Biomedical subjects
Publications and source records attributed to N N Shikhverdiev.
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Infectious endocarditis (IE) is mainly a surgical problem and requires an integration of efforts of specialists of different fields for its treatment. Successful treatment of this severe disease is to be based on the early diagnosis and early operation. So IE should be estimated as a surgical pathology and this nosological form must be included in all manuals on general surgery and studying infectious endocarditis must be included in the programs of training doctors at surgical series of lectures. Such interpretation of this question will change doctors' mentality and will lead to the earliest admission of the patient with this pathology to specialized cardiosurgical hospital and will allow to avoid severe disabling complications of IE, to increase the number of valve-saving operations and to improve prognosis in the treatment of this disease.
The authors have analyzed 139 patients with specific features of the clinical course of infectious pathology, massive and unusual destruction of the intracardiac structures, non-standard kinds of valvuloplasty. They required individualized strategy of diagnosing and operative treatment.
Using a mathematical model of artificial neuronal network the authors have determined the main significant factors for prognosis of the development of acute myocardial insufficiency during aorto-coronary shunting.
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Serological markers of Epstein-Barr virus (EBV) infection has been investigated in 28 patients with infectious endocarditis. In 75% of patients IgM antibodies to "early" antigen of the virus which are the marker of active viral infection occurred vs 6.2% among healthy blood donors. Specific for infectious endocarditis reaction profile (anti-EBV combination in one person) indicates reactivation of latent viral infection. The conclusion is made on the necessity of further investigation of both the role of EBV in pathogenesis of pyoseptic diseases and immunologic mechanisms for reactivation of latent viral infections.
Antibodies to cytomegalovirus class IgG and IgM and level of tumor necrosis factor (TNF) in the serum were measured in 81 patients with severe surgical infections. In patients with acute lung abscess TNF level was twice higher and activation of cytomegalovirus infection (specific IgM) was three times more frequent than in patients with infectious endocarditis. The conclusion is made that severe surgical infections inducing progressive immunodeficiency create conditions for activation of latent viral infections, cytomegalovirus, in particular). Recommendations on prevention of hemotransmissible cytomegalovirus infection are presented.
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The paper analyzes the experience in treating 75 patients with cardiac abscesses of various sites. Abscesses complicated the natural history of infectious endocarditis in all patients. The clinical features of cardiac abscesses are shown to be related to the stage of the destructive process. Echocardiography, follow-up analysis of ECH, PhCG and overall clinical data are demonstrated to play a role in their diagnosis. The paper discusses the specific features of surgical intervention into the heart if abscesses are present. Out of 75 patients who have been operated on for abscessing infectious endocarditis, 53 have had an operation and survived.
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A multifactorial correlation and regression analysis with the use of a pack of applied programs "SAND" in the computer SM-4 was performed for prognosis of the outcome of the disease in 38 patients with acquired heart diseases operated upon under conditions of extracorporeal circulation. A linear mathematical model was obtained which allowed predicting the course of the postoperative period and outcome of the disease of cardio-surgical patients with 70-80% probability.
An analysis of the experience with surgical treatment of more than 320 patients with infectious endocarditis has shown the necessity to isolate pyo-septic cardiosurgery into an independent line. The arguments are: the specificity of the contingent of patients, special features of diagnosing, operative technique and period of rehabilitation, sanitizing regimen of the artificial blood circulation and others. The organizational aspect includes the necessity of active surgical tactics in treatment of pyo-surgical foci of cardiac localization. Successful treatment of this category of patients can be performed due to the availability of special antiseptic centers which must closely cooperate with cardiosurgical departments functioning in the regimen of emergency diagnostics and cardiac surgery.
An analysis of results of investigation of the influence of apparatus plasmathrombocytopheresis on the immune status of 29 patients with heart diseases is presented. It was shown that intensive plasmapheresis was not followed by substantially decreased level of IgA, IgM and C3 fraction of the complement. The curative effect of this operation in cardiosurgical patients manifests itself as decrease of the level of circulating immune complexes.
The clinical picture of endocarditis in addicts is characterized by mainly right-sided localization of the process in the heart, poor auscultatory picture of the heart, pleuro-pulmonary manifestations against the background of a feverish course of the disease. The leading role in diagnosis of infectious endocarditis in addicts should be given to echocardiography. A description of three cases of surgical treatment of infectious endocarditis in addicts is presented.
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The immunologic status of 28 patients with angiogenic sepsis was studied. Characteristic impairments and the prognostic value of certain indices (T- and B-lymphocytes, isohemagglutinin, circulating immune complexes, general clinical analyses of blood with the counting of the leukocyte intoxication index) were established. Recommendations for the assessment of the immune protection of the patients and a program of the immune-correcting therapy are given.