[The method of replacement of defects in impression fractures of calcaneus. Porous NiTi or autotransplant?].

An experience with treatment of 149 patients with severe injuries of the ankle joint operated using constructions of titanium-nickelide and autotransplant from the iliac crest is presented. Porous NiTi being bio-inert to organism tissues, having high through porosity, the formation of consolidation of the fracture develops more rapidly. Application of porous NiTi allowed the period of disablement to be on an average 20 days shorter and long-term results to be reliably better.

Estudo multicêntrico comparativo de quatro diferentes tipos de sensores: atividade, acelerômetro, temperatura e período de pré-ejeçäo / Comparative study with different rate adaptive pacing systems

Recentemente diferentes princípios têm sido utilizado para estimular o coraçäo na tentativa de recuperar o débito cardíaco. Neste estudo multicêntrico, foram comparadas as respostas à estimulaçäo por 4 tipos de sensores, sendo 3 tipos de resposta de alça aberta (atividade física, acelerômetro e temperatura venosa central) implantados em 30 (SSIR-8 e DDDR-22), 9(SSIR-5 e DDDR-4) e 12 (SSIR) pacientes respectivamente. Um outro sensor do tipo alça fechada, sensível às variaçöes do sitema nervoso autôno, foi implantado em 57 pacientes, todos no modo DDDR. Os resultados obtidos durante a realizaçäo de atividade física diária, de teste ergométrico e de Holter de 24 horas foram comparados sendo possível observar uma maior fidelidade na curva de resposta de frequência frente a atividade física, nos pacientes submetidos à estimulaçäo de alça fechada

[Clinical experience with the first 100 operations to implant programmed electrocardiostimulators]. / Klinicheskii opyt pervykh 100 operatsii implantatsii programmiruemykh élektrokardiostimuliatorov.

The implantation of a home programmed device "ECS-500" was performed in 121 patients with different disturbances of the cardiac rhythm. Programmed ECSs were used in 103 patients with echocardiography and integral rheography. Seventy six patients were observed in terms from 2 months to 1.5 year. Optimum frequencies of electrostimulation (ES) were determined for different groups of patients. Lower frequencies of ES allowed to lessen manifestations of angina pectoris in patients with ischemic heart disease. Higher amplitude of the impulse prevented reoperations in 4 patients with "block of output" of electrodes. The experience allows "ECS-500" to be recommended for introduction into clinical practice.

[A case of a iatrogenic defect of the tricuspid valve caused by endocardial electrodes]. / Nabliudenie iatrogennogo poroka trekhstvorchatogo klapana, obuslovlennogo éndokardial'nymi élektrodami.

One case of a rare complication of the permanent heart electrostimulation is observed among many patients treated with such method for many years. A 77-year-old man having a permanent electrostimulation during 13 years because of a complete atrioventricular heart blockade, developed a defect of the tricuspid valve resulting from two endocardial electrodes. Narrowing of the right atrioventricular aperture and a severe dilatation of the right atrium worsened the circulation deficiency. More frequent use of various methods of the nonfunctioning endocardial electrode elimination is recommended. Transvenous destruction of the fibrous capsule at the end of endocardial electrodes is an efficient method developed by the authors for their elimination.

[Physiologic electrostimulation of the heart ventricles in disorders of atrioventricular conduction]. / Fiziologicheskaia elektrostimuliatsiia zheludochkov pri narusheniiakh atrioventrikuliarnogo provedeniia.

Thirty-two patients with disturbed atrioventricular conduction underwent operation for continuous P-wave electrostimulation (ES) with implantation of Soviet-made serial KC-320 apparatuses by the myocardial (28 patients) and endocardial (4 patients) methods. The patients were examined in postoperative periods of 3 to 15 months. Stable bio-controlled ES with a good clinical result was recorded in 29 patients, dislocation of the atrial endocardial electrode--in one patient; the development of frequent paroxysms of atrial flutter-fibrillation made it necessary to change the ES regimen. The authors' experience allows KC-320 to be recommended in wide clinical practice.

[Electric stimulation of the heart in disorders of atrio-ventricular conduction and paroxysmal supraventricular tachycardia in patients with sick sinus syndrome]. / Elektrostimuliatsiia serdtsa pri narusheniiakh atrio- ventrikuliarnogo provedeniia i paroksizma'lnykh nadzheludochkovykh takhiaritmiiakh u bo'lnykh s sindromom slabosti sinusovogo uzla.

Continuous atrial (73) or ventricular (77) electrostimulation, alone or combined with transvenous endocardial electrodestruction of the AV junction (24) was performed in 150 patients with sick sinus syndrome (SSS). Five-year follow-up of 148 patients identified groups of patients with impaired atrioventricular conductivity and bradytachy-arrhythmic SSS syndrome. Prolonged atrial electrostimulation is shown to be possible in cases of moderately impaired atrioventricular conductivity. Antiarrhythmic efficiency of atrial and ventricular electrostimulation was found to be insufficient for the prevention of atrial fibrillation paroxysms. It is concluded that transvenous electrodestruction of the atrioventricular junction in combination with ventricular electrostimulation is highly effective in cases of bradytachy-arrhythmic SSS syndrome. Surgical strategy is proposed for different types of the SSS syndrome.

[Pilot experience with implantations of 100 continuous atrial pacemakers in sick sinus syndrome: advances, problems, prospects]. / Opyt pervykh 100 operatsii postoiannoi élektrostimulatsii predserdii pri sindrome slabnosti sinusovogo uzla: Dostizheniia, problemy, perspektivy.

Long-term results of continuous atrial pacing were assessed in 100 patients with sick sinus syndrome followed up for 6 years. Implantation of the pacemaker was performed via extrapleural and extraperitoneal approaches using serial myocardial non-suture electrodes. Antiarrhythmic efficacy of atrial pacing was found insufficient. Continuous atrial pacing proved advantageous only in Wenckebach point at 100-120 per min.

[Use of myocardial electric stimulation for the treatment of cardiac rhythm disorders]. / Primenenie operatsii miokardial'noi élektrokardiostimuliatsii dlia lecheniia narushenii ritma serdtsa.

Under study were 3 kinds of national sutureless myocardial electrodes compared with sutured electrodes. Sutureless electrodes were simply and reliably implanted into the ventricles and right auricle of the heart, they had better biophysical properties than sutured electrodes. The application of sutureless electrodes and special elevator of the breast bone allows to decrease the duration and traumatism of operations of myocardial electrocardiostimulation, lethality can be reduced to 1%, the amount of hospital complications to 5%.

[Experience in using transesophageal electrocardiostimulation in emergency heart rhythm disorders]. / Opyt primeneniia chrespishchevodnoi élektrokardiostimuliatsii v urgentnoi kardioritmologii.

The paper is concerned with the results and analysis of transesophageal electrocardiostimulation in 383 patients before and in hospital over 6 years for urgent therapy of brady- and tachyarrhythmias. The method was assessed using a simple, recoverable and effective first aid element in combined resuscitation measures, in therapy of paroxysms of supraventricular tachycardia, in patients with the sinoatrial node weakness syndrome during cardioversion and narcosis, in primary and repeated pacemaker implantations, in acute myocardial infarctions complicated by bradyarrhythmias. Transesophageal electrocardiostimulation in urgent therapy of bradyarrhythmias, the sinoatrial node weakness syndrome, disorders of permanent electrocardiostimulation with fits of Morgagni-Adams-Stokes syndrome is an uncomplicated method of choice and a stage before temporary endocardial and permanent electrocardiostimulation.

[Clinical evaluation of continuous myocardial electrostimulation of the atria in the sick sinus syndrome]. / Klinicheskaia otsenka postoiannoi miokardial'noi élektrostimuliatsii predserdii pri sindrome slabosti sinusovogo uzla.

Forty-four patients with the syndrome of pacemaker weakness were subjected to the operation of the continuous electrostimulation of the right atrium from the infrasternal access using sutureless electrodes. Patients with grave attendant diseases were shown to benefit from this procedure. The use of Soviet commercially available sutureless electrodes makes it possible to considerably simplify the main stage of the operation and to ensure the reliable functioning of the biocontrolled cardiostimulators at the long-term postoperative period.