[The first clinical experience with orthotopic transplantation of the liver]. / Pervyi opyt ortotopicheskoi transplantatsii pecheni v klinike.

The article deals with material concerning the performance of 4 operations for orthotopic liver transplantation (OLT). The operations were carried out on 2 males and 2 females whose ages ranged from 20 to 52 years. The indications for OLT were as follows: ++hemangioendothelioma of the liver, hepatocellular carcinoma, cirrhosis-carcinoma of the liver, and metastatic affection of the liver. One male patient died immediately after the end of the operation, another patient died 3 days after the operation due to nonfunctioning of the transplant. In 2 female patients the operations were carried out successfully. One of them was discharged from the clinic in 62 days in a satisfactory conditions and a well functioning transplant. The other patient died from a complication which was not connected with the operation--perforation of the small intestine 69 days after OLT. The technical aspects of and the provision for the operation and the postoperative management of patients are discussed. The encountered complications are analysed.

[Clinical use of artificial heart ventricles]. / Klinicheskoe primenenie iskusstvennykh zheludochkov serdtsa.

The article discusses the results of applying for the first time Soviet-made "Modul" and "Yasen" artificial ventricles of the heart (AVH) in a left ventricular bypass regimen in patients with refractory cardiac insufficiency. Improvement of AVH design and rational tactics of attendant drug therapy allowed the period of the safe application of the AVH in the organism to be increased to more than 8 days.

[Water content of the lungs during 7-day anti-orthostatic hypokinesia]. / Soderzhanie vody v legkikh cheloveka vo vremia 7-sutochnoi antiortostaticheskoi gipokinezii.

The time-course variation of the water content of the lungs of seven male volunteers were examined during 7-day head-down tilt (at -15 degrees). As compared to the horizontal subjects, the tilted subjects showed a significant increase in the water content from 557 +/- 19 ml to 612 +/- +/- 63 ml by the 7th hour of the tilt. Later on the parameter gradually declined and on tilt day 7 almost returned to the pretest level, i.e., 567 +/- 46 ml. This increase in the water content during the first hours of the exposure can be attributed to the hydrostatic factors: higher pulmonary artery pressure and higher cardiac output. The increase in the water content on tilt days 3-7 can be associated with changes in the permeability of lung capillaries, drainage function of the lymphatic system of the lungs, and colloidal-osmotic pressure in the perivascular space of the lungs.

[Central circulation in the healthy human being during 7 days of head-down tilt and decompression of different body areas]. / Tsentral'noe krovoobrashchenie zdorovogo cheloveka vo vremia 7-sutochnoi antiortostaticheskoi gipokinezii i dekompresii razlichnykh oblastei tela.

The effect of 7-day head-down tilt (-15 degrees) and decompression of various body parts (lower body-LBNP, upper body in the area of the hydrostatically indifferent point-UBNP, and local negative pressure applied to both calves-LNP) on central circulation was investigated on eight healthy test subjects who, for 10 days, had catheters (Swan-Ganz) implanted into the pulmonary and radial arteries. It was shown that, when calculated by square centimeter of the decompression area, the effect of UBNP on central venous pressure (CVP) and pulmonary artery pressure (PAP) was 3-4 times greater than that of LBNP or LNP. This indicates a high sensitivity of this body part to the exposure. During the 7-day study, CVP and PAP showed the most distinct changes. By the 7th hour of the head-down tilt study, CVP remained unchanged and systolic PAP increased by 5.5 mm Hg (27%) (p less than 0.05). This was paralleled by a decrease of plasma aldosterone and renin. By the 2nd day of the study, CVP and PAP were close to the pretest level; on the 3rd day, they began to decline and remained about 3 mm Hg lower than the pretest values to the end of the study (p less than 0.05). During this same period, the contractility of the right heart (the mean rate of right ventricular pressure increment) decreased by 34% (p less than 0.05) and its work by 27% (p less than 0.05). By the 24th hour after the study (the recovery period), CVP and PAP were close to the pretest values, whereas heart rate, cardiac index and oxygen tension in the mixed venous blood were significantly higher than the pretest values (p less than 0.05). The factors responsible for these changes and the potential application of the catheterization technique in biomedical investigations during real space flight are discussed.

Early haemodynamic effects of mitral valve prosthesis in patients with acquired heart disease.

42 patients with isolated mitral valve defect were divided into two groups: without cardiac complications -- and with acute myogenic heart failure, after implantation of a mitral valve prosthesis. In the first postoperative hours, a decrease in cardiac output and pulmonary hypertension were observed in both groups. By the end of the 1st postoperative day, cardiac output reached in both groups the initial level, but in patients of group 2 only thanks to catecholamine administration. The poor functional state of the heart before surgery is consequently the main cause of the fact that surgical intervention is not immediately followed by normalization of haemodynamics. Acute heart failure occurs in the early postoperative period in patients with an extremely impaired left ventricular pump function and with depleted myocardial reserves. In these patients, special attention must be given during surgery to myocardial protection.

Central circulation of a normal man during 7-day head-down tilt and decompression of various body parts.

The effect of 7-d head-down tilt (-15 degrees) and decompression of various body parts (lower body--LBNP, upper body in the area of the hydrostatically indifferent point--UBNP, and local negative pressure applied to both calves--LNP) on central circulation was investigated on eight healthy test subjects who, for 10 d, had catheters (Swan-Ganz) implanted into the pulmonary and radial arteries. It was shown that, when calculated by square centimeter of the decompression area, the effect of UBNP on central venous pressure (CVP) and pulmonary artery pressure (PAP) was 3-4 times greater than that of LBNP or LNP. This indicates a high sensitivity of this body part to the exposure. During the 7-d study, CVP and PAP showed the most distinct changes. By the 7th hour of the head-down tilt study, CVP remained unchanged and systolic PAP increased by 5.5 mm Hg (27%) (p less than 0.05). This was paralleled by a decrease of plasma aldosterone and renin. By the 2nd day of the study, CVP and PAP were close to the pretest level; on the 3rd day, they began to decline and remained about 3 mm Hg lower than the pretest values to the end of the study (p less than 0.05). During this same period, the contractility of the right heart (the mean rate of right ventricular pressure increment) decreased by 34% (p less than 0.05) and its work by 27% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Closing volume of the respiratory airways and total lung capacity during 7-day antiorthostatic hypokinesis]. / "Ob'em zakrytiia" dykhatel'nykh putei i struktura obshei emkosti legkikh vo vremia 7-sutochnoi antiortostaticheskoi gipokinezii.

By mass spectrography and pneumotachography structural variations in total lung capacity (TLC) were investigated in 7 test subjects during 7-day head-down tilt at -15 degrees. By the 7th hour of head-down tilt TLC, vital lung capacity (VLC), functional residual capacity (FRC) and residual volume (RV) decreased significantly and closing volume (CV) increased insignificantly. The CV/FRC ratio grew from 0.82 +/- 0.03 to 1.24 +/- 0.08 (P less than 0.01), indicating the closure of respiratory pathways in certain lung structures within the tidal volume. These changes in the TLC structure persisted till day 7 but the CV/FRC ratio fell down to 1.01 +/- 0.07. The above findings can clarify the mechanism responsible for a lower oxygenation of arterial blood in the head-down position. The expiratory closure of the airways within the tidal volume causes regional changes in alveolar ventilation and ventilation-perfusion relations and, consequently, a larger venous admixture and a smaller oxygen saturation of arterial blood.

[Heart function in patients with mitral defect immediately after the insertion of a mitral valve prosthesis]. / Funktsional'noe sostoianie serdtsa u bol'nykh mitral'nym porokom v rannem periode posle protezirovaniia mitral'nogo klapana.

Changes in left and right ventricular function were examined in 42 patients before and early after the application of mitral valve prosthesis (MVP). Hemodynamic suppression observed early after MVP application was found to be due to reduced preload, and critical inhibition of contractility in 1/3 of the patients. Baseline left-ventricular contractility and pumping function parameters were decreased to a greater degree in patients constituting Group 2. It is suggested that early postoperative circulatory disorders are rooted in preoperative myocardial lesions, inadequate heart muscle protection during extracorporeal circulation with general hypothermy, and violation of conditions of left-ventricular loading immediately upon the recovery of the mitral valve blocking function.

[Central blood circulation in the healthy human being during 7 days' head-down tilt hypokinesia]. / Tsentral'noe krovoobrashchenie zdorovogo cheloveka vo vremia 7-sutochnoi antiortostaticheskoi gipokinezi.

The effect of 7-day head-down tilt (-15 degrees) and lower body negative pressure on circulation and oxidative metabolism was investigated on 13 healthy male test subjects. For 7-10 days they had Swan-Ganz catheters implanted in the pulmonary artery and a special cannula in the radial artery. The most marked changes were seen in the pulmonary artery pressure (PAP) and central venous pressure (CVP) that varied in a phase-like manner. By the 7th hour of bed rest the PAP increased significantly; this was followed by increases in the total lung resistance and the right ventricle function, as well as by a slight decrease of renin and aldosterone. Beginning with bed rest days 2 or 3 the PAP and CVP declined and remained lowered, as compared to the pretest level, till the end of bed rest. The responses to LBNP tests changed by bed rest day 2. Possible mechanisms of the above changes at rest and during LBNP tests are discussed.

Effects of various countermeasures against the adverse effects of weightlessness on central circulation in the healthy man.

The effect of lower body negative pressure, local negative pressure below the knee joint, and both pneumatic and mechanical occlusion cuffs at the upper third of the femur on central circulation, oxidative metabolism, and acid-base equilibrium of blood was studied on eight healthy male volunteers with doublelumen Swan-Ganz flow-directed thermodilution catheters implanted for 7 d into the pulmonary artery. The counter-measures against the adverse effects of weightlessness were used in two regimens: regimen I at -30, -50, +40 torr and regimen II at -60, -100, and +60 torr. The parameters were recorded in recumbency, during the head up tilt at 70 degrees for 15 min, and then during the head-down tilt at -20 degrees for 60 min. After the first 20 min of anti-orthostasis, the effects of the above countermeasures in the two regimens were investigated. The tile-induced changes in central circulation, those observed during application of the countermeasures, and the effect of different countermeasures were studied on a comparative basis. It was demonstrated that the highly informative method of implantation of catheters into the pulmonary artery can be successfully used in biomedical investigations of normal men.

[Effect of negative pressure on the lower half of the body (the Chibis suit) and of local negative pressure on central circulation in the healthy human]. / Vliianie otritsatel'nogo davleniia na nizhniuiu polovinu tela (kostium "Chibis") i lokal'nogo otritsatel'nogo davleniia na tsentral'noe krovoobrashchenie zdorovogo cheloveka.

Catheters were chronically implanted into pulmonary and radial arteries of 8 healthy volunteers to examine the effect of lower body negative pressure (LBNP in the Chibis suit) and local negative pressure on the leg on central circulation, oxidative metabolism and acid-base equilibrium in the blood. In 1-hour head-down tests (at -20 degrees) the effect of two regimens of LBNP (at -30 and -60 mm Hg) and local negative pressure (at -50 and -100 mm Hg) was studied, each exposure averaging 15-20 min. Both LBNP and local negative pressure induced changes in central circulation that were similar qualitatively and dissimilar quantitatively. The use of regimen I of both exposures caused more marked changes than that of regimen II.

[Effect of negative pressure and occluding cuffs on the intravascular pressure in the lower extremity of the healthy human being]. / Vliianie otritsatel'nogo davleniia i perezhimnykh manzhet na vnutrisosudistoe davlenie v nizhnei konechnosti zdorovogo cheloveka.

The effect of local negative pressure on the leg (with a bladder sealed above the knee) and occlusion cuffs (located as close as possible to Poupart's ligament) on the leg intravascular pressure was investigated in recumbency. In two experimental runs 8 healthy volunteers participated. Each of the two exposures was used at two levels: local negative pressure at -50 and -100 mm Hg and occlusion cuffs at +40 and +60 mm Hg with the exposure time averaging 5-7 min. Catheters were inserted into the femoral artery and vein, and arteries and veins of the back of the foot. The arterial pressure remained unchanged during both exposures: local negative pressure and occlusion cuffs. Upon exposure to local negative pressure the venous pressure in the back of the foot (with respect to the atmospheric pressure) did not change and in the femoral vein decreased. Upon exposure to occlusion cuffs the venous pressure in the back of the foot increased noticeably and in the femoral vein decreased slightly. It is concluded that none of the exposures can reproduce the major gravitational effect on leg vessels, i.e. characteristic changes in gradients of the intravascular (transmural) pressure.