[Use of topical haemostatic agents in cardiovascular surgery]. / Ispol'zovanie mestnykh gemostaticheskikh sredstv v serdechno-sosudistoi khirurgii.

The problem of haemostasis in cardiovascular surgery is of current concern. Recent trends are towards increased use of topical haemostatic agents. Tachocomb has been used for more than 30 years in abdominal surgery and oncology. The purpose of the present publication is to analyse the literature data and formulate the indications for the use of Tachocomb in cardiovascular surgery. Multicenter randomized and local studies have demonstrated efficacy of Tachocomb in treatment of surgical haemorrhage in operations on the heart, thoracic aorta, carotid arteries and lower-limb arteries, resulting in significantly decreased time to achieve haemostasis, decreased volume of blood loss and haemotrasfusion, as well as reduced frequency of complications. Also shown was economic efficacy, including a shortened length of patients' hospital stay. This is followed by describing a wide spectrum of examples of alternative use of Tachocomb, including its use for seamless closure of defects of cardiac chamber walls, aero- and lymphostasis, prevention of formation of commissures. Convincing experimental and clinical results make it possible to formulate a series of indications for the use of Tachocomb in cardiovascular surgery.

[Laboratory signs of activation of the hemostasis system in patients with coronary heart disease, who had coronary artery bypass surgery.]

The hypercoagulable state is a risk factor for shunt thrombosis in patients who had coronary artery bypass surgery. That is why the study of factors and operative intervention which can lead to hypercoagulable states are extremely valuable and vital issues. 85 patients who had coronary artery bypass surgery were examined. 40 of them have 2 type diabetes mellitus. All patients underwent a study of the content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, von Willebrand factor, induced platelet aggregation in the blood on the 14th day after the surgery. There were no significant differences in content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, induced platelet aggregation in the blood between patients with diabetes mellitus and patient without diabetes mellitus. It was detected the connection between separate indicators of the hemostatic system studied and age, height, weight, waist circumference and how long ago myocardial infarction had occured. It was detected that indicators of induced platelet aggregation correlate with indicators of lipid metabolism and degree of coronary artery stenosis. According to the information received, progression of hypercoagulable state after coronary artery bypass surgery is depends on weight, waist circumference, age, how long ago myocardial infarction had occurred, indicators of lipid metabolism and degree of atherosclerotic cardiovascular disease of coronary arteries.

[A case of multifocal fibrosis].

We report a case of multifocal fibrosis extending retroperitoneally (Ormond's syndrome) with urinary tract obstruction and bilateral ureterohydronephrosis that resulted in chronic renal insufficiency. The development of mediastinal and pericardial fibrosis was accompanied by clinical symptoms of exudative and constrictive pericarditis. Fibrosis of cardiac conducting system was associated with compromised sinus node and intraventricular blockade. Paraaortic, paraorbital, and periportal extension of fibrosis was documented. Diagnosis was made based on clinical observations and results of MSCT. Duration of the disease was 20 years. Immunosuppressive therapy failed to improve the patient's condition because of irreversible structural and functional changes in the organs.

[Remote results of surgical treatment management for atherosclerotic lesions of the brachiocephalic trunk].

AIM: Optimization of diagnosis and surgical treatment of lesions of the brachiocephalic trunk (BCT) based on analysing the course of cerebrovascular disease in operated and nonoperated patients presenting with atherosclerotic lesions of the BCT. MATERIALS AND METHODS: During the period form 1992 to 2008, we followed up a total of sixty-three patients presenting with atherosclerotic lesions of the BCT, who were subdivided into two subgroups: Subgroup One ("surgical") was composed of the patients subjected to reconstructive operations on the BCT (n =25), and Subgroup Two ("therapeutic") comprised nonoperated patients (n =38). RESULTS: Patients from Subgroup One underwent a total of 25 operations: twelve patients endured intrathoracic reconstruction with linear prosthetic repair of the BCT and the remaining thirteen sustained balloon-mediated dilatation of the BCT. Intraoperative restoration of the BCT's patency was achieved with all interventions. The reoentgenoendovascular operations were accompanied with no complication. In 2 cases (16.7%) prosthetic repair of the BCT was followed by thrombotic complications (1--thrombosis of the BCT and 1 thrombosis of the stenosed ipsilateral vertebral artery) in the early postoperative period. During the follow-up period, patients of the surgical subgroup developed 3 strokes (12.0%), 3 myocardial infarctions (12. 0%) and 1 sudden death (4.0%). Over the 5-year period, patients with the BCT le-sions resulting from the natural course of cerebrovascular disease developed 14 ischaemic strokes (31.6% (chi 2=26.4, p<0.0001), 5 (13.2%) myocardial infarctions (chi 2 =0.14, p =0.712), and 2 (5.3%) cases of sudden death. The relative risk of stroke in the therapeutic subgroup amounted to 32.6%. A decrease in the absolute risk of ischaemic stroke resulting from reconstruction of the BCT amounted to 24.8%. Hence, in order to prevent one stroke it is necessary to operate on four patients presenting with BCT lesions. CONCLUSION: Reconstructive operations on the BCT are efficient in relation to prevention of ischaemic strokes. However, intrathoracic reconstructions were accompanied andfollowed by a relatively high level o fcomplications. Therefore, it is necessary to use noninvasive methods of diagnosis to reveal patients presenting with BCT lesions at the stage of moderate stenoses and to subject them to preventive operation of balloon-mediated angioplasty.

[Stress-dependent lesions of the gastroduodenal mucosa during operations with cardiopulmonary bypass].

A continuous retrospective study was conducted in order to reveal risk factors and optimal ways of prophylaxis of gastroduodenal hemorrhage after operations with cardiopulmonary bypass. All the 559 cases operated on with cardiopulmonary bypass in Department of Cardiosurgery of Omsk Regional Clinical Hospital between January 2003 and December 2005 were analyzed. Risk factors and the effectiveness of different methods of antisecretory prophylaxis of hemorrhage were evaluated. It was found that the frequency of postoperative gastroduodenal hemorrhage was influenced by the degree of circulatory insufficiency, duration of artificial lung ventilation, cardiopulmonary bypass, and aortal occlusion, as well as application of anticoagulants and the frequency of gastric and duodenal erosions or ulcers prior to operation. The most effective means of prophylaxis was omeprazole administered intravenously during three days followed by oral application during three weeks. A short course of H2-histamine blockers discontinued abruptly increased hemorrhage-related lethality in this group of patients due to withdrawal syndrome.