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Biomedical subjects

R S Akchurin

Publications and source records attributed to R S Akchurin.

At least 19 recordsLinked to original sources
PubMed1992

[Prevention and treatment of infectious complications in myocardial revascularization].

The study was conducted in a group of 440 patients who underwent planned operations for ischemic heart disease. Three current methods of preventive antibiotic therapy were compared. The influence of various risk factors on the incidence of infectious complications was analysed. Experience with closed mediastinitis management was also analysed. The effect of a short-term (1-3 days) course of claforan in prevention of infectious complications is the same as that of a 5-7-day course of cefamezin or gentamicin. Postoperative mediastinitis developed in 11 (2.5%) patients. It was managed in all patients by closed irrigation and drainage of the retrosternal space. The average duration of mediastinal irrigation was 7.4 days. Convalescence was attained in all cases.

Cefazolin↗
PubMed1992

[Renal scintigraphy with captopril in the diagnosis of renovascular hypertension].

Altogether 16 patients with arterial hypertension (AH) were examined. Of these, 11 were with stenosis of renal arteries, 4 had essential hypertension (EH) and I with nephrogenous parenchymatous AH. To estimate the influence of captopril on the total and separate renal function in patients with and without stenosis of renal arteries and the possibility of the use of the given pharmacological test in the diagnosis of renovascular hypertension (RVH), all the patients underwent renal scintigraphy with 99Tc-DTPA on admission to the hospital and 1-7 days after a single intake of 25 mg captopril per os. Later on in the operated patients the results of the test were compared with the hypotensive effect of the surgery. The rate of glomerular filtration (RGF) was measured according to the Gates method. In patients with stenosis of renal arteries and EH, the total filtration renal function remained unchanged after the intake of a single dose of captopril. In patients with stenosis of renal arteries, there was a significant decrease of the RGF on the side of stenosis made for by an insignificant elevation of the RGF in the contralateral kidney, which was accompanied by an increase of asymmetry of the renograms. In patients with no hypotensive effect of the surgery, the test with captopril was negative, which supports the possibility of this test application in the diagnosis of RVH.

Adolescent↗
PubMed1992

[Anti-arrhythmic therapy of patients with recurrent ventricular tachycardias after prior myocardial infarction].

An examination of 30 patients with paroxysmal ventricular tachycardias following prior myocardial infarction showed that drug tests by using invasive and noninvasive monitoring of the action of antiarrhythmic agents allowed beneficial pharmacotherapy to be chosen for their long-term use in 20% of this category of patients. The remaining 80% were resistant to antiarrhythmic drug therapy, which was associated with the highly unfavourable prognosis confirmed by 50% mortality on a 2-year follow-up. Open heart surgeries were performed in 3 cases refractory to antiarrhythmic therapy. The operations aimed at liquidating the source of tachycardia produced a full antiarrhythmic effect. The application of this method for treating patients with postinfarction cardiosclerosis is limited by severe organic heart lesion that determines the high risk of operative mortality. This makes it necessary to intensively develop other methods of non-drug therapy providing less surgical intervention and to introduce them into practice.

Adult↗
PubMed1991

[Transplantation of the heart-lung complex (the first clinical experience)].

The article deals with experience in the first transplantation of a heart-lung complex in the USSR. The recipient was a 34-year-old male with dilation cardiomyopathy. It was decided to perform the transplantation because the terminal stage of cardiac failure and secondary pulmonary hypertension developed (cardiac index 1.3 l/m, pressure in pulmonary artery 80/50 mm Hg, resistance of pulmonary vessels 10.4 units after Wood). The heart and lung were transplanted from a 19-year-old male who died from a craniocerebral injury. Cyclosporine, metipred , imuran, dopamine in small doses, cardiotonics, and antibiotics were given in the postoperative period; the patient was kept on artificial respiration for 48 hours. For up to 10 days the patient's condition was relatively stable and his consciousness was clear. Bilateral pneumonia developed, however, from which he died on the 12th postoperative day. The article discusses organizational problems and some questions of immunosuppressive therapy, immunological monitoring, and the management of patients after transplantation of a heart-lung complex.

Adult↗
PubMed1991

[Transesophageal echocardiography during intraoperative evaluation of central hemodynamics in surgical treatment of ischemic heart disease].

Whether transesophageal echocardiography may be used in the assessment of central hemodynamics has been studied in 40 patients undergoing direct cardiac revascularization in extracorporeal circulation. Changes in the mean values of end diastolic area (EDA) and end-diastolic anteroposterior dimensions, end-systolic myocardial stress (ESMS), anteroposterior size shortening fraction (SF), and area decrease fraction (ADF) of cross left ventricular section are outlined in the paper. It has been indicated that at the beginning of extracorporeal circulation EDA showed, on an average, a 22% decrease (p less than 0.001), after its termination, it practically returned to the baseline values. ESMS remained high at the beginning of the operation, but at the onset of extracorporeal circulation it also dropped by 26% (p less than 0.001), being rather low until the end of the operation. The highest SF and ADF values were observed after termination of extracorporeal circulation. The changes in the parameters in question were found in hypovolemia and decreased myocardial contractility. The application of transesophageal echocardiography along with direct blood pressure monitoring correctly and fully assesses central hemodynamics.

Coronary Disease↗
PubMed1991

[Dynamics of physical exercise tolerance in patients with ischemic heart disease during the 1st year after direct myocardial revascularization operation].

The bicycle ergometric testing was performed in different periods within the first year of direct myocardial revascularization by using microsurgical techniques. The parameters of physical fitness and myocardial blood flow were found to be substantially increased in the early periods of postoperation (10-18 days later), less increased at months 2-4, and then unchanged within the year. Thus, it is suggested that cardiovascular performance becomes stable 2-4 months after a successful operation. In this connection, the time the patients with coronary heart disease can resume work after the operation should be revised.

Coronary Disease↗
PubMed1991

[Effects of surgical treatment on hypertrophy of the myocardium of the left ventricle in patients with symptomatic arterial hypertension].

A total of 50 patients with arterial hypertension were examined. Group 1 included 28 patients with renovascular hypertension, 18 of them had unilateral renal artery stenosis, the remaining 10 had bilateral renal artery stenosis. Group 2 consisted of 16 patients with primary aldosteronism. Group 3 comprised 6 patients with pheochromocytoma. The examination was made with echocardiograph. Changes in left ventricular myocardial mass (LVMM) were studied 1 and 6 months after surgical intervention. The maximum hypertrophy was observed in the patients with primary aldosteronism, no changes occurred in any of the groups examined 1 month after surgical management. The LVMM was found to be significantly diminished by 13% in the patients with renovascular hypertension and by 23% in patients with adrenal tumors (pheochromocytoma, aldosteroma).

Adrenal Gland Neoplasms↗
PubMed1991

[Current trends in the development of coronary surgery].

The authors conducted a comparative study of various methods of coronary shunting by means of microsurgical techniques in 240 patients who were operated on for ischemic heart disease. Total myocardial revascularization, including arteries measuring less than 1.5 mm in diameter and vessels in the zones of cardiosclerosis, was found to be more effective than the techniques of shunting of only the affected major branches. The advantages of a mammary-coronary shunt over anauto- logous venous shunt in reconstruction of coronary arteries under unfavourable hemodynamic conditions are demonstrated. It is also shown that multiple bi-mammary-coronary shunting of the branches of the left coronary artery is a promising method.

Adult↗
PubMed1990

Local prevention of thrombosis in animal arteries by means of magnetic targeting of aspirin-loaded red cells.

Thrombosis was induced in 18 dog and 16 rabbit arteries by surgically inverting a vascular wall flap into its lumen. A completely occluding red thrombus was formed inside the vessel 4 to 5 hours later in 80% of cases. SmCo5 magnet was secured externally to one of the arteries. The constant magnetic field produced by the magnet had no influence on the clot formation. Autologous red cells loaded with ferromagnetic colloid compound and aspirin were administered intravenously and completely aborted arteriothrombosis on magnet-supplied side with no deterioratory effect on clot formation in the control artery.

Animals↗
PubMed1990

[Hemodynamics of transplanted rat heart].

Hemodynamics of intra-abdominally transplanted rat heart was studied. Investigations were performed on 14 rats 7 to 260 days after transplantation. Significant changes revealed included increase in coronary vascular resistance and decrease in coronary blood flow and left ventricular contractility. These hemodynamic changes are ascribed to total denervation of the transplanted heart, absence of pump function and asynchronous contractions of transplanted and recipient hearts.

Animals↗
PubMed1990

[The diagnosis of renal artery stenosis by the data from ultrasonic study methods].

The purpose of the present investigation was to elaborate diagnostic criteria for stenosing of renal arteries according to ultrasonic dopplerography. The investigation included 35 patients suffering from vasorenal hypertension with stenoses of the renal arteries documented by angiography and 63 patients with stage II essential hypertension, who made up the control group. Ultrasonic scanning of the kidneys and dopplerography of the renal arteries were performed with the use of the Acuson-128 ultrasonic system fitted out with a sector transducer operating at a frequency of 3.5 MHz. The authors have devised a method of an ultrasonic study of the renal arteries by means of the posterolateral access. Established criteria for diagnosing stenosis of the renal artery. Among these are a decline of the pulsation index, the resistive index, and the systolic-diastolic velocity ratio as compared to the contralateral artery and nonstenosed renal arteries in the control group patients.

Adolescent↗
PubMed1990

[Specific proteinase plasma sorption in surgery with artificial blood circulation].

Cardiosurgery with artificial circulation (AC) is attended with activation of plasma cascade proteolytic systems, which leads to homeostatic disturbances and postoperative complications. AC with the use of specific proteinase plasma sorption in a column with sepharose-immobilized acid-base proteinase inhibitor from human urine prevents activation of proteinase in the plasma. Application of specific plasma sorption facilitates rapid restoration of the plasma protein concentration lowered during AC, improves the course of the postoperative period, and reduces the risk of pulmonary, cardiovascular, and nervous complications.

Adult↗
PubMed1990

[Model of occlusion-reperfusion arrhythmias of the transplanted heart in rats].

Rats with heterotopically transplanted heart were used for modeling of occlusion-reperfusion arrhythmias. Heart transplantation was carried out by performing the anastomoses between the recipient carotid artery and jugular vein and innominate artery and pulmonary artery of the transplant respectively. The reversible ischemia of myocardium was achieved through temporal occlusion of recipient carotid artery supplying transplanted heart. The model is characterised by total denervation of the heart, the absence of pump function, total nature of myocardial ischemia during occlusion of supplying artery, high reproducibility of arrhythmias and the opportunity of repeated use of the animals.

Animals↗
PubMed1990

[Early prognosis of work capacity in patients with ischemic heart disease after direct myocardial revascularization].

The study was designed to estimate the clinical status and exercise tolerance in 25 patients in the preoperative and early postoperative periods, as well as at weeks 6-8 of direct myocardial revascularization performed by applying microsurgical techniques. The clinical status improved in all the patients. Their exercise tolerance was increased by 67 and 106% 2-3 and 6-8 weeks after the surgery, respectively. Thus, with uncomplicated coronary artery reconstruction, the patients can perform graded physical exercise in the early postoperative period, which provides evidence for reduction of a patient's stay in hospital.

Adult↗
PubMed1990

[Potentials of transesophageal echocardiography in cardiology and cardiac surgery].

The paper is concerned with some potentialities of transesophageal echocardiography (TE echoCG) in diagnostic and cardiosurgical practice. Four examples are provided (interatrial septal defect, a new growth in the right atrial cavity, vegetation on the cusps of the aortal valve, left atrial thrombus), illustrating that the use of TE echoCG was of help in the establishment of a correct diagnosis. The method is described as holding promise for observation over heart activity in cardiosurgery. In addition, the authors mark difficulties encountered during interpretation of the data obtained.

Cardiac Surgical Procedures↗