[Visceral debranching in hybrid surgery of thoracoabdominal aortic aneurysms]. / Vistseral'nyi debranching v gibridnoi khirurgii torakoabdominal'nykh anevrizm aorty.

Presented herein is a review of the literature dedicated to the method of visceral debranching, i. e., switching of the visceral and renal branches of the abdominal aorta to its intact portion, using synthetic vascular prostheses as the first stage of hybrid surgical treatment of thoracoabdominal aortic aneurysms prior to endovascular aortic aneurysm repair. This is accompanied and followed by describing the history of the problem, operative technique, results of studies, as well as the data from registries and meta-analyses. Also discussed are the main complications of the method and measures of their prevention. We conclude that hybrid surgery of the thoracoabdominal portion of the aorta is a promising method in a particular cohort of patients, especially those at high surgical risk of 'open' aortic surgery.

[Removal of ascending aortic dissection and residual blood flow after transcatheter isolation of descending aortic dissection]. / Ustranenie rassloeniia voskhodiashchei aorty i rezidual'nogo krovotoka posle transkateternoi izoliatsii rassloeniia niskhodiashchei aorty.

Presented herein is a clinical case report concerning successful simultaneous surgical treatment of a female patient with a complication after transcatheter treatment for chronic dissection of the descending portion of the thoracic aorta. The woman was subjected to elective transcatheter isolation of chronic dissection of the descending thoracic aorta using a stent graft with complete coverage of the zone of the origin of the left subclavian artery. Repeat control imaging studies several months after the intervention revealed residual blood flow through the false channel, directed retrogradely from the distal edge of the stent graft to the left subclavian artery. Besides, the patient was also found to have local dissection of the distal part of the ascending aorta (zone 0). An operative intervention was performed: sternotomy, prosthetic repair of the ascending portion of the aorta and part of the aortic arch, as well as transposition of the left subclavian artery to the left common carotid artery. The control imaging studies confirmed radical removal of the false aneurysm of the ascending aorta and the presence of total thrombosis of the false channel at the level of the stent graft.

[Hybrid treatment of patients with aneurysms and dissections of the aortic arch and descending portion of the thoracic aorta]. / Gibridnoe lechenie bol'nykh s anevrizmami i rassloeniiami dugi i niskhodiashchego otdela grudnoi aorty.

The authors share herein their experience with hybrid surgical treatment of 21 patients presenting with lesions of the aortic arch and descending thoracic aorta. Aortic pathology included dissection of the thoracoabdominal aorta (n=15), a sacciform aneurysm of the aortic arch (n=5), and a spindle-shaped aneurysm of the distal portions of the aortic arch (n=1). The first stage consisted of the following operations: transposition of the left subclavian artery into the left common carotid artery (n=9; 42.8%), partial debranching (n=11; 52.5%), and total debranching (n=1; 4.7%). The second stage consisted in implantation of a stent graft: to the thoracic aorta in 18 (85.8%) cases, and to the thoracic and abdominal portions of the aorta in 3 (14.2%) cases. The most significant complications of the immediate postoperative period included acute cerebral circulation impairment (n=1) and local dissection of the ascending aorta (n=1). Type I endoleaks were observed in 4 (19%) patients, type II endoleaks in 1 (4.7%), and type III endoleaks in 1 (4.7%). The mean duration of the follow up after discharge from hospital amounted to 11.6±7.9 months. In 4 patients after 6 months the findings of the control MSCT angiography showed no significant changes of the endoleaks. 1-year patency of the shunted branches of the aortic arch amounted to 95.2%. The cumulative survival rate amounted to 95.2%.

[Functional properties of smooth muscle cells in ascending aortic aneurysm].

Thoracic aortic aneurism (TAA) develops as a result of complex series of events that dynamically alter the structure and composition of the aortic vascular extracellular matrix (ECM). The main elements that alter the composition of aortic wall are smooth muscle cells (SMC). The purpose of the present work was to study alteration of smooth muscle cell functions derived from the patients with TAA and from healthy donors. As it is supposed that TAA associated with bicuspid aortic valve (BAV) and with tricuspid aortic valve (TAV) differ in their pathogenesis, we compared the SMC and tissues samples from BAV-, TAV-patients and healthy donors. We compared TAA patients' derived tissues and SMC to healthy donors' ones in several parameters: SMC growth, migration and apoptotic dynamics; metalloproteinase MMP2 and MMP9 activity (zymography) and elastin, collagen and fibrillin content (Western blot) in both tissue samples and cultured SMC. Proliferation ability of both BAV and TAV SMC was decreased comparing to donors cells; migration ability in scratch tests was increased in TAV-derived SMC comparing to donor cells. BAV-cells migration ability was not changed comparing to donor-SMC. Elastin content was decreased in TAA SMC comparing to donor cells whereas the content of fibrillin and collagen was not altered. At the same time elastin and collagen protein level was significantly higher in tissue samples of TAA patients comparing to donor-derived samples. SMS proliferation and migration ability is differently affected in TAV and BAV-associated TAA that supports the idea of different nature of these two groups of TAA. Also our data show that SMC functional properties are altered in TAA patients and these alterations could play a significant role in the disease pathogenesis.

[Improvement of aortic root replacement technique with aortic valve sparing: immediate and long-term results].

One of the approaches to treatment of the aortic root aneurysms combined with aortic insufficiency is valve-sparing aortic root replacement. An analysis of immediate and long-term results dealt with 19 operations of replacement of the ascending parts of the aorta with sparing the aortic valve by the David I modified technique. The results demonstrated effectiveness and relative safety of this method of correction. At the long-term period 3 patients (16%) showed the II degree aortic regurgitation, in the other patients it was not higher than I degree. The improved David I technique is thought to be optimal in patients with the aortic root aneurysms, aortic insufficiency and unaltered aorta valve cusps.

[Informational function of heart and its apply if diagnostics of medical disease].

Biophysical properties of the electric, magnetic and hydrodynamic impulses generated by the heart suggest the existence of the informational function of the heart: the ability to apply impulses across the body; probable variability of their main parameters, the presence in the heart of the amplitude and frequency-phase modulation carries the information into the cardiosignls. The main tenets of the theory of information functions of the heart are implemented in the technology of informational analysis of electrocardiosignals based on encoding--transformation of the probable variability of parameters electrocardiosignals into the code text. Specific sets of combinations of symbols of norm and rules of internal diseases were indentified. On their basis diagnostic systems which let to diagnose the most common diseases of internal organs were tested. Practical recommendations for the use of diagnostic systems in medical practice are given.

[Cardiac autotransplantation in a patient with congestive heart failure].

Congestive heart failure with intact or moderately lowered left ventricular pump function is caused in some patients by mitral regurgitation. Consequences are dilation of the left atrium, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, rhythm disturbances, elevated risk of sudden death. Efficacy of drug treatment, electroimpulse therapy is little and surgery is the method of choice. One of alternatives is cardiac autotransplantation. A successful experience of application of this technique is presented. Cardiac autotransplantation was carried out in a female patient with moderately lowered left ventricular contractile function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation and pronounced signs of congestive heart failure.

[Informational function of heart].

The facts, testifying that electric, magnetic and hydrodynamic impulses generated by heart can be information carriers in human organism, are represented in the article. The conclusion about presence in the heart a modulation mechanism transforming cardiac impulses to signals according to filling information, and about presence structural elements accepting these signals, made by the author. Informational analysis technology based on transformation of space-time electric cardiac dynamics to pattern is proposed. First experience of the use of this technology for internal organs diseases diagnostics is obtained. A new computer diagnostic system for preliminary diagnostics of latent or preclinical diseases has been developed.

[Morphohistochemical appraisal of the efficacy of hyperbaric oxygenation, cytochrome c, and thymalin in the management of experimental gastric ulcers]. / Morfogistokhimicheskaia otsenka éffektivnosti giperbaricheskoi oksigenatsii, tsitokhroma c i timalina v lechenii éksperimental'nykh iazv zhedudka.

The authors studied the content of xanthine oxidase and the activity of the reparative process in the border of an acetate ulcer after Okabe in 48 rabbits before and during treatment by HBO, cytochrome c, and thymalin. In treatment by HBO and cytochrome c the activity of the enzyme was normalized rapidly, which coincided with cicatrization of the ulcer. In treatment with thymalin xanthinE oxidase activity was not normalized in this period and mucosal inflammation persisted in the zone of ulcer cicatrization.

[Autotransfusions of sorbent blood in treating peptic ulcer patients with an unfavorable course]. / Autotransfuzii sorbentnoi krovi v lechenii bol'nykh iazvennoi bolezn'iu s neblagopriiatnym techeniem.

Autotransfusion of sorbent blood was used in the complex treatment of 62 patients with gastric ulcer characterized by an unfavourable course. The course of autotransfusions favoured scarring of the gastric ulcer in 70.9% of patients, normalized the helper/suppressor relations of regulatory subpopulations of T-lymphocytes, normalized the indices of natural killer activity.

[Functional and morphological characteristics of the digestive reaction of gastric mucosa]. / Funktsiona'no-morfologicheskaia kharakteristika pishchevaritel'noi reaktsii slizistoi obolochki zheludka.

Morphological state of connective tissue (stromal) cells of the stomach mucous membrane has been studied in healthy persons, having a habitual regime of feeding. During digestive period in the stomach mucous membrane, certain changes develop, which are considered as a digestive reaction. Three stages of the digestive reaction, having strict morphological signs are determined, their connections being stated by means of morphometry and mathematical analysis. I stage (preparatory) is characterized with a moderate vascular reaction, degranulation of mast cells under the superficial++ epithelium of the mucous membrane, with a moderate neutrophilic leukopedesis and a moderate lymphocytic infiltration; II stage (developed) is distinguished as a definitely demonstrated reaction of the microcirculatory bed, intensive degranulation of mast cells at all levels of the mucous membrane, massive discharge of neutrophilic granulocytes and lymphocytes into stroma; III stage (restorative) is characterized with a predominance of fibroblasts and fibrocytes, with reparation of mast cells, with decreasing saturation of stroma with neutrophilic granulocytes, lymphocytes, an increased number of eosinophilic granulocytes takes place. The data obtained widen our knowledge on functional morphology of the stomach mucous membrane, normal and at gastroduodenal pathology.

[The clinical significance of endoscopic signs in neurodermatitis patients with gastric and duodenal pathology]. / Klinicheskoe znachenie nekotorykh éndoskopicheskikh priznakov u bol'nykh neirodermitom s patologiei zheludka i dvenadtsatiperstnoi kishki.

Basing on the findings of fiber gastroscopy, used in examinations of 262 patients with neurodermatitis, the authors describe the so-called "minor endoscopic signs", i.e. enhanced gastric peristalsis, pyloric spasm, hypersecretion, duodenogastric reflux. These signs are diagnostically and prognostically significant for the treatment and rehabilitation of neurodermatitis patients.

[Morphologic characteristics of the mucous membrane of the stomach and duodenum in patients with acute complications of gastroduodenal ulcers after surgical procedures]. / Morfologicheskaia kharakteristika slizistykh obolochek zheludka i dvenadtsatiperstnoi kishki u bol'nykh s ostrymi oslozhneniiami gastroduodenal'nykh iazv posle khirurgicheskikh vmeshatel'stv.

Patients with acute complications of gastroduodenal ulcers are characterized by common morphological alterations in mucous membranes of the stomach and duodenum which consisted in higher or normal content of parietal, main and EcI-cells, substantial deficiency of Ec-cells as well as in progressively decreased mucin formation from proximal portions of the stomach to distal ones with its lowest level in the duodenum.

[Arterial and venous hemodynamics in peptic ulcer and the preulcerous state]. / Arterial'naia i venoznaia gemodinamika pri iazvennoi bolezni i pred''iazvennykh sostoianiiakh.

The method of tensometric universal occlusion plethysmography was used to determine the arterial and venous hemodynamics in 106 patients with ulcer disease and chronic gastroduodenitis with symptoms of ulcer disease. Reliable changes of the peripheral blood flow were revealed during exacerbations of the disease and clinico-morphological remission. The changes are caused by disorders in the system of regulation of the peripheral hemodynamics.