Effect of Trimetazidine on Regressione of Ischemic Dysfunction of Myocardium After Coronary Bypass Surgery on Beating Heart

AIM: To study effect of trimetazidine on restoration of hibernating myocardium after myocardial revascularization on beating heart. MATERIAL: Patients with ischemic heart disease subjected to direct myocardial revascularization on beating heart: 25 patients received trimetazidine (60 mg/day) in pre and postoperative periods and 30 patients did not. METHODS: Echocardiography, veloergometry, 6 minute walk test, myocardial scintigraphy with Tl-199. RESULTS: Course (35 days) treatment with trimetazidine provided significant decrease of frequency and severity of episodes of angina, reduction of nitrate consumption, enhancement of tolerance to physical exercise, improvement of myocardial perfusion manifested as significant decrease of mean size of transient perfusion defects. CONCLUSION: These results demonstrate efficacy and expediency of trimetazidine use in therapy of reversible myocardial dysfunction in patients with ischemic heart disease subjected to direct myocardial revascularization.     

Pulmonary hypertension and right ventricular failure. Part XIV. Differentiated therapy of primary (idiopathic) and associated forms of pulmonary arterial hypertension

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification, peculiarities of its pathogenesis and treatment in various diseases and conditions. The last 14-th communication contains consideration of issues of differentiated administration of modern pulmonary vasodilators to patients with PAH taking into account etiology and severity of the disease, availability of evidence based efficacy and safety data, method of application, and contraindications. In patients with PAH of II and III functional class (FC) endothelin receptor blocker bosentan is believed to be the drug of first choice. Bosentan can be administered orally. In patients with significant liver involvement phosphodiesterase inhibitor type 5 sildenafil should be used instead of bosentan for long term treatment of PAH. Sildenafil also can be taken orally. If bosentan is not sufficiently effective it can be combined with sildenafil; inhalations of prostanoid iloprost can be added to this combination when necessary. Is this tiple combination is not effective iloprost inhalations can be replaced by subcutaneous treprostinil or continuous intravenous infusion of epoprostenol. In patients with IV FC PAH therapy is started with subcutaneous administration of treprostinil or infusion of epoprostenol, while bosentan or/and sildenafil is added when necessary.     

Treatment tactics of patients with choledocholithiasis complicated with acute cholangitis

The results of observation and treatment of 137 patients with choledocholithiasis complicated acute cholangitis are presented. The estimated scale APACHE II is adopted for the state severity of patients with choledocholithiasis and cholangitis sigh determination are examined. With multivariant correlative-regression analysis the most informative factors are determined, its grade estimation are carrying out. Optimal treatment tactics depended from state severity is definited. It permits to improve the treatment results owing to decrease of postoperative complications frequency, duration of patients therapy in hospital.     

Diagnostics and treatment of postcholecystectomy biliary complications

The study concerns early postoperative bile leak and obstructive jaundice syndrome after cholecystectomy. 4865 patients were included in the study. The initial cholecystectomy was performed through the traditional laparotomy (n=2122), minilaparotomic access (n=1024) and laparoscopic access (n=1710). Early biliary complications were registered in 135 (2,8%) patients, of whom 47 had bile leak and 88 develop obstructive jaundice. The external drainage bile leak was registered in 0,68%; bile leak trough the trained common bile duct had 0,17% and bile leak into the abdominal cavity had 0,12% of these patients. In 17 cases the bile leak was caused by the cystic duct stump insufficiency, 12 cases were caused by bile leak from the gall bladder bed. 73,5% of bile leak were caused by misdiagnosed choledocholithiasis and papilla Vateri stenosis. Obstructive jaundice in early postoperative period was determined by underdiagnosed bile ductal pathology in the majority of patients (84 patients of 88). The main diagnostic method of biliary complications was the retrograde cholangiopancreaticography with the efficacy of 99,2%. Endoscopic transpapillary operations were curative in 97% of cases. Complications after endoscopic manipulations developed in 3,3%, all of them were successfully conservatively treated.     

Bypass grafting of the celiac trunk of superior mesenteric artery in treatment of patients with chronic ischemia of digestive organs

In the period from 1984 to 2010 operations were made on 41 patients aged from 36 to 76 years with chronic ischemia of digestive organs (CIDO), infarction of the small intestine was determined in 7 of them mainly due to atherosclerotic injury of the celiac trunk (CT) and/or superior mesenteric artery (SMA). In 41 patients antegrade (15) or retrograde (26) shunting of CT and/or SMA were fulfilled with synthetic prostheses in combination with resection of the small intestine in 7 patients, with lethal outcome in 2 of them only. No prosthesis infection was noted. Lethality in early terms was 17.1% mainly at the early stage of the work. Observations during the period from one month to 24 years were followed up in 26 (63.4%) patients. Their state remains satisfactory, the shunts are patent. In treatment of patients with CIDO the antegrade and retrograde shunting of CT and/or SMA are shown to be effective methods.     

Intestinal gallstone obstruction

Three cases of intestinal obstruction due to obturation with gallstones are presented. These patients made 1,3% of all patients operated for acute intestinal obstruction and 0,2% of all patients operated for cholelithiasis. This variant of intestinal obstruction is rare disease and is not characterized with a typical picture and specific symptoms. Analysis of complaints, anamnesis, additional methods of abdominal examination help to suspect biliary ileus. In emergency cases scope of surgery must be minimal and directed to adequate elimination of intestinal obstruction. Indications for simultaneous disjunction of biliodigestive fistula depend on many factors which must be regarded individually for each patient.     

Tuberculosis morbidity in the Sverdlovsk region

Childhood and adolescence tuberculosis morbidity rates are higher in girls than in boys. Adult males fall ill 5.3 times more frequently than adult females. Males fall ill with destructive (6.1 times), bacillary (4.1 times), pulmonary tuberculosis (5.3 times) more frequent than females. Females experience extrapulmonary tuberculosis 1.6 times as high as males. Convicts and those under investigation are ascertained to have earlier forms of respiratory tuberculosis than in the general population. At the same time, the facilities of the RF Ministry of Justice do not record extrapulmonary tuberculosis. Goal-oriented work with these facilities has caused a reduction in tuberculosis morbidity in the whole Sverdlovsk region.     

Endoscopic bronchial care in patients with chronic bronchitis

Endoscopic bronchial sanitation was made in 194 patients with an exacerbation of chronic bronchitis. Catarrhal and purulent endobronchitis was endoscopically diagnosed in 121 and 73 patients, respectively. For endoscopic sanitation, therapeutical lavage was used at fiber bronchoscopy. Ringer's solution added by methyluracil and dioxidine was used as a wash liquid. In patients with staphylococcal or streptococcal infection, the bronchial washing was completed by the administration of specific phage preparations. Good and fair effects could be achieved in 97.7 of the treated patients.