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The authors describe "The regulations of administration of blood components" taking into account the purposeful parameters of homeostasis, which must be obtained during transfusion of blood components. The volume of erythrocytes and plasma transfused in the Center during the first and second quarters of 2006 and 2007 years were compared with the main indicators of the medical activities. The introduction of the limiting strategy of hemotransfusions based on the advantages of the world conclusive medicine was not followed by worse results of treatment, but promoted economy of facilities and blood components for the country.

Results of diagnosis and treatment of 150 patients with thymoma and generalized myasthenia are analyzed. The results of examination were registered before surgery, and also in 1, 3, 5 and 10 years after one. It is demonstrated that thymoma is potentially malignant tumor with risk of recurrence and requires long follow-up of patient after operation. Morphologic type and stage of tumor, severity of myasthenia are the main predictors in the prognosis of surgical treatment. Thymomectomy with excision of fatty tissue of anterior mediastinum is absolutely indicated for this severe category of patients, and it decreases the risk of tumor progression. Mortality of patients depends not only on tumor growth or recurrence but also on concomitant myasthenic disorders.

Portal hypertensive gastropathy (PHG) is a pathological process in the gastric mucosa (GM) that develops due to portal hypertension (PH) and bears a high risk of hemorrhage. Eradication of esophageal varicose veins (EVV) is one of important factors influencing the course of PHG. The purpose of this study was to investigate the course of PHG after eradication of EVV in patients with hepatic cirrhosis (HC). Fifty-two HC patients (39 men, 13 women, mean age: 56.5 years), who underwent EVV ligation, were included in the study. The number of patients with PHG increased three months after EVV ligation; the severity of EVV also increased. The course of PHG differed depending on the time of its onset after surgery. Patients who had not had PHG before EVV ligation developed its signs in 75% of cases. In 31.3% of these patients PHG was resolved, while in 43.6% it did not change during the whole term of observation. In patients who had had PHG before EVV ligation, the latter resolved in 8.3% of cases, became more severe in 33.3% of cases, and remained at the same level in 58.3%. The authors distinguish four types of PHG course. Newly-developed PHG that occurred after EVV eradication, the signs of which remained during the whole period of observation (type I), took place in 13.5% of patients; transient PHG, the signs of which disappeared within three months of observation (type II), was seen in 15.4% of patients; persisting PHG, which was observed before EVV ligation and did not change during the whole study period (type III), was found in 40.3% of patients; progressing PHG, observed before or after EVV ligation and the severity of which grew during the observation period (type IV), was revealed in 23.1% of patients. In 4 (7.7%) of patients PHG signs were absent during the whole time of the study. PHG hemorrhage was observed in 11.5% of the patients. Thus, EVV ligation presents a risk factor of the onset and progression of pre-existing PHG in patients with HC.

Basic clinical and special methods of diagnosis of cardiac echinococcosis are described. Among 12 patients with cardiac echinococcosis 5 patients have been operated and 7 patients have been not. Five of seven non-operated patients died during 1 year due to disruption of the cysts. All 5 operated patients survived. It is demonstrated that surgical treatment should be performed with artificial extracorporeal circulation, and postoperative anti-recurrent anti-helminth therapy is mandatory. Medication before surgical procedures is contraindicated because it leads to cysts disruption with high risk of lethal outcome.

A comparative study of 48 carotid stent grafting and 23 open carotid endarterectomies was carried out. Patients of both groups were comparable by cerebrovascular insufficiency degree and concomitant diseases. General rate of complications after carotid stent grafting (CSG) was 5.1%. There was a small ischemic stroke with right-sided hemiparesis and aphasia in one patient during CSG. Complete regress of the neurological symptoms was seen on the 5th day. In the nearest postoperative period after CSG there was a big ischemic stroke in the territory of MCA in one patient. Rate of complications after open carotid endarterectomy (OCEAE) was 8.7% Transient ischemic attacks were seen in 2 patients in early postoperative period. Paresis of the IX cranial nerves was in one patient. In long-term postoperative period after CSG 2 patients died due to cardiac causes. One patient died 18 months after OCEAE due to ischemic stroke. In long-term period after OCEAE restenosis of the internal carotid artery was seen in 4.5% cases, while there were no restenosis after CSG. It is concluded that CSG is an effective method of treatment of carotid stenosis with lower lethality and postoperative complications rate compared with OCEAE. Indications for CSG are symptomatic stenosis of ICA (60%), asymptomatic stenosis of ICA(70%), two-sided lesions of the carotid arteries, carotid stenosis with lesions of other brachiocephalic arteries, insufficiency of Willis circle.

The urgent need to discuss with military surgeons the problem of improvement of educational process in the faculty of managerial medical staff of the Military-and-Medical Academy under the new social-and-economic conditions against the background of the RF Armed Forces reformation has prompted the authors to write this article. The first report deals with the problems of general organization of educational process taking into account the needs for surgeons with higher military education and creation of certified specialized surgical care in the Troops. The authors suggest that all people with interests at stake should express their opinion concerning this problem.

To elucidate features of hemodynamics in patients with lymphoma and hemodynamic effects of polychemotherapy.Parameters of central hemodynamics were studied echocardiographycally in 42 patients with lymphoma.In a definite rise in the levels of tumor progression markers, changes in the immunity, impaired hemopoiesis there was rearrangement of hemodynamics (development of tachycardia, trend to excentric remodeling of the left ventricle). The above changes in hemodynamics enhanced in conduction of polychemotherapy.To avoid cardiotoxicity of polychemotherapy, lymphoma patients should receive cardioprotectors.

Impaired elastic characteristics of the left heart ventricle and restructuring of its diastolic bloodflow were revealed in 28 patients with Hodgkin's disease by complex Doppler echocardiographic study of intracardiac hemodynamics. The most pronounced disorders of the diastolic function were detected in patients with pericardial involvement. More pronounced tumor intoxication in patients with mixed-cell variant of the tumor resulted in remodeling of the left ventricle, left atrial dysfunction, and restructuring of the diastolic bloodflow, which indicated combined impairment of the left ventricular diastolic relaxation and left atrial contractility. Chemotherapy augmented disorders in diastolic bloodflow, the increase in the number of polychemotherapy courses being associated with a trend to deterioration of left-ventricular relaxation. Hence, tumor intoxication and drug cardiotoxicity determine the formation of central hemodynamic disorders, one of whose principal components is diastolic dysfunction of the left heart ventricle.

The article presents some conclusions on ambulatory surgery in the Military Medical Academy and Surgery Centers in St. Petersburg resulting in higher efficiency of surgical aid and its availability for military beneficiaries. Organization frames and staffing principles for day-time ambulatory surgery stations.

A 62-year-old patient with Leriche's syndrome and critical ischemia of the low extremities has undergone the surgery of aortofemoral grafting. A patient has developed the severe ARDS on the second day of reperfusion (bilateral diffuse infiltrates, PO2/FiO2100, lung injury score was 3). Different ways of administration of bovine surfactant (SURFACTANT BL, Russia) were used during the treatment. Total application time was 84 hours, total dose was 4000 mg (50 mg/kg). Considerable improvement of lung function occurred after start of the continuous inhalation of surfactant with a constant rate of 63 mg/h. Two hours after this step PO2/FiO2 reached 400 mm Hg and remained stable 12 hours more, up to the end of surfactant administration. The patient was soon successfully extubated and discharged on the 25th day after surgery. It is supposed that in spite of a small total dose of bovine surfactant the success was achieved due to an early start of the surfactant replacement, continuous inhalation and its definite rate.

Major stress protein HSP72 is known to participate in protecting cells and organisms against harmful factors including ischemia, trauma etc. Under study was the level of HSP72 in the myocardium of 32 patients with coronary disease operated in Military-medical academy. HSP72 was detected in probes of the right atria before and after pre-cardiopulmonary bypass in all cases induction of HSP72 was observed in 40% of patients, and directly correlated with the time of cardiopulmonary bypass and standing of the disease. The cardioprotective effect of the elevated pre-operational level of HSP72 was shown to be proportionate to the lower activity of cardiospecific enzymes, creatine phosphokinase (CK-MB). It is suggested that HSP72 is involved in the mechanism of cardioprotection during cardiopulmonary bypass.

On the basis of practical experience of the clinic for Cardiovascular Surgery and up-to-date literature data the causes of early bleedings after open-heart surgery are summarized. The main clinical, roentgenological and laboratory features of the bleeding and the methods for the assessment of their origin are demonstrated. The authors consider pathophysiologic causes of hemocoagulation disturbances after surgery with artificial circulation. Characteristics of clinical and laboratory tests for coagulation and hemostasis disturbances and the algorhythms for their interpretation are described. Both nonspecific and pathogenetic methods for management of coagulopathy bleedings in early postoperative period have been described and discussed.

The radionuclide investigation was performed 1-3 and 24 hours after injection of a radiopharm preparation and included the single photon emission computed tomography of the heart and scintigraphy of the whole body. Inflammation foci were found on the scans as hyperfixation foci of autoleukocytes labeled with 99mTc-HMPAO (hexamethylpropilene aminooxime). Four patients had abscesses with 0.8-1.5 cm diameter in projection of the aortal and mitral valves of the heart, and in 10 patients there were foci of inflammation and suppuration of extracardiac localization (in the area of the operation wound, anterior mediastinum, frontal sinuses, transverse colon, parietal pleura). The data obtained convincingly speak of high sensitivity and specificity of radionuclide diagnostic methods with the help of labeled elements of the whole blood in recognizing latent inflammatory and suppurative processes in cardiosurgical patients at the pre- and postoperative periods.

The authors have analyzed results of examination of 107 patients with infective endocarditis (IE) of the natural (IENV) and artificial valves (IEAV) of the heart. It was found that the revealed ultrasonic symptoms of IE were specific in 97.7% of patients with IENV and in 100% of patients with IEAV. The sensitivity of transthoracal echocardiography was 89.6% in patients with IENV and 65% in patients with IEAV. The intracardiac morphological alterations were found to coincide with the findings of echocardiography in 78.2% of patients with IENV and in 55%--with IEAV. The authors have elaborated an algorithm of the complex diagnostic examination of patients.

A conclusion about the hemodynamic significance of aneurysm having the area of more than 30% of the left ventricle surface is made on the basis of an analysis of the pre- and post-operative parameters of the myocardium contractility and hemodynamic indices in 49 patients with postinfarction aneurysm of the left ventricle (main group) and 26 patients with ischemic heart disease without this complication (control group). Formation of the syndrome of chronic insufficiency of blood circulation in hemodynamically insignificant aneurysm results from ischemia of the myocardium, rather than the aneurysm as such. Improvement of blood supply to the myocardium as a result of its revascularization in such patients led to normalization of the left ventricle geometry.

The actuality of a problem of cytomegaloviral infection in military transfusiology is substantiated by the increasing number of immunocompromised recipients, mass use of hemocomponent therapy in prophylaxis and correction of anemia, thrombohemorrhagic and immunodeficient syndromes. Cytomegaloviral infection in the recipients of hemocomponents may have unfavourable consequences, such as the development of mononucleosis, enhanced sensitivity to opportunistic infectious agents as a result of virus-induced immunodepression, graft rejection, risk of the development of oncologic diseases, atherosclerosis, disorders in the processes of reparation and regeneration. In the northwestern part of Russia the cytomegaloviral antigens are disclosed in 65-75% of men, age 18-23. Actual tasks are the following: put into practice cytomegaloviral antigens test for donors, make a wide use of effective leukocytic filters for leukocyte removal from hemotransfusional medium, minimize posttransfusion immunosuppression, determine recipients who need transfusions of hemocomponents prepared from seronegative donors.

One of the basic approaches which provides for the increase of immunological safety of hemocomponental therapy is the use of donor-recipient histocompatible blood. The decisive factor in the organism's individuality is HLA-antigen system. Antigen incompatibility of donor's and recipient's tissues in HLA-antigen causes the development of delayed hypersensitivity and sensibilization of the recipient, which provoke a number of complications and posttransfusion reactions. Histocompatibility is the key problem for modern transfusiology and transplantology.

On the basis of a deep clinico-immunological examination of 23 patients with septic endocarditis it was established that HLA B35 antigen and haplotype A2-B35 are the most probable markers of the genetic predisposition to the development of infective endocarditis. Immune deficiency is accompanied by a decreased content of T-helpers, decreased activity of natural killers and phagocytic activity of granulocytes. A combination of a genetically determined defect of the immune response with a modification of histocompatibility antigens by infective agents, drugs (narcotics, antigens etc.) and other factors are thought to be of pathogenetic significance in the development of infective endocarditis.

The paper presents the analysis of calcinosis frequency and expressivity of calcinosis revealed during surgical treatment of 598 patients with acquired heart defect. In operative interventions under EKG conditions calcinosis was observed in 25% cases, and in performance of closed mitral commissurotomy in 36.7%. Retrospective analysis of special features of the illness course in 346 patients with rheumatic mitral defect accompanied by predominant stenosis in dependence on presence and degree of stenosis expessivity. The role of calcinous conglomerates as chronic intracardiac infection reservoirs is noted.

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.

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 state of the cellular and humoral immunity was studied in patients with acquired valvular disease of rheumatic etiology who were subjected to closed commissurotomy. It was established that the patients whose postoperative course was complicated by a suppuration of the wound had low levels of T-lymphocytes, immunoglobulins in their peripheral blood in the postoperative period. A dramatic elevation of the content of immunoglobulins of all classes on the 7th day of the postoperative period is considered to be the evidence of the development of an infectious process.

Experience of endovenous laser coagulation in the treatment of the varicose disease of the lower extremities is presented. This method was used in 107 patients. Surgical technique of isolated endovenous laser coagulation and combined phlebectomy was described in detail. Morphologic data on laser injury of a venous wall are presented. Short- and long-term results were evaluated with clinical and ultrasonic methods. It is demonstrated that endovenous laser coagulation may be regarded as alternative to traditional saphenectomy. This method decreases surgical trauma, number of complications and hospital stay.

11 syndrome X patients and 8 healthy controls were investigated by myocardial scintigraphy (SPECT) with 123-I-MIBG. Regional defects in cardiac 123-I-MIBG uptake were found in 90% syndrome X patients. Total cardiac 123-I-MIBG uptake appeared significantly higher in syndrome X patients. Perfusion defects on stress 99m-Tc-MIBI scintigraphy were found in 10 syndrome X patients who had also abnormal 123-I-MIBG scintigrams. It is suggested that impairment of efferent cardiac adrenergic nerve fiber function in syndrome X patients may contribute to pathophysiologic and clinical features of syndrome X.

Great surgical aggression in operations on the heart and resulting immunodeficiency create prerequisites for the appearance and grave course of infectious complications. The authors have analyzed results of operative treatment of 100 patients with acquired valvular diseases. It has been established that low parameters of the resistance index of organism (RIO) before operation can be estimated as an unfavourable prognostic sign of the development of infectious complications. The RIO dynamics at the postoperative period in many aspects reflects the character of its course. RIO and the indices of the adaptation reaction show the degree of intoxication, make the clinical estimation objective, allow the assessment of efficiency of therapy and correction of medical prescriptions.

To analyse the experience in diagnosis and treatment of arterial hypertension (AH) of adrenal genesis.A total of 243 patients with adrenal AH (mean age 46.3 +/- 3.2 years) were examined. 134 of them had endogenic adrenohypercorticism (EAH), 62--primary hyperaldosteronism (PHA), 47--chromaffin tissue tumors (CTT). Diurnal urinary excretion of adrenal hormones (epinephrine, norepinephrine, aldosteron, hydrocortisone) and peripheral blood hormones (aldosteron, renin, hydrocortisone, ACTH) were measured. Topic diagnosis was made with ultrasound, computed tomography, MR-imaging, angiography, adrenal venous sampling and 123I-MIBG scintigraphy.Adrenalectomy was made in 224 patients (predominantly with tumor lesions). 19 patients (idiopathic hyperaldosteronism, advanced adrenocortical carcinoma) were treated conservatively (calcium antagonists, ACE inhibitors, AT1-receptor blockers, spironolacton). Good results of the surgical treatment were achieved in 60% patients with aldosterone-producing adenoma and adrenal Cushing's syndrome as well as in 80.5% patients with pheochromocytoma. Long-term outcomes depend on hypertension duration, histologic type of the tumor, age and family hypertension history (risk of essential hypertension).Hypertension of adrenal origin occurs more frequently than it was supposed previously. Its late diagnosis may be due to lack of typical signs and symptoms, insufficient application of novel diagnostic techniques and poor alertness of physicians. It is recommended to include tests for adrenal hormones in urine and blood and ultrasound investigation of the adrenals in a complex of primary examination of patients with severe refractory hypertension.

Endothelium as the main structural unit of the vessel appears to exert a considerable influence on the processes of regulation of the cardiovascular system. The authors generalize herein and present the findings of the studies aimed at investigating endothelial dysfunction in varicose disease. Based on analysing the results of various methods of study they show importance of endothelial dysfunction, followed by discussing possibilities of medicamentous correction thereof, proceeding from pathogenetic mechanisms of its development.

During the recent 6 years (2004-2010) tumors of the small intestine were diagnosed in 19 patients. Mean age of the patients with benign tumors was 63 years, with malignant tumors--57 years (age variations from 19 to 82 years). There were 16 (84%) men and 3 (16%) women. In 9 patients tumors were localized in the jejunum, in 10 patients--in the ileum. Complications appeared in 11 patients which was the cause of emergency operations. In 33.3% of the patients clinical manifestations of benign tumors of the small bowel were as episodes of intestinal bleedings which were not intensive as a rule, but were of recurrent character. Malignant tumors of the jejunum had clinical manifestations in 87% of patients. Most frequent symptoms were spastic or diffuse pains in the abdomen (63% of the patients), loss of the body mass (50%), intestinal obstruction (27.7%), intestinal bleedings (5.5%).

The algorithm of the acute destructive pancreatitis' treatment is based on the analysis of 167 patients data. It includes medical activities on patient's admission, basic medication components and indications to the operative treatment. The application of the algorithm ensured satisfactory results of the treatment in 94% of patients with the destructive pancreatitis on early stages.

From 1981 to 2001 (20 years) 1307 patients with lung cancer underwent surgery. Postoperative lethality was 1.7% (after 635 pneumonectomies it was 2.4%, after 672 lob- and bilobectomies--1.2%). Medical histories of 171 operated patients with severe concomitant diseases was studied to analyze surgical outcomes depending on such important factors as age, concomitant diseases, surgical trauma. It is demonstrated that age of patients is not a factor of postoperative prognosis, but concomitant diseases and surgical trauma (i.e. pneumonectomy) are important factors of it. Results of surgery in the group of patients with four and more concomitant diseases after pneumonectomy were most unfavorable (lethality was 22.9%). In less severe surgical trauma (lobectomy) results of surgery were more favorable. It is concluded that surgery in patients with a lot of concomitant diseases must be less radical to obtain lower lethality. Radicality of treatment in these patients is ensured due to complex chemo- and radiation therapy after surgery.

Forty-year experience with surgical treatment of generalized myasthenia (GM) based on 2977 cases is analyzed. Role of special methods of mediastinum examination (CT, MRT) is demonstrated, indications to thymectomy are validated. It is noted that developed diagnostic algorithm, surgical technique, management before and after surgery improved significantly immediate and long-term results. Development of clinical, immunological and morphologic criteria of thymectomy effect permitted to predict course of GM and to optimize complex therapy after surgical treatment.