[Extra-anatomical bypass grafting from the ascending to the descending aorta combined with removal of the thoracic-aorta stent graft and a para-aortic abscess following endoscopic repair of the descending portion of the thoracic aorta].

The outcomes of reconstructive repair operations for aneurysms of the descending portion of the thoracic aorta typically appear to be relatively satisfactory. However, a certain cohort of patients presenting with the pathology concerned require repeated secondary interventions due to the development of false aneurysms in the area of the anastomosis and infection of the synthetic vascular stent graft, with the number of such patients steadily increasing with each year. The authors describe herein a clinical case report regarding successful treatment of a patient diagnosed with an infected pseudoaneurysm of the descending portion of the thoracic aorta after an endovascular repair operation. This case report demonstrated a present-day approach to appropriate treatment of patients presenting with the pathology involved.

Orientation sensitive properties of visually driven neurons in extrastriate area 21a of cat cortex.

Orientation sensitive properties of extrastriate area 21a neurons were investigated. Special attention was paid to the qualitative characteristics of neuron responses to the different orientations of visual stimulus motion across neuron classical receptive fields (CRF). The results of experiments have shown that a group of neurons (31%) in area 21a with specialized responses to moving visual stimuli changed their direction selective (DS) characteristics depending on the orientation of the stimulus movement. Some neurons reveal an abrupt drop of the direction sensitivity index (DI) to certain orientation (58%), and some show significant increase of DI at one of applied orientations of stimulus motion (22%). Detailed investigation of response patterns of non-directional neurons to different orientations of stimulus motion have revealed clear-cut qualitative differences, such as different regularities in the distribution of inter-peak inhibitory intervals in the response pattern in dependence of the orientation of stimulus motion. The investigation of neuron CRF stationary functional organization did not reveal correlations between RF's spatial functional organization, and that of qualitative modulations of neuron response patterns. A suggestion was put forward, that visual information central processing of orientation discrimination is a complex integrative process that includes quantitative as well as qualitative transformations of neuron activity.

[An analysis of hospital mortality of casualties with combined cerebro-cranial traumas in St. Petersburg and problems of the quality of medical care].

Clinico-statistical characterization of 661 subjects who died from combined cerebro-cranial traumas in hospitals of St. Petersburg in 2004 is presented with an analysis of the quality of medical care rendered to them. Most of those subjects had severe combined injuries with dominating or markedly seen signs of combined cerebro-cranial traumas. The main cause of death was most frequently a severe combined trauma of the body (52%) and different complications of trauma disease (36.3%). In the process of complex expert assessment of the quality of medical care each case was referred to one of three categories of outcomes: avoidable, conventionally avoidable and unavoidable. The groups of subjects with avoidable and conventionally avoidable outcomes (53.6%) are considered to be a substantial reserve for improvement of the results of treatment of combined cerebro-cranial traumas.

Spatial summation processes in the receptive fields of visually driven neurons of the cat's cortical area 21a.

The spatial summation in receptive fields (RF) of single neurons in cat's extrastriate area 21a was investigated as a basic neurophysiological substrate for central integration processing of visual information. The results showed that the majority of investigated neurons changed their response patterns with gradual increase of applied stimulus size. In approximately 82% of cases the suppression of neuron discharges was observed when the length of the moving strip exceeded that of the RF. In some neurons the increased size of the moving stimulus leads to the changes in the RF substructure. Receptive fields of neurons recorded at the same microelectrode penetration depth showed a great variety of RF superpositions distributed in a spatially asymmetric manner. As a result, every single RF consists of multiple sub-regions within the RF, differing from each other by the number of superimposed RF-s (density factor). We suggest that such complex spatial organization of the RF provides the neurophysiological basis for central integration processing of the visual information.

[Comparative analysis of spontaneous unit activity of the cerebellum fastigial nucleus' neurons in different periods of vibration influence].

In conditions of acute experiment on white rats anaesthetized with Nembutal (40 mg/kg, interperitonially) recording and analysis of spontaneous impulse activity of the fastigial nucleus' neurons in norm and after 5, 10 and 15 days of vibration influence on the organism were carried out. Distribution of the neurons was evaluated by the dynamics of neuronal current flow and the modality of the interspike interval hystograms, as well as the statistical parameters: the average discharge frequency and the coefficient of the interspike interval variation. It is shown that more significant changes in neuronal activity of fastigial nucleus cells are formed during the first 10 days of vibration influence. On the 15th day, there was a tendency towards return to control levels of the parameters under study.

[The effects of influence of electromagnetic irradiation of millimeter wavelength on background impulse activity of supraoptic nucleus' neurons of rats' hypothalamus].

In conditions of acute experiment on white rats anaesthetized by Nembutal (40 mg/kg, intraperitoneally), the registration and analysis of background impulse activity of the supraoptic nucleus neurons of rats' hypothalamus in norm and after electromagnetic irradiation of millimeter wavelength on organism, were carried out. Distributions of neurons by the degree of rhythm regularity, the character of types of dynamics of the following impulse flows, the modality of histograms of interspike intervals, the average discharge frequency, the coefficient of interspike intervals variation, were found out. Changes of the background impulse activity which were related mainly to the changes of the inner structure of registered impulse flows, were revealed. Significant shifts were generally observed in the character of dynamics of neuronal current flows and degree of regularity of the impulse activity. Statistically significant changes of the average frequency of discharges of different frequency range neurons' populations were revealed.

[Complement componenets, C3 and factors B, in the blood of patients with acute ischemic stroke].

Several studies suggest that activation of compliment cascade contributes to the development of the inflammatory immune response in ischemic stroke and results in tissue injury by initiating apoptosis and necrosis. It is proposed that suppression of the compliment activation may have positive effect on stroke severity and outcome. However, the majority of data relevant to involvement of the compliment in the pathogenethic mechanisms of stroke have been obtained in animal models of stroke that does not allow to extrapolate these data to humans. Our previous studies were the first ones demonstrated the involvement of both the classical and the alternative complement activation pathways in the pathogenetic mechanisms of generation and development of stroke in humans. In the present work, using immunoblotting, we determined the levels of key components of the classical and alternative pathways of complement activation, C3 and factor B, in the blood of patients with ischemic stroke. Comparing to healthy controls, patients with ischemic stroke are characterized by the increased level of C3 and decreased level of factor B.

Results of myocardial revascularization by two internal thoracic arteries using a Y-shaped conduit.

MATERIAL AND METHODS: Between August 2002 and September 2004, 276 patients with coronary artery disease underwent surgical treatment using a Y-shaped conduit formed from two internal thoracic arteries (ITA). In 268 (97.1%) patients, myocardial revascularization required exclusively bi-mammary bypass grafting. In creation of the Y-shaped conduit in the capacity of a free transplant, the intercepted right ITA was connected to the left internal thoracic artery (LITA). In the remaining 7 (2.5%) patients, venous bypasses together with the internal thoracic arteries were employed: in one patient (0.36%), the radial artery was used. RESULTS: Three patients (1.08%) died after operation. The survival rate accounted for 98.4%. CONCLUSION: The use of two internal thoracic arteries for complete myocardial revascularization provided beneficial results in the short- and long-term postoperative periods.

[Influence of mental and emotional stress on the levels of electrolytes in the saliva of senior schoolchildren]. / Vliianie umstvenno-émotsial'nogo napriazheniia na soderzhanie élektrolitov v sliune starsheklassnikov.

Salivary Na+,K+-excretory function was studied in senior schoolchildren-entrants during an academic year and entrance examinations. The time course of changes in the salivary levels of Na+ and K+ in entrants during an academic year was undulating. In late October that is coincident with the beginning of lessons given by tutors, the salivary content of Na+ reduced while that of K+ increased. The second peak of decreased excretion rates for Na+ and increased excretion rates for K+ and that of less Na+/K+ ratios was observed in May on the eve of entrance examinations. On the eve of the examinations, 70% were observed to have tachycardia, elevated levels of integral parameters of cardiac rhythm regulation, a considerable reduction in the concentration of Na+, and an increase in the level of K+ with less Na+/K+ ratios. The pattern of the observed changes also retained in the postexamination period. On the eve of the examinations, 30% were found to have lowered levels of integral parameters of cardiac rhythm regulation and elevated levels of Na+. After an examination, there was a reduction in Na+ excretion which did not yet achieve the initial level. The mechanisms responsible for ionic shifts in the composition of saliva during psychoemotional stress are discussed.

[Adolescents' health in Nagorno-Karabakh]. / Sostoianie zdorov'ia podrostkov Nagornogo Karabakha.

Some health indices were studied in teenagers in Nagorny Karabakh. The paper presents data on their physical development, hemodynamics, sexual maturity, and total morbidity. There are some regional features in the study indices, which consist in low harmonicity of physical development and hemodynamics, as well as in high morbidity rates with a predominance of cardiovascular and collagen diseases. The found abnormalities may be directly related to the poor environment for teenagers in Nagorny Karabakh after the 1991-1994 war in the region and show it necessary to improve their living conditions, medical control, and therapeutical-and-prophylactic measures.

[Surgical technologies in the treatment of aneurysms of thoracic and thoraco-abdominal aorta]. / Khirurgicheskie tekhnologii v lechenii anevrizmy grudnogo i torakoabdominal'nogo otdelov aorty.

From 1993 to 2001 279 patients with aneurysms of the thoracic and thoracoabdominal aorta were operated. Cause of aneurysm formation in 74% cases was degenerative changes of aortal wall (Marfan's disease or Erdheim syndrome). Aneurysms were revealed in ascending aorta in 38 (14%) cases, in the ascending aorta with insufficiency of aortic valve--in 67 (24%), in the ascending aorta and aortic arch--31 (11%), in descending aorta--54 (19%), thoracoabdominal aneurysms--in 89 (32%). Twenty patients underwent surgery for combined aneurysms of the ascending aorta with it arch and descending part, thoracoabdominal aneurysms, and also for thoracic aneurysms in combination with coronary heart disease. Lethality in early postoperative period in patients with aneurysms of the ascending aorta was 5%, with aneurysms of the ascending aorta and insufficiency of the aortic valve--6.2%, in aneurysms of the ascending aorta and aortic arch--16.2%, in aneurysms of the descending aorta--6.4%, in thoracoabdominal aneurysms--15%.

[Armenia: implementation of national program of malaria control]. / Armeniia: osushchestvlenie natsional'noi programmy po bor'be s maliariei.

Malaria has been existing in Armenia since antiquity. In the 1920"s to 1930s, thousands of people suffered from this disease in the country. Enormous efforts were required to prevent further spread of the disease. A network was set up, which consisted of a research institute and stations. A total of 200,000 cases of malaria were still notified in 1934. Rapid development of the health infrastructure and better socioeconomic conditions improved the malaria situation and reduced the number of cases in 1946. Malaria was completely eradicated in Armenia in 1963, and the malaria-free situation retained till 1994. During that period, comprehensive activities were undertaken in the country to prevent and control malaria. Since 1990, following the collapse of the Soviet Union, the situation became critical in many newly independent states. Economic crisis, human migration, worsening levels of health services, and the lack of necessary medicines, equipment, and insecticides significantly affected the malaria epidemiological situation in the country. Malaria cases started to penetrate into Armenia from neighboring countries. In 1994, a hundred ninety six military men contacted malaria in Karabakh, which was unfavorable in terms of malaria, as well on as the border with Iran and along the Araks river. The first cases recorded in Armenia were imported, afterwards they led to the incidence of indigenous cases, given the fact that all the prerequisites for malaria mosquito breeding and development were encountered in 17 regions and 3 towns of the country. In 1995, there were 502 imported cases and in 1996 the situation changed: out of 347 registered cases, 149 were indigenous. The Ministry of Health undertook a range of preventive measures. In 1997 versus 1996, the total number of malaria cases increased 2.3-fold: 841 registered cases of which 567 were indigenous (a 3.8-fold increase). The overwhelming majority of cases were recorded in the Ararat and Armavir marzes. In 1998, there were a total of 1156 cases, of them 542 being locally contacted. The situation became stable thanks to joint efforts of WHO, IFRX, the Armenian Red Cross Society, UNICEF, the Ministry of Health of Armenia and its Government. Under Minister's Decree No. 292 of May 17, 1999, a malaria project implementation office was established in the Masis Sanitary and Epidemiological Surveillance Center of Hygienic and Antiepidemic Surveillance to improve progress of the malaria control programme in Armenia. WHO allocated some 7,700 USD for 5-month maintenance and work of the office. Thus, analyzing the malaria cases registered in 1999 and 1998 indicates a 1.9-fold decrease (616/77). The setting up the malaria programme field office under the Minister's decree was instrumental in planning and implementing activities in situ. In 1999, four cases of tropical malaria were recorded in Armenia. The patients were Armenian pilots who contacted malaria during duty travels: 1 in Sudan and 3 in Congo. The list of pilots making flying to endemic countries was submitted to the Republican Center to implement preventive measures in the future. In Armenia malaria surveillance has been improved to ensure timely detection of all suspected cases and to carry out malaria control activities. In this regard, a seminar was held for 21 entomologists and 12 parasitologists. UNICEF and WHO Armenian offices provided a substantial support to organize seminars. To facilitate the seminars, the manual "Malaria parasitology and entomology" was published and distributed among their participants. On April 19, 1999, the session of the Ministry's Executive Board (Collegium) gave recommendations to reinforce malaria control activities in the country. Decrees No. 256 of May 31, 1999, No. 47 of May 29, 1999, and No. 245 of April 30, 1999, "On malaria and preventive and control activities" were issued by the Ministry of Health, the Ministry of Defense, and the Ministry of Internal Affairs and National Security to serve as a guideline for planning and implementing activities. The Ministry of Agriculture undertook to clean the collective irrigation (drainage) system covering 102 and 77 km in the Ararat and Armavir marzes, the Ministry of Health provided a list of endemic foci where cleaning was a priority. Taking into account the importance of the people's participation in ensuring effective prevention and control, emphasis was laid on health education activities: publication of leaflets, as well as articles in local newspapers, radio broadcasts and TV shows. Throughout the season, the early detection of malaria cases, timely hospitalization (in no later than 1-3 days) for at least 5 days and subsequent treatment under direct supervision of a physician were successfully carried out due to home-to-home visits. Entomological studies conducted in the malaria foci show an increase in the presence and density of a malaria vector in the buildings. As far as treatment is concerned, the overall surface of stagnant waters comprised 2642 ha in 1999 (2733 ha in 1998), including 1285 ha of anophelogenic stagnant waters (2276 ha in 1998). The biggest stagnant water surfaces were in the Ararat and Armavir marzes--2209 ha, where the majority of malaria cases were recorded. A total of 1,283,111 and 559,213 sq. m. of constructions were treated in 1999 and 1998, respectively, out them there were 1,259,637 sq. m. in 5 endemic regions. Stagnant water surfaces were treated with bacticulicides on 250.7 and 743.8 (almost 3 times more) in 1998 and 1999, respectively. In 1999, 740 ha of surface were biologically treated using Gambusia compared to 900 ha treated in 1998. There is no highly qualified diagnostic specialists in many regions of the country, which necessitates the holding of further seminars involving relevant specialists, in all malaria regions. There is a tendency of geographical spread of malaria: malaria cases occur in new regions and dwellings. A country-wide action plan was drafted for 2000, mainly focusing on staff training. With WHO assistance, a seminar was held for 324 specialists from endemic regions. During the first quarter of 2000, 13 cases of tertian malaria were recorded as compared 59 cases during the same period of last year. All these patients contacted malaria in the previous season and demonstrated long incubation periods. Thus, the malaria control plan recommended by WHO and the rational and targeted use of its assistance has shown a 2-fold decrease in the incidence of malaria.

[Sensitivity of different tissues of rats to the effects of a permanent magnetic field]. / O chuvstvitel'nosti razlichnykh tkanei krys k vozdeistviiu postoiannogo magnitnogo polia.

The biological effects of magnetic fields are known to be realized through the water structure of living organisms, which is the 60-90% of cells. In this respect the experiments investigating the magnetosensitivity of different tissues of rats by measuring the changes of hydration are of great interest. As it was shown, the tissues with higher hydration state (brain) were more sensitive to SMF influence, where depending on the exposure time the hydration of brain tissue increased. The hydration of the liver tissue, which was initially the least, was not changed.

Beditine, a new benzodioxane derivative, as a suppressor of human polymorphonuclear leukocyte and platelet activation.

Beditine, 2-(2-amino-4-thiazolyl)-1,4-benzodioxane hydrochloride is a new substance which reduced platelet activation and degranulation, prevented aggregation and superoxide generation by activated human polymorphonuclear leukocytes (PMNL) and inhibited the activation of arachidonate 5-lipoxygenase. Beditine may, therefore, be a useful agent in the treatment of cardiovascular disease.

Molecular mechanism of the desensitization of beta-adrenergic receptors and adenilate cyclase by hypoxia in human endothelial cells.

Long-term oxygen deficiency in vivo leads to the progressive blunting of responsiveness to sympathetic stimulation and blood catecholamines in many human and animal tissues. In order to better understand the molecular processes that underlie this phenomenon we examined the effect of hypobaric hypoxia (290 mm Hg, pO2 = 40 mM Hg) on the--beta-adrenoreceptor (beta-AR) density and the activity of adenylate cyclase (AC) and phosphoinositide turnover (PI-turnover) in cultures of human pulmonary artery and umbilical vein cells. We discovered that 30 min of hypobaric hypoxia increased basal levels of inositol mono-, bis- and tris-phosphate, products of PI-turnover in endothelial cells (EC). After 60 min of hypoxia their content amounted to 250-300% of the basal level. Desensitization of PI-turnover to histamine stimulation in EC was observed after 60 min of hypoxia. Basal and isoproterenol (beta-AR-agonist)-stimulated AC activities therewith were markedly reduced. beta-AR-density was decreased in EC membranes after 2-3 hrs of hypoxia. Similar desensitization of beta-AR and AC occurred after 1-2 hrs treatment of EC with histamine and platelet activating factor (stimulators of PI-turnover) and with phorbol myristate acetate (PK C activator). Neither hyproxia nor phorbol myristate acetate influenced beta-AR density or AC activity in protein kinase C-deficient EC (72 hrs treatment with phorbol myristate acetate). The data suggest that hypoxia-induced desensitization of beta-AR and AC in endothelial cells is mediated via hypozia-stimulated turnover and subsequent protein kinase C activation.

Increased nitric oxide deactivation by polymorphonuclear leukocytes in patients with intermittent claudication.

PURPOSE: Local activation of polymorphonuclear leukocytes (PMNLs) is considered an important aspect of the pathogenesis of intermittent claudication, although concrete mechanisms of their effects on circulatory homeostasis in peripheral atherosclerotic disease remain unclear. This study evaluated the ability of PMNLs to deactivate nitric oxide (NO), a key regulator of regional circulation, as a possible factor determining PMNL involvement into ischemic disorders in patients who have intermittent claudication before and after vascular reconstruction. METHODS: A total of 57 patients who had peripheral occlusive disease in an aortofemoral segment before surgical treatment (group 1) and 65 patients who had similar occlusive lesions and other clinical and demographic data 6 to 12 months after undergoing inflow vascular reconstruction (group 2) were examined. All patients from group 2 had anatomically patent grafts; their satisfaction and level of function after surgical treatment were assessed by a five-point questionnaire. The sex- and age-matched control group included 35 subjects. NO activity was bioassayed by measuring its ability to increase cyclic guanosine monophosphate (cGMP) accumulation in rat fetal lung-cultured fibroblasts (RFL-6 cells). The ability of PMNLs to deactivate NO was characterized as the percent decrease in NO-induced cGMP accumulation in RFL-6 cells. RESULTS: Stimulated PMNLs caused inhibition of the activity of authentic NO; accumulation of cGMP induced by sodium nitroprusside was not affected. PMNLs from patients with peripheral atherosclerotic disease either before or after vascular reconstruction had a more marked capacity of NO inactivating than the cells from healthy subjects. For both groups of patients, levels of PMNL-induced NO deactivation were higher for patients with diabetes, and especially both diabetes and arterial hypertension. For both groups of patients, there was no correlation between levels of PMNL-induced NO deactivation and resting ankle-brachial indexes (ABIs). In contrast, close correlation was revealed between levels of PMNL-induced NO deactivation and postexercise ABIs and percent decrease in resting ABIs after exercise in patients evaluated either before or after surgical treatment. CONCLUSIONS: The ability of stimulated PMNLs to deactivate NO is elevated in peripheral occlusive disease and may be implicated in the pathogenesis of intermittent claudication. In patients who underwent successful recanalization of magistral arteries, levels of PMNL-induced NO deactivation remained higher than in control subjects. The increase in the ability of PMNL to deactivate NO positively correlated to ABI decreases after exercise in patients with peripheral occlusive disease either before or after surgical treatment.

Dynamics of polymorphonuclear leukocyte accumulation in acute cerebral infarction and their correlation with brain tissue damage.

BACKGROUND AND PURPOSE: This study was performed to study the dynamics of polymorphonuclear leukocyte (PMNL) accumulation in human cerebral infarction and its association with neurological outcome and brain lesion. METHODS: A total of 88 patients diagnosed as having hemispheric ischemic stroke were examined. PMNL accumulation was studied using technetium-99m hexamethylpropyleneamine oxime (99mTc HMPAO)-labeled leukocyte brain single-photon emission computed tomography (SPECT). Volume of brain infarction was evaluated by CT scan. The Mathew Scale was used for neurological assessment. Dynamics of PMNL accumulation was studied at 3 to 6, 6 to 12, and 12 to 24 hours and 6 to 9, 28 to 30, and 90 days after stroke onset. In parallel, at admission, at 6 to 9 days, and at 28 to 30 days neurological outcome and infarction volume were evaluated. RESULTS: Generally, PMNL accumulation progressively increased during 6 to 24 hours after stroke, remained at a high level up to 6 to 9 days and then declined. With the use of cluster analysis, all patients were subdivided into three groups: patients with severe PMNL accumulation that dramatically increased within 12 hours after stroke onset and persisted even at 28 to 30 days (group A); those with moderate PMNL accumulation that significantly decreased at 30 days (group B); and those with mild PMNL accumulation that decreased at 6 to 9 days (group C). Baseline neurological deficit and brain tissue damage at admission appear to be at a similar level for all groups of patients. In dynamics, however, in patients with severe PMNL accumulation, neurological outcome was worse and infarction volume larger than in patients with less marked PMNL accumulation. CONCLUSIONS: The present clinical study confirms that PMNLs intensively accumulate in the regions of cerebral infarction. The present study revealed that this accumulation correlated with the severity of the brain tissue damage and poor neurological outcome.

[The combined x-ray-endoscopic evaluation of the late results in organ-preserving operations with vagotomy in peptic ulcer]. / Kompleksnaia rentgenéndoskopicheskaia otsenka otdalennykh rezul'tatov organosokhraniaiushchikh operatsii s vagotomiei pri iazvennoi bolezni.

The article gives an objective assessment of remote results of surgical treatment of 197 patients who underwent organ-sparing operations combined with vagotomy for ulcer disease. Combined utilization of contemporary roentgenologic and endoscopic techniques allowed some important conclusions of practical value to be drawn.