread of contractural myocardial lesions were found, this likely to be bound with different mechanisms of death (ventricular fibrillation, asystole). A low degree of spread of these lesions was noted more frequently in grave stenoses (greater than 75%) of coronary arteries. A direct correlation between the spread of contractural lesions and renin activity in plasma is found.

[Electrocardiographic methods in the diagnosis of focal cicatricial lesions of the myocardium in dilated cardiomyopathy]. / Elektrokardiograficheskii metod v diagnostike ochagovo-rubtsovykh porazhenii miokarda pri dilatatsionnoi kardiomiopatii.

The authors compare the pathomorphological and electrocardiographic data in 38 cases of dilated cardiomyopathy. Autopsy revealed the signs of myocardial hypertrophy associated with dilatation, myocardial fibrosis of varying degree was found despite otherwise normal coronary arteries. Myocardial fibrosis influences the ECG changes, thus reducing the informative value of the method in the diagnosis of myocardial hypertrophy and often causes abnormalities of intraventricular conduction as well as focal-cicatricial myocardial lesions.

[Cardiogenic shock and sudden cardiac death]. / Kardiogennyi shok i vnezapnaia serdechnaia smert'.

The study of 148 cases of sudden cardiac death revealed in 25 (17%) of them morphological signs of cardiogenic shock characterized by severe microcirculatory disorders: uneven blood-filling of the vessels of the microcirculatory bed and increasing number of nonfunctioning capillaries in the myocardium and hypothalamus; signs of juxtamedullar shunting in the kidneys and the development of sludge phenomenon in different parts of their microcirculatory bed combined with high activity of renin in the plasma. The signs of cardiogenic shock in the group of observations of sudden cardiac death were noted predominantly in the presence of myocardial infarction, large foci of ischemia in the heart or multiple scattered foci of cardiomyocyte damage. Cardiogenic shock was found to occur in sharp reduction of the density of adrenergic nerve structures in the myocardium.

[Morphology of fibromuscular dysplasia of the renal arteries]. / Morfologiia fibrozno-myshechnoi displazii pochechnykh arterii.

Fibromuscular dysplasis of the renal arteries was revealed in 35 patients with renovascular hypertension. Histological examination revealed the following forms of this lesion: fibroplasia of the intima, hyperplasia and fibroplasia of the media, subadventitial fibrosis, as well as their combination. It was found that not only the main branch of the renal artery but also the small intrarenal branches are affected. A decrease of the elastic elements in the middle layer and degenerative changes of various degree in the inner elastic membrane were noted in the wall of the involved artery. This was attended with fibrosis of the intima and disorder of the shape and orientation of the smooth-muscle cells. It is presumed that a local defect in the elastic framework of the artery forms the basis of fibromuscular dysplasia, while the fibrous changes in the vascular wall are evidently secondary and may be associated with the increased synthetic activity of the smooth-muscle cells.

[Morphogenesis of fibromuscular dysplasia of the renal arteries (an ultrastructural study)]. / O morfogeneze fibrozno-myshechnoi displazii pochechnykh arterii (ul'trastrukturnoe issledovanie).

Ultrastructural examinations of 32 cases of various forms of fibrousmuscular dysplasia (FMD) of renal arteries showed the lesions at the subcellular level to be identical in all these forms and to differ only in their intensity and localization. As the disease progresses, smooth muscle cells (SMC) show signs of activation accompanied by an increased collagen synthesis. In this, the cells exhibit large multiblade nuclei, intensive proliferation of the granular endoplasmic reticulum, hypertrophy of the Golgi complex. In cases of intensive fibrous changes, occasional fibroblasts appear in the arterial media. As collagen accumulates in intercellular spaces, signs of involution of various degrees are found in SMC. The number of elastic fibers in the media of the affected arteries decreases markedly as compared with the control. The inner elastic membrane of the arteries is frequently destroyed, particularly in the intimal form of the lesions. The study suggests that all forms of FMD represent a single process in the morphogenesis of which the leading role is played by fibroblast-like transformation of SMC.