[New possibilities of complex monitoring of the cardiovascular system during thoraco-abdominal surgeries].

The aim of the study was to compare effectiveness of combined cardiovascular monitoring in assessment of quality of anesthetic protection during combined general anesthesia with thoracic level epidural analgesia during thoraco-abdominal surgeries. The study included 56 patients (ASA II-IV). The preoperative examination consisted off: ECG (rest), ECG (stress), 24 hour ECG monitoring. The intraoperative hemodynamic parameters (BPsist., BPdiast., BPmed., HR) were monitored both by invasive and non-invasive methods. Using the measurements of cardiac output (extrasternal dopler) the cardiac index, specific peripheral vascular resistance and stroke index were calculated. During intra and postoperative period (1st and 5th day) ECG monitoring was made. The received data was compared according to the following parameters: character of rhythm, circadian index, supraventricular and ventricular ectopic activity, dynamics of the ST segment. The results show that inclusion of thoracic epidural blockade combined with general or total intravenous anesthesia during thoraco-abdominal surgeries is accompanied by more favorable hemodynamic restructuring, heart rate stability and well expressed anti-ischemic effect. Thus, inclusion of modern combined cardiovascular monitoring methods during anesthesia widens the diagnostic abilities and noticeably increases the patient safety during high risk surgeries.

[Short- and long-term results of balloon dilatation of aorta coarctation].

Balloon dilatation is an alternative method of aorta coarctation (AC) treatment, and it may be effective in 80 - 90% cases with appropriate indications. Arterial hypertension is one of the symptoms of AC and frequent complication of short- and long-term postoperative period. Surgical correction does not guarantee regress of pathological symptoms in all the cases, and method of surgery does not influence the rate of postoperative arterial hypertension. The study reviews CA balloon dilatation experience and analyses cases of late arterial hypertension rate in long-term period after balloon dilatation procedure.

[Holter monitoring of ECG and exercise tests in patients with ischemic heart disease on the stage of preparation for surgical revascularization of the myocardium]. / Kholterovskoe monitorirovanie EKG i nagruzochnye proby u bol'nykh IBS na étape podgotovki k khirurgicheskoi revaskuliarizatsii miokarda.

One hundred and fifty-two patients aged from 30 to 82 years were examined. All the patients were divided into 3 groups: group 1 -- patients with macrofocal scar alteration of the myocardium, group 2 -- patients with small-focus scar alteration of the ardium, group 3 -- patients without myocardial infarction. Increase of the number of patients with disturbances of cardiac rhythm of high gradations was seen in all groups of patients during exercise test and after-exercise period. These disturbances were first diagnosed in 15,6% patients of group 1, in 14% patients of group 2 and in 22% patients of group 3. It is concluded that exercise tests must be performed very carefully in patients with low tolerance to exercise. If there is combination of several risk factors, it is recommended to refuse exercise tests.

[Variations of cardiac cycle length in patients with coronary heart disease before and after aortic coronary bypass surgery]. / Variabel'nost' dlitel'nosti kardiotsikla u patsientov s ishemicheskoi bolezn'iu serdtsa do i posle aortokoronarnogo shuntirovaniia.

It is well known that variations in cardiac cycle length or heart rates may be used for noninvasive evaluation of autonomic cardiovascular control. The investigation uses an original procedure. The data for analysis of cardiac cycle length variations (CCLV) are those obtained regularly at follow-up intervals, random 24-hour Holter 2-lead ECG recordings for 5 sec, and simultaneously calculated continuous sequence of mean heart rate. With the procedure, the correlations of CCLV with the parameters reflecting the early postoperative status of patients with CHD, including acute myocardial infarction, acute heart failure, rhythm and conduction disturbances, as well as age, operative stress, concurrent diseases. The findings are of both diagnostic and predictive value at subsequent stages of CHD treatment.

[The isolation of the contribution of the parenchyma to the radionephrogram and the assessment of kidney purifying function]. / Vydelenie vklada parenkhimy v radionefrogrammu i otsenka ochistitel'noi funktsii pochek.

The authors described the principle and algorithms of the separation of a summary radionephrogram into constituents, reflecting the contribution of a radiopharmaceutical, uptaken by neutrons, and RP in the surrounding tissues. The authors proposed a correct method for estimation (using the first constituent) of the efficacy indicator of RP uptake by the kidneys (Q-parameter) and the indicator of the mean time of transit (t) in the kidneys of RP uptaken by their parenchyma. The results of testing of the proposed methods of Q and t calculation were presented. Values of these parameters were determined in health and in essential hypertension, I and II degree, pyelonephritis, chronic nephritis (latent and hypertensive types), stenosis of the renal artery, obstruction of the upper urinary tracts, and in one kidney. These results indicate the physiological adequacy of the employed mathematical models, proving the diagnostic informative value of the calculated indicators.

[Use of dynamic scintigraphy, x-ray computed tomography, ultrasonic scanning of the kidneys and determination of the enzyme activity and beta 2-microglobulin levels of the blood and urine of arterial hypertension patients]. / Primenenie dinamicheskoi stsintigrafii, rentgenokomp'iuternoi tomografii, ul'trazvukovogo skanirovaniia pochek, opredeleniia aktivnosti fermentov i kontsentratsii beta 2-mikroglobulina v syvorotke i moche u bol'nykh arterial'noi gipertoniei.

A total of 59 patients aged 16-74 years with arterial hypertension (AH) were examined. The AH duration was from 0.5 to 28 years. In 42 patients AH was stable, 17 patients had the syndrome of malignant AH. X-ray computerized renal tomography (CRT), dynamic renal scintigraphy (DRS), ultrasonic renal scanning (URS) were used in the study, furthermore, the activities of enzymes (beta-glucuronidase, alanine aminopeptidase, arylsulfatase A), beta 2-microglobulin (beta 2-MG) concentration were determined in the serum and urine. It has been found that combined use of the investigation methods largely increases diagnostic possibilities, significantly expands the data of such invasive procedures as excretory urography, aortography, renal biopsy, and in a number of cases it enables making the diagnosis without applying the invasive procedures. It is advisable to use URS and to determine the enzymatic activity and beta 2-MG concentration in the urine just at the first stage of examining the patients with AH (simultaneously with general clinical methods). When renal pathology is detected or suspected it is necessary to perform DRS. When voluminous process, "mute" kidney, cystic lesions, calculous chronic pyelonephritis are suspected CRT should be employed.

[Determination of enzyme activity and beta 2-microglobulin concentration in the urine in chronic diffuse glomerulonephritis and hypertension]. / Opredelenie aktivnosti fermentov i kontsentratsii beta 2-mikroglobulina v moche bol'nykh khronicheskim diffuznym glomerulonefritom i gipertonicheskoi bolezn'iu.

Activity of alanine aminopeptidase (AAP), aryl sulphatase A (ASA) beta-glucoronidase (beta-GA) and the concentration of beta 2-microglobulin in urine was determined in 12 patients with chronic diffuse glomerulonephritis and in 16 patients with essential hypertension. The control group consisted of 6 practically healthy persons. The AAP activity in urine of patients with chronic glomerulonephritis was significantly higher than that in healthy subjects. Renal excretion of lysosomal enzymes (ASA, beta-GA) appeared to be less expressed; no significant differences as regard to their excretion were noted between the above mentioned groups. Concentrations of beta 2-microglobulin in urine of patients with chronic glomerulonephritis 6 times exceeded its concentration in healthy persons and in hypertensive patients, more than 3 times as much. Determination of the enzyme activity and beta 2-microglobulin concentration in urine may serve a test in differential diagnosis, for evaluation of the treatment efficiency of patients with chronic glomerulonephritis accompanied by arterial hypertension and those suffering from essential hypertension.