[Pharmacotherapy of portal hypertension and its complications: analysis of efficacy of preparations for clinical practice and discussion of promising methods of treatment].

Bleeding from oesophageal varicose veins is the terminal stage of a sequence of complications of liver cirrhosis caused by progressive fibrosis, circulation blockade, and development of portal hypertension syndrome followed by collateral shunt. It leads to progressive vein dilation and their rupture. The main issue of today is to prevent the development of successive stages of portal hypertension, to search for therapeutic and surgical methods for marked reduction of pressure in the portal system, and to prevent the risk of hemorrhage from varicose veins. Another approach is to use local endoscopic treatment of varicose veins for prevention of their rupture. The authors analyse the efficacy of pharmacotherapy in patients with liver cirrhosis and portal hypertension and discuss the existing recommendations on the prevention of hemorrhage with special reference to the yet unsolved problems and prospects for the improvement of therapy.

High resolution electrocardiographic abnormalities as possible indexes of electric instability of the myocardium.

OBJECTIVE: To evaluate the signal-averaged high resolution electrocardiogram in the time domain and the frequency domain in various cardiac patients. DESIGN: Patients in seven clinical diagnostic categories were compared with a healthy control group. PATIENTS AND METHODS: The control group consisted of 70 clinically healthy persons. The 525 cardiac patients were divided as follows: group 1, 29 patients with surgically corrected mitralvalvular disease; group 2, 42 postinfarction patients with-bypass grafting; group 3, 57 patients with ventricular tachycardia; group 4, 198 patients with medically treated angina; group 5, 63 patients with hypertension; group 6, 46 patients with paroxysmal atrial fibrillation; and group 7, 90 patients with acute pulmonary insufficiency. The Frank orthogonal leads were used to derive the signal-averaged electrocardiogram in the usual manner by averaging over 200 complexes. Time domain and frequency domain data were recorded for both the P wave and the QRS complex. RESULTS: Ventricular late potentials were found most often in patients with postinfarction ventricular tachycardia (59%). The prevalence of ventricular late potentials in the mitral valvular disease group increased from 45% to 70% after surgery; in the bypass grafting group it also increased. Spectral temporal mapping revealed a substantial decrease of the total spectral power in the bypass grafting group, to 129 +/- 19 microV2/Hz compared with the preoperative period (205 +/- 16 microV2/Hz). The high frequency power decreased, so the ratio of low frequency to high frequency power increased. A significant correlation was found between the root-mean-square signal in the last 40 ms of the QRS complex and each of the amplitude parameter, the frequency domain localization and time domain localization of the power density peaks. CONCLUSIONS: High resolution electrocardiography including time domain and frequency domain analyses may prove helpful in diagnosis and management.

[Late potentials of the heart ventricles and a method of spectral mapping for evaluating the action of dalargin in intensive therapy]. / Pozdnie potentsialy zheludochkov serdtsa i metod spektral'nogo kartirovaniia dlia otsenki deistviia dalargina v intensivnoi terapii.

The data of 114 examinations of 38 patients with respiratory failure of different genesis have been presented. The method used was that of averaging the ECG signal with analysis of late ventricular potentials and parameters of spectral mapping, as well as analysis of the R-R intervals. The patients were examined initially, 30-45 min after intravenous injection of 1 mg dalargin and 16-20 hours later. The results have shown that there were differences in the changes of a number of basic characteristics of the QRS complex spectrum. In 18 cases (21%) signs of late potentials have been recorded, 14 of them (78%) in the group with decreased total spectral density. A shift of extremums by the beginning of QRS was observed. Statistical and spectral characteristics of the R-R intervals changed in one direction. It has been shown that dalargin has a complex effect on electrophysiological myocardial properties. The use of the method of ECG signal averaging and its different modifications broadens considerably the quality of evaluation of the drug effect in the heart. The technique of spectral-time mapping simplifies the diagnosis of late potentials and elucidates their inner structure.

[Use of a Soviet-made device for recording late ventricular potentials]. / Ispol'zovanie otechestvennoi ustanovki dlia registratsii pozdnikh potentsialov zheludochkov.

Late ventricular potentials (LVP) were detected with an ECG signal-averaging installation developed at the Institute of Radio Engineering and Electronics, USSR Academy of Sciences. A total of 103 patients were examined: 33 with sustained ventricular tachycardia (VT), 30 with unsustained VT and high-grade ventricular premature contraction, 20 with coronary heart disease, postinfarction cardiosclerosis without arrhythmias and 20 apparently healthy subjects (controls). LVPs are the most susceptible to sustained VT in the presence of postinfarction cardiosclerosis (77%), their specificity is lower (70%). LVPs are a low sensitive marker (35%) for sustained idiopathic VT. In unsustained VT and high-grade premature ventricular contraction, LVPs were recorded infrequently in 1 (3%) of the 30 patients.

[Analysis of late potentials of the heart ventricles in patients with respiratory failure]. / Analiz pozdnikh potentsialov zheludochkov serdtsa u bol'nykh s dykhatel'noi nedostatochnost'iu.

The ECG signal was studied by the method of Simson in 43 patients with the clinical pattern of respiratory failure of different genesis with the aim in view to detect signs of late ventricular potentials (LVP) in the QRS vector and in separate orthogonal leads X, Y and Z. The signal was averaged by 150 complexes. It has been shown that 53% of the patients examined have signs of LVP, their incidence being much higher in critical patients subjected to controlled lung ventilation. Characteristic differences of the LVP signs analysed in leads X, Y and Z have been detected, as compared to the analogous parameters of the control group.

[Experience in the use of external fixation devices in the treatment of limb bone fractures, their sequelae and complications]. / Opyt primeneniia apparatov vneshnei fiksatsii pri lechenii perelomov kostei konechnostei, ikh posledstvii i oslozhnenii.

The present paper reflects the experience of treatment of 243 patients with utilization of external fixation apparatus. Two methods of extrafocal perosseous osteosynthesis were employed: traction wire apparatus were utilized in 217 (89.3%) victims, rod apparatus--in 26 (10.7%). The construction of employed traction wire apparatus and method of its application have been described. Remote results of treatment have been followed in 194 (79.8%) patients. Fracture consolidation has been observed in 187 (77%) patients. Complications, registered in the process of application of apparatus of different constructions, have been analyzed. The authors have come to a conclusion about high efficiency of the employed apparatus, indicated obvious advantages of the rod apparatus.